Socialtjänstens Användning av Standardiserade Klientbedömningsinstrument – ASI som Retorik och Praktik i Två Svenska Kommuner

Abstract

Aim The aim of the paper is to study how the Addiction Severity Interview (ASI) is integrated in the ordinary work of social services in two Swedish towns that use ASI regularly. According to an ideal model for using ASI, it should fulfil three functions: to be a structured tool for assessing client problems, to facilitate the follow-up of treatment measures for each client, and to form a basis for the systematic follow-up of treatment units. This paper asks specifically how ASI is used compared to this ideal ASI model, how ASI is viewed by the different hierarchical levels within the social service organisation, how the social worker's tasks are perceived, and how the use of ASI is followed up. Methods Qualitative interviews were undertaken with staff at different levels within the social service organization in the two towns, which were chosen from a county known for its extensive use of ASI. Results Although rhetorically the social workers have adopted the use of ASI, in practice, however, the use of ASI seemed rather far from ideal. The foremost advantage the social workers perceived with ASI was that it supplied basic information in an initial investigation of client needs. The problems connected to the use of ASI were that it is not suitable for all clients and that some clients are subjected to too many ASIs. Other problems were that it was hard to maintain sufficient quality in the use of ASI due to too high staff turnover and too few opportunities to conduct interviews. In spite of the well-known obstacles for efficient use of ASI, little control was undertaken to monitor use or how information from the interviews is used. Conclusions The demand on social work to meet politician's expectations for service development can be in direct conflict with the practical considerations of the social service work, which may explain the shortfall between rhetoric and practice. From a political legitimacy point of view, it is more important that the social service organization is supported by the political funding sources than to meet demands for treatment efficiency. A loose coupling between rhetoric and practice allows for ASI to be adopted only rhetorically, while the regular work can continue to meet the practical considerations. The use of ASI cannot therefore be seen as a simple solution to the problems that the Swedish treatment system is struggling with.