In the centre or caught in the middle? – Social workers’ and healthcare professionals’ views on user involvement in Coordinated Individual Plans in Sweden

Fragmentation of social service and heath care services has been given attention in many countries and a variety of strategies and models are used in attempts to remedy the problem. In a parallel development, demands have been made that users/patients should have more influence over their own care, and research has shown that user involvement can support the recovery process. This article focuses on how professionals view user involvement in collaborative efforts in care planning, using the Coordinated Individual Plan (CIP) in Sweden as an example. Since 2009, social service and health care agencies are required to draw up CIPs when they are judged to be needed, with the purpose of improveing the care process. An additional purpose is to increase users' involvement in their own care. Semi-structured interviews were conduced in 2019 with 20 professionals working within social service and health care agencies for people with mental health and/or substance abuse problems in the Stockholm region. Analysis was by qualitative content analysis. Findings show that professionals experience ambivalence concerning user involvement in care planning. On the one hand, they support the user's own demands of services and on the other hand, they correct the user's demands to fit the range of services and organisation of care. The user/patient's position is expressed as vulnerable, caugh between caregivers who often safeguard their own organisational duties and economical restrictions. These findings reflect the conflict predicted by Lipsky's theory of street-level cureaucracy. Professionals are expected to act as advocates for the user/patient, while at the same time exercising a controlling and gatekeeping function. The question is raised whether a model such as CIP provides sufficiently for factors which can counterbalance the power of the professionals relative to the user/patient in care planning