Den här slutrapporten redovisar den uppföljning av Mångbesökareinom missbruks- och beroendevård som gjorts i Norrbotten mellanseptember 2011 och december 2013. Uppföljningen har genomförtsgemensamt av Kommunförbundet, FoU Norrbotten och Norrbottensläns landsting, i samarbete med Kriminalvården/Frivården.I uppföljningen analyseras tretton mångbesökares nyttjande av sjukvårdens,socialtjänstens samt Kriminalvårdens/Frivårdens resurserunder ett år. Syftet med uppföljningen är tredelat. För det första ärsyftet att kartlägga och följa upp mångbesökares nyttjande av olikatyper av vård- och stödinsatser, vilket sker genom en journal- och aktgranskning.I kartläggningen ingår även en kostnadsberäkning. För detandra är syftet att undersöka mångbesökares uppfattning om och upplevelseav vården och stödet samt om det bemötande som de har fåttfrån de olika organisationerna. Här utgör intervjuer den huvudsakligainsamlingsmetoden. För det tredje är syftet att identifiera och arbetamed de systembrister som framkommer i uppföljningen. En viktig deli arbetet med systembrister är de fokusgrupper vi träffat. Deras erfarenheterutgör en viktig del i uppföljningens resultat.Till mångbesökare räknas personer med missbruk eller beroende somunder en tolv månaders period har besökt landstingets akutsjukvård(den somatiska eller psykiatriska) minst fyra gånger eller som har vårdatsminst fyra gånger på en av landstingets vårdavdelningar.Urvalet av mångbesökare gjordes vid Länsgemensam psykiatri ochMoB-enheten. Det innebar att drygt hälften av mångbesökarna hadebåde missbruk eller beroende och psykiatrisk problematik (samsjuklighet).I den här rapporten redovisas dessa mångbesökares nyttjandeav vård- och stödresurser, till exempel sluten- och öppenvård frånsjukvården, insatser från socialtjänsten och Kriminalvården/Frivården.Dessutom redovisas kostnader för dessa insatser.Det centrala i analysen utgör fallstudierna som ger en helhetsbild avindividernas vård och stöd, samt deras upplevelser under ett år. Sexfallstudier presenteras, med fyra män och två kvinnor i olika åldrarmellan 20-60 år. Olika typer av missbruk (drog- och alkoholmissbruk,blandmissbruk, missbruk av läkemedel) illustreras. Dessa personerföljs under ett års tid via medicinska journaler, socialtjänstens akter,Kriminalvårdens/Frivårdens handlingar samt intervjuer. Två fallstudiergjordes på mångbesökare som hade fått särskilda former av stöd,Case managers samt substitutionsbehandlingen LABO. För att än merlyfta fram brukarperspektivet gjordes en extra fallstudie där intervjumaterialettilläts ha tyngdpunkten på mångbesökares och närståendesupplevelse av vården och stödet. Samtliga fallstudier har illustreratsmed ett flödesschema och kompletterats med en kostnadsanalys.

There is a sentence by Bob Dylan – the times they are a-changin’. This is true also for participatory design (PD) – today design projects are distributed between sites and people, and extended in time. PD is now diverse and multi-directional and in need of re-thinking designer responsibility. How to change our methods in line with concerned personnel’s abilities and ways of expressing themselves? Yet, still it is needed someone that overlooks and ensure the PD process. This is especially important when a PD project results in new experiences for people. We suggest that systems designers’ shoulder the responsibility as an angel, which we use as a metaphor for a person with the overall responsibility for the PD process. As part of this we suggest that systems designers would gain by adapting the PD process in line with the PAR methodology and by the use of Soft Systems Methodology’s Rich Picture building.

As demographic ageing impacts across the world, health and welfare organisations are seeking new paradigms of care that address people's needs as well as being inherently more scalable than the incumbent processes and services. The aim of this paper is to describe the current situation in Europe with information on service provision, before signposting some possible new ways to develop sustainable business models that support care models. The paper uses a case study approach to examine the issues in the introduction of such business models, from a perspective of the translation of research proof of concepts into business services and from the perspective of developing innovations from research that address unmet or poorly considered needs of user. The paper shows how several innovative European projects are anticipating the need for service change and are designing their research outcomes to match the needs of service commissioners more fully. The conclusion discusses several different approaches before drawing together strands of the work and providing tentative recommendations on the way forward to develop new inclusive technology-enhanced services in health and social care.

Participation and the contribution of participatory design methods and techniques are explored in the context of a Scandinavian Home Healthcare project. The project was undertaken during 2004-2005. Its aim was to introduce mobile ICT equipment to health care workers in order to improve planning, including quality and precision of information exchange. The study was designed according to Participatory Action Research and Participatory Design principles. Methods employed in the project were observations, interviews, future workshops, and story boards to actively involve different stakeholders. The experience of the project indicates that, although the rhetoric was that of a participatory design and research project, participants are not equally regarded in terms of experiences and knowledge of the actual practice. Assumptions about technology influence development and implementation at the expense of the actual care activity. Further, participation and participatory design techniques used in the project demonstrate the complexity of home healthcare and the necessity to involve all the different occupational groups involved in the care of the client. However, organisational boundaries reinforced shortcomings in cross-functional and cross organisational cooperation. A final conclusion is that time for collaborative and collegial reflections is a necessity to support the learning process.

The aim of this article is to explore the tensions and ambivalences of new and old technology and political visions of keeping viable, quality care and services for elderly citizens through the use of new information technologies. The visions of politicians and social service managers of keeping alive the welfare state and retaining its ability to offer quality care and services for elderly citizens are compared with the experiences of female care assistants and their expectations of technology. A feminist figure — the cyborg — will be used in this exploration. We consider how care assistants are integrated in networks of socio-technical relations between humans and non-humans, and the extent to which gender or asymmetrical power relations between women and men intervene in their stories.

People working in the home health care sector are seldom consulted when development and implementation of ICT is involved and which effects their work practices. This is surprising given the assumptions of participatory design principles that have in¬fluenced Scandinavian re¬search and design work. To address this shortcoming, this thesis takes the perspective of the homecare personnel. A central purpose of the thesis is to explore care staff's participation in, experiences and knowl¬edge of the design and use of ICT in home health care services, with a special focus on care assistants. The methodological approach for this exploration is based on qualita¬tive methods and interpretive and hermeneutic perspectives applied in four different research and development projects. The empirical ma¬terial was conducted with focused interviews, undertaken work with focus groups, facilitated workshops, engaged in systematic observations and used the storyboard technique with personnel working in the home health care services. Thus a variety of participatory design meth¬ods and techniques have been used. The gathered data has been ana¬lysed using different methods: discourse analysis, the cyborg figure, thematic analysis, and reflective analysis. The findings from each analy¬sis complement each other and bring forward different perspectives. Common assumptions about participatory approaches are that partici¬pation improves workplace democracy and increases user acceptance. Nonetheless, it is not that straight forward. This research has revealed that participation involves conscious reflections on when, where, and how the users should participate in the design process. The degree of participation is an issue where the ultimate level is shared collaborative decision-making for reaching effective and high quality systems that supports the work processes. An additional issue in the design process is the quest for official power. The conducted research confirms that participatory design is difficult and takes time, participation and participatory design techniques that have been used demonstrate the complexity in the work practice and that it is not only to "get the work done". Further, if the point of de¬parture is taken in (participatory) action research and participatory de¬sign it is possible to intervene in the process and change the direction of a research and development project in order to engage all stake¬holders that are involved in the care of the client. Finally, when applying an appreciative approach, care staff were en¬abled to value their situated knowledge and how it contributes to the services delivered i.e., they were enabled to reflect on their work, learn, and share together. Findings indicate that by integrating the principles of participatory action research (PAR) in the participatory design (PD) process, the users participate during the full development process, make decisions and take part in the design work. With this degree of participation, the care staff are able to follow the whole process, reach a realistic expectation of what to expect from the de¬signed technology and additionally develop their situated knowledge about the relations between technology and work practices.

An important factor for health is the possibility to be active and mobile. To make this possible different kind of support are needed. Integrating geographical information systems technology and user experiences is important in the development of more user-friendly positioning devices. The Lighthouse Alarm and Locator trial aimed to test a new mobile alarm system with additional functionality such as positioning and monitoring of vital signs which can be used regardless of location (in hospital, at home). The system was tested by elderly persons from a pensioner organisation and home care personnel answered up on the alarms. After the tests qualitative interviews were performed with the two groups. The results showed that their experiences of the new mobile alarm system could be described in three main categories: to be supervised, to feel safe and to be mobile. These categories formed a theme: Positioning - an ethical dilemma. The clients' mobility was perceived to increase. The personnel did not think that positioning was ethical but the clients (elderly) did.

If future demands on health and home care are to be met effectively, implementing information and communication technology (ICT) is acknowledged as a necessity. New (mobile) ICT may also be seen as a tool for empowering elderly people. Enabling the right to self-determination among the elderly will also change professionals'ways of thinking, and thus the basis of their involvement. In the e-Home Health Care @ North Calotte project (eHHC, 2003-2005) a set of guidelines was developed for a methodology for empowennent when implementing mobile ICT into home healthcare. This project coordinated field trials in four municipalities in northern Finland, Norway and Sweden. The Swedish trial used a Participatory Action Research approach (PAR) and included Future Workshops, focus-group interviews, reflective interviews and observations. The aim of this study is to present the working process and the methods used when creating guidelines for a methodology for empowerment. The dimensions of empowennent are discussed, together with results from the Swedish trial in the eHHC project. The experiences from this trial show that to ensure the empowerment process when developing ICT in home care, close cooperation with clients, relatives and professionals is needed.