• Dokumentation, profession och hälso- och sjukvård : rättsliga perspek...
  Wendel, Lotta  : Malmö universitet Serie: Malmö University Health and Society Dissertations;2019:3 (2019)	Doctoral dissertation

  

  

  English abstract:

  This dissertation fills part of the existing knowledge gap regarding the relationship between the legal obligation to document medical care and treatment on the one hand, and the professional practice, conditions and identities of professionals on the other. Three basic questions serve as points of departure: what are the origins of the obligation to document medical care and treatment? How is the relationship between the patient and the professions affected by the obligation? How does the obligation affect professional identities? The dissertation consists of five sub-projects performed with a combined legal and social constructivist approach. Two relate to the historical emergence of an obligation for physicians and other professions to document medical care and treatment in Swedish healthcare. One concerns how standardized forms of documentation affect the patient’s legal position and two are built upon the fact that the legal obligation for licensed psychotherapists within municipal family counselling to document their interventions has lapsed, even though the legislation clearly prescribes such an obligation. The results suggest that the form of governance known as New Public Management has been preceded by regulations regarding the obligation of documentation, which are clearly intended to meet financial and organizational goals. This may have contributed to the fact that Sweden is one of the countries where New Public Management has influenced the public administration the most. The thesis concludes that the effects of the regulations regarding of the obligation to document medical care and treatment, and the forms of implementation of the obligation, are of crucial importance for a patient’s legal position. Further research is needed in order to highlight and better understand the processes that are at play when the regulations are enforced and implemented amongst health care professionals.

  978-91-7877-039-7_Wendel_muep.pdf   (2.984Mb)

• Hate crime victimization : consequences and interpretations
  Andersson, Mika  : Malmö universitet Serie: Malmö University Health and Society Dissertations;2018:5 (2018)	Doctoral dissertation

  

  

  English abstract:

  The field of hate crime studies is a young one and as such it is characterized by a high proportion of explorative and inductive studies. This methodological approach is well founded when a field is unfolding as they often generate theoretical conclusions or assumptions. Since I began working with the present dissertation in 2013, I have observed an increased tendency towards deductive studies testing the conclusions and assumptions made by field pioneers. The present dissertation is part of this branch and has two primary aims; 1) to test field assumptions and 2) develop present theoretical frameworks on causes and consequences of hate crime. In Article 1, me and my co-author examine the assumption that hate crime victimization result in higher levels of fear in comparison to non-bias crime. The assumption is tested by comparing fear of crime, behavioral adaptations and place-based worry among students with an immigrant and/or national minority background. The results show that hate crime victims reported significantly higher levels of fear of crime in comparison to non-victims and non-bias victims. However, there were few significant differences in behavioral adaptations and place-based worry. From interviews with hate crime victims we learned that place-based worry is not primarily associated with the physical characteristics of a certain area, but geographical concentrations of racist attitudes. Moreover, the behavioral adaptations that the interview participants used to avoid future victimization were often based upon de-identification. From these results we can conclude that traditional measures of place-based worry and behavioral adaptations does not adequately capture consequences of hate crime. In Article 2, me and my co-authors examine the assumption that police reporting is lower among victims of hate crime that target more than one of their identity categories. Contrarily to the assumption, we find that victims of hate crime with multiple motives report their experiences to the police to a higher extent in comparison to victims of hate crime with single motives. We also found that participants with several intersecting group identities endowed with stigma were more likely to be targets of hate crime with multiple motives, but not more likely to experience repeat victimization. These results support the branch of intersectional theory holding that group belongings primarily influence the expressions of violence rather than the risk of being subjected to violence. In Article 3, me and my co-authors examine the assumption that hate targets the identity of the victim and thereby attack the core of the victim’s self. We found that hate crime targets a negative stereotype associated with the perceived identity of the victim. Consequently, interview participants did not regard hate crime as a direct attack on their selves as they did not identify with the negative stereotype. However, hate crime remain a violation of the self as it denies the victims self-representation. The results also showed that the meaning-making regarding hate crime victimization is reflexive as the participants used earlier experiences when assigning meaning to incidents. This process was also recursive as new incidents lead to re-interpretations of previous experiences. In sum, the participants developed and negotiated their experiences of hate crime over time. In Article 4, me and my co-authors examine the assumption that vicarious victims respond in similar ways as direct victims since hate crime signal the presence of threat beyond the initial victim, sometimes referred to as the in terrorem effect. We examine the in terrorem effect by comparing fear of crime between non-victims, vicarious victims of hate crime, and direct victims of hate crime in three communities; women, Muslims and sexual minorities. The results showed that direct victims were generally more afraid of crime in comparison to non-victims in all communities. Though not all differences were significant, the reaction pattern among non-victims, vicarious victims and direct victims in the studies commu-nities showed the pattern of a stair, with the lowest rates among non-victims and the highest rates among direct victims. These results thereby contradict the proposed pattern of the in terrorem effect in which vicarious victims and direct victims are held to react in similar ways. In sum, the results of the present dissertation call for a more complex understanding of both individual and community effects of hate crime. The theoretical development and integration in Chapter 3 along with the results of Articles 1-4 results in hypotheses for future research on causes and consequences of hate crime in Chapter 6.

  2043_23423_Andersson_muep2.pdf   (5.733Mb)

• Risk assessment of intimate partner violence in a police setting : re...
  Svalin, Klara  : Malmö university, Faculty of Health and Society Serie: Malmö University Health and Society Dissertations;2018:4 (2018)	Doctoral dissertation

  

  

  English abstract:

  The Swedish Police Authority conducts violence risk assessments in cases of intimate partner violence (IPV) using specific assessment tools. Such assessments are conducted in order to identify high-risk offenders and thereafter implement suitable interventions to prevent repeat IPV. In this thesis, two different risk assessment tools have been evaluated: The Police Screening Tool for Violent Crimes (PST-VC) and the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER, Kropp, Hart, & Belfrage, 2005; 2010). The overall aim has been to contribute to improving the knowledge on police employees’ violence risk assessment and management, specifically with regard to the predictive validity and inter-rater reliability of such assessments. In the first study, we evaluated whether the PST-VC can be used by police employees to identify high-risk cases of repeat IPV. In addition, the preventive effects of the recommended crime preventive and victim protective actions were discussed and also whether these create a confounding problem with respect to predictive validity. The results showed that the predictive accuracy of the tool was fairly weak. Further, the assessors recommended a higher level of interventions in high-risk cases, but these did not reduce the rate of repeat IPV. Study II aimed to examine the inter-rater reliability of the PST-VC and the BSAFER. Police employees conducted pairwise assessments of IPV cases using one of these tools. The tools were evaluated separately and the cases used for the assessments were different for each tool. This means that the consistency of the assessments could not be compared head-to-head across the tools. The results were nonetheless rather similar for both tools; the inter-rater reliability for the individual items was low for most of the individual factors, but was relatively high for the global risk assessments. A suggested explanation for this was that the assessors may have used their tacit knowledge, rather than the individual items, in their global risk assessments and that they shared this tacit knowledge, at least to some extent. The third study focused on the B-SAFER tool, and on the predictive accuracy of the individual items and the global risk assessments in relation to repeat IPV. The study also aimed to examine to what extent the recommended crime preventive and victim protective actions were implemented and whether these interventions had a preventive effect on repeat IPV. The predictive accuracy of the individual B-SAFER items and the global risk assessments was low overall. The majority of the recommended interventions were not implemented, and they did not prevent repeat IPV. The final study (IV) took the form of a systematic literature study with the aim of evaluating the predictive accuracy of IPV risk assessments conducted by practitioners in different settings, with IPV recidivism as the outcome measure. The number of studies that fulfilled the inclusion criteria was small (N= 11). One of these studies was conducted in a treatment setting, while all the others were conducted in criminal justice settings. The predictive accuracy for the global risk assessments ranged from low to medium, and the role of treatment or other interventions to prevent repeat IPV had been analyzed in one way or the other in eight of the studies. However, there was no consistency with regard to the importance of the interventions for repeat IPV. In summary, the predictive accuracy of the police employees’ IPV risk assessments was rather low, and the same applied to the inter-rater reliability for most of the individual items included in the tools. The level of consistency was higher, however, for the global risk assessments. The IPV preventive interventions were not effective in preventing repeat IPV. The predictive validity of IPV risk assessments conducted in other settings was found to be similar, but results regarding the potential mediating role of interventions were mixed.

  2043_24791_Svalin_muep.pdf   (5.549Mb)

• Ambulatory risk assessment and intervention in the prison services : ...
  Vasiljevic, Zoran  : Malmö University Serie: Malmö University Health and Society Dissertations; 2018:2 (2018)	Doctoral dissertation

  

  

  English abstract:

  The transition from prison to society is a challenging period for offenders released from prison. Recidivism rates are high, and the offender’s situation can change rapidly. Advances in technology in recent decades have provided new ways for correctional agencies to provide the level of supervision and immediacy needed to help prisoners to successfully re-enter society. One such area of advance is the widespread use of mobile phones and related developments in communication technologies, such as Interactive Voice Response (IVR), an automated telephony system. The overall aim of this thesis is to investigate the feasibility of using IVR to assess and intervene on everyday stress-related acute risk factors for crime among prisoners on parole. Paroled offenders (N=108) performed daily assessment during their first 30 days after leaving prison. Before release, they also completed a baseline assessment of stable risk factors, including personality, substance use problems, and mental health problems. Data on criminal recidivism one year following parole was collected from the Swedish Prison and Parole Service. After release, all subjects were called daily and answered assessment questions. Based on the content of their daily assessments, subjects in the intervention group received immediate feedback and a recommendation by automated telephony, and their probation officers also received a daily report by email. Although the intervention had no effect on criminal recidivism, the intervention group showed greater improvement than the control group on several of the acute dynamic risk factors studied. Several of these factors could predict criminal recidivism with marginal accuracy, and could provide incremental predictive validity beyond the baseline risk level of stable risk factors, i.e. problematic drug use and impulsiveness trait. In conclusion, IVR may be a feasible way to assess and intervene on daily stress-related acute dynamic risk factors among prisoners on parole.

  Vasiljevic_muep.pdf   (11.55Mb)

• Parental socialization and adolescent offending
  Nilsson, Eva-Lotta  : Malmö University, Faculty of Health and Society Serie: Malmö University Health and Society Dissertations;6 (2017)	Doctoral dissertation

  

  

  English abstract:

  The overarching aim of this thesis is to extend the existing knowledge on how different aspects of parenting are associated with adolescent problem-related behaviors, such as offending. This relationship is illustrated in the four studies included in this thesis and has been conducted each with its own specific objective. The first study examine gender differences in several dimensions of family-related variables in the explanation of adolescent offending. The findings in the study show that there are clear gendered differences in both levels of the family variables and in the associations between the different family var-iables and offending. The results in this study are not only indicative of real and important differences in the dynamics in patterns of family attachment among boys and girls, they also point to the importance of conducting more nuanced and detailed studies of the different elements of family attach-ments in order to be able to capture the gendered differences that exist. The second study employ a longitudinal design and explore both time-variant and long-term associations of parenting, deviant peer affiliations and substance use among a sample of adolescents aged 12-17, and their par-ents. The main findings in this study show that parents knowing where their children are, what they are doing, and whom they are with, is beneficial in providing protection against involvement with deviant peers, which in turn appear to be important to the development of substance use. These results apply to both time-variant and long-term associations. The results also indi-cate that adolescents vary in susceptibility to social influences by age, and that parenting in early adolescence shape the landscape for involvement with deviant peers and substance use in later adolescence. In addition to more common between-group comparisons, analyses of with-in-person changes was also conducted in the third paper, with the aim to study different aspects of parental monitoring and young people’s moral values in the explanation of why some adolescents are more exposed to criminogenic settings than others. The results showed that adolescents ex-periencing less monitoring and adolescents with poor moral values tend to be more exposed to criminogenic settings. The findings also indicate that a decrease in monitoring over time can explain some of the increase in crimi-nogenic exposure over time. Parental monitoring also showed to be im-portant regardless of the level of a young person’s moral values. Overall, this thus indicate that it is important for parents to maintain high levels of monitoring during adolescence. In the fourth paper, parental knowledge is not only examined as a predictor, but also as an outcome variable in order to increase knowledge of how con-textual factors might shape parenting strategies. The aim of the study is to examine whether there are differences in parental knowledge in relation to level of collective efficacy and disorder in the neighbourhood. Additionally, we will examine how parental knowledge interact with collective efficacy and disorder in the explanation of adolescent offending. Two sources of data were employed to measure the contextual variables – adolescent percep-tions, as well as an independent, aggregated measure. Only the adolescent perceptions of the contextual variables were significantly associated with parental knowledge and offending. The main findings indicate that the per-ceived neighbourhood characteristics are associated with different levels of parental knowledge. Parental knowledge is more important in predicting of-fending than neighbourhood characteristics, however, the existence of an interaction between parental knowledge and perceived collective efficacy was found, indicating that collective efficacy has a different effect on of-fending for adolescents with different levels of parental knowledge. In conclusion, the results presented in the thesis show that parents is a ro-bust predictor of adolescent problem behaviors throughout adolescence, however the parent-child interaction does not seem to be universal. The findings also indicate that it is important to examine multidimensional measures to be able to identify variations and to capture the complexity comprised in the parent-child interaction in general, and in some concepts in particular.

  2043_22366 Nilsson MUEP.pdf   (8.388Mb)

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