Planning at the edge - aspects on inter-municipal and border related spatial planning in a new Swedish geography

This licentiate thesis investigates how municipal division and local borders may affect spatial planning and the possibilities for coordination of inter-municipal and cross-border planning issues, which has become increasingly important in recent decades as a result of, amongst other things, regional enlargement and an emerging need for increased environmental consideration and climate change adaptation. The overall question, which derives from the author's many years of professional experience as a planning architect, is examined through two studies, presented in two different papers: The first paper explores the problem from a municipal perspective through a case study of two municipalities, Hallsberg and Kumla, with a long history of border related conflicts and collaborations, while the second paper examines the question primarily from a state perspective by investigating the Swedish planning system and municipal division in relation to certain recent geographical changes. Generally, the findings indicate that municipal borders are increasingly suboptimal due to the discrepancy between the emerging new geography and the “old” geography that has formed the basis of both municipal division and the planning legislation. Local geography and territorial conditions are thereby being increasingly influential to the process and outcome of spatial planning. On a theoretical note, the thesis contributes to a fuller understanding of the complex local border geography and helps to bring the discussion on planning back to a geographical, and territorial context

Negotiating asymmetric borders in an emerging soft region

In contemporary planning, the development of soft regions through inter-municipal collaborations plays an increasingly important role. However, as previous research has shown, local borders and local jurisdiction are likely to remain as part and parcel of the new region. This paper argues the need to consider the geography of such local borders, to reveal asymmetries which could weaken the opportunities for inter-municipal collaboration. Following relational geography, we argue that the municipalities don't necessarily share the same border; if understood as a relational effect, the border plays different roles for each municipality. With this in mind, we offer a case study of how a Swedish local border is being negotiated within planning. The case of Kumla and Hallsberg reveals how one municipality is active in trying to negotiate the border, whereas the other procrastinates around any action which do not lie in their interest. The result is a border haunted by decades of poorly coordinated, even provocative, planning actions. Our study opens up for a discussion on asymmetries and a relational understanding of the geography (and history) of planning, as well as for further studies of the interplay between the renegotiation of the local borders within emerging soft regions

Individual Placement and Support is the keyhole : Employer experiences of supporting persons with mental illness

BACKGROUND: Rehabilitation professionals are increasingly interested in the vocational rehabilitation approach called Individual Placement and Support (IPS) for persons with serious mental illness. OBJECTIVE: Since employers play a crucial supporting role for the IPS service user in the workplace, the aim of this study was to explore the experiences and views of employers in Sweden who have participated in the IPS network and taken IPS service users into their workforce. METHODS: Grounded theory with situational analysis was used to analyze data from nine employers. RESULTS: The core category being socially committedwas identified. Six stages/categories illustrated the employer process, from taking on IPS service users to supporting them at work: 1) IPS is the keyhole, 2) being ready to open the door, 3) making a job offer, 4) removing barriers, 5) achieving the goal, and 6) pride mixed with negative feelings. CONCLUSION: The study results suggest that collaborative relationships with employers must be based on trust and professionalism, and that employers must be provided with adequate support

Flexible assertive community treatment teams can change complex and fragmented service systems: experiences of service providers

Background Implementing innovative health service models in existing service systems is complicated and context dependent. Flexible assertive community treatment (FACT) is a multidisciplinary service model aimed at providing integrated care for people with severe mental illness. The model was developed in the Netherlands and is now used in several countries, such as Norway. The Norwegian service system is complex and fragmented, with challenges in collaboration. Limited research has been performed on FACT teams and other new integrative health service models as part of such systems. However, such knowledge is important for future adjustments of innovation processes and service systems. Our aim was to explore how FACT teams are integrated into the existing formal public service system, how they function and affect the system, and describe some influencing factors to this. We sought to address how service providers in the existing service system experience the functioning of FACT teams in the system. Methods Five focus group interviews were undertaken 3 years after the FACT teams were implemented. Forty service providers representing different services from both levels of administration (primary and specialist healthcare) from different Norwegian regions participated in this study. Team leaders of the FACT teams also participated. Service providers were recruited through purposeful sampling. Interviews were analysed using thematic text analysis. Results The analysis revealed five main themes regarding FACT teams: (1) They form a bridge between different services; (2) They collaborate with other services; (3) They undertake responsibility and reassure other services; (4) They do not close all gaps in service systems; and (5) They are part of a service system that hampers their functioning. Conclusions The FACT teams in this study contributed to positive changes in the existing service system. They largely contributed to less complex and fragmented systems by forming a bridge and undertaking responsibility in the system and by collaborating with and reassuring other services; this has reduced some gaps in the system. The way FACT teams function and needs of the existing system appear to have contributed positively to these findings. However, complexity and fragmentation of the system partly hamper functioning of the FACT teams.publishedVersio

Flexible Assertive Community Treatment in Rural and Remote Areas: A Qualitative Study of the Challenges and Adaptations of the Model

Flexible assertive community treatment (FACT) is an innovative model for providing long-term treatment to people with severe mental illness. The model was developed in the Netherlands but is now used in other countries, including Norway, which has a geography different from the Netherlands, with many rural and remote areas. Implementation of innovations is context dependent. The FACT model’s potential in rural and remote areas has not been studied. Therefore, we aimed to gain knowledge regarding the challenges and modifications of the model in rural and remote contexts and discuss how they can affect the model’s potential in such areas. This knowledge can improve the understanding of how FACT or similar services can be adapted to function most optimally in such conditions. We sought to address the following questions: Which elements of the FACT model do team leaders of the rural FACT teams find particularly challenging due to the context, and what modifications have the teams made to the model. Digital interviews were conducted with five team leaders from five rural FACT teams in different parts of Norway. They were selected using purposive sampling to include team leaders from some of the most rural teams in Norway. The interviews were analysed using thematic text analysis. The following three themes described elements of the FACT model that were experienced particularly challenging in the rural and remote context: multidisciplinary shared caseload approach, intensive outreach, and crisis management. The following eight themes described the modifications that the teams had made to the model: intermunicipal collaboration, context-adaptive planning, delegation of tasks to municipal services, part-time employment, different geographical locations of staff, use of digital tools, fewer FACT board meetings, and reduced caseload. Rural and remote contexts challenge the FACT model’s potential. However, modifications can be made, some of which can be considered innovative modifications that can increase the model’s potential in such areas, while others might move the teams further away from the model.publishedVersio

Integration of Care in Complex and Fragmented Service Systems: Experiences of Staff in Flexible Assertive Community Treatment Teams

Introduction: To provide more integrated care, several countries have implemented the Flexible Assertive Community Treatment (FACT) model. However, this model does not guarantee full integration, especially in complex and fragmented service systems like in Norway. Hence, we investigated which barriers that might reduce the potential for integrated care in the Norwegian system, as described by staff in FACT teams, and how they adjust their way of working to increase the opportunities for integration. Methods: Online focus group interviews involving 35 staff members of five Norwegian FACT teams were conducted using a semi-structured interview guide. The material was analysed using thematic text analysis. Results: Six themes described the barriers to integrated care in the service system: fragmentation, different legislation and digital systems, challenges in collaboration, bureaucracy and limited opening hours. Three themes described adjustments in the teams’ way of working to enhance integration: working as the responsible co-ordinator, being a collaborator, and the only entry channel into the service system. Conclusion: The FACT team staff described several barriers to integration within the system. However, they made some adjustments in their way of working that might provide opportunities for integrated care within complex and fragmented service systems.publishedVersio

Service User Experiences of How Flexible Assertive Community Treatment May Support or Inhibit Citizenship: A Qualitative Study

The aim of this study was to explore and describe service user experiences of how receiving services from a Flexible Assertive Community Treatment (FACT) team may support or inhibit citizenship. Within a participatory design, individual interviews with 32 service users from five Norwegian FACT teams were analyzed using thematic, cross-sectional analysis. The findings showed that FACT may support citizenship by relating to service users as whole people, facilitating empowerment and involvement, and providing practical and accessible help. Experiences of coercion, limited involvement and authoritarian aspects of the system surrounding FACT had inhibited citizenship for participants in this study.publishedVersio

How Activist Claims Can Help Explain Intensity of Violence in Environmental Conflicts : Evidence from Colombia

Why do activists in some environmental incompatibilities experience a high intensity of violence, while protesters in other environmental conflicts do not? To answer the query, this thesis presents a novel theoretical argument where it is stated that the type of legal claim posed by activists impacts the intensity of violence that they receive. Due to a ‘relational citizenship’-mechanism, activist claims that are similar to secessionist demands are suggested to negatively provoke state elites’ security provision, with the consequence of a higher intensity of violence, ceteris paribus. From the theoretical argument, a hypothesis is derived, predicting that higher intensity of violence is expected for environmental mobilisations that pose identity-territory rights claims, than environmental mobilisations that pose universal rights claims. The hypothesis is tested on two local-level gold mining conflicts in the Colombian departments Tolima and Cauca between 2009-2014. The cases are selected with a most similar case design and are analysed with a structured focus comparison methodology. The analysis of the cases lends tentative support for the prediction that environmental movements that pose identity-territory rights claims experience a higher intensity of violence than environmental movements that instead apply universal rights claims