Et evidensbasert familievern – et bedre familievern? En diskursanalyse av innføringen av det kliniske verktøyet ”Klient- og resultatstyrt praksis” (KOR) i familievernet

Abstract

contribute to define and change the terms for professional practice. We have used Mitchell Dean and his governmentality analysis as a theoretical base to look at how prevailing governmentalities emerge as terms for practice. Our starting point is family counselling and what happens there in the light of these perspectives. In 2006, a process in family counselling named “User-oriented quality improvement” started. As a result of this process, it was decided that family counselling will use the clinical tool “Client-Directed, Outcome-Informed Therapy” (KOR) for systematic feedback in therapy. Family counselling will also offer an “individualized evidence-based treatment”. The Norwegian Directorate for Children, Youth and Family Affairs (Bufdir) is responsible for this development and for implementation of KOR in the whole service. They have received their mandate from the Ministry (BFD). There are two documents that describe the thinking and the process relating to "User-oriented quality improvement" and the introduction of KOR in family counselling. In these documents it is taken for granted that the introduction of KOR and evidence base will improve quality. Our research question is to ask whether an evidence-based family counselling is a better family counselling. In connection to this, we ask if an injunction of clinical feedback tool in therapy makes therapy better, and whether the result of research and being denoted as evidence-based will ensure quality and make therapy better. These questions are directed to Bufdir’s own analysis and argumentation as it emerges from the above-mentioned documents. We use discourse analysis as a method to analyze the two documents and the context in which they are a part. The approach to discourse analysis that is applied is described by Iver Neumann, and is based on part of Michael Foucault's theory. We have through our analysis found that the process "User-oriented quality improvement" and the introduction of KOR in family counselling is guided by a motivation and an injunction that family counselling must be modernized in line with prevailing governmentalities in society. These governmentalities set the conditions for professional practice, and apply therefore far beyond family counselling's situation. The clinical tool KOR should be used for purposes beyond the clinical context, e.g. supervision and management, and consequently other purposes reach the therapy room. Whether an evidence-based family counselling and introduction of KOR becomes a better family counselling is an open, empirical question. We find, however, that the new systems will be able to create a different family counselling with a different professional logic for what creates quality in therapy. This can change the discourse on family counselling’s therapy, and the prevalent clinical logic in the family counselling’s knowledge tradition