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Shared decision making in the social services? Reasons to consider when choosing methods for service user participation

Journal article
Authors Pia Nykänen
Published in Journal of Evaluation In Clinical Practice
Volume 26
Issue 2
Pages 569-574
ISSN 1356-1294
Publication year 2020
Published at Department of Education, Communication and Learning
Pages 569-574
Language en
Keywords reasons, shared decision making, social care, social services, social work, user participation
Subject categories Social Work, Practical philosophy, Ethics


User participation is nowadays a desirable feature of social services work. The International Federation of Social Workers states that staff shall promote the participation of clients so as to “enable them to be empowered in all aspects of decisions and actions affecting their lives.” The statement is codified in various national ethical codes; the Swedish Code of Conduct and Ethical Behaviour for Social Workers specifies that interventions shall build on client participation and common agreement. However, a 2012 Swedish governmental report noted that among 16 methods for user participation in the social services, psychiatry, and abuse and addiction care, only one, shared decision making (SDM), had been evaluated in randomized controlled trials (RCTs). Given this lack of evaluations, how ought professionals to choose between the various methods? The aim of this article is to introduce distinctions in order to answer the question of how social workers ought to choose between different user participation methods, to suggest how this choice could be made, and to argue that the case for SDM seems to be stronger than for other methods. We can distinguish between justificatory, motivational, and explanatory reasons in order to clarify what types of reasons are relevant when choosing between methods. Another distinction concerns general and specific reasons for user participation. No particular method for user participation can inherit its support only from general reasons, since these ordinarily do not point out any method as better than another one. Rather, specific reasons are needed. Social workers do have good reasons for choosing certain methods for user participation rather than others. These methods can be found by looking at specific justificatory reasons. The case for SDM is strengthened by its having been evaluated in RCTs and also because the SDM components harmonize with relevant components in the presented (Swedish) legislation.

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