The Role of Reflection in Family Support Social Work and Its Possible Promotion by a Research-Supported Model

ABSTRACT

Purpose: There is a prevailing controversy over the use of evidence-based practice (EBP) within human-service organizations. Since it is argued that it is a threat to reflection, proven experience, and tacit knowledge, we wanted to investigate the impact of the research-supported, family-centered model Family Check-Up (FCU) on practitioners’ use of, and opportunities for, reflection.

Method: Focus group interviews with family support social workers trained in FCU (n = 19) were conducted.

Results: The significance of reflection for social work practice is clearly indicated. It is crucial for providing quality care: for making progress, processing cases, and effecting change in client-related work. Described as a coping-mechanism, it is also crucial for practitioners. Since various elements of FCU require practitioners’ reflective ability, it was argued that it promotes both reflection and professional learning.

Discussion: Rather than constituting a threat to reflection, FCU was seen as promoting it, indicating an inaccuracy in prevailing assumptions about research-supported models. This implies the need for revising the definition of such models to promote their potential use and benefits. Working with FCU, however, demands sufficient resources.

Conclusion: With an increased focus on “production” leading to changes in priorities, it is argued that resources and opportunities for reflection decrease. As FCU and similar models seem to allow for the incorporation of reflection into ordinary tasks, we propose that they be used to prevent reflection from becoming even more difficult. However, to gain from the benefits of both reflection and research-supported models, various external factors need to be considered.

KEYWORDS:

• Reflective practice
• EBP
• social work
• professional development
• workplace learning
• human service organizations
• focus groups

The role of reflection in complex, dynamic practices, like Western social work, has been emphasized in previous studies (e.g. Kinsella, 2010; Mann, Gordon, & MacLeod, 2009; Ryding, Sorbring, & Wernersson, 2018; Schön, 1991; Thompson & Thompson, 2018). Despite its many benefits, like constituting an important part of experiential learning, improving decision-making and increasing productivity (Avby, 2018; Ellström, 2006; Kolb, 2015; Schön, 1991; Sicora, 2017; Yliruka & Karvinen-Niinikoski, 2013), resources for reflection and reflective practice appear to be decreasing in favor of other practice-approaches. The increased governance of the public sector is one example of external changes affecting social work. Such changes have led to a strong focus on economic efficiency, performance management and standardization, which in turn mean increased levels of documentation and an impact on practitioners’ discretion, autonomy and opportunities for reflection and learning (Lorenz, 2015; SOU, 2018:32; Thompson & Thompson, 2018). Moreover, it is argued, prevailing changes in social work practice are caused by a political agenda (Bergmark & Lundström, 2011; Denvall & Johansson, 2012) building on, from a social work perspective, contradictory ideas and ideals from the audit system and private sector (Liljegren & Parding, 2010; Munro, 2004; Webb, 2001). Organizational logic, with its bureaucracy as a tool for control, has furthermore led to an increased emphasis on standardized and manual-based treatments, assessments, and programs for the performance of work (Liljegren & Parding, 2010; SOU, 2018, p. 32), often research-supported ones. This type of approach entails the risk of degrading and subordinating practitioners’ professional knowledge, and to an even larger extent their proven experience, tacit knowledge, reflection and relationship-based ways of conducting social work (e.g. Barfoed & Jacobsson, 2012; Heiwe et al., 2013; Ingram, Fenton, Hodson, & Jindal-Snape, 2014).

Another consequence of the attempts to improve public sector organizations using ideas from other sectors is the prevailing controversy surrounding evidence-based practice (EBP), also evident within social work. EBP is a phenomenon with various definitions. Its varied meanings within different fields and contexts have impacted the understanding and interpretation of what it is and its possible use in practice. Sackett and colleagues’ definition is one that is frequently referred to: “the conscientious, explicit and judicious use of current best evidence about the care of individuals [clients]” and “the integration of best research evidence with clinical expertise and [client] values” (cited by Parrish & Oxhandler, p. 272, Parrish & Oxhandler, 2015). Evidence-based social work is one example of EBP occasionally defined according to a particular context:

placing the client’s benefits first, evidence-based practitioners adopt[ing] a process of lifelong learning that involves continually posing specific questions of direct practical importance to clients, searching objectively and efficiently for the current best evidence relative to each question, and taking appropriate action guided by evidence. (Gibbs, 2003a, p 6, in Mullen, Shlonsky, Bledsoe, & Bellamy, 2005)

With these definitions in mind, it appears that autonomy and the capacity of being informed and critical consumers of evidence, as well as being capable of assessing and individualizing practices, constitute important features for working with both EBP and research-supported treatments and models. Thus, further studies on EBP in various fields are needed for a better understanding of its impact and role in practice. In addition to this, few previous studies have investigated reflection in relation to EBP and research-supported models. This highlights the need for such studies to gain further insight into whether or not such models constitute a “threat” to essential features of social work practice, like reflection, emotions, and values, something often hinted at by its opponents (D’Cruz, Gillingham, & Melendez, 2007; Ingram et al., 2014). Indeed, practitioners’ experience and intuition, or practice wisdom, is an important aid in decision-making and finding solutions to each case. Despite using manuals or methods, solutions to specific situations might not be provided immediately (Kwan & Reupert, 2018; Schön, 1991), therefore requiring the practitioner’s reflective capacity and intuition for judging how to proceed (Mullen et al., 2005; Thompson & Thompson, 2018). Intuition thus means more than merely a “gut-feeling”; it is rather a capacity based on both professional knowledge and experience (Eneroth, 1990). In light of this, the purpose of this study is to investigate the opportunities for reflection in using the research-supported model Family Check-Up (FCU). Trying to enhance practice through EBP has, among other worries, raised concerns about the control and regulation of practitioners in a “planned and systematically organized environment” (Webb, 2001, p. 57). Randomized control trials (RCT), placed at the top of the “evidence-hierarchy,” are frequently criticized in relation to the complex nature of social work. Advocates of EBP do, however, emphasize its beneficial characteristics, like the capacity to reduce the theory-practice gap and uncertainty, to improve service quality and increase efficiency and effectiveness through ongoing evaluation and improvement (Gambrill, 2010; Gredig & Marsh, 2013; Heiwe et al., 2013; Mullen et al., 2005). Indeed, the controversy seems real, and is described in previous research with concepts like “new” and “traditional” professional styles (Barfoed & Jacobsson, 2012), and “organizational” and “occupational” professionalism (Liljegren & Parding, 2010). However, to differentiate between practices so strongly can be considered problematic. Surely reality is not as black and white (also emphasized by Liljegren & Parding, 2010). Certainly, both approaches have advantages that are important and useful for improving practice. Not having to choose between types of knowledge, such as between research-based and experience-based knowledge, or between economically and professionally motivated prioritizations is a goal worth striving for, i.e. bridging the gap (e.g. Soydan, 2015). Hence, the controversy makes it both necessary and interesting to view EBP from other angles than the ones dominating discussions today (Mantzoukas, 2008; Webb, 2001).

In terms of research-supported treatments and models, this study focuses on FCU: a strengths-based family-centered intervention aimed at promoting children’s mental health and providing parent-support. The model has two phases: assessment and feedback and parent management training. Since it is adaptive, it can be adjusted to fit the specific needs of each family. In Sweden, FCU is offered by Social Services and used for preventative and treatment-focused interventions, thus including various professions like social workers, school counsellors and practitioners at children’s health centers. Presently, FCU is offered at a couple of health centers in Sweden and has also been used in a pilot-study regarding children’s obesity. This study focuses on family support social workers who are educated and active in FCU. In their work, they meet families in crisis or those with social problems, like abuse, or families with children exhibiting problematic social behavior. The purpose of family support is thus to help the family find useful strategies for overcoming their difficulties. The participants’ work contains both individually designed efforts (with the specific family) and group activities, like parent groups, and is performed individually or in pairs of social workers. The services offered are either voluntary or mandated. The practitioners meet the families both in their homes and at the social services resource-unit. Family support can also assume different forms: dialogue (i.e. with an individual or family), network meetings, direct work in everyday situations, and other supportive activities. Video observation and assessments are common elements in the work with FCU. The social workers involved are offered method-, process-, and specific FCU-supervision when handling dilemmas in practice. The specific FCU-supervision is provided by the Centre for Progress in Children’s Mental Health (UPH) (public primary care). UPH is responsible for the implementation and education of FCU in Sweden. Studies on FCU have been conducted in both Sweden and the U.S., providing evidence for its effect in treating families with children who have mental health problems (e.g. Dishion, Forgatch, Chamberlain, & Pelham, 2016; Ghaderi, Kadesjö, Björnsdotter, & Enebrink, 2018).

Reflection in practice

It is argued that EBP diminishes important features of the way social work is conducted, and strong criticism has been directed at it (Gredig & Marsh, 2013; Ingram et al., 2014; Thompson & Thompson, 2018). However, EBP and reflection do, in many ways, appear to share similar objectives. Theory-based knowledge and EBP have, for example, been shown to promote life-long learning (e.g. Mullen et al., 2005) – as has reflection – in constituting an important feature of effective learning from experience and in the identification of knowledge gaps (Ellström, 2006; Gould, 2004; Kolb, 2015; Mann et al., 2009; Schön, 1991). A holistic approach/perspective is another similarity, in which several factors are taken into consideration when treating clients, thus reducing the risk of mistakes as well as providing ethical treatment with the client’s needs and interests in mind (Mullen et al., 2005; Sicora, 2017). Additionally, both are characterized as process-driven rather than being one-time applications (e.g. Boud, Keogh, & Walker, 1985; Kolb, 2015; Mullen et al., 2005).

Nevertheless, current influences from the audit system are affecting human-service organizations and their professions (Liljegren & Parding, 2010; Munro, 2004), implying the need for “softer” features of practice and emphasizing reflection, relationships and intuition (e.g. Ingram et al., 2014). A study by Ryding et al. (2018) investigated family support social workers’ use of reflection, describing it as a necessity for being able to adopt differing perspectives and making progress in the client-related work. Furthermore, it offers a sense of legitimacy and serves a protective function. However, due to it being more “intangible”, or “fuzzy,” in character, it can be difficult to measure reflection to prove its value and impact, one possible reason for its not being prioritized (e.g. Bindels, Verberg, Scherpbier, Heeneman, & Lombarts, 2018; Ryding et al., 2018). Productive reflection is a concept used in relation to reflection at work (Boud, Cressey, & Docherty, 2006; Dilschmann & Docherty, 2007). Considered to be a way of releasing new productive forces within organizations by encouraging co-workers’ vital and creative sides, productive reflection can enable new commitment, with practitioners being part of the creation of new identities and meanings, i.e. non-material assets for the organization. However, to make reflection productive, emphasis on life-quality of co-workers and continuous learning is needed (Dilschmann & Docherty, 2007).

Reflection is a multifaceted concept with several designated meanings and definitions. Turning to dictionaries, the Swedish National Encyclopedia defines reflection as thorough (and deep) thought or spontaneous thought or conclusions. Merriam-Webster defines it as a formed thought, idea or opinion or a remark made, or the consideration of some subject matter, idea or purpose. It is important to note that reflection and thinking are two different activities; reflection implies a more structured, systematic, and purposeful way of thinking, linking fact with deeds otherwise isolated from each other, and bridging a gap between the two. As it makes possible both a conversation with and an observation of oneself, insights and perspectives on actions and experiences can be reached, which then enables learning (Arms Almengor, 2018; Bie, 2007; Birge Rönnerfelt & Norman, 2015; Dewey, 1998; Hood, 2018; Watkins, 2016). Nevertheless, reflection, similar to professional expertise, is a skill that is learned and thus takes time to master. By investigating what you are doing and why, reflection is a tool for developing both self-awareness as well as an understanding of the practice you are in (Hood, 2018).

In relation to reflection and work, one common concept is reflective practice. Reflective practice can be described as a reflective conversation with the situation (Schön, 1991), in which the concepts espoused theories and theories-in-use are used, referring to what we say we do and what we actually do. At times the two are not consistent. To narrow the gap between the two, reflective practice is regarded as purposeful, aiding in increasing our awareness about this inconsistency (Arms Almengor, 2018; Schön, 1991). Taking both the past, present and future into consideration, reflective practice is a process for evaluating one’s own, and the client’s, behavior, thoughts and responses (Dicken & van Graan, 2016; Schön, 19912; Yip, 2006).

Reflection and reflective practice are important elements for integrating new learning into individuals’ knowledge-bases. Tacit and impersonal, it is a knowledge-type often expressed through actions rather than words, resulting in difficulty for others to access it. By transforming such knowledge into rules and work-routines, possibilities are created for its transfer to a collective level. Hence, this type of learning and knowledge-acquisition can support organizational learning (Nilsen, Nordström, & Ellström, 2012; Redmond, 2004).

For facilitating reflection at work, various tools are described as useful. These are tools with varying structures and applicableness at the individual and/or collective level. One often-mentioned tool, or source, for facilitating reflection is supervision. With various forms of supervision, such as process and method supervision, occurring within the field of social work, space for various types of reflections is offered, both individually and collectively. Different forms of supervision offer practitioners the possibility to reflect on various aspects of work, e.g. a specific client, the organization, management, or a specific method, either together with a colleague/-s or alone with the supervisor. Supervision therefore enables social workers to think about various aspects of their practice, both critically and on a wider, contextual and organizational level, thus offering a reflective forum (provided there is enough support) (Ingram et al., 2014). Since it promotes both individual (together with the supervisor) and collective reflection, supervision can be seen as contributing to both a managerial, supportive, and educational function, as proposed by Kadushin (1976, in Ingram et al., 2014). Occurring in different constellations, it can be argued that various forms of supervision are of varying appropriateness for dealing with different questions. Thus, certain matters are, for example, dealt with in individual supervision, while others are handled collectivley, in turn enabling and promoting various types of reflection as well as learning, all depending on structure and form (e.g. Bradley & Höjer, 2009; Ryding et al., 2018).

In conclusion, resources for reflection in practice appear to have decreased, making it an individual responsibility for social work practitioners. Simultaneously, focus on EBP has increased, a possible result of external forces affecting social work practice. However, since it is argued that EBP makes practitioners less reflective, concerns have been raised as to whether EBP restrains social work practice (e.g. Avby, 2015; Scurlock-Evans & Upton, 2015). Clearly, prevailing trends are affecting the practitioners, presumably placing them in the dilemma of trying to balance organizational demands and client needs.

The present study

Although it has been increasingly advocated and implemented during recent years, attitudes toward EBP vary. This has created a controversy in terms of possible advantages and disadvantages (e.g. Mullen et al., 2005; Soydan, 2015; SOU, 2018:32; Webb, 2001). Opponents regard the increased implementation of research-supported treatments and models as the result of unwanted influences from the audit system that include increased focus on external control, standardization, and cost-effectiveness, which in turn affects human service organizations (e.g. Avby, 2018; Bergmark & Lundström, 2011). This is furthermore a change that is believed to orient practice towards prioritizing economic frames rather than emphasizing relationships and values as a means to secure clients’ best interest (c.f. people-processing and people-changing, Hasenfeld in Gibson, Samuels, & Pryce, 2018). If reflection is a useful tool in social work practice (Mantzoukas, 2008; Ponnert & Svensson, 2016; Ryding et al., 2018), and important for learning (Boud et al., 1985; Ellström, 2006; Kolb, 2015), this trend can be considered problematic and not very constructive for practice. On the other hand, the view of EBP as a threat to reflection may not be quite correct either. With reflection making up an important part of practitioners’ ability to apply research and make informed decisions based on both research and experience, EBP can be considered to include reflection rather than constitute a threat to it (e.g. Barfoed & Jacobsson, 2012; Gambrill, 2010; Gredig & Marsh, 2013). This is a matter that obviously depends on context.

The described controversy related to EBP and human service organizations raises questions about these practices and the practitioners functioning in them. Hence, this study aims at investigating the impact of a research supported model on social workers engaged in family support, who are trained and active in the model FCU, and what they see as the value and use of reflection. Does FCU affect their use of reflection in everyday practice, and if so, how? A further aim is to investigate practitioners’ experience of resources and opportunities provided for reflection. The study was guided by the following research questions:

1. What is social workers’ understanding of reflection in everyday practice and in relation to their work with the research-supported model FCU?

2. In what ways are opportunities and resources for reflection provided?

Method

Participants

The empirical basis of this study is part of a larger data set produced in 2016. Social workers who work for the Department of Social Services in a city in western Sweden were invited to participate in focus groups. The collaboration-partner in this research-project is the above mentioned UPH, which, among other things, provides implementation and training in FCU. Prior to the recruitment of participants, it was decided that only practitioners from the districts in which FCU is offered would be included in the study. At the time, seven out of 10 districts offered FCU.

In the larger material, a total of 103 social workers were invited to participate. Out of these, 30 were trained and active in FCU and 19 chose to participate, forming five focus groups (of a total of 12). All participants belonged to pre-existing work groups at their respective workplace. The participants shared experiences from the same type of work and are trained in various models/methods related to the field, of which FCU is one. Further information about the participants is shown below (Table 1).

Each focus group had between three and five participants and the duration of the interviews was between 75 and 102 minutes (in total 7 h, 34 min). All interviews were recorded with a Dictaphone and transcribed verbatim. The first author conducted all focus groups. Neither the first author nor the co-author had previous experience of social work practice or previous research in the specific field. (The co-author has long experience of research on education and learning.) Extensive reading on the specific area had, however, been done prior to planning the study, and the first author has previous experience and knowledge about conducting focus group interviews and thematically analyzing data.

Procedure and interview

With the aim of reaching the standpoints of a professional group, rather than interviewing on an individual basis, the use of focus groups for collecting data was considered an appropriate method. Allowing participants to discuss the topic in groups rather than individually enabled both complementary and argumentative interaction (Kitzinger, 1994). Another advantage is the possibility of stimulating participants to share concrete, specific, and personal answers, supporting the disclosure of varying dimensions in opinions and understandings (Hylander, 2001; Kitzinger, 1994).

To recruit participants, an information letter about the study was first sent to the managers of each Social Services Resource Unit in the district, asking them for the names of practitioners working with family support. These practitioners were contacted individually by email regarding their interest in participating in the study, which later was confirmed via email or telephone. An information and consent letter describing the voluntariness and confidentiality of the study was sent to all invitees. Prior to conducting each focus group interview, a reminder was sent out. The first author conducted the interviews, which were held at the participants’ respective work-place or at the UPH office in connection with occasions for the specific FCU-supervision. Each focus group began with participants being asked briefly to describe their respective work. What followed were a few open questions for promoting a discussion about reflection and their experience of the opportunities and resources provided, as well as their thoughts on FCU, without interfering in the dialogue. Before the focus-groups finished up, time was given for additional comments and thoughts.

Prior to conducting this study, a representative from the regional Ethical Board was consulted in regard to ethical approval for the study. However, due to its specific aim and focus, it was not considered necessary. Other ethical rules and requirements for conducting research in Sweden (Vetenskapsrådet, 2017), have been respected and applied.

Analysis

The data-analysis was conducted along the lines of Braun and Clarke’s recommendations for thematic analysis. The first step was to transcribe the audio files into text format by using the software ExpressScribe, which enabled a direct transcribing procedure of the audio-files. The process was comprised of listening to the files, using the software, while transcribing in Swedish what the participants were saying. To ensure its accuracy in matching the original content, a slow, careful listening was applied, making sure that everything the participants said was written down correctly. When there were difficulties in identifying what the participants said, the files were played back until it was determined that the transcription was accurate. After completing the process, the content of each focus group interview was copied and saved in a Word document. The transcripts from the five focus groups with FCU-trained practitioners constituted the unit of analysis. The second step was to read through the transcriptions, noting important content and developing ideas about possible interpretations. What followed was a second reading of the transcriptions using the software MAXQDA, thus enabling further coding and analysis and the organizing of the material into categories. No categories were developed beforehand; the study’s research questions did, however, serve as guidance for the process of analysis. The subsequent step involved the organization of codes into themes, i.e. the compilation of various areas of interest. During the process of analysis, code and theme names were adjusted for an accurate highlighting of the content. All the above-mentioned steps were done using the Swedish transcripts, i.e. the coding-procedure in MAXQDA was done using Swedish codes and categories for capturing the content of the unit of analysis. Consequently, the results of the thematic analysis were all in Swedish but were, however, later translated into English. A professional proofreader was consulted for assuring the accuracy of the English language used, and for assisting in translating the quotes to make sure they corresponded to the original meaning. The first author had the major responsibility for both the analysis and the writing of this article. Throughout the process there was, however, a continuous discussion with the second author. Lastly, in 2018 the preliminary results of this study were presented at a network meeting for FCU-trained practitioners, which a number of participants from the previously completed focus groups attended. No remarks or objections were raised, however. An example of the analysis-procedure is found in the Appendix.

Findings

The thematic analysis resulted in three themes (see Table 2). Themes 1 and 3 had subthemes. When quoting, the relevant focus group is abbreviated FG, followed by its number. Quotes have been translated from Swedish into English. The word “client” can refer either to a family or an individual.

Table 1. Focus group participants

Participants (n = 19)
No. of focus groups	5
Female	18
Male	1
Age range (years)	34–62
Mean age	47,57
Work experience range (years)	7,5–40
Mean work experience (years)	19,97

Table 2. Themes and sub themes

Themes	Subthemes
1. Reflection – a necessity in social work ^p	1.1. A protective function
2. The structuring of reflective practices
3. A matter of priorities and resources	3.1. Facilitate and promote reflection with Family-Check Up?
	3.2. A model that limits reflection?

Theme 1. reflection – a necessity in social work

It became evident that reflection is regarded as absolutely important for dealing with practice and all that it can imply. When discussing their thoughts and when hearing the word “reflection,” expressions like: “without reflection I don’t think there would be any change-work [working for change]” (FG3) and opinions of reflection as invaluable and crucial for conducting social work emerged. Hence, the notion that reflection is an important ingredient, or tool, was made clear, or as one participant said: “If you look at it the other way round, I cannot imagine how anyone could work in social work without reflecting” (FG5).

When discussing reflection in relation to their work, the use of questions was highlighted. What are we doing? What happened? What could have been done differently? Is it helpful, meaningful? Are the parents and/or the child getting what they need? were questions presented as examples, enabling the process in cases. Being related to each and every specific treatment-goal, they both inform and create a foundation for the next steps in the process. One participant argues:

Reflection is much about are we going the right way, do we have consensus, are we doing what the family wants or… sometimes you can, there might be a conflict, they [the client/family] actually want something that we don’t believe in. Or reflection on them… the interpersonal that happens between us. …. (FG4)

Reflections occurring in relation to each and every case also concern the matter of closing these cases. At times, it was mentioned, closing a case can be difficult, particularly when they involve clients you worked with for a long time. Perhaps the efforts were not leading to further progress or help; it can still be perceived easier to just keep working with the client rather than closing the case. In such situations, the need for reflecting upon the specific case and the therapeutic relationship, asking oneself whether any progress is still being made, was emphasized. If the answer is no, it is necessary to realize that it’s either time for closure, or that another therapist should take over the case. Reflection enables a clarification of your role as a professional, your work and the potential influence you exert on the client. One participant describes it this way:

For me, reflection is when I see, what is, let’s take a conversation or what I have observed during a conversation. I mean it’s much about myself as I see it. What is it that comes from the parent, what is the parent’s or the child’s action and what is my part in this? That I must always see, pay attention to. Even if I am silent as a mouse in the corner, I am still there… …. It is not just the interaction between parents and children, it’s also the parent-child interaction in relation to me that is sitting there. That I think is part of reflection, i.e. to see things from different positions and approaches. (FG4)

To reflect also upon your own role as a professional, in addition to the client’s progress, was thus considered important.

Theme 1.2. a protective function

When discussing the need for reflection, one important aspect, or role it plays, emerged: that of protection. Functioning in a challenging and difficult practice, reflection appeared to have a protective function for the practitioners, in various ways. One participant says: “To cope with your work, to endure what is social work and family treatment it [reflection] is absolutely necessary” (FG2). For handling the close contacts with clients, which are occasionally emotionally charged, energy-consuming and even dangerous, emotions that arise and the complexity of their work were examples of why reflection was seen as crucial. “Clearing one’s head” was another way of describing ‘the need to get it out’ (FG1), emphasizing the processing function of reflection as a coping mechanism. Participants in FG 2 stressed the importance of reflection as follows: “What would have happened to us if we didn’t reflect?” “…. I think I would have lost myself,” and:

I think, sometimes you get hurt…. or become strongly affected. I think, if I didn’t have the capacity or possibility to reflect upon it (the situation), or the permission [to do so], I would have, I think I would have driven myself into a ditch. It would have been really bad.

This was followed by a participant suggesting that reflection might in fact be considered a protective function, and the others agreed.

Considered obvious in situations of danger, menace or violence, it was nevertheless argued that reflection is equally important in tough situations in which no physical violence or danger is present. Situations can be difficult and stressful anyway, pointing to the need for reflection even then. Additionally, supervision was emphasized as important, when arguing for increased “safety.” When there are at least two reflecting together, rather than only one person, it reduces the risk of being caught or dragged down in the situation/emotion. Likewise, reflection seemed more commonly used for handling difficult situations, rather than positive/easy ones:

I rarely reflect when something turned out really well, what was it that was good, what takes most time for reflection is when you are stuck …. When you experience some kind of difficulty, an obstacle or something, that’s when it starts for me. It is very rare to reflect that “this turned out very well, how did it turn out so well?” But maybe I’m a little bit too problem-oriented, or difficulty, or obstacle oriented. (FG4)

It became evident that they wondered what would happen if they were not able to reflect. The risk of losing oneself, and becoming affected to a level that would not be healthy, were considered possible outcomes, complicating the possibility of “disconnecting” during time off.

Theme 2. the structuring of reflective practices

Discussions about forms of reflection occurred in the focus groups. Reflection was said to occur on an individual basis, a type of reflection occurring more or less constantly, in which you use yourself as a tool. This means reflecting by oneself when dealing with experiences, dilemmas, thoughts etc., occurring anywhere and at any time. It was described as an activity important for preparing for client-meetings, for reflecting during such meetings and in other situations. One participant says:

I think, in the work with a family, I think that, I think I reflect all the time, in some way. You say something and then you think and then… Then there are moments when I reflect more, but perhaps I’m not aware. In a way, it happens I think. (FG5).

Individual reflection was described as occurring after various meetings, with clients, colleagues or others, in which it functions as a tool for summarizing and processing impressions and experiences, aiding decision-making on future steps in the specific case. “There is always a reflection occurring in the head, directly after every meeting, I think. In my own head only” (FG2). Despite occurring only personally, it was said to vary in formality, depending on when and how it is performed. When time is set aside for reflection, like in conjunction with client meetings, it was claimed to be more formal, and the more constant, ongoing type of reflection was considered less formal. In addition to the individual type, collective reflection with colleagues and clients or in supervision was mentioned, similarly varying in formality. Examples of more formal occasions were supervision, whereas knocking on a colleague’s door or “buttonholing” one or two co-workers down the hall for joint reflection was considered less formal. The level of formality thus depends on prior planning and structure, at least partly. The importance of all types was, however, emphasized. At times, it might not be possible to wait for supervision for dealing with a thought or dilemma, for which it was argued the informal type is necessary for handling the situation at hand. Enabling sharing and the creation of mutual understandings were other benefits to collective reflection that were described. Individual and collective reflection also seemed to complement each other: if a solution or answer cannot be reached through individual reflection, or one’s reflective capacity is limited, the dimensions or perspectives provided by collective reflection were considered helpful and valuable. Both individual and collective reflection were said to be important for doing a good job, and developing as a social worker. The need for sharing in general was emphasized, however more specifically for difficult situations:

After difficult meetings, and you are able to sit down with a colleague and really work through and feel that you are prepared for the meeting [the next one with that specific client], and you have twisted and turned and worked and you go in and have the meeting and it turns out the way you had expected, you feel like “yes!” afterwards and it feels really good, when you have had the possibility to do that work. You then feel very professional and very good. So, it is important, yes, important reflections. (FG5)

Additionally, the role of reflection for ensuring quality in the care provided was emphasized. This was specifically evident in situations of collaboration with other professionals on a client, where talking and sharing was crucial. As one participant observed: “That’s a situation where it’s really important to somehow manage to get together and reflect for… yes, for the sake of the case, for the sake of the family…” (FG1). Consequently, reflection does not only serve a protective function for the practitioners (Theme 1.2), but also for the clients. Talking about reflection and clients, collective reflection together with the client was also discussed and depicted as important for bringing about change and progress. Similar to the importance of collective reflection with colleagues, joint reflection with the client was felt to be essential, especially if perspectives or perceptions on the specific situation are not shared ones:

…. it will be a good basis for discussion, also with, both with your colleague but then also with the family. Sometimes you can be very open when you have reflected upon that “After meeting last time, I was thinking like this. When we are talking about it I was thinking that I noticed this… what are your thoughts?” and so on. That’s exciting. Sometimes you ask for permission: “I have been thinking about something, is it ok that I bring it up?” (FG3)

The very activity of reflection thus entails so much more than merely thinking about something, implying there is a need for “doing” something with the reflections you make since it doesn’t lead to something “automatically” (e.g. FG2).

Theme 3. a matter of priorities and resources

It was revealed that the participants shared an opinion that resources and opportunities for reflection – no matter the type – had decreased. Reasons for this were their increasingly busy practice and a limited prioritization of reflective practice, in favor of management tasks/elements. Despite limited time, there is, however, still a need to reflect. Due to this situation, they argued that it is all about finding, and taking, time for reflection. This can, however, be difficult if the time doesn’t exist in everyday work (due to a heavy workload, for example). One is, of course, allowed to reflect, but the organization is nevertheless responsible for controlling employees’ workload. This situation is said to hamper opportunities for less formal, collective reflection:

…most of it [reflection] occurs in your own chamber… because it can take time and, it might be a feeling you have that you want to think about… and then you may need to set aside time I think, so it might not always be that easy to just nab a colleague and propose what you want to reflect about, and if, is it just venting or is it something that’s a bit troublesome. (FG4)

This situation, it was argued, related to prevailing trends in social work. They talked about social work moving from a “reflection-domain” to a “production-domain,” resulting in reduced time for reflection and an increased level of administration and meetings:

In general, sometimes one feels that it gets to be a bit too much, regular meetings so, certain weeks when you both have case reviews, teams, supervision, APT, workplace meetings, and you sort of “ok, when do we have time to meet someone [i.e. a client] or work…?”. Some weeks are really tough when it turns out like that. Sometimes you almost have to choose one thing over something else, even if it… yes… (FG3)

Many of the meetings they are required/expected to attend were not considered forums for discussing or sharing experiences, reflections and dilemmas, but rather about “production”:

Then we are in production, this is where we’ll run the business, here we have the organization and political commissions and all those things, that we should relate to. It’s more so that you have much space for, I mean, we have a lot of room for information that I find completely uninteresting. Area sectors and managers, that I think, we spend quite a bit of time on.” (FG4)

Time as a factor was a recurring topic during the discussions. Allocating even 15 minutes for reflection after a meeting was considered difficult and something that could require organizational support. The participants felt that the provision of more structured reflection-time would be a possible solution to this problem since this might change the perception that reflection is an individual responsibility only, instead of the organisation’s. Although structured opportunities such as supervision are offered, these meetings were not considered sufficient. Besides, one may not always be able to attend these meetings, due to a stressful work situation that prevents them from taking advantage of such opportunities for reflection. One participant says that this “is completely counterproductive since it [whatever the social worker needed to reflect upon] might leak out elsewhere, a little more unstructured, but you cannot really cope, sit there and talk, then it’s better I go and work” (FG5). Another risk encountered when there is too little time for reflection at work is the negative effect on one’s leisure time. Due to the prevailing situation, the participants argued that much reflection is conducted on the way home from work or in the evenings and weekends. One of the participants says: “…. you never get off work. It doesn’t matter if it is Saturday, Sunday or Monday. If you don’t have time to reflect at all at work, they [clients/cases] have to pop up in your spare time” (FG2).

A final comment, however, is that the participants considered themselves lucky in terms of possibilities for reflection when compared to other professionals within the Swedish social services.

Theme 3.1. facilitate and promote reflection with family check-up?

Since the participants were trained and active in FCU, that model was also discussed during the focus groups. The notion emerged that it promotes reflection, even demands that they include reflection in their practice. However, this is on the condition that sufficient time for working with it is provided by the employer. Reasons for this view were several, some primarily connected to the various elements of the FCU model, like observing recorded interactions (part of the assessment), which both requires and allows for reflection, Motivational Interviewing (MI) and the specific FCU-supervision (provided by UPH), but also through the work of encouraging parents to be reflective as well as the joint reflection between practitioners and parent/s. These factors are furthermore regarded as necessary for developing professionally.

Perhaps I reflect equally as much [as in other models], but, for example with FCU, as I said, when you for example are to prepare feedback, then you sort of go in and just, it’s sort of just a lot of reflection, or well, it becomes a massive effort, here I have to… and reflect. Like a selective measure, then of course you reflect in the meantime as well, but there, it gets to be so much. I don’t think I experience that when I’m working with family-treatment and am not working with FCU, when it occurs more… when you don’t have to deliver an assessment. That’s the difference, I think. It is really required of me that now on Tuesday it has to be done, completed, and then I have to deliver something, bring something. And for that it is required of me that I reflect. That I think is a huge difference. (FG5)

With reflection being included in the model in different ways, spending time on it was also felt to be more “approved of” compared to other models/methods in which reflection is not explicitly assumed as needed to make progress. This is, furthermore, a matter that they claim has affected their work in general, making them more reflective even in other situations.

I think that… it becomes very detailed reflection when we have gone through it here [at UPH], when you have sent in a film [for supervision and in this case prior to certification]. That rarely happens otherwise. You even get a numerical assessment of how you do things. Much else [in their work] is based on preferences and thoughts and gut feelings, and well yes, intuition, but in this case, there is more, more practice of this. So, those reflections have left their marks, have become a springboard for trying to do things differently. (FG4)

Although agreeing that FCU promotes reflection, it was revealed in the analysis that there were variations in opinions regarding the amount or level of individual versus collective reflection. Most often, the work with FCU is performed individually and not in pairs as is otherwise common, thus enabling relatively good possibilities for individual reflection, especially since they are required to reflect to be able to complete various elements (of FCU). At the same time, it was asserted that collective reflection, was offered through the FCU-supervision, constituting an additional opportunity for supervision besides their regular ones. More informal types of collective reflection were thought of as their own responsibility to organize, through gathering some colleagues for joint reflection, watching observations together, etc. Still, the participants expressed a wish for more collective reflection opportunities, regardless the level of formality.

Theme 3.2. a model that limits reflection?

While FCU was mostly seen as promoting reflection, it was also revealed that there were those who saw it as limiting reflection. These opinions were, however, mainly present in one focus group, thus not expressed as frequently as claims of the opposite. Some considered its sessions to leave less room for reflection in the direct client-meeting compared to other models/methods. One reason was its highly structured character, that was in turn controlling, or “locking in” a practitioner through certain steps he/she must/should follow, certain things he/she needs to say etc., reducing one’s flexibility and restricting, or leaving less room for, reflection. Occasionally, these practitioners were of the opinion that FCU actually sets aside more time for reflection when compared to other methods/models: however, the type of reflection included is more superficial in character.

Discussion

This study provides insight into family-support social workers’ described use and need of reflection while active in the research-supported model FCU. With the prevailing controversy over the use of EBP in human service organizations in mind, the study also aimed at providing further insight into the possibilities of reflective practice when working with a research-supported model. Similar to the study by Ryding et al. (2018), the results emphasize the need for reflection in handling social work practice and for providing best possible care, which bears a resemblance to the described benefits of EBP. Likewise, it was argued that reflecting together with the client, one of the reflective practices described, is a way to achieve the client’s satisfaction regarding the service provided. Furthermore, it enables the creation and sharing of a mutual understanding between practitioner and client in terms of situation and goals. This constitutes another similarity between reflective practice and EBP that is in need of emphasis in light of the prevailing controversy. However, despite being regarded as highly important, time for reflection appeared to have decreased, due to an increased level of different forms of administration that are “stealing” from much-needed reflection-time. Other reasons were a poor understanding of the importance of reflection on the part of managers, in addition to various external factors inherent in a politically controlled organization. It nevertheless needs to be mentioned that the participants, when comparing themselves to other professionals within the Swedish Social Services, considered they were lucky in terms of reflection opportunities.

While describing how social work is changing, leading to a reduced prioritization of reflection, FCU was nevertheless said to promote reflection and professional development. FCU, it was also argued, renders work in general more structured and effective. The idea that reflection is necessary for professional development and learning aligns with previous research (Boud et al., 1985; Ellström, 2006; Kolb, 2015; Schön, 1991). According to this study, FCU is an example of a research-supported model with the capacity to promote various types of reflective practice, thus also good for learning and professional development. Similarly, the reduction of resources for individual reflection is noted in previous research (e.g. Börjesson, Cedersund, & Bengtsson, 2015; Ryding et al., 2018; Thompson & Thompson, 2018), where one underlying cause is assumed to be a lack of effort put into organizing schedules that include reflection (SOU, 2018, p. 32). The present study does, however, seem to imply that social workers applying FCU in their work experience have rather good opportunities for engaging in individual reflection, mostly due to the model requiring them to be reflective. This finding shows that reflection and relationship-based approaches to practice can be integrated in standardized and manual-based treatments, thus contesting one argument against research-supported models. The way opponents and advocates portray EBP and differentiate between practices might make sense in theory but it does not, however, mirror real practice. By promoting not only practitioners’ reflection but also parents’/clients’ reflective ability, FCU enables practitioners to reflect upon the specific situation, to weigh in clients’ needs and tailor a suitable treatment based on the model’s different parts (e.g. Neander, 2011). Something that would most certainly not be possible without reflection. This aligns with research emphasizing practitioners’ own capacity for applying the cyclical process of EBP (e.g. Mullen et al., 2005). Since social workers are required to combine and integrate evidence, client values, and expectations as well as their own expertise (Mullen et al., 2005), it can be argued that reflective capacity and proven experience are crucial even when working with research-supported models like FCU (Thompson & Thompson, 2018). Gibbs has conceptualized working with evidence-based practice in six steps (2003aa, in Mullen et al., 2005) (see Table 3), which can be seen as confirming the need for reflection when working from an evidence-based approach, thus also with research-supported models.

Table 3. The six steps of evidence-based practice (reproduced from Gibbs, 2003a, in Mullen et al., 2005).

1. Convert information need (prevention, assessment, treatment, risk) into an answerable question;

2. Track down the best evidence to answer the question;

3. Critically appraise the evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in our practice);

4. Integrate critical appraisal with practice experience, client’s strengths, values and circumstances;

5. Evaluate effectiveness and efficiency in exercising steps 1–4 and seek ways to improve them next time;

6. Teach others to follow the same process (Sackett, et al., 2000)

This conceptualization together with EBP as a cyclical process, underscore the resemblance to the aggregated definition of reflective practice by White, Fook, and Gardner (2006). They believe that reflective practice, in various processes, has the capacity to question assumptions and thus improve action and learning (see Table 4).

Table 4. Defining reflective practice (reproduced from White, Fook & Gardner, 2006)

1. A process (cognitive, emotional, experiential) of examining assumptions (of many different types and levels) embedded in actions or experience.

2. A linking of these assumptions with many different origins (personal, emotional, social, cultural, historical, political).

3. A review and reevaluation of these according to relevant criteria (context, purpose etc.).

4. A reworking of concepts and practice based on this re-evaluation.

Reflection is depicted as useful for integrating new perspectives into already existing experience and understanding, in turn enabling different or new approaches (Mantzoukas, 2008). In a similar way, it can be argued that systematic studies are both important and useful for practitioners in helping clients effectively, through for example its provision of methods and manuals. A combination of the two could be suggested as necessary for dealing with social work practice. This aligns with the statements from the participants, arguing that the use of FCU, in being a research-supported model, provides a sense of comfort, since they are not basing work merely on their own personal opinions or experiences. This is something that, if mentioned to the client, was also considered to be giving a certain probity to the treatment. An approach to work combining reflections upon the specific case with systematically tested knowledge regarding similar cases, forms a foundation on which to stand when treating the client. Bearing in mind that a degree in social work is an academic degree that is grounded in science, it appears quite strange that evidence and research is considered something “odd” or different, not compatible with social work practice. This is another argument for the continued use of research also later in practice.

The study reveals benefits in terms of working with a research-supported model, in this case FCU. However, to take advantage of these benefits, certain factors need to be addressed in relation to its everyday use. With a possible impact on both implementation and subsequent use, time, as in resources provided by the organization, is very important and in need of consideration. As per the participants, FCU as a model can be time-consuming. Nonetheless, when applied, it provides an extensive amount of information about the client, and can therefore be regarded as time well spent. However, with limited time for working with the model, benefits like these are at risk of being lost. Thus, a lack of sufficient time, aligned with other factors like a dearth of resources and negative or skeptical attitudes, are possible hindering factors, that are also described in previous research (Gray, Joy, Plath, & Webb, 2014; Heiwe et al., 2013; Pope, Rollins, Chaumba, & Risler, 2011; Scurlock-Evans & Upton, 2015). Another possible consequence of limited time is practitioners’ choice to work from experience and tacit knowledge, instead of basing choices on evidence, since this requires less effort in comparison (Muskat, Mishna, Farnia, & Wiener, 2010). The evident struggle with time, for both reflective practice and working with specific models, needs to be analyzed in relation to previous and current trends in the field of social work, as mentioned in the introduction.

Similar to time, economy appears to be another important factor. Social Services in Sweden is a state agency, which means there is legislative and regulatory impact on the layout of practitioners’ work. However, representing the welfare system, social workers need to respond to both organizational frameworks at a local level as well as to legislation and Social Services guidelines. The participants described a subjective experience of social work moving from a “reflection-” to a “production-domain,” also being their perceived reason for the decrease in resources for reflection. Such changes in practice have been portrayed in previous research also (e.g. Dolan, Pinkerton, & Canavan, 2006; Lorenz, 2015; Ponnert & Svensson, 2016; Thompson & Thompson, 2018). This is a situation that poses a risk of practitioners being caught in a dilemma in regards to whose needs to prioritize: their own, the client’s or the organization’s? and this in a hierarchic and bureaucratic environment (Bradley & Höjer, 2009; Burton & Van Den Broek, 2009). This undesirable situation means the risk of problems like deficiencies in treatment, heavy workloads, depletion of professionalism and a negative effect on budgets and results (Björktomta & Arnsvik, 2016). Furthermore, there is a risk to practitioners’ well-being. Through reflection, one’s role as a professional, the work done as well as potential influence on the client can be clarified. This, aligned with its possible positive impact on client work and treatment outcome, further stresses the role of reflection for ensuring good and professional care to the service users. Besides, not being able to process experiences through something like reflection, might pose a risk for long-term health problems, stress or other consequences (Ingram et al., 2014; Ryding et al., 2018; Yip, 2006). Since the participants describe reflection as a coping mechanism, this may be considered additionally supportive. This brings to mind Antonovsky’s Sense of Coherence (SOC) in which he argues that Generalized Resistance Resources (GRR) are important for reaching and maintaining SOC, i.e. to cope with stressors, challenges and misfortunes. Among the factors possible for constituting such resources, coping strategies, social support and the individual’s state of mind, are found (Antonovsky, 2005; Idan, Eriksson, & Al-Yagon, 2017).

The existence of various understandings of EBP and research-supported treatments and models was highlighted in the introduction. Critics argue that requiring the adoption of research-supported treatment is undertaken due to economic motives, with one major aim being increased cost-efficiency. A focus by many considered inappropriate for human service organizations (e.g. Gould, 2004; Ponnert & Svensson, 2016; Webb, 2001). However, effectiveness can imply various things, pointing at the matter’s complexity. The expression “time is money” implies that the issue is not the origin of the knowledge used, but rather the cost accepted for treating clients. Politicians and decision-makers might assume that manuals and structured models are more cost-effective than other approaches. However, research-supported models might imply extensive work, thus possibly also being more expensive. Costs and efficiency in short- contra long-term perspectives are presumably about a combination of factors, thus more complicated than the type of knowledge used. Mullen and colleagues (Mullen et al., 2005) argue that there is a difference between the mere application of manuals or guidelines and practitioners embracing an evidence-based way of conducting work. That is, there is a difference between practitioners as consumers of guidelines and manuals created by others and practitioners as critical information-seekers, examining research, justifying treatment decisions based upon the client’s needs and circumstances, and in turn evaluating the result of the treatment for future adjustment and use. Is such a distinction enough? A third alternative could be imagined in which EBP bridges science and practice and aims at reducing the problem of practice and academia not understanding each other. With attitudes, knowledge, and skills playing an important role in the application of EBP in practice, a coherent understanding is especially important (e.g. Gray et al., 2014). EBP could thus be regarded as a confusing and indistinct concept, similar to reflection and reflective practice which are accused of lacking “conceptual clarity” (Kinsella, 2010). Again, this highlights the need for bringing about an understanding of EBP acceptable to both its opponents and advocates.

To work with and treat human beings is a complex practice consisting of problems not always clearly defined or possible to capture in unambiguous terms. This implies the need for a renewed and more clarifying view of EBP. By doing so, its multifaceted character can be displayed and promoted, and its benefits taken advantage of (Gambrill, 2010). Doing the same with reflection, a new understanding and use of both can be enabled, possibly improving social work practice.

Limitations

First, the sample originates from one city only. A geographical breadth could have provided varied insights, but was, however, not possible. Secondly, the approach of self-selected participants could be a limitation, since it implies that only practitioners with interest in the topic participated, possibly affecting the results. Thirdly, some focus groups were conducted at the UPH’s office and some at the participants’ respective work-place. Although not obviously noted by the interviewer, it may have influenced the discussions. Despite these limitations, this study still contributes with important and useful insights.

Conclusion and implications

Time as an important, occasionally hindering, factor in utilizing FCU in practice became evident, which supports the results of previous studies. Being an extensive model, thus occasionally time-consuming, the provision of sufficient time by the organization so that practitioners to work with it is of the utmost importance. This matter can be related to the importance of organizational readiness when implementing new models in practice (Ogden, Amlund Hagen, Askeland, & Christensen, 2009; Shea, Jacobs, Esserman, Bruce, & Weiner, 2014). The implementation process can greatly affect the potential success, or non-success, of a new model/practice within a context (Edmunds, Beidas, & Kendall, 2013). Thus, more tailored implementation strategies in which local context and circumstances are both considered and adapted to are advocated nowadays (Ogden et al., 2009; Pope et al., 2011; Stanhope, Tuchmann, & Sinclair, 2011). Prior to starting the implementation-process, organizations thus need to be sufficiently prepared for avoiding factors like insufficient time and resources that can later become obstacles. The need for thinking through and planning what will be the everyday use of models and methods before sending practitioners to training, is moreover highly important. Based on the participants’ statements, it appears that sending practitioners to training in new models/methods is a rule rather than an exception, no matter the number already in their treatment-repertoire. But the question is, how many treatments do, and can, practitioners use in practice? How many is it possible to use simultaneously with retained quality and fidelity? Or put differently, what creates ineffective organizations is a constant trial of new solutions, thus never allowing any one of them to become routinized, (March, 1991, in SOU, 2018, p. 32). If working with new approaches implies a struggle for the practitioner, falling back on previous approaches, like basing work solely on experience, is a risk (Muskat et al., 2010).By investigating the actual need for new knowledge and treatments in the work-group/organization, while both bearing clientele and surrounding factors in mind and planning ahead in terms of training, practice can be well thought-through, priorities determined, and resources saved.

In times of increased economic focus, the practitioners seem to sense a decrease in the time they have for those features of care that are important in terms of providing good quality and attaining long-lasting results. One example of these features is reflection. However, contrary to the opinions of its critics, FCU, the research-supported model in focus for this study, actually appears to promote reflection. This is indeed positive, but also problematic, if practitioners trained in the model are hindered by organizational factors from utilizing it, not least from an economic perspective. A perception of reduced resources for reflection was stated by the participants, while simultaneously arguing for FCU to promote reflection. This brings to mind the notion of trying to satisfy part of their reflection-need by enabling them to work with research-supported models, like FCU. Bearing in mind the previously stated potentially positive aspects of working with such models, it can be argued that it is a way of both satisfying the need for time for reflection and enabling competence development. Reflection thus needs consideration when allocating resources. Since it is important for coping with work and making progress in cases, there are few reasons for the ignorance of reflection. By using certain models, such as FCU, for enabling practitioners to reflect, research-supported models and reflective practice could possibly also be combined. Sharing similar objectives, a profitable situation could be reached. However, this requires decision-makers’ realization and acknowledgement of reflection as important for taking on an “evidence-based approach.” If not, there is a risk of practitioners becoming the mere users of models or guidelines, and thus applying them in an uncritical and unreflective way. This is an approach that is presumably not beneficial in the long run. By depicting both reflective practice and EBP in a different way, a new understanding could be reached. For doing so, similarities and benefits of the two concepts are in need of highlighting, to replace existing, and not rarely destructive, preconceptions.

Acknowledgments

The authors wish to thank the participants for contributing and bringing valuable insights to the matter being researched. Also, thanks to the Center for Progress in Children’s Mental Health for co-financing this project.

Additional information

Funding

This research was partly funded by the Center for Progress in Children’s Mental Health, a unit within the public primary care provider Närhälsan, Sweden.

Appendix.

Procedure of the data analysis which was guided by the recommendations of Braun and Clarke (2006). The presented examples were originally in Swedish and later translated into English

Table

Phase	Description	Example
Transcribing ^p	All transcriptions of what the focus groups said are verbatim, using the software ExpressScribe.
Reading through	All transcriptions were read through so that I became familiarized with the content. Important content and initial ideas about interpretations and connections were noted.	Example of content noted as important: ^p‘I think that it is also in relation to the goals you are working towards together with the family. It is there, in that you are discussing and reflecting upon, like, where are we going and how far have we come and what is left before we reach the end of the road, and so on. I mean it is, there wouldn’t be any point, I think… I mean if it wasn’t included in our work. And that it is also to help the families in that way of thinking. That you, like you are saying, discuss together with the parents “where are we and how does it look”, sort of. And if we didn’t have that possibility, I mean with our colleagues, together in these various, like you are saying, these [situations] with supervision and method and so on, then I think it also would have been difficult for us to do it together with the family…’
Coding	A second reading of the transcripts followed, using the software MAXQDA, and simultaneously organizing data into initial codes that later were organized into groups of codes (i.e. categories). The created codes identified features of the data with relevance to the aim of the study. Codes were reworked after the initial coding.	The extract above was organized into the following codes: Benefits and need reflection, Reflection as process/analysis, Collective reflection, Structured reflection, Supervision The codes were later organized, and thus summarized, into one common category: Reflection importance/meaning
Searching for themes	Final codes were categorized into different, initial, themes. Codes relevant to one area of interest where collected under one theme, some with subthemes, with the aim of providing a true description of the data and in relation to the aim of the study.	For example: the codes mentioned above, which were summarized into the category Reflection importance/meaning, were considered to be related to the importance of reflection in a social work practice. Thus, there were various reasons for the importance of reflection according to the participants. An idea which was initially described by the theme “The need for reflection in social work”.
Reworking of themes	Initial themes were reworked to ensure that they highlight the content of the data. Initial theme-names were reworked during the process to ensure their consistency with the data set.	The coded segments categorized into the theme “The need for reflection in social work” was reviewed and adjusted to fit the theme, with some being removed and other new codes, added. During the process, the theme was renamed “Reflection – a necessity in social work”.
Findings	The final themes were used to describe the findings of the study. Quotes from the participants are used to further illustrate the content and meaning of each theme.	This specific theme was then used to describe the participants’ thoughts and discussions of the importance and need of reflection in social work practice. The goal of this specific, and quite broad theme, was to capture the various reasons why reflection was considered important, like adding processes and progress to the client-related work, and serving as a coping-mechanism for practitioners, to mention a few examples.