Discretionary Collaboration in Work-Oriented Rehabilitation: Approaches Among Coordinating Caseworkers in Sweden

This presentation addresses tensions between discretion and entitlement to work-focused rehabilitation for sick-listed unemployed individuals, highlighting how caseworkers’ decisions on collaboration are influenced by factors that also affect access to resources and realization of entitlements. Collaboration is a priority in the Swedish welfare state, particularly for work-focused rehabilitation, reflecting how the work-first approach has become a norm for such networked service. This study examines how caseworkers with coordinating roles at the Swedish Social Insurance Agency (SSIA) navigate complex expectations during the planning phase. The group has diverse educational and professional backgrounds, often holding a university degree. A vignette-based survey, answered by 853 respondents (with a 45% response rate), explored discretionary initiatives to collaborate in the context of social entitlements for work-focused rehabilitation.

The findings identify three approaches to collaboration: boundary spanners (33%), boundary keepers (10%), and boundary users (57%). Boundary spanners, typically with shorter SSIA tenures and working in specific contexts, engage external actors such as healthcare providers and the Public Employment Service, actively seeking information and consensus. However, requests for medical documentation correlate with client ethnicity, indicating potential bias. No other significant correlations were found concerning ethnicity, gender, or caseworkers’ educational background.

In contrast, boundary keepers—often with longer SSIA tenures—exhibit limited collaboration, focusing primarily on SSIA’s framework. Boundary users employ flexible strategies, adapting collaboration to cases while relying on internal resources. The analysis shows how geographic area and tenure influence collaborative practices and strategies. The study raises questions about discretion in coordinating collaborative services and how policy is translated within organizational contexts and continues into collaborative practices, potentially affecting access to resources and realization of social entitlements. The findings can inform future policy development to address inclusion of diverse professional roles at the planning stage of this networked welfare service, as well as responses to complex needs.