Therese Dwyer Løken

• Løken, Therese Dwyer & Vike, Halvard (2024). Thinking and acting outside the box: The co-existence of formal bureaucratic integration and informal street-level integration in municipal health and social care services. Nordisk tidsskrift for livskvalitet og bærekraftig velferdsutvikling. 3(1), p. 53–67. doi: 10.18261/njwel.3.1.5. Full text in Research Archive Show summary

  Integration of health and social care services is the recommended approach for people with concurrent mental health and substance abuse problems. Integrated service approaches can, however, be difficult to achieve due to organizational and financial barriers. This is a study of practice-level service integration in municipal health and social care organizations that provide services to people with mental health and substance abuse problems. More precisely, we study the co-existence of formal and informal integration in a service field which is threatened by cost-savings and cuts in resource use. The study is designed as a qualitative single-case study, with three Norwegian municipalities as case organizations. The empirical data consists of a combination of in-depth individual interviews, focus group interviews and observations of decision meetings. This material is analysed with a deductive thematic analysis approach based on theories concerning formal integration and street-level diplomacy. The findings reveal that commitment to the goal of service integration can be both symmetrical and asymmetrical between managers and professionals. Co-existence between formal bureaucratic integration and informal street-level integration is possible if the commitment is symmetrical, and if professionals are granted increased autonomy and less formal control.

• Løken, Therese Dwyer; Helgesen, Marit Kristine & Bjørkquist, Catharina (2022). Collective Competence as an Enabler for Service Integration in Health and Social Care Services. Journal of Multidisciplinary Healthcare. 15, p. 2817–2830. doi: 10.2147/JMDH.S387719. Full text in Research Archive Show summary

  Purpose: Fragmentation in health and social care services can result in poor access to services, lack of continuity and inadequate provision for needs. A focus on integration of services are thus suggested to prevent negative consequences of fragmentation for service recipients. There are, however, few studies that explore the competence needed for integration of services in municipal health and social care organizations. This study explores which types of competence stakeholders require and how collective competence can promote service integration. Methods: This is a single-case study, and the data consist of focus group interviews and individual interviews with service recipients, family caregivers, professionals and managers. The data were analysed both inductively and deductively. Results: The analysis resulted in four main themes: 1) Knowledge about individual life situations and organization and system, 2) investigation competence, 3) person-centred collaboration competence and 4) facilitating competence. The themes form the basis for a collective competence framework that can promote service integration. Conclusion: As service integration involves a high degree of interlinked activities between professionals and organizational units, a collective approach to the concept of competence is presumably applicable. When service integration competence is approached as a collective attribute of a network within and between organizational units, the organization can facilitate this competence by encouraging an active exchange of knowledge between professionals. We also argue that service integration competence increases connectivity and interdependency between professionals and organizational units, and includes service recipients and family caregivers as legitimate extra-professional parts of the collaborative network.

• Løken, Therese Dwyer; Helgesen, Marit Kristine; Vike, Halvard & Bjørkquist, Catharina (2022). Being bound and tied by the ropes of frugality: a case study on public management values and service integration. Journal of Health Organisation and Management. ISSN 1477-7266. 36(9), p. 95–111. doi: 10.1108/JHOM-10-2020-0401. Full text in Research Archive Show summary

  Purpose – New Public Management (NPM) has increased fragmentation in municipal health and social care organizations. In response, post-NPM reforms aim to enhance integration through service integration. Integration of municipal services is important for people with complex health and social challenges, such as concurrent substance abuse and mental health problems. This article explores the conditions for service integration in municipal health and social services by studying how public management values influence organizational and financial structures and professional practices. Design/methodology/approach – This is a case study with three Norwegian municipalities as case organizations. The study draws on observations of interprofessional and interagency meetings and in-depth interviews with professionals and managers. The empirical field is municipal services for people with concurrent substance abuse and mental health challenges. The data were analyzed both inductively and deductively. Findings – The study reveals that opportunities to assess, allocate and deliver integrated services were limited due to organizational and financial structures as the most important aim was to meet the financial goals. The authors also find that economic and frugal values in NPM doctrines impede service integration. Municipalities with integrative values in organizational and financial structures and in professional approaches have greater opportunities to succeed in integrating services. Originality/value – Applying a public management value perspective, this study finds that the values on which organizational and financial structures and professional practices are based are decisive in enabling and constraining service integration.

• Løken, Therese Dwyer (2021). Rekruttering og deltakelse i kvalitativ forskning: Tjenestemottakere og pårørende som deltakere. In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 9788202734534. p. 43–62. doi: 10.23865/noasp.140.ch3. Full text in Research Archive
• Fineide, Mona Jerndahl; Løken, Therese Dwyer & Haug, Erna (2021). Samordning av lokalbaserte tjenester: Når svake formelle samordningsstrukturer kompenseres av uformelle samordningsgrep. In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 9788202734534. p. 175–194. doi: 10.23865/noasp.140.ch9. Full text in Research Archive
• Løken, Therese Dwyer & Helgesen, Ann Karin (2019). Jeg får tilbake livet mitt. Pårørendes erfaringer med ambulerende dagaktivitetstilbud til hjemmeboende personer med demens. Geriatrisk sykepleie. ISSN 1891-1889. p. 13–20. Full text in Research Archive
• Løken, Therese Dwyer & Kirchhoff, Jörg W (2018). Samarbeidets vilkår etter Samhandlingsreformen - en enkeltcase-studie. Nordisk tidsskrift for helseforskning. ISSN 1504-3614. 14(2). doi: 10.7557/14.4570. Full text in Research Archive

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• Gjellebæk, Camilla; Løken, Therese Dwyer & Ihlebæk, Hanna Marie (2025). Time, Money and Good Quality Care. doi: https:/www.utupub.fi/bitstream/handle/10024/194329/WORK2025%20Work%20in%20the%20Era%20of%20Unruly%20AI%20-%20Abstract%20book.pdf?sequence=1&isAllowed=y. Full text in Research Archive
• Platou, Jeanette & Løken, Therese Dwyer (2025). EKKO, Ditt bosted avgjør hjelpen du får. [Radio]. NRK. Full text in Research Archive
• Sletten, Marina Snipsøyr; Bjørkquist, Catharina; Helgesen, Marit Kristine; Løken, Therese Dwyer; Kvakic, Minela & Østensen, Amalie Fernanda (2025). Digitale systemer og tjenesteutvikling i barnevernet -Fra politikk til praksis. Full text in Research Archive
• Løken, Therese Dwyer & Ihlebæk, Hanna Marie (2024). Tverrfaglig samarbeid som kollektiv kunnskap og ekspertise. Full text in Research Archive
• Løken, Therese Dwyer & Bergsagel, Ingvald (2024). Integrering av kommunale helse- og velferdstjenester. Tidsskriftet sykepleien. ISSN 0806-7511. Full text in Research Archive
• Fredheim, Nina Skajaa & Løken, Therese Dwyer (2024). Hva skal til for å sette personer med både psykiske lidelser og rusavhengighet i stand til å leve et bra liv? [Internet]. Forskning.no. Full text in Research Archive
• Arnesen, Mats & Løken, Therese Dwyer (2024). Therese ble overrasket etter disputasen: Plutselig var skattefradraget fjernet. [Journal]. Khrono. Full text in Research Archive
• Korneliussen, Stein Ove & Løken, Therese Dwyer (2024). Trenger flere helsefaglærlinger. [TV]. NRK Østlandet. Full text in Research Archive
• Løken, Therese Dwyer (2024). Hvorfor var det ingen som ropte varsku? Full text in Research Archive
• Bjørkquist, Catharina; Fineide, Mona Jerndahl & Løken, Therese Dwyer (2023). Mange – og varierende veier til kommunale helse- og velferdstjenester. Full text in Research Archive
• Løken, Therese Dwyer (2022). Interdependent collaboration in municipal health and social care organizations. Full text in Research Archive
• Løken, Therese Dwyer & Bjørkquist, Catharina (2022). ROPIT presentasjon Bydel Gamle Oslo. Full text in Research Archive
• Løken, Therese Dwyer (2021). «Offentlige styringsverdier og vilkår for integrerte og personorienterte tjenester». Full text in Research Archive
• Løken, Therese Dwyer (2021). Organizing financial resources in the municipality: a case study on integrated services provision to persons with dual diagnosis. International Journal of Integrated Care (IJIC). 21(S1). doi: 10.5334/ijic.ICIC20289. Full text in Research Archive
• Løken, Therese Dwyer (2021). Alvorlig psykisk syke mennesker blir kasteballer med døden til følge. Full text in Research Archive
• Løken, Therese Dwyer; Johannessen, Aud & Bjørkquist, Catharina (2020). Organizing financial resources in the municipality: a case study on integrated services to persons with concurrent substance abuse and mental health challenges. Full text in Research Archive Show summary

  Introduction: There is a risk of fragmentation of services for persons with concurrent drug addiction and mental health challenges (dual diagnosis). The services are primarily given in separate systems with separate funding streams and budgets. This can lead to structural barriers, and we presume that this division of work and the structure and flow of funds can affect various aspects of integrated services. In this study, we view integration as a coherent set of methods and models on the funding, administrative and organisational levels designed to create connectivity, alignment and collaboration within and between the government agencies and departments in Norwegian municipalities. The aim is to investigate how the organising of financial resources in Norwegian municipalities affect integrated service provision to persons with dual diagnosis. Method: This is a case study, using three municipalities as units of analysis. The case is how the organising of municipalities` financial resources affect integrated municipal services to persons with dual diagnosis. We conducted in-depth interviews with employees and managers. In addition, we made observations of meetings where services to persons with dual diagnosis were discussed, assessed and allocated. The data was analysed with a Stepwise- Deductive Inductive approach. Results: Preliminary findings point at the tendency to shift responsibility for the financing of individuals` services between the different government agencies and departments in the organisation. This applies for both municipal services, as well as admissions in private institution units. The government agencies and departments have separate budgets, and none of them has admissions in private institution units as a budget item in their main budget. When the severity and complexity in the service recipients` situation requires such an admission, the participants describe this responsibility shift as a way to avoid these kinds of high-price solutions. In practice, this leads to discussions regarding which of the service recipients challenges that are most dominant, in order to place responsibility at the most suitable municipal service. There existed no unwillingness to collaborate once the responsibility was clarified. These processes throws persons with dual diagnosis back and forth in the system, and can lead to complex needs not being met. Discussion: The results point at the framework conditions in the organisation, the silo-budgets and keeping the costs as low as possible. The responsibility shift becomes a structural barrier where the patients` issues are explained as more or less dominant in order to force other departments to “pay the bill”, instead of joining up to address the persons complex needs together in an integrated manner. Conclusions: There is a need to evaluate the organizing of Norwegian municipalities’ financial resources in order to find solutions that integrates mental health-, social- and somatic services. This is a case study, which can lead to challenges when it comes to generalising the findings. There is a need for further research on how funding solutions can promote integrated care to persons with dual diagnosis.

• Hansen, Gunnar Vold & Løken, Therese Dwyer (2019). Electronic messaging system and the challenges for professional judgement. Full text in Research Archive
• Løken, Therese Dwyer; Johannessen, Aud; Helgesen, Marit Kristine & Bjørkquist, Catharina (2019). “Money talks”: a qualitative study on how organising of financial resources affect integrated services to persons with dual diagnosis. Full text in Research Archive
• Hansen, Gunnar Vold & Løken, Therese Dwyer (2019). Electronic messaging system and the challenges for professional judgement. International Journal of Integrated Care (IJIC). 19(4), p. 273–274. doi: 10.5334/ijic.s3273. Full text in Research Archive
• Løken, Therese Dwyer & Samuelsen, Finn (2018). Samarbeid om rehabilitering. Full text in Research Archive
• Løken, Therese Dwyer & Tjøstolvsen, Inger Marie (2018). Tverrfaglig samarbeid om rehabilitering. Full text in Research Archive
• Løken, Therese Dwyer & Gregersen, Anne-Grethe (2018). Tverrfaglig samarbeid om rehabilitering. Full text in Research Archive
• Løken, Therese Dwyer & Helgesen, Ann Karin (2018). «Jeg får tilbake livet mitt» Pårørendes erfaringer med ambulerende dagaktivitetstilbud til hjemmeboende personer med demens. Full text in Research Archive
• Løken, Therese Dwyer & Aagaard, Heidi (2017). Ernæring ved sykdom. Full text in Research Archive
• Løken, Therese Dwyer (2024). The dynamics between policy and practice: A case study on the integration of municipal health and social care services for people with mental health and substance abuse challenges. Universitetet i Sørøst-Norge/Universitetet i Søraust-Noreg. ISSN 9788272068218. Full text in Research Archive Show summary

  This doctoral project examines the integration of municipal health and social care services for people with concurrent mental health and substance abuse challenges. The main aim is to explore how professionals and managers adapt to and operationalize policies regarding the integration of municipal health and social care services. This aim is explored through four specific research questions, which are addressed across three research articles. The Norwegian health and social care sector faces sustainability and quality challenges while providing services to people with concurrent mental health and substance abuse challenges. These issues stem from the increasing number of people who seek help from the public services, and from the fragmentation of the service system. In fragmented systems, service recipients can experience difficulties in accessing care, maintaining continuity of services, and having their needs adequately met. Consequently, researchers and decision-makers promote the integration of health and social care services as a means to improve access, quality, and continuity of services, while mitigating the negative consequences of fragmentation. The doctoral project is designed as a qualitative single-case study with participants recruited from three Norwegian municipalities. Data is gathered through various sources including: observation of meetings; individual in-depth interviews with professionals and managers; focus group interviews with professionals, managers, service recipients, and family caregivers; and individual telephone interviews with service recipients and family caregivers. The result of this is a comprehensive data set which enables the analysis of how factors at system, organization, and practice level influence the integration of municipal health and social care services. The findings from these analyses are presented across the three embedded research articles. The first article explores how the values within public management principles influence organizational and financial structures as well as professional practices in municipal health and social care services. As such, this article connects central public management values at the system, organizational, and practice levels. The second article consists of a competence framework required for the implementation of service integration, along with a discussion on the need for a collective approach to develop service integration competence. This article contributes to analyzing the impact of factors at the organizational and practice levels. The third article explores formal and informal integration. The article highlights how professionals’ relational work related to networks and networking skills are important for achieving service integration. Thus, the third article illustrates the impact of factors affecting integration at the practice level. Findings from the articles are integrated in this dissertation to explore how public management values influence the ways in which professionals and managers adapt to and operationalize policies regarding service integration. The economic and frugal values within government documents, stimulate municipal managers to structure health and social care services in a way that makes financial management, accountability, and reporting feasible. It also stimulates municipal managers to promote frugal approaches in decision making rather than integrated approaches. The policies directing service integration do not entail strong incentives, but appeal more to the autonomy granted to Norwegian municipalities. Municipalities who choose to structure and approach services based on the integrative values of adaptivity, flexibility, robustness, and resilience, succeed to integrate services to a great extent. The dissertation also discusses the trust-control nexus between the Norwegian government and the municipalities. On the one hand, the controlling elements within performance management policies, creates sanctions and anxiety for the municipalities. On the other hand, Norwegian municipalities are granted autonomy to adapt to and operationalize service integration policies according to their contextual needs. This may be understood as a high level of governmental trust in municipalities’ abilities and willingness to accommodate the aim of service integration. Lastly, this dissertation points out that the trust-control nexus between the Norwegian government and the municipalities should be better balanced. This requires new tools for controlling and safeguarding qualitative policy objectives such as the integration of municipal health and social care services. In this regard, this dissertation proposes that in the development of municipal health and social care, national authorities can consider controlling qualitative policy objectives by enabling professionals and managers to provide resilient services. Investing in the capacity of practice level managers and professionals to respond to evolving changes and challenges, can prepare for the national authorities’ trust in Norwegian municipalities to provide safe and high-quality services for the wellbeing of citizens.

• Samuelsen, Finn; Hansen, Gunnar Vold; Gregersen, Anne-Grethe; Løken, Therese Dwyer; Tjøstolvsen, Inger Marie & Aarøen, Kari [Show all 7 contributors for this article] (2018). Samarbeid om rehabilitering 2. Høgskolen i Østfold. Full text in Research Archive
• Hansen, Gunnar Vold; Aarøen, Kari; Gregersen, Anne-Grethe; Hansen, Mette Tindvik; Løken, Therese Dwyer & Samuelsen, Finn [Show all 7 contributors for this article] (2017). Samarbeid om rehabilitering. Høgskolen i Østfold. ISSN 9788278254486. Full text in Research Archive Show summary

  Regjeringen legger opp til at det skal bli tydeligere arbeidsdeling og samarbeid mellom sykehus og kommuner om rehabilitering. Denne rapporten bygger på et prosjekt der ett sykehus, tre kommuner og høgskolen samarbeidet for å avklare hvilke utfordringer man hadde med hensyn til samarbeid om rehabiliteringspasienter. Undersøkelsen er gjennomført før det er helt avklart hvordan samarbeidet mellom sykehus og kommuner skal organiseres og gjennomføres. De aktuelle kommunene er likevel kommet langt og har opprettet egne lokale rehabiliteringsavdelinger. Undersøkelsen viser at det er utfordringer knyttet til brukermedvirkning og inkludering av pårørende. Det er tegn i våre data som tyder på at formell kommunikasjon og misforståelser som følge av at den ikke er tilstrekkelig god, bidrar til en viss grad av mistro mellom sykehusansatte og ansatte i kommunen. Det anbefales derfor at man tilrettelegger for bedre kommunikasjon. Kommunene har i noen grad etablert en praksis der representanter for kommunens tildelingskontor møter pasientene allerede mens de er på sykehuset. Erfaringene med denne løsningen er gode og ordningen anbefales videreført og utvidet.

• Løken, Therese Dwyer (2014). Tverrprofesjonelt samarbeid: en kvalitativ studie av samarbeidet mellom fastleger og sykepleiere i hjemmesykepleien. Therese Dwyer Løken. Full text in Research Archive

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