Public defence: Vidar Bakkeli

Drawing on interviews and fieldwork conducted in two frontline offices in the Norwegian Labour and Welfare Administration (NAV), this dissertation examines how an evidence-based intervention called Individual Placement and Support (IPS) was implemented in street-level activation services. Activation work involves complex tasks of motivating and assisting citizens with diverse problems and needs toward employment. The dissertation articles illuminate implementation from three distinct angles by focusing on frontline supervisors and their activities to implement the intervention (Article 1), activation workers and how they worked with the intervention in practice (Article 2) and clients’ service experiences and interactions with the activation workers (Article 3).

This dissertation is situated at the intersection between scholarly debates on professionalism in activation work, evidence-based standardization of social services and studies of implementation in street-level organizations. In discussions of activation work, there are concerns about too much managerialism and too little professionalism. There are challenges related to increasing organizational control through rules, procedures and measurement, as well as the lack of a solid knowledge base and expertise among activation workers. Implementation of evidence-based interventions and standards have raised polarized debates about managerialism and professionalism across social services. This thesis expands on previous research by exploring how the implementation of such interventions influences frontline activation practices. 

A main finding of the thesis was that the evidence-based intervention was implemented through a continuous, dynamic interplay between intervention demands and situated frontline actors with agency who interpreted the intervention rules and combined these with additional professional knowledge when facing challenges in everyday situations. The intervention had a hybrid character that both constrained and enabled new frontline practices. While it contained managerial elements like performance measures, the intervention also detached the activation workers from existing demands and procedures in their organizations. The intervention enabled flexible, individualized and comprehensive follow-up of clients and employers.

The present thesis makes three contributions to the broader literature on the implementation of evidence-based interventions in social services. First, in contrast with common views of implementation as linear and stepwise processes, the thesis foregrounds how implementing evidence-based interventions is contested, interpretive and interactional work. The articles show how supervisors and activation workers interpreted intervention rules in light of local concerns and needs, handling tensions between the intervention and existing practices, meanings and stakeholders in the organizations. 

Second, contrary to dominant claims in the literature emphasizing how evidence-based interventions promote managerialism and limit professional discretion, the thesis shows how such interventions can revitalize professional practices by promoting social work principles. This includes facilitating a relational orientation, an emphasis on client preferences, personalized follow-up work and service coordination.

Third, while evidence-oriented knowledge views risk marginalizing practice-based and tacit knowledge, the thesis shows how the intervention depended on skilled practitioners and supervisors to work in practice. To solve daily challenges with clients and employers, they combined the intervention with other knowledge resources in pragmatic ways. 

Taken together, the articles and the thesis as a whole nuances dichotomous views about evidence-based interventions and professional frontline practice. On the one hand, deviation from intervention demands is often viewed as implementation failure in both practice fields and academia. However, too rigid implementation frameworks risk marginalizing knowledgeable practitioners who need space for pragmatic improvisation in interactions with individual clients. The findings suggest implementation processes should allow for flexibility and adaptation. On the other hand, the thesis also nuances dominant conceptions in the social work literature of evidence-based interventions as rigid standardization, by contributing knowledge about how such standards can promote professional, relational practices. Researchers, policymakers, leaders and practitioners should all aim for a middle ground, characterized by a nuanced approach to the dynamic and complex processes that unfold when implementing evidence-based interventions in street-level practice.