AIM-This article explores the implementation and use of the Addiction Severity Index in addiction treatment practice, both as a clinical instrument and as a way of facilitating outcome measurement. This is regarded as incorporating "laboratory logic" into clinical practice characterised by "the logic of care". DATA-The data is based on ethnographic fieldwork in a Swedish metropolitan social service agency known for its systematic ASI work. RESULTS-The findings suggest that much effort must be dedicated to coordinate activities in the agency in line with the laboratory logic, making sure that the interviews are administered systematically. In use, the ASI and the variables in clinical practice are adjusted to each other, making it possible to follow both logics at the same time. In some cases, however, there is a conflict: the ASI becomes an extra task that does not further the clinical work. Once collected, the ASI data must be coordinated in line with other information. This has not yet been realised in the agency, which makes the value of the ASI data unknown. CONCLUSIONS-It requires hard work to handle the two logics simultaneously in addiction treatment practice: activities must be coordinated , and instruments and variables in clinical practice must be continuously "tinkered" with. Further, outcome measurement is not only about systematic use of standardised instruments, but much work must be done after the ASI data has been collected. KEY WORDS-Addiction severity index (ASI), standardised assessment instruments, outcome measurement, clinical practice, ethnography, Sweden

Under de senaste två decennierna har det ställts allt högre krav på standardiserad dokumentation och uppföljning inom socialtjänstens fält, både nationellt och internationellt (Socialstyrelsen, 2004; Tilbury, 2004; Lynch-Cerullo & Cooney, 2011). Utvecklingen hänger ihop med övergripande strömningar som Evidensbaserad praktik (EBP) och New Public Management (NPM) som sätter fokus på att mäta effektiviteten av offentlig verksamhet utifrån kvantitativa mått. Den grundläggande idé som förts fram är att standardiserad dokumentation inom den reguljära verksamheten ska möjliggöra kontinuerlig mätning av socialtjänstens utfall, både på individuell och aggregerad nivå, och att informationen ska användas till att förbättra insatsernas kvalitet.

In discussions and empirical investigations of the implementation of evidence-based interventions there is often a narrow focus on treatment fidelity. Studying a social services agency trying to incorporate Motivational Interviewing (MI), commonly regarded as evidence-based, this paper problematises a one-sided attention to treatment fidelity by showing how non-fidelity can be constructive from an organisational perspective. While treatment fidelity is one important aspect, it is argued that there might be other rationales to take into account when implementing evidencebased interventions in professional practices.

No abstract

This paper seeks to provide an empirically grounded discussion of the critical appraisal model of Evidence-based practice (EBP) in social work practice. Studying real-time treatment decisions, the paper looks ethnographically at an attempt to implement critical appraisal in everyday social work practice, and problematizes some of the assumptions underlying this idea. Whereas critical appraisal tends to view treatment decisions as clear-cut events emanating from autonomous social workers, participant observation shows that decisions emerge over time and are 'organizational' rather than individual. Drawing on the notion of 'logic of care' and findings from studies of organizational decision-making, a more practice oriented understanding of treatment decision-making is outlined.