Diversity in residential care and treatment for young people in Sweden

The overall aim of this thesis was to explore and describe the diversity in residential care and treatment for young people in Sweden on the individual level, the interactional level and the contextual level. This thesis consists of five papers based on two studies. Papers I and II use data from a survey of residential care for young persons in Sweden. Papers III, IV and V are based on qualitative data from interviews with staff and residents in a single treatment home. In Paper I, different residential settings were compared according to the problems of the youths in care, the mean length of stay, staff characteristics and aspects of the care and treatment provided. In Paper II the aim was to identify different approaches to treatment and investigate whether these approaches were related to characteristics in the home, the staff and type of care. In Paper III the aim was to examine whether there are personal approaches to treatment among careworkers. In Paper IV the adolescents’ experiences of living in the treatment home were explored. The intention in Paper V was to describe how careworkers and young persons have perceived their relationships with each other. According to the results reported in Paper I, different settings in residential care are related to differences in the care and treatment delivered. Institutions run by the public sector have better educated staff and a higher staff-resident ratio than privately run institutions. Despite this, they were found to be more restrictive in their intake and had youths with fewer problems, especially delinquency and other antisocial behaviours. There were indications that the longer time in care was related more to the setting per se than to the needs of the young persons. In Paper II the diversity of residential care became evident when the homes described the care they give in their own words. Despite this diversity it was possible to identify five different approaches to care and treatment that different homes agreed with to different extents. These approaches were found to be related to the variety within residential care. In Paper III six different intentions in the care delivered could be identified. The distribution of each careworker’s statements created a pattern that illustrated the careworker’s general treatment perceptions. This pattern made it possible to study and compare different careworkers’ perceptions of treatment which indicated that each careworker had a rather unique and stable personal approach to treatment. In Paper IV interviews with the six young persons conducted two or three years after they had left the institution, revealed that living in the same institution during the same time period does not mean sharing the same experiences. Paper V illustrates how interactions between the young person’s needs, his/her former experiences of relationships, the climate in the youth group and the psychological availability of the careworkers could influence the young person’s need of support as well as experiences of support. In conclusion, diversity in residential care was found on multiple levels: on the individual level, the interactional level and on contextual levels such as settings and approaches to treatment. It was also found that some of these differences, for example careworkers’ perception of treatment and institutions’ approaches to treatment, are not only possible to describe but also to “measure”. Keywords: Residential care, treatment approach, youth, staff, relationship