Purpose– The purpose of this paper is twofold: first, to report results from a quasi-experimental study of outcomes of a leaving care project for youth placed in secure unit care and second, based on the (zero) results, to analyse and discuss the interplay between organisational boundaries, social work and the target group when implementing a project such as the one studied.

Design/methodology/approach– The outcome study had a quasi-experimental design. The young people in the leaving care programme were compared with a matched reference group who did not get the special leaving care services. Data were collected (structured Adolescent Drug Abuse Diagnosis-interviews) when the young people entered secure units and on follow-up (registered crime and re-entry into care).

Findings– The outcome study showed that the leaving care project had no effect on the young people's situation at follow-up regarding re-offending and re-entry into secure unit care. This is understood and discussed in relation to the poor implementation of the leaving care project along with an inbuilt conflict between state and local municipality that overshadowed the good intentions of the project.

Research limitations/implications– The effect study has a quasi-experimental design, and hence differences between the project group and the comparison group at T1 cannot be fully precluded, although nothing is pointing in such a direction. The unclear content of the intervention makes it difficult to decode how the variation in the support given to the young people eventually impacted the results. The zero-results apply to group level, but that may not be valid for each and every one in the project.

Practical implications– According to earlier research, a key person following young persons through different phases of the care trajectory may be of importance. Learning from the CoC project, one can conclude that such a key person should preferably take the role of advocate for the young person, and not be an administrator mainly concerned with coordinating other professionals. Further, when planning and financing is split between organisations, that split hinders efforts to actually mobilise support for young people leaving secure unit care.

Originality/value– Few leaving care services are designed for youth with severe behavioural problems and hence, the research is scarce. This study contributes with important knowledge about leaving care interventions for the target group.

The number of unaccompanied minors arriving in Sweden has grown rapidly in recent years and the care of these children has become a significant part of the Swedish child welfare system. In this article, we discuss what has happened to the residential care market (known as HVB for short) in which most of these children are placed by the municipal social services. The specific questions we seek to illuminate are: Which type of residential care actors have expanded their operations? Have new actors entered the residential care market for unaccompanied minors? How can we understand changes in the residential care market in the current situation? The study is based upon the Health and Social Care Inspectorate’s registry of all licensed residential care units in Sweden. We compare data for all residential care units that targeted unaccompanied minors in 2014 with an updated register from March 2016. The residential care units are categorized based on organizational type (municipal, large and small private companies, municipal entrepreneurs, and non-profit organizations) and the article illustrates the composition of organizational type. The results show that despite the growing need for residential care for unaccompanied minors, the composition of organizational type has not changed significantly since 2014. However, the number of beds for unaccompanied minors is higher than for traditional HVBs, and it has increased between 2014 and 2016. The study also indicates that the composition of residential care for unaccompanied minors differs from the residential care market for other groups of children and young people. 

Syftet med artikeln är att analysera organisering av och synen på mottagandet av ensamkommande barn inom socialtjänsten våren 2016 – en tidpunkt då antalet asylsökande ensamkommande barn nyligen nått en extrem omfattning under kort tid. Artikeln baseras på en totalundersökning (enkät) av socialtjänstens resurser, organisering och insatser i arbetet med ensamkommande barn och ungdomar. Resultatet visar att trots en statlig ambition om normalisering och integrering av mottagandet i den sociala barnavården, har en tydlig respons från socialtjänsten varit att specialisera verksamheten utifrån den ökande klientgruppen. Den här studien ger inget belägg för att specialiseringen lett till bättre kvalitet, tvärtom indikeras ett positivt samband mellan kvalitet och en integrerad organisation. Främst tyder studien på att resurser, övergripande samverkan och engagerade politiker har varit viktigt för hur man inom socialtjänsten uppfattar möjligheten att anpassa stödinsatser efter behov och att följa upp insatser. Noterbart med tanke på tidpunkten för studien är att  en majoritet av respondenterna (företrädesvis chefer inom socialtjänstens verksamhet för ensamkommande barn) var förhållandevis nöjda med det stöd som erbjöds till ensamkommande barn/ungdomar, dock påtalades brister i möjlighet att följa upp och tillgång till insatser som matchar målgruppens behov.

In this article we will give an account of the introduction of evidence-based practice (EBP) in Swedish social work. The Swedish development may serve as an example of what happens when the process is driven by bureaucracy with a strong public funding/back-up rather than by the academy. This is not to say that the Swedish case is unique, but rather that problems and controversies that are well established on the international arena are in Sweden framed in a very particular context. The most far reaching efforts to implement EBP in Swedish social work have been carried out by central bureaucracy. The introduction of EBP may be depicted as a top-down guideline project, with randomized controlled trials as the gold standard. Shortage of evidence paired with political pressure to implement EBP has to a certain extent also brought about dissolution of the basic concept. The article concludes with an elaborated assessment of how current conceptions of EBP relates to professional and contextual conditions of Swedish social work practice. We also address the issue of how to establish what adequate and valid evidence is by suggesting an approach that deviates from predominant evidence hierarchies and polarized extremes.

Since the start of the 1990s, a number of professional fields in the Western world have been confronted with increasingly explicit demands for scientific assurance regarding the effects of the work they do. The debate on the relationship between research and practice in social work has often been carried out under the heading of evidence-based social work or evidence-based practice (EBP). This article is based on a survey distributed to a representative sample of social workers and middle managers within the Swedish municipal social services. The results indicate a generally positive attitude among Swedish social workers towards EBP; at the same time they show a low level of active contact with the research literature of relevance for EBP. The results are contextualized and discussed against the background of some major methodological issues in EBP, such as, for example, the so called Dodo bird verdict in psychotherapy outcome research.

Socialtjänstens individ- och familjeomsorg (IFO) är en central del av den svenska välfärdsmodellen. De insatser som förmedlas där svarar mot behov som andra trygghetssystem inte förmår möta, och till stor del handlar arbetet om att erbjuda hjälp till utsatta grupper i samhället.

Författarna har studerat tre områden inom socialtjänsten i 100 svenska kommuner: barn och ungdom, försörjningsstöd och missbruk. De försöker identifiera trender och rörelser i socialt arbete. Framför allt är det resurser och organisering som stått i centrum för intresset och hur dessa faktorer påverkar insatserna.  Boken har både ett beskrivande och ett analytiskt anslag och vill fungera som utgångspunkt för diskussioner inom socialtjänsten om dess fortsatta utveckling och kopplingen till de socialpolitiska sammanhangen. Den vänder sig både till studerande vid socionomutbildningen och till yrkesverksamma inom socialtjänstens IFO.

R&D units in Swedish social services: From local integration to regional collaboration.

For a period of over thirty years, the emergence of R&D units serving locally based Swedish social services has been considered an important ingredient in the evolvement of more professional and knowledge-based social services. It has also been regarded as a vital component for increasing practice orientation in social work research, both inside and outside the universities. In this article we describe and analyse the development of these units, with respect to their pro-liferation, organizational features and how they are valued by representatives of local social servi-ces. Our data show that almost every municipality in Sweden is, in one way or another, served by an R&D unit. These units, however, display a considerable variation with respect to basic resour-ces, activity and organizational framework. Data enabled the identification of four basic catego-ries that, more or less, represent different phases in the evolvement of R&D activities. At one end, representing the early stages, there are units integrated with and exclusively serving single municipalities. At the other end there are R&D units organized within regional associa-tions, serving multiple municipalities and in general established in recent years. In between, there are two categories of R&D units formed in direct collaboration between a limited number of municipalities – one category formally connected to academia, another with less systematic con-tacts with university-based research. In general, development over time has resulted in a dilution of resources and an increasing distance between practice and R&D activities. Originally, the units were established by the initiatives of the municipalities and expected to respond to research needs emanating from practice. The regional associations have to a considerable extent been initiated and funded by earmarked state grants with the intention to implement evidence-based practice.

Syftet med studien var att undersöka hur mellanchefer i socialtjänstens individ- och familjeomsorg upplevde krav, kontroll och stöd i arbetet. Undersökningsgruppen innefattade 402 chefer på tre olika nivåer som svarat på frågor om arbetssituation och om upplevelser av den psykosociala arbetsmiljön. Med utgångspunkt i Karaseks krav-/kontrollmodell identifierades en grupp chefer med hög arbetsbelastning som sedan analyserades vidare. Resultaten visade att gruppen upplevde mindre stöd från de närmast överordnade, men det fanns inget samband mellan arbetsbelastning och andra former av stöd som kurser i ledarskap, handledning i ledarskap eller nätverksstöd. Organisatoriska faktorer som kommunstorlek, chefsnivå, antal anställda eller arbetsområde hade liten betydelse. Jämförelser mellan de med hög belastning och övriga chefer visade att de förstnämnda använde mer tid till administration, att de i mindre grad såg budgetarbete som en möjlighet att utöva makt i organisationen och att de hade en mer negativ uppfattning om sin organisation, speciellt när det gällde möjlighet att utöva inflytande. Det hade också mindre tilltro till hur organisationen styrdes.

In this paper we present a comparative analysis of out-of-home care in Australia and Sweden. We compare the age structure of the out-of-home care population and the types of out-of-home care services provided to children and young people in both countries. Our analysis reveals that in Australia the out-of-home care service system is focused mainly on children who are deemed to be abused or neglected within their families, while in Sweden the majority of the out-of-home care population are teenagers who cannot live with their families for emotional or behavioural reasons. These population differences intersect with variations in the forms of service provision in both countries, with a much greater reliance on home-based care in Australia than in Sweden, while there is more extensive use of residential care in Sweden. We envisage that this paper will demonstrate how the age structure of the out-of-home care population, though rarely considered in international comparative child welfare research, reveals much about the assumptions on which State intervention with children and young people is based. We intend that this analysis will assist social workers to better understand and address the gaps in the quality and comprehensiveness of out-of-home care service provision to children and young people in both countries.

Research indicates that a number of psychosocial interventions are effective for reducing behavioural problems in youth. These interventions are now often included on best practice lists aiming to facilitate informed treatment choices among practitioners. However, analyses in neighbouring research areas have highlighted serious shortcomings in how primary studies are analysed and how studies are synthesised in research reviews. This study took a closer look at the evidence of efficacy for psychosocial interventions that aim to reduce behavioural problems in youth, as shown in systematic research reviews by the Cochrane and the Campbell Collaborations (n = 8). The findings suggest a bias towards overemphasising the efficacy of the interventions in several reviews, an over-confidence in the validity of the findings in some reviews and, overall, a somewhat uncertain evidence base for the efficacy of the interventions. Systematic reviews are crucial for summarising research but more attention to methodological issues may be needed in this area.

We explore how four evidence-producing organisations in the US go ahead when they rate the evidence base for psychosocial interventions, using the Incredible Years programme as our case study. The findings demonstrate variation in the procedures and resulting evidence claims across the organisations, with some organisations being strict and some being permissive. The presence of such conflicting practices highlights central challenges for the evidence-based practice framework and its ambition of obtaining uniform evidence statements. We conclude that practitioners and policy makers should be aware of such variation in order to be able to make informed decisions regarding which programmes to use.

Trots att förekomsten av ADHD-diagnoser och ADHD-medicin är mycket hög inom den sociala barnavården har forskare inom socialt arbete i stor utsträckning lyst med sin frånvaro i akademiska diskussioner kring ”ADHD-epidemin”. Denna artikel syftar till att uppmuntra forskare och praktiker inom socialt arbete att bidra till forskningen och debatten om hur vi ska förstå ADHD bland barn i allmänhet och samhällsplacerade barn i synnerhet. Socialt arbete som profession kan bidra med viktig förståelse av ett fenomen som är vanligt bland barn och ungdomar som är i kontakt med socialtjänsten, som ofta förekommer tillsammans med andra tillstånd och som är sammanlänkat med social utsatthet. Vi menar att forskning kring ADHD inom den sociala barnavården bör prioriteras högt och pekar på viktiga frågor som behöver adresseras av såväl forskare som praktiker.

ADHD är den snabbast växande psykiatriska diagnosen bland unga i Sverige. Till många av de diagnostiserade förskrivs också läkemedel. I artikeln analyseras geografiska skillnader i förskrivning. De kommunala skillnaderna är mycket stora men skillnaderna kan bara i viss grad förklaras av variabler på kommunal nivå. Kommunernas tillhörighet till landsting tycks ha stor betydelse för nivån på förskrivning och systemfaktorer som olikartad organisering, mer eller mindre explicit policy och professionell hållning diskuteras som tänkbara förklaringar till skillnader som inte endast kan ha att göra med förekomst av fenomenet.

How deficient is out-of-home care? Some measurement problems in observationalstudies of children in care

For decades, out-of-home care for children has been criticized based on discouraging results fromempirical studies. Registry studies consistently show that children in out-of-home care fare worse than their counterparts from the normal population, and these studies have played an important role in highlighting the adverse situation of this group. This article thoroughly discusses the question of whether the negative outcomes among children in care can be attributed to the placement as such. Research on out-of-home care is based on observational studies and it is widely known that it is difficult to make causal inferences from such a design. This particularly holds true regarding out-of-home care where the placed children constitute a highly selected group. In the absence of randomized controlled trials, we can basically never know whether the poorer outcomes among placed children are due to the placement or to other factors that we lack data on. A central argument is that not even the most advanced statistical techniques can solve the challenge of identifying the causal effect of the placement in observational studies. However, some of the challenges may be overcome through design, where a stronger methodological approach is to include comparison groups that are more similar to the children being placed in out-of-homecare. A few methodologically stronger studies adopting such an approach give appreciably fewer indications that the placement has a negative impact on children.

In recent decades, Swedish out-of-home care has been criticised for a number of reasons. In this article, based on research and public debate, we discuss this criticism as well as the institutional responses that have been evoked. We use the concepts of risk, control and trust to structure the analysis, which outlines three core issues portrayed as problematic: a) certain principles of the Swedish child welfare system with relevance for the placement of children and adolescence, b) the quality of out-of-home care and c) the privatisation of out-of-home care and the possibility of generating profits on such services. The institutional response to the criticism has mainly been increased control measures, but the development is not uniform - trust and control-oriented responses are often combined. We conclude the article by relating Swedish out-of-home care to international child welfare trends, discussing the institutional responses and the implications for social work practice.

I artikeln presenteras en undersökning av hur barn som är placerade i dygnsvård upplever sin situation. Det visar sig att de allra fl esta är nöjda men att det finns grupper som inte trivs i sin vårdmiljö. Särskiltmissnöjda är flickor i institutionsvård. Barns upplevelser av vården diskuteras också i förhållande till andra sätt att mäta kvalitet och utfall.