How To Evaluate Quality In Treatment Organizations For Young

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SVUF-konferens 7-9 oktober 2015, Hilton Stockholm Slussen/Utvärderingars värde värden i utvärderingar Konferenspaper How to Evaluate Quality in Treatment Organizations for Young People – and what Factors Matters for a Positive Treatment Process Hur utvärderas kvalitet inom behandlande institutioner – och vilka faktorer spelar egentligen roll för att en ung vuxen ska påverkas positivt under en institutionsvistelse? Jürgen Degner Örebro University/The School of Law, Psychology, Social Work 2015 SAMMANFATTNING Barn och ungdomar utvecklas i de allra flesta fall i ett sammanhang bestående av positiva familje- och vänrelationer, samt genom utvecklande prosociala aktiviteter (arbete, skola och fritid) – medan ungdomar som är placerade på institution ofta haft en uppväxtmiljö präglad av kriminalitet, missbruk och/eller andra psykosociala svårigheter. Den behandlande institutionens uppdrag är därför att fokusera på de olika livs-områden (en s.k. multimodal ansats) som bidragit till ungdomens nuvarande problembelastning. Detta innebär egentligen att en placering på en ungdomsinstitution handlar om att befinna sig i ett miniatyrsamhälle, där det är summan av prosociala interaktioner, specifik metod/programverksamhet och andra aktiviteter, dygnet-runt (24/7) som avser att förändra ungdomen i positiv riktning. Detta innebär samtidigt att det är stora problem att utvärdera vilka specifika, och ”evidensbaserade” metoder (t.ex. kognitiv beteendeterapi [KBT], motiverande samtal [MI], aggression replacement traning [ART]) som egentligen har effekt på individens utveckling. Trots detta så implementeras specifika behandlingsmetoder just med argumentationen att de är evidenstestade i ett antal studier och metaanalyser – med bl.a. institutions- och/eller fängelsepopulationer (dock inte ART inom kriminalvården). Syftet med studien är, med utgångspunkt i ett 24/7-baserat pilotprojekt inom Statens institutionsstyrelse (SiS), att kartlägga vilka a) organisatoriska förutsättningar som finns för att en ungdom ska kunna utvecklas positivt inom institutionsmiljön, b) vilka hinder och möjligheter som utkristalliseras inom ramen för den verksamhet som bedrivs, och c) att utreda och diskutera vad som behöver beaktas för att designa en utvärdering av en individ placerad i en komplex institutionsmiljö. Metoden har en multistrategisk ansats och data har insamlats genom CPAI-intervjuer (n=8) med institutionsledning tre pilotinstitutioner (särskilda ungdomshem) inom SiS regi. The Correctional Program Assessment Inventory 2000 (CPAI) är ett instrument för att kartlägga organisatoriska förutsättningar, behandlingsinnehåll, ledarskaps- och personalkarakteristik, samt proportionen mellan icke-schemalagda och schemalagd/-bundna aktiviteter. Vidare genomfördes, under ett år, 12 projektmöten på vardera institutionen med mellan 10-15 nyckelpersonal (institutionsledning, hälso- och skolpersonal samt avdelningspersonal), samt avslutningsvis användes en enkät för att erhålla delvis samma, och kompletterande, information från samtliga personal på institutionerna (ledning och personal) (n=103). Resultatet visar att av veckans totalt 168 timmar (8/8/8x7) spenderas en mindre andel tid i schemalagda/-bundna aktiviteter (inklusive specifik metod) i relation till övrig icke-schemalagda/-bundna aktiviteter – och där både schemalagda/-bundna och icke-schemalagda/-bundna aktiviteter har en diffus, och rörande ickeschemalagda/-bundna aktiviteter mycket svag koppling, till en tydlig pedagogisk, teoretisk eller metodisk utgångspunkt. Detta resultat får stora komplikationer för vilket värde vi kan tillskriva de evidensanspråk som uttalas för specifika metoder – och vilka tillämpas inom ramen för en institutionell kontext. En holistisk och komplimenterande syn på hur institutionsbehandling (samma grundvillkor finns inom kriminalvården) ska kunna utvärderas kommer att diskuteras på seminariet. Nyckelord: Utvärdering, ungdomar, institutionsvård och prosociala interaktioner och aktiviteter. INTRODUCTION Most young people have positive relations to family and friends – and participate in pro-social activities (e.g. school, work and leisure time). In contrast, delinquent youths, placed in residential treatment care, often have dysfunctional relations and negative life experiences in these key areas. When treatment for adolescents are performed in an institution, it is important to realize that the total amount time, around the clock, will have an impact on the young adult, positive or negative, depending on how the placement is organized and which type of treatment methods being offered. Another key objective of the placement is for the youth to understand the importance of breaking a destructive psychosocial development, as well as stimulating education, and to actively create visions, or goals, for a future profession. In sum, this is a very difficult task and requires not only theoretical and pedagogical skills by staff, but also a consistency in the staff group, active cooperation between different professionals SVUF-konferens 7-9 oktober 2015, Hilton Stockholm Slussen/Utvärderingars värde värden i utvärderingar Konferenspaper within (e.g., management, ward staff, school/teachers at the facility, psychologists, health professionals) and between institutions and the local community (e.g., social service agency, employment office, outside facility leisure activities, practical placement programs) to be successful (Ahonen, 2012; Andreassen, 2003; Gendreau & Andrews, 1994). The aim with this paper is to explore the a) organizational prerequisites for a youth to develop positively in an institutional environment, b) the obstacles and opportunities that exist in this settings, and c) discussing what needs to be considered for designing an evaluation of an individual placed in a complex institutional context. The 24/7-project The project includes three Swedish state run pilot-institutions (five treatment wards). The Correctional Program Assessment Inventory 2000 (CPAI) was used to perform 8 interviews with head of institution (n=3) and ward manager (n=5). CPAI 2000 is an instrument aiming to evaluate the quality of treatment programs for criminal offenders and delinquent youth in institutional care. CPAI contains 131 questions covering program demographics, organizational culture, program implementation/maintenance, management/staff characteristics, client risk/needs practice, program characteristics, core correctional practice, interagency communication and evaluation. In addition, we performed more than 12 project-meetings at all three pilot-institutions, and administered a questionnaire to all staff (n=103) in the participating wards. The questionnaire is composed of 7 main areas all of which are related to fundamental treatment components, such as: …theoretical foundation, 5 items (e.g. My work demands intimate knowledge about theoretical foundations, to perform treatment; treatment method/methods used, 5 items (e.g. I have intimate knowledge of the treatment methods, to perform treatment); therapeutic perspective, 19 items (e.g. In my work I consider a total absence of drugs to be a prerequisite for a positive treatment outcome); daily structure, 24 items (e.g. There are clear instructions about how I should perform my duties); information flow, 4 items (e.g. I receive enough information about what is happening at my workplace); treatment climate, 3 items e.g. (What is your opinion of the solidarity among colleagues?); and specific fundamental treatment components, 9 items (e.g. I work actively to involve the young people’s families in treatment). (Ahonen, 2012, p. 54) Until the end of 2014, there has been 12 regular project-meetings conducted at each of the three pilot institutions. Each meeting began with a partly pre-planned structure, which were both based on the project's objectives and issues, research in the area, as well as guidelines for project-implementation (see e.g. The National Board, 2012). The final content for the respective meetings have been continuously modified on the basis of the discussions that occurred during the previous meeting at each institution. Below are examples of issues discussed. Invent all staff-operated and non-staff-operated activities – including school, method, work, and leisure time – available in each ward. b) Which of these different activities have a clear pedagogical, theoretical and knowledge based (research) platform – but delivered without a “verified” treatment-manual. c) Which of these different activities have a clear pedagogical, theoretical and knowledge based (research) platform – but delivered with a “verified” treatment-manual. a) SVUF-konferens 7-9 oktober 2015, Hilton Stockholm Slussen/Utvärderingars värde värden i utvärderingar Konferenspaper EVALUATING INSTITUTIONAL TREATMENT PROGRAMS CHALLENGES INDIVIDUAL AND INSTITUTIONAL The pathway to psychosocial maturity A young person is normally expected to receive a variety of skills, in a relatively few number of years, before she or he will become a productive adult in a larger societal context. This continues throughout life, but the individual maturity and the skills required for the upcoming role as an adult is mainly concentrated from the late teens to early adult age. During late adolescence young people are expected to generally adopt more mature roles and take on more demanding responsibilities (see e.g. Bronfenbrenner, 1979; Larson, 2006). A central part of this is the teenage years, when experiences, norms and values accumulated and are internalized into their own action plans. To enable this transformation from adolescent to adulthood requires a lot of coordination of resources and skills. Steinberg, Chung & Little (2004) and Greenberger (1984) define the personal goal for this transition process, with the concept of psychosocial maturity. This means that a continuous and gradual developmentchain takes place in three key psychosocial domains: mastery/self-control and competence, interpersonal relationship and social functioning skills, and (self-definition and selfgovernance. To achieve a profound psychosocial maturation and function as independent and productive adults in today's industrialized society, young adults need, according to Steinberg, Chung, and Little (2004), walk through a series of developmental and tasks within each of these three domains. In terms of mastery/self-control and competence, adolescents are expected, at the end of transformation period, to have developed the necessary knowledge (school) and skills (expertise) needed to understand the purpose of being a part of the social production and community welfare organizations. Thereby, developing oneself through leisure activities and appreciate higher values, such as different forms of culture. In line with this, the young adult is expected to have achieved a sufficient level of education and vocational training to be employable in the labour force. When it comes to interpersonal relationships and social functioning, young adults are expected to have conquered the social skills necessary to interact with others, and to be able to establish and maintain close relationships (cf. Bowlby, 1988 and the internal working model). They are expected to be able to work in groups and take responsibility for the common resources available in the community. Further, taken their own self-awareness into account, they need to have developed a positive sense of their own personal worth as individuals and acquire the competence to act in a responsible and moral way. However, that it is initially done as a result of external control/monitoring of any "adult", but will later on, as the young grow older, be progressed by youth’s own internal motivation. They are also expected to be independent/autonomous in relation to others, and have a good understanding of how to achieve meaningful personal goals – and also have an internal motivation for positive personal growth (see Larson, 2000; Larson, 2006). Even though it is not expected that these "abilities" are fully developed in the late teens, they need to have made significant progress in each of these three mentioned domains before she or he is ready for transition to the role of a responsible adult. This is of course complicated facts, but it is obvious aspects that we expect from – and how life in general looks for – an ordinary young human being. In sum, it is central that most activities offered at the institution must SVUF-konferens 7-9 oktober 2015, Hilton Stockholm Slussen/Utvärderingars värde värden i utvärderingar Konferenspaper have a goal, as well as a therapeutic and pedagogical intent (and being progression-based) – and be linked to relevant research on what correlates with an individual to achieve psychosocial maturity and develop into responsible young adults. Prerequisites for institutional treatment When young people with severe psychosocial problems are placed in institutional treatment centers, it is crucial that the treatment program is based on an ethical, evidence- and knowledge-based platform. This basically means that the organization, leadership styles and staff should be govern by theories and methods that are proven effective for the each client group (young people or adults), and that components of the treatment program (e.g. education, job training, and other pro-social activities), everyday, are designed to foster a positive and long lasting psychosocial development. This requires skills from both management and staff. Within the "What Works" research tradition model (i.e., what works for different type of clients), we can trace a number of basic principles who are fundamentals in order to define a human change organization as evidence- and knowledge-driven. These principles are suggested both nationally and internationally by treatment researchers (Ahonen, 2012; Andrews, Bonta & Wormith, 2010; Latessa, Cullen & Gendreau, 2002; Gendreau, Smith & French, 2006). These principles, and starting points, also follows quality indicators found in both organization theory in general (e.g. Christensen, Lægreid, Roness, Røvik, 2005), as well as in social work and institutional care, more specific (Carmichael, 2005; Hicks, Gibbs, Weatherly & Byford, 2009). Below, these principles will be briefly presented (see Latessa, Cullen & Gendreau, 2002; Gendreau, Smith & French, 2006 for further descriptions): 1) The first principle addresses the programs demographics and organizational culture/structure. Where emphasis will be on ensuring that the organization has well-defined objectives, and strategies to achieve those objectives. There must be flexibility and an openness to the application of new ideas in the work, together with a reflexive ethical approach. The organization will work to provide a good atmosphere and low staff turnover, through good communications – both between staff group in general, and between management and staff. 2) The second point is the program implementation, which means that the staff skills match the treatment program provided. This particular is to ensure that program components is implemented in the way it is supposed (program fidelity). This principles also suggest a continuously making analysis to determine if, for example, current research have made new conclusions about the effectiveness of the specific care provided. 3) The third point is about management strategies, which emphasizes the importance of that leaders and staff have adequate training, experience and a professional approach. Central is also a progressive leadership to enthuse staff to develop their job skills and work competence. 4) The fourth principle means that staff need to identify and offer treatment components that will target the clients’ specific risk and protective factors (i.e. criminogenic need such as to change a destructive lifestyles, "pro-criminal' attitudes, negative patterns of social interaction with other people, strategies to prevent violence, the perception of anti-social role models etc.), and to the level of treatment intensity (i.e. if there is high risk of relapse). And SVUF-konferens 7-9 oktober 2015, Hilton Stockholm Slussen/Utvärderingars värde värden i utvärderingar Konferenspaper reverse, if there is a low risk of relapse, the treatment offered should have low intensity (preferably in open care). This also is defined as the risk-need-responsivity model (R-N-R) (Andrews, Bonta & Wormith, 2010). These three concepts forms the backbone of what is today termed as a prerequisite for successful treatment for clients with different types of psychological and psychiatric conditions, as well as clients with comorbidity overlaps (numerous symptoms including drug problems and criminality). 5) This principle is about that the specific methods and program offered in the institution must contain components (preferably cognitive and social learning theory), showing evidence in order to contribute to a positive treatment outcome (see for example Latessa, Cullen & Gendreau, 2002). It means to specifically target the young peoples’ both dynamic risk and protective factors. 6) The sixth principle is about how staff, in everyday situations, actually train the residents in various problem solving techniques, stimulates their learning abilities and vocational skills training, positive reinforcement for positive behavior, train the clients on alternative responses to problematic situations, and increase the youngsters’ prosocial behaviors in increasingly more difficult situations. 7) The seventh principle is about the importance of cooperation between the institution and various agencies, such as social welfare office, psychiatric institutions, employment office, other outpatient care, education agencies, and voluntary organizations. 8) The final principle involves a systematic evaluation of the treatment program at an organizational level (which includes the quality, and performance, of all the principles), as well as a systematic monitoring of the treatment progress for each client – throughout the treatment process. In sum, to understand the facility milieu, in which the staff operates, we need to have advanced knowledge, from theory and research, in a number of key areas based on the principles above: This means that staff not only must have a professional and allianceforming approach (see e.g. SiS, 2012; Ahonen, 2012), but the theoretical platform, for a 24/7treatment program, as indicated by the eight principles, must be multifaceted; with core concepts emanating from both organizational and leadership theory (see e.g. Gendreau, Smith & French, 2006). Further, it is essential to understand human development, based on developmental ecology/-psychology, theory of motivation and moral development, just to name a few (Ahonen, 2012; Steinberg, et al., 2004; Larsen, 2006; Bronfenbrenner, 1979). To conclude, the ability to work knowledge/evidence-based treatment for both young people, and adults, in treatment institutions (although the same factors, of course, can be transferred to adult prisons and psychiatry outpatient organizations or similar measures) must be understood in light of this complexity (see figure 1 below). This is also one the reasons why there is an urgent need for discussing the concept of evidence based methods, and the possibility to evaluate these treatment programs in this multifaceted milieu. SVUF-konferens 7-9 oktober 2015, Hilton Stockholm Slussen/Utvärderingars värde värden i utvärderingar Konferenspaper Inside a treatment facility Based on the project-meetings and CPAI-interviews in the 24/7-project, data show that the young people/residents spend more time in non-scheduled/supervised activities (e.g. watching TV, playing computer games, spending time with fellow-residents, sports), than in scheduled staff-monitored and goal-oriented (e.g. school, vocational/work training programs, pro-social skill training activities) programs. Both scheduled and non-scheduled activities have a diffuse – or no connection at all – link to a pedagogical, theoretical or methodological viewpoint. (See figure 2 below): Figure 2. An approximate day schedule at the wards/institution: Further, results from project meetings, interviews, and survey show that although the staffs partly shares a common view on the theories and methods used in each department, there are significant differences. This affects not only the staff’s common strategies and control of SVUF-konferens 7-9 oktober 2015, Hilton Stockholm Slussen/Utvärderingars värde värden i utvärderingar Konferenspaper treatment content, but also the implementation of methods and approaches. When applying the theories, methods and pro-social activities, there are both differences and similarities: In two of the wards there are a social learning theoretical platform, with methods such as ART (Aggression Replacement Training), ADL (Activities of daily living), and various forms of therapeutic discussions and meetings with key staff (but rarely with an psychologist). One of the institutions also has “Stop and think” as a specific manual-based method. The third institution has a psychodynamic-/relation oriented theory and milieu therapy as method, but offers other programs such as LEVA-program (a social skills developing program) and other therapeutic meetings with key staff. All institutions offer schooling and a variety of activities such as horseback riding, bowling, hockey, soccer, training to ride public transportation, photography courses, creative writing and social skills training, etc. Through the SWOTanalysis1, similar threats, weaknesses, strengths and opportunities have been identified at the three institutions, which includes the increased collaboration between different categories of staff (i.e. management, teachers, psychologists and department staff) and between department specific areas/modules (ADL, family/network work, school, method/treatment programs, leisure activity, work/job training) will be central to the development. This implies the need to create a greater consensus and organizational interaction model so that the activities within, and between, these modules/areas have a more pronounced therapeutic purpose related to the treatment plan – not only creating opportunities for young people to be motivated to schools and education, but to serve as a base for a future profession.2 CONCLUSIONS AND PRACTICAL IMPLICATIONS Based on the previous discussion, some key development areas, linked to how to view quality of an institutional treatment setting treatment, and the complexity how to evaluate the core of the treatment content, have emerged. In this, quality aspects are linked both to collaboration between the institutions' internal (different staff categories, such as ward staff, health care staff/nurses/psychologist and school teachers) (see figure 3 below) and external resources (the employment office, psychiatry, regular schools outside the institution, social service agency etc.). And further, we need to create a holistic approach viewing both specific treatment methods (e.g. ART, CBT, Ono-to-One), and other pro-social activities such as school, ADL, Family and network, work training, and positive leisure time activities, as equal important for a positive treatment process outcome. This include to promote both ward/treatment staff, specific therapists, and teachers making continuous SMART-goals3 with the young in different life/key areas. This imply to measure the resident’s treatment progression in these life domains over time. For this project, a 24/7-goalchecklist has been developed in the areas, as shown in figure 3 below, based on previous checklists such as the Independent Living Skills – A checklist for young people in care (New south wales, Family and Community Service); the Independent living skills assessment tool, (Department of Social & Health Services, Washington State, 2000/2006). Specific goals, in the checklist, are also found in theory and 1 A SWOT-analysis is used to evaluate the strengths, weaknesses, opportunities and threats of an organization. See Degner & Ahonen (2014) and Degner & Ahonen (2015) for more specific data. For further discussions concerning institutional treatment settings, see also Ahonen (2012) and Ahonen & Degner (2014). 3 A SMART-goal model describes what a goal should contain for it to be optimal, developing and reachable. Each goal should be: (S) – specific), (M) – measurable, (A) – attainable, (R) – relevant, and (T) – time-based. 2 SVUF-konferens 7-9 oktober 2015, Hilton Stockholm Slussen/Utvärderingars värde värden i utvärderingar Konferenspaper research of the concept psychosocial maturity (e.g. Greenberger & Sørensen, 1974; Steinberg, Chung & Little, 2004; but also see Bowlby, 1988 and Bronfenbrenner, 1979), and finally, goals have been transformed from questions in the ADAD-manual4. Figure 3. One way to organize the institutional for a 24/7-strategy – and in order to stimulate both evaluation of the individual, as well as the level of internal cooperation between staff groups. In sum, most young people (and adults) who are placed in state driven intuitions have complex psychosocial problems in many different life areas/domains. This urge for developing a research based, theoretical, and pedagogical content in both staff monitored and non-staff monitored pro-social activities (e.g. education, work training, therapeutic programs, social relationship- and practical skills training/ADL, fitness and sport activities, music, cultural expressions, religion, cooking skills, and artistry), that mostly already exists in the facilities. For this it is important, which is one goal of the 24/7-project, to develop a model/guide (24/7-manual) that will, at an organizational level, guide the institutional management to organize the facility treatment program, and enable to make an evaluation design, both according to the eight principles mentioned earlier in the paper, as to each resident’s individual development in the program. To clarify, the 24/7-manual will support the implementation of a clearer theoretical and research-based framework that, taken together, will form the cornerstone for psychosocial maturity, 24 hours a day, 7 days a week, in order to increase psychosocial growth, and post-detention enhanced employability. 4 ADAD is an assessment instrument for young drug users and young people with social problems. The instrument has been developed in the US in the late 1980s by Alfred Friedman and Arlene Utada (1989), and is used by The Swedish National Board of Institutional Care. SVUF-konferens 7-9 oktober 2015, Hilton Stockholm Slussen/Utvärderingars värde värden i utvärderingar Konferenspaper REFERENCES Ahonen, Lia & Degner, Jürgen (2012). Moral development as a crucial treatment goal for young people in institutional care: A critical comparison between Milieu Therapy and Cognitive Behavioral Therapy. International Journal of Therapeutic Communities, 33, 414. Ahonen, Lia & Degner, Jürgen (2014). Working with Multi-Faceted Problem Behaviors in Juvenile Institutional Care: Staff’s Competence and Organizational Conditions. Journal of Prisoner Health, 10, 212-227. Ahonen, Lia (2012). Changing behaviors or behavioral change? A study of moral development and transbehavioral processes in juvenile institutional care. Dissertation. Örebro: Örebro University. Andreassen, T. (2003). Institutionsbehandling av ungdomar – vad säger forskningen? [Treatment of juveniles placed in institutions. What does research tell us?]. Stockholm: Gothia. Andrews, Don A., Bonta, James & Wormith, Stephen J. (2010). The Risk-Need-Responsivity (RNR) Model: Does Adding the Good Lives Model Contribute to Effective Crime Prevention? Criminal Justice and Behavior, 38, 735-755. Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York: Basic Books. Bronfenbrenner, U. (1979). The ecology of human development. Experiments by nature and design. Cambridge, Mass: Harvard University Press. Carmichael, Susan (2005). Total Quality Management and Outcomes Based Quality Improvement: Revisiting the Basics. Home Health Care Management & Practice, 17, 119124. Christensen, Tom, Lægreid, Per, Roness, Paul. G. & Røvik, Kjell, A. (2005). Organisationsteori för offentlig sektor. (1. uppl.) Malmö: Liber. Degner, Jürgen & Ahonen, Lia (2014). Utvecklingsprojekt för kunskapsbaserad dygnet-runtvård: Kartlägga och utveckla vårdinnehållet i verksamhet utöver strukturerad behandling och skola. Halvtidsrapportering. Stockholm: Statens institutionsstyrelse (SiS). Degner, Jürgen & Ahonen, Lia (2015) Datasammanställning av 24/7-projektet. Bilaga till slutrapporteringen av 24/7. Stockholm: Statens institutionsstyrelse (SiS). Gendreau, P., Smith, P. & French, S. A. (2006). The theory of effective correctional intervention: Empirical status and future directions. In F. T. Cullen, J. P. Wright, & K. R. Blevins (Eds.), Taking Stock – The status of criminological theory (pp. 419-437). New Brunswick, NJ: Transaction. Gendreau, Paul & Andrews, Don (1994). The correctional program assessment inventory, St John, NB: University of New Brunsvick. Greenberger, Ellen & Sørensen, Aage. (1974). Toward a concept of psychosocial maturity. Journal of Youth and Adolescence, 3(4), 329-358. Hicks, Leslie, Gibbs, Ian, Weatherly, Helen, och Byford Sarah (2009). Management, Leadership and Resources in Children’s Homes: What Influences Outcomes in Residential ChildCare Settings? British Journal of Social Work, 39, 828–845. SVUF-konferens 7-9 oktober 2015, Hilton Stockholm Slussen/Utvärderingars värde värden i utvärderingar Konferenspaper Jansson, Lasse & Björck, Caroline (2012). Traumatisering bland ungdomar med antisocial problematik. Resultat från en litteraturöversikt. Institutionsvård i fokus. Stockholm: Statens institutionsstyrelse. Larson, Reed (2000). Toward a psychology of positive youth development. American Psychologist, 55, 83-170. Larson, Reed (2006). Positive Youth Development, Willful Adolescents, and Mentoring. Journal of Community Psychology, 34, 677-689. Latessa, Edward J., Cullen, Francis T. & Gendreau, Paul, (2002). Beyond Correctional Quackery: professionalism and the possibility of effective treatment. Federal probation, 66, 43-49. Shannon, David, (2011). Follow-up of youths admitted to SiS youth care facilities 1997-2001. Institutionsvård i fokus nr 4. Stockholm: Statens institutionsstyrelse. SiS (2012). Statens institutionsstyrelse Årsredovisning 2012. Stockholm: Statens institutionsstyrelse. SiS (2012). Statens institutionsstyrelse Årsredovisning 2012. Stockholm: Statens institutionsstyrelse. Steinberg, Laurence, Chung, He Len & Little, Michelle (2004). Reentry of Young Offenders from the Justice System A Developmental Perspective. Youth Violence and Juvenile Justice, 2, 21-38. Jürgen Degner, Ph.D., and assistant professor in Social Work, Örebro University, Sweden. //Scientific head of project//. Lia Ahonen, Ph.D. in Social Work and assistant professor in Criminology, Örebro University Sweden, University of Pittsburgh, USA. //International coordinator and assistant researcher//. The Swedish National Board of Institutional Care The National Board of Institutional Care (Statens institutionsstyrelse, or SiS) is a Swedish government agency that delivers individually tailored compulsory care for young people with psychosocial problems and for adults with problems of substance misuse (at 25 institutions//Author comment). SiS provides care and treatment where voluntary interventions have proved insufficient and care on a compulsory basis has therefore become necessary. Orders for compulsory care are made by the Administrative Court (Förvaltningsrätten), on the application of social services. SiS runs special residential homes for young people (särskilda ungdomshem), which receive young people with psychosocial problems and problems of substance misuse and criminal behaviour. Care is provided under the terms of the Care of Young Persons (Special Provisions) Act (LVU). Some of these residential homes also care for young people who have committed serious criminal offences and who have been sentenced to secure youth care under the Secure Youth Care Act (LSU). SiS also operates 'LVM' homes (10 institutions//Author comment), which treat adults with serious problems of misuse involving alcohol, controlled drugs, prescription drugs or a combination of these. Here, care is provided under the Care of Substance Abusers (Special Provisions) Act (LVM). The LVM homes and special residential homes for young people run by SiS are the only treatment facilities for adults with substance misuse issues and for young people with psychosocial problems that have the right to forcibly detain individuals who have been taken into compulsory care. (From web-page: institutional-care/) http://www.stat-inst.se/om-webbplatsen/other-languages/the-swedish-national-board-of-