Background: Adolescent health is regarded as central to global health goals. Investments made in adolescent health and health services protect the improvements witnessed in child health. Though Saudi Arabia has a large adolescent population, adolescent health-care only began to emerge in recent years, yet widespread uptake has been very limited. Health-care providers are key in addressing and providing the necessary health-care services for adolescents, and so this study was conducted with the aim of identifying opportunities for the advancement of knowledge transfer for adolescent health services in Saudi Arabia.

Methods: This Web-based, cross-sectional study was carried out at four hospitals in Saudi Arabia. Physicians and nurses were invited to participate in an online survey addressing their contact with adolescent patients, and training, knowledge, and attitudes towards adolescent health-care.

Results: A total of 232 professionals participated. The majority (82.3%) reported sometimes or always coming into contact with adolescent patients. Less than half (44%), however, had received any sort of training on adolescent health during their undergraduate or postgraduate education, and only 53.9% reported having adequate knowledge about the health-care needs of adolescents. Nurses perceived themselves as having more knowledge in the health-care needs of adolescents and reported feeling more comfortable in communicating with adolescents as compared with physicians. The majority of participants were interested in gaining further skills and knowledge in adolescent health-care and agreed or strongly agreed that adolescents have specific health-care needs that are different than children or adults (82.3% and 84.0%, respectively). With respect to health services, the majority (85.8%) believed that adolescents should be hospitalized in adolescent-specific wards. Only 26.7% of health-care providers believed that patients should be transferred from child to adult health-care services at 12-13 years of age, as is currently practiced in the country.

Conclusion: A gap exists between the training, knowledge and skills of health-care providers, and the needs to address health-care issues of adolescents in Saudi Arabia. This coupled with the fact that health-care providers are interested in gaining more knowledge and skills and are supportive of changes in the health-care system provides an opportunity for building local capacity and instituting medical and nursing education and health-care reform that can better serve the needs of the country's young population.

Ungdomar med allvarliga beteendeproblem har en ökad risk för psykisk och fysisk ohälsa, fortsatt kriminalitet och missbruk och lägre utbildningsnivå längre fram i livet. Det är därför angeläget att hitta effektiva metoder för denna svårbehandlade grupp, såväl för samhället i stort som för den enskilde individen och de familjer som berörs.

MultifunC är en strukturerad behandlingsmodell utformad för institutionsvård av ungdomar med hög risk för att återfalla i normbrytande beteende och kriminalitet. Behandlingsmodellen omfattar hela behandlingsförloppet, från en inledande utredning till avslutande eftervård, och bygger på vetenskaplig kunskap om effektiva insatser för målgruppen. MultifunC utmärks bland annat av:

• ett multimodalt förhållningssätt som riktas mot förändring av riskfaktorer både hos den unge själv och i dennes omgivning
• behandlingskomponenter som bygger på kognitiv beteendeterapi och social inlärningsteori
• ett målinriktat familjearbete som inleds redan vid placeringens början
• en förkortad institutionsvistelse som följs av en integrerad eftervård som befäster och fortsätter det psykosociala förändringsarbete som påbörjats under institutionsvistelsen

I den här rapporten presenteras resultat från en oberoende effektstudie som utvärderat MultifunC jämfört med traditionell institutionsbehandling på de särskilda ungdomshem som drivs av Statens institutionsstyrelse (SiS). Effektstudien är en egeninitierat utvärderingsprojekt som inleddes av Institutet för utveckling av metoder i socialt arbete (IMS) och ungdomar inkluderades i studien under åren 2009 – 2012. De registerdata som ligger till grund för den här rapporten med information om vad som hänt ungdomarna två år efter att de kom med i studien inhämtades 2015. En tidigare rapport med resultat från ettårsuppföljningen publicerades 2014.

Undersökningsgruppen bestod av 80 ungdomar, varav hälften fått MultifunC och hälften traditionell institutionsbehandling. Huvudfynden var att:

• Ungdomar i MultifunC-gruppen hade färre dagar återplacerade på något av SiS särskilda ungdomshem, färre dagar i annan institutionsvård (annat HVB än SiS) och färre dagar med öppenvårdsinsatser inom socialtjänsten.
• MultifunC uppnådde, trots en kortare institutionsbehandling, minst lika god effekt som traditionell SiS-behandling vad gäller fortsatta beteendeproblem som återfall i kriminalitet.
• Den uppskattade ackumulerade genomsnittskostnaden per ungdom var drygt 400 000 kronor lägre för dem som fått MultifunC jämfört med ungdomar som fått traditionell institutionsvård.

Although research has repeatedly shown that residential care for youth with a serious behavior problem has little rehabilitation success, there is a group of youth for whom residential care in a locked setting is necessary. In this article, a manualized therapeutic residential treatment model for adolescents with serious behavior problems, MultifunC, is evaluated. The program theory of MultifunC is based on a review of the literature and synthesis effective treatment components. This study included 80 youth aged 15–17 years with a medium high or high risk for reoffending. Half of the participants received MultifunC, and half treatment as usual (TAU). Although non-randomized, the two groups were found to be equivalent on important background variables. After 24 months, this first evaluation of MultifunC demonstrated that youth participating in MultifunC had a reduced need for residential care in a locked setting as well as out-of-home placement in general compared to youth in the TAU group. The economic analysis found MultifunC to be a cost-effective alternative to TAU due to the reduced need of residential care in locked settings. There were no significant effects on reoffending or psychiatric care. 

Multisystemisk terapi (MST) är en strukturerad familje- och närmiljöbaserad öppenvårdsbehandling inom socialtjänsten för ungdomar med beteendeproblem. Det här är den tredje och sista delstudien i en utvärdering som undersökt hur MST har fungerat jämfört med socialtjänstens traditionella insatser. Undersökningsgruppen består av 156 ungdomar som genom randomisering fördelades till MST eller traditionell behandling. I den här rapporten undersöks ungdomarnas situation under en femårsperiod med hjälp av information från olika register.

Resultaten visar att:

• Ungdomarna har fått ett stort antal insatser från socialtjänsten under femårsperioden, både inom öppenvård och i form av placeringar utom hemmet. Två av fem (39%) ungdomar har varit aktuella för en eller flera insatser under mer än två år sammantaget. Nästan hälften (47%) har vid något tillfälle varit placerade utom hemmet.
• Två tredjedelar (69%) av ungdomarna har dömts för ett eller flera brott under uppföljningsperioden. Vanligast var tillgreppsbrott, personbrott och narkotikabrott. Andelen ungdomar som lagfördes för brott varierade inte nämnvärt under de fem åren.
• Nästan fyra av tio ungdomar (38%) hade antingen fått vård inom psykiatrins öppen- eller slutenvård (26%) eller vård inom hälso- och sjukvården för missbruksproblematik (17%). Var femte ungdom (19%) har varit i slutenvård för missbruk och/eller psykiatri.
• Resultaten visar att MST och traditionella insatser var lika effektiva för den undersökta gruppen ungdomar.
• MST-gruppens ungdomar har i genomsnitt kostat samhället 112 000 mer än ungdomar som fått traditionella insatser. Totalt har de 156 ungdomarna lågt räknat kostat 154,7 miljoner under de fem åren.
• En av bakgrundsfaktorerna, kön, kan ha haft en differentierande effekt på behandlingen; flickor i MST-gruppen var mindre kriminellt belastade än de i den traditionella gruppen, medan det omvända förhållandet gällde för pojkarna. Detta resultat är dock mindre tillförlitligt och behöver följas upp i fortsatt forskning.

Resultatens betydelse för socialtjänstens fortsatta utvecklingsarbete diskuteras avslutningsvis. 

Multisystemisk terapi (MST) är en strukturerad öppenvårdsbehandling som vänder sig till familjer med ungdomar som har beteendeproblem. MST har utvecklats i USA som ett alternativ till placering utom hemmet. MST lägger stor vikt vid att arbeta med alla de system som en ung människa finns i (t.ex. familjen, skolan kamratkretsen). Arbetet styrs av konkreta behandlingsmål som i sin tur bestämmer valet av interventioner. Behandlingen utvärderas regelbundet genom intervjuer med föräldrarna. MST-arbetet utförs inom små team bestående av tre till fyra terapeuter och en teamledare. Varje terapeut arbetar med familjen under fyra till sex månader. Terapeuterna/teamet finns tillgängliga dygnet runt.

I den här studien jämförs MST med socialtjänstens traditionella insatser (t.ex. placering i dygnsvård, samtalsstöd, familjeterapi). Undersökningsgruppen utgörs av 156 ungdomar mellan 12 och 17 år med allvarliga beteendeproblem motsvarande kriterier i den psykiatriska diagnosen uppförandestörning (eng. conduct disorder). Ungdomarna har fördelats till MST eller traditionell behandling genom randomisering. Utvärderingen berör 27 kommunala förvaltningar och sammanlagt sex MST-team från Göteborg, Halmstad, Malmö och Stockholm. Totalt har elva olika mätinstrument använts för att beskriva ungdomarnas psykiska problem, normbrytande beteende (inkl. kriminalitet), drogbruk, sociala förmågor, förhållande till kamrater, familjerelationer, känsla av sammanhang samt föräldrarnas psykiska hälsa. Dessutom har information om insatser och dess kostnader inhämtats från socialtjänstens akter samt från Statens institutionsstyrelse (SiS). I den här rapporten beskrivs ungdomarnas situation efter två år samt en ekonomisk analys av samhällets kostnader

In Swedish child welfare, there are no mandatory guidelines on what interventions to use. Local authorities are able to set their own criteria for implementing or designing interventions. We carried out a survey to identify interventions in use in Children's Social Services and Child and Adolescent Psychiatric Care in Sweden. A total of 102 interventions were stated to have been in use, with between 31 and 45 different interventions for each of the four different child welfare populations. Of the 102 interventions, 56 were designed outside Sweden and later imported. Only 27 interventions were supported with some kind of research evidence. About half of the interventions targeted the child. Possible implications for practice and research are discussed. 

Introduction: The goal of these studies was to investigate the reliability and validity of virtual systematic social observation (virtual SSO) using Google Street View in a Swedish neighborhood context.

Methods: This was accomplished in two studies. Study 1 focused on interrater reliability and construct validity, comparing ratings conducted in-person to those done using Google Street View, across 24 study sites within four postal code areas. Study 2 focused on criterion validity of virtual SSO in terms of neighborhoods with low versus high income levels, including 133 study sites within 22 postal code areas in a large Swedish city. In both studies, assessment of the neighborhood context was conducted at each study site, using a protocol adapted to a Swedish context.

Results: Scales for Physical Decay, Neighborhood Dangerousness, and Physical Disorder were found to be reliable, with adequate interrater reliability, high consistency across methods, and high internal consistency. In Study 2, significantly higher levels of observed Physical Decay, Neighborhood Dangerousness, and signs of garbage or litter were observed in postal codes areas (site data was aggregated to postal code level) with lower as compared to higher income levels.

Discussion: We concluded that the scales within the virtual SSO with Google Street View protocol that were developed in this series of studies represents a reliable and valid measure of several key neighborhood contextual features. Implications for understanding the complex person-context interactions central to many theories of positive development among youth were discussed in relation to the study findings.

BACKGROUND: In Sweden, 72% of people with dementia live in ordinary housing. Of these, 50% receive home care services. Older people with dementia may benefit from developments in decision-making support which aim to facilitate their ability to communicate their personal needs and preferences with care managers and staff in home care services. In this study, we will test and evaluate the use of TalkingMats in Swedish municipal home care services for older people with mild to moderate dementia. TalkingMats is a low-technology communication tool, to help people with communication difficulties express their views. It uses a simple system of picture symbols which are placed on a textured mat. This study will provide insight into the extent to which TalkingMats benefits older people with dementia to feel more involved in decisions related to home care services. In addition, this study will assess the extent to which the use of TalkingMats promotes service providers' efforts to involve service recipients in decision making. The implementation of TalkingMats in home care services will also be studied.

METHODS: A parallel group, two-armed randomized controlled trial design in which TalkingMats and Usual Conversation Method will be compared. Two specific situations where older people with dementia must make decisions about home care services will be studied. First, a follow-up needs-assessment conversation between study participants and care managers will be studied. Second, a conversation between participants and home care staff regarding the delivery of the decided home care services will be studied. In addition, a qualitative approach will be used to gain an understanding of study participant and service provider experiences of the impact and implementation of TalkingMats.

DISCUSSION: The combined exploratory, descriptive, and experimental study design is considered an important strength which will facilitate multi-facetted knowledge production concerning the involvement and communication needs of older people with dementia generally and within the context of home care services specifically. Combining qualitative and quantitative methods will maximize our ability to assess the effects of TalkingMats.

TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT05561998 . Registered in September 28, 2022.

Background: Advances in knowledge of how to promote positive youth development (PYD) have significant potential to enrich intervention science. As part of a broader movement in the direction of a more fully integrated intervention science, PYD intervention research can provide practitioners in youth behavioral and mental health with an updated set of intervention tools beyond problem-focused strategies for reducing or preventing dysfunction.

Objective: The objective of this commentary is to highlight potential contributions of PYD research to the development of more complete models of youth intervention, as well as to identify directions for future PYD intervention research.

Method: This commentary discusses and expands on findings from the present articles that contribute to an empirical foundation for connecting PYD promotion with the science and practice of treatment and prevention.

Results: The findings point to practical advantages that result from understanding the empirical links among PYD, treatment, and prevention on the way to achieving a more fully integrated intervention science, as well as methodological challenges involved in pursuing this agenda.

Conclusions: In this context, the next generation of intervention science will be driven by integrating PYD’s contextual, cultural, relational, global, and participatory values into the science of building and testing youth interventions. 

The preschool edition of Promoting Alternative THinking Strategies (PATHS®) is a school-based, teacher implemented universal intervention developed in the United States designed to promote social emotional competence (SEC) in children as a foundation for improved mental health. PATHS is delivered as a curriculum and it is based on theories and research regarding SEC, brain development, and optimal school environments. A majority of children in Sweden attend preschool, which is government-subsidized and follows a national curriculum focusing on both academic and social emotional learning. However, there is not so much focus on formal instruction nor manual-based lessons. The purpose of this study was to assess the short-term (pre- to post-test) effects of PATHS in the Swedish preschool setting. Using a two-wave cluster randomized trial with multi-method and informant assessment (N = 285 4 and 5-year-old Swedish children; n = 145 wait-list control; n = 140 intervention; K = 26 preschools; k = 13 intervention; k = 13 control) we assessed changes in child emotional knowledge, emotional awareness, social problem solving, prosocial play, inhibitory control, and working memory using structural equation modeling (SEM). We included schools with at least one classroom of 4–5-year-old children from three municipalities. We excluded open preschools, parent cooperative preschools, and family day homes. After random assignment, schools were informed of condition assignment. Research team members were not blind to assignment. We hypothesized that relative to children in control schools, children in intervention schools would evidence improvements in social emotional competence as well as other outcomes. Children in PATHS, relative to children in the control, evidenced improvements in working memory and prosocial play, but also showed an increase in hyperactive behaviors. Girls in PATHS, relative to girls in the control, showed improvement in emotional knowledge and reduced anxiety. These results are considered in light of efforts to promote positive development and mental health. The trial registration number at ClinicalTrials.gov is NCT04512157.

This chapter concerns theory and research relevant to child development and early childhood education and care (ECEC), which is a key ecology for human development. In this chapter, the authors provide an overview of the organizational features and processes important to understanding these settings. The authors then focus on describing the Nordic welfare model as it relates to ECEC settings, with an exploration of how certain ethics are reflected in the design, goals, and practice of ECEC settings in Sweden. The chapter then moves to summarizing and reflecting on the empirical research literature on how Swedish ECEC settings may support aspects of children’s moral development; finally, the authors pose several questions that may prove important to advancing future research in this area.

This chapter is a commentary regarding advances in the intervention cultural adaptation research literature, particularly as it concerns positive development (PD) interventions. An overview of research on PD interventions is provided. Thereafter, the chapter focuses on the implementation of PD interventions cross-nationally, highlighting the importance of cultural adaptation in this process. The Planned Intervention Adaptation (PIA) protocol is used along with a case study, as an illustration of steps that can be taken in the cultural adaptation of interventions and to highlight issues that can be at stake when culturally adapting PD interventions. The case is an overview of the cultural adaptation of the preschool edition of PATHS^®. PATHS^® is an American (U.S.) developed, school-based teacher implemented intervention designed to support young children’s social emotional competence and to change schools’ climate in ways that foster social emotional learning. Social emotional competence is an important expression of PD. This chapter provides an overview of how specific aspects of culture and context were considered in a PATHS^® effectiveness trial. This chapter concludes with a summary of lessons learned from this case and the need to culturally recast some concepts in the process of translation, as well as a consideration of promising approaches to advance the development, impact, and spread of adaptable culturally relevant PD interventions.

Introduction: The current high prevalence rate of mental health problems (depression, anxiety, stress) among university students is alarming. It causes suffering for the individual student, threatens academic performance, and increases the risk of drop-out.

Universities have primarily responded to this situation by offering individualized psychological support. While research has found such interventions to be effective, they are highly resource demanding and not all students that suffer from mental health problems can access individual services. Moreover, many of the reasons for students' mental health problems originate from the learning environment or academic culture, far beyond the individual. Nevertheless, structural efforts aimed at promoting and building healthy, sustainable learning environments for all students are lacking in the field. Few empirical studies have examined such approaches. Understanding the current literature in this field is a crucial step in advancing policy, practice, and research related to students' mental health.

The aim of this study was to identify and describe what is currently known about structural approaches and interventions to promote mental health or prevent mental ill-health among students in higher education, and to explore areas for future research and policy development. 

Early interventions that foster the participation, engagement, and development of children attending preschools, including those in economically disadvantaged (low-income) neighborhoods, are of high priority. One such intervention is a universal socioemotional learning (SEL) program called Promoting Alternative Thinking Strategies (PATHS®) which aims to promote social emotional competence and positive adjustment in children, in general, and may have unique benefits for children attending preschool in low incomes areas. In the SEL field, areas in need of exploration include the possible role that neighborhood income level (i.e., all residents’ income in a postal code that a preschool is located in) could have for children’s social emotional competence and positive adjustment and how neighborhood income level may relate to benefits of an intervention such as PATHS. The study aims were to investigate 1) the baseline group differences in social emotional competence and adjustment depending on the neighborhood income level and 2) to determine if neighborhood income level moderated the effects of PATHS on children’s social emotional competence and adjustment from pre to posttest. Participants were 275 children aged four to five years old, from the preschools randomized into an immediate intervention (n = 145 children) or a wait-list control group (n = 130 children). Overall, 42.9% (n = 118) of the children attended preschools in economically disadvantaged neighborhoods and 57.1% (n = 157) of the children attended preschools in economically advantaged neighborhoods. Children’s social emotional competence and adjustment were assessed through child tasks, child observations and teacher reports. The moderation of intervention effects by the preschools’ neighborhood income was tested in a series of just-identified structural equation models (SEM) that explored interaction effects (income*PATHS interactions). At baseline, relative to children attending preschool in economically advantaged preschools, children attending preschool in economically disadvantaged neighborhoods showed lower levels of inhibitory control, working memory, task orientation and higher levels of inattention. Children attending preschools in economically disadvantaged neighborhoods participating in PATHS also showed reductions in inattention, social withdrawal and anxiety compared to control group children also attending preschool in disadvantaged neighborhoods. Additionally, PATHS children from advantaged neighborhoods improved their prosocial behavior, but not their social independence, relative to control group children who also attended preschool in advantaged neighborhoods. Offering PATHS as an SEL intervention in early childhood education and care settings could help to reduce disparities among children in a number of key outcomes.

Children and teens placed in out-of-home care experience a long-term disadvantage in virtually all health-related and socioeconomic outcomes compared to youth who do not have this experience. Few interventions that aim to support youth in leaving out-of-home care and help them prepare for adult life have been identified in the scientific literature. Even fewer have evidence of being effective. As a response to the lack of consistent support for young care leavers in Sweden, two attempts to develop transition services have been initiated during the past few years. Practice experience of intervention development has not been leveraged in scientific research and though many theoretical frameworks for intervention development have emerged in recent years, such frameworks are often developed by researchers, for researchers. Still, most interventions are developed by practitioners, in local, practice settings. Research indicates that locally developed interventions seem to be more successful than interventions that are adopted without adaptation. Investigating how practitioners approach conceptualization and development of interventions can provide an important insight into how interventions can better be designed to fit the needs of those for whom they are designed and increase our theoretical and empirical understanding of this process. By exploring the development process of locally developed interventions for youth leaving out-of-home care in Sweden, the aim of this project is to contribute to the intervention development literature by investigating the possibility for researchers to learn from practice about how we can develop more effective and ethical interventions for vulnerable populations. Interviews with developers of preventive interventions for youth will explore activities and priorities in the practice-based intervention development processes and how these compare and contrast across a spectrum of approaches to intervention development in the scientific literature. Preliminary results and implications for future practice and research will be discussed based on the interviews.

We aimed to explore social workers’ experiential accounts of developing complex interventions for youth and families within practice settings. Social workers’ experience of developing interventions has not been leveraged in scientific research even though many complex interventions in use are developed by social workers in practice settings. Lack of insight into the intervention development process impairs our ability to link approaches to outcomes and thereby assess whether specific approaches produce interventions that are more successful than others. We conducted semi-structured interviews with 12 developers of seven complex interventions. Through qualitative content analysis we identified 11 categories of activities participants engaged in during the development process. Participants described engaging in a range of activities found in the scientific literature. However, participant engagement in development activities were motivated on different grounds and conducted at different stages than suggested by current intervention development frameworks. Contextual and organisational factors were important in shaping the final approach to intervention development. We recommend future research on intervention development from the practitioner perspective to further explore and validate these findings. We encourage practitioners to document important details in their intervention development work to build a literature base and guide other practitioners who engage in complex intervention development.

This study examined the adjustment of a sample of adolescent girls and young women (N = 228) who were in compulsory care in Sweden between 1999 and 2000. Using person-oriented analyses, participants’ responses to the Adolescent Drug Abuse Diagnosis Instrument (Friedman & Utada, 1989; ADAD) at intake yielded five externalizing problem configurations. The main analyses focused on examining whether problem configuration at intake was important to participants’ adjustment at a four-year follow-up. Overall, results indicated that problem configuration can be important to later adjustment (less life satisfaction, more drug use, and problems controlling violent behavior), particularly if the problem configuration involves multiple problems at elevated levels and/or drug use. The implications of the study results are discussed in light of efforts to improve the tailoring of care and treatment for diverse youth who experience multiple problems. 

Aim: This cross-sectional study investigates the psychometric properties of the Swedish edition of the Adolescent Drug Abuse Diagnosis (ADAD), and specifically examines the internal consistency and construct validity of five life domains reported by female adolescents in special residential care in Sweden (N = 780; Mage = 16 years old).

Methods: Principal component analysis and entropy-based analysis were used to test construct validity.

Conclusion: Results indicate that ADAD may be able to reliably distinguish between areas that are important targets for intervention. 

This study compares two approaches to the estimation of social welfare intervention costs: one "topdown" and the other "bottom-up" for a group of social welfare clients with severe problem behavior participating in a randomized trial. Intervention costs ranging over a two-year period were compared by intervention category (foster care placement, institutional placement, mentorship services, individual support services and structured support services), estimation method (price, micro costing, average cost) and treatment group (intervention, control). Analyses are based upon 2007 costs for 156 individuals receiving 404 interventions. Overall, both approaches were found to produce reliable estimates of intervention costs at the group level but not at the individual level. As choice of approach can greatly impact the estimate of mean difference, adjustment based on estimation approach should be incorporated into sensitivity analyses. Analysts must take care in assessing the purpose and perspective of the analysis when choosing a costing approach for use within economic evaluation.

The purpose of this dissertation is to evaluate the effectiveness and cost-effectiveness of Multisystemic Therapy (MST) in Sweden. This evaluation is set against the background of evidence-based social work practice and is organized around four separate but interrelated studies. The first of these studies used program theory reconstruction to investigate three conceptualizations of evidence-based practice (EBP). Here it is argued that evidence-based practice is not a homogeneous concept, and that interested parties within research, practice and policy may not have a shared vision of EBP, even though they may use the same terminology. The second study, a randomized trial, assessed the effectiveness of MST within the normally operating social services system for 156 youths who met the diagnostic criteria for conduct disorder. Youth were randomly allocated between MST and treatment-as-usual (TAU) groups. Assessments were conducted at intake and seven months after referral. Results from mulitagent and multimethod assessment batteries showed a general decrease in psychiatric problems and antisocial behaviors among participants across treatments. There were no significant differences in treatment effects between the two groups. The third study assessed the costs of treating conduct disorder with MST and TAU. From the perspective of the municipal social welfare system, all intervention costs were collected for the six-month period starting at randomization to treatment group. MST was not found to reduce the extent to which youth were placed outside of their homes. In addition, the costs of out-of-home placement were the same for both MST and TAU group youth. MST was, however, associated with a reduction in the use and costs associated with other non-placement services. This reduction was not found to offset the additional cost of MST. The fourth and final study investigated the treatment outcomes and costs associated with MST versus TAU for intervention with substance abusing and non-substance abusing conduct disordered youth. This study found no differences in treatment outcome between these two groups. This dissertation found MST to be equally effective but less cost-effective than TAU. 

Background: As research moves from questions of efficacy (can an intervention work) to questions of effectiveness (does an intervention work in practice), questions of efficiency (what are the costs and consequences of the intervention) become increasingly important. The incorporation of economic evaluation into the planning and execution of effectiveness research brings with it several practical and methodological benefits.

Objective: The goals of this article are to provide an overview of economic evaluation and its current use in the field of social welfare (social work, social services, etc.) as well as highlight and discuss benefits of economic evaluation.

Methods: This commentary describes and reviews relevant empirical and theoretical literature on this subject.

Results: This commentary suggests that there are several implications of the points made in the article for the development of standards of quality for effectiveness research

Våld mot kvinnor i nära relationer är ett vanligt och allvarligt samhällsproblem som medför ett stort lidande för kvinnor, barn och andra närstående. Vidare medför våld mot kvinnor i nära relationer stora ekonomiska kostnader.

Under 2007 fick Socialstyrelsen uppdraget att utvärdera metoder och arbetssätt i socialtjänstens arbete med våldsutövande män samt metoder och arbetssätt i socialtjänstanknutna verksamheter för våldsutsatta kvinnor och barn som bevittnar våld. Vidare planerades analyser av kostnadseffektivitet i anslutning till dessa tre utvärderingar. Det är de ekonomiska analyser som denna studie fokuserar på.

Den ekonomiska analysen baseras på data som samlats in i samband med Behandling av män som utövar våld i nära relationer – en utvärdering (Socialstyrelsen, 2010), Utvärdering av Socialtjänstens insatser för våldsutsatta kvinnor (Schaffer Lindgren, Bergkvist, Dufort & Tengström, 2010; FORUM, 2011), och Utvärdering av behandlingar som stödjer barn som bevittnat våld mot mamma (Broberg, Almqvist, Axberg, Almqvist, Cater & Eriksson, 2010; Broberg, Almqvist, Axberg, Grip, Almqvist, Sharifi, m fl, 2011). Alla tre utvärderingar använde sig av en kvasiexperimentell design där deltagarna följdes för att undersöka förändringar över tid.

De ekonomiska analyserna omfattar 29 verksamheter för barn, kvinnor och män. För den ekonomiska analysen samlades uppgifter in om verksamhetskostnader, produktion hos verksamheterna, och resursanvändning av utvärderingsdeltagare för att estimera behandlingskostnaden för utvärderingarnas deltagare. Jämförelser gjordes mellan behandlingsgrupper för att undersöka kostnaden för att uppnå de resultat som redovisas i ovan nämnde utvärderingarna.

Resultaten tyder på att Kriscentrums verksamhet erbjuder behandling till det lägsta enhetspriset och också erbjuder den minst intensiv behandling för män som har utövat våld i nära relationer. En behandling hos Kriscentrum kostade i genomsnitt mindre (8 363 kr) än en behandling hos Alternativ till våld (ATV) (28 373 kr) och Utväg (34 043 kr) med samma behandlingseffekt. Verksamheterna med särskild inriktning mot barn som hade upplevt våld mot mamma hade ett lägre enhetspris för sina behandlingar till barn som hade bevittnat våld mot mamma trots att de träffade sina klienter 2 – 5 gånger mer än de ordinarie verksamheter med respektive utan stöd till barn. Även om det inte fanns några större skillnader mellan de särskilda och de ordinarie verksamheter i de totala behandlingskostnader, uppnådde klienter i de särskilda verksamheterna större förbättringar i psykisk ohälsa och sociala förmågor än klienter i de ordinarie verksamheterna med stöd respektive de utan stöd. Det saknades tillräckligt underlag för att uppskatta kostnadseffektiviteten hos de verksamheter som erbjuder behandlingar till våldsutsatta kvinnor.

Det finns ett stort behov av att utveckla metoder och procedurer inom socialtjänst och socialtjänstnära verksamheter för registrering av grundläggande verksamhetsstatistik om antal behandlade individer, typ av behandling individerna får och hur mycket behandling som individerna får. Endast fyra av de 29 verksamheterna kunde presentera alla nödvändiga uppgifter för fullständiga kostnadsanalyser och åtta saknade all relevant information och måste därför exkluderas ur analyserna.

Within the context of a randomized trial, this study assessed the costs of treating conduct disorder with multisystemic therapy (MST) or treatment as usual (TAU) for 156 youth in Sweden. From the perspective of the municipal Social Welfare Administration, all intervention costs were collected for the 6-month period starting at randomization. MST was found to cost, on average, US$8,847 per youth. A course of intervention including MST was found to cost significantly more (US$5,038 per youth) than TAU. Although MST was found to reduce the use of and costs associated with non-placement interventions, MST was not found to reduce the use of or costs associated with placement interventions. This is contrary to findings reported from studies undertaken in the USA. Intent-to-treat (ITT) and treatment-of-treated (TOT) analyses are presented.

Objectives: The purpose of this study was to investigate the costs and benefits associated with multisystemic therapy (MST) for conduct disordered youth, 2 years following intake.

Methods: The study employed a secondary analysis of 156 youth enrolled in a randomized trial assessing the psychosocial and behavioral outcomes of MST.

Results: MST cost on average 105,400 SEK per youth. MST was associated with a direct benefit to participants of 1,000 SEK per youth and positively impacted the use of nonplacement downstream interventions for a benefit of 62,100 SEK per youth. These benefits did not offset the cost of MST.

Conclusions: MST was associated with a net loss to society after 2 years of 44,500 SEK per youth.

This study aimed to estimate the cumulative productivity losses and victim costs incurred between 1975 and 2005 as a result of crimes committed by a cohort of women with a co-occurring substance abuse and mental disorder placed in a compulsory treatment facility for substance abuse between 1997 and 2000. As such, this adds to a prior study estimating the direct criminal justice system costs incurred for crimes committed by the same group during the same period. Official register data were obtained for the period 1975-2005 on a consecutive sample of 227 women. Total productivity losses due to homicide and incarceration as well as victim costs totaled approximately 250,000 Swedish crowns (2010 values, non-discounted) per person. Productivity losses and victim costs as estimated in this study accounted for roughly 19-25% of the societal costs of crimes committed by this group. 

This article uses programme theory reconstruction to investigate three conceptualisations of evidence-based practice (EBP). The first two are taken directly from the literature and contrasted with a third taken from a relevant policy programme. The article argues that 'evidence-based practice' is not a homogeneous concept, and that interested parties within research, practice and policy may not have a shared vision of EBP even though they may use the same terminology. It is important for the successful implementation of EBP within practice and policy that there is a clear understanding of what EBP is and how EBP is supposed to work if research, policy and practice are to work together toward common goals.

Youth in out-of-home care are an extremely vulnerable population subject to disproportionate negative outcomes. Few interventions have been identified as being effective in supporting this population in transition from out-of home care to independent living. At the start of this project there were no interventions delivered in Sweden designed to support youth in their transition from out-of-home care to independent living. Although standards for effectiveness guide stakeholders interested in disseminating and scaling up interventions in practice to implement interventions with fidelity, there is growing evidence that adapting interventions when transferring them between contexts or developing interventions within the context in which they will be implemented may be more effective strategies than straight adoption. This may be due to the adaptation process’s impact on perceived acceptability and appropriateness among professionals that will be delivering the intervention in its new setting. Ethical practice is concerned with acceptable and appropriate behavior based on the values and norms of the profession as well as the values and norms of client groups. From a practice perspective, interventions and their components that are approved of and accepted by the professionals that will deliver them and the youth that will participate in them can be understood as at least in part more ethical than interventions which are not approved of or perceived as accepted by these groups. The aim of this project is to develop an effective and ethical intervention to support youth in out-of-home care transition to independent living through a co-creation process with practitioners. We use an open source, evidence-based implementation framework, Getting to Outcomes , to guide our work. We present the development process and preliminary results from a pilot study with focus on acceptability, appropriateness, and feasibility from a practitioner and youth perspective. We present how these results led to refinement of the intervention. 

Mitt val – min väg! är en insats som syftar till att stödja ungdomar i övergången från samhällsvård till vuxenlivet. Programmet har tre huvudområden: utbildning och anställning, positiva vardagsrutiner samt hjälpsökande beteende. Vi arbetar med dessa tre huvudområden för att nå målet att ungdomarna ska ha ett liv som är fritt från droger och kriminalitet.

Denna manual innehåller instruktioner för MVMV-lotsar som ska arbeta med Mitt val – min väg! En lots är ofta en ungdomsbehandlare eller liknande. Som MVMV-lots arbetar du med att hjälpa en ungdom, som finns i samhällsvård, att navigera genom den svåra passagen från ungdomslivet till vuxenlivet.

Manualen består av 19 kapitel och är författad av tre forskare med stor erfarenhet av sociala insatser och arbete inom socialtjänsten. Yrkesverksamma från socialtjänsten har varit ett viktigt bollplank i utvecklingen av manualen för att den ska passa för socialtjänstens verksamhet.

Mitt val – min väg! är för dig som är på väg att bli vuxen. Passagen från ungdomslivet till vuxenlivet är en spännande tid med många tankar om framtiden. När du arbetar med Mitt val – min väg! är det du som sätter mål som du vill uppnå i ditt liv. Din lots kommer att hjälpa och stödja dig att nå dessa mål. Målen kan handla om allt möjligt. Det är du som bestämmer. Denna bok innehåller material som du och din lots använder tillsammans för att arbeta mot dina mål.