Young residents' view of support persons ...

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Young residents’ view of support persons’ involvement in the institutional treatment programme: a one-year follow-up a

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Jürgen Degner , Anna Henriksen , Lia Ahonen & Lars Oscarsson a

School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden b

Social Work, University West, Trollhättan, Sweden

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The Life History Research Program, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA d

Social Work, Ersta Sköndal University College, Stockholm, Sweden Published online: 25 Jul 2014.

To cite this article: Jürgen Degner, Anna Henriksen, Lia Ahonen & Lars Oscarsson (2014): Young residents’ view of support persons’ involvement in the institutional treatment programme: a oneyear follow-up, Nordic Social Work Research, DOI: 10.1080/2156857X.2014.939699 To link to this article: http://dx.doi.org/10.1080/2156857X.2014.939699

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Nordic Social Work Research, 2014 http://dx.doi.org/10.1080/2156857X.2014.939699

Young residents’ view of support persons’ involvement in the institutional treatment programme: a one-year follow-up Jürgen Degnera*, Anna Henriksenb, Lia Ahonenc and Lars Oscarssond


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School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden; bSocial Work, University West, Trollhättan, Sweden; cThe Life History Research Program, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; dSocial Work, Ersta Sköndal University College, Stockholm, Sweden Many youths placed in residential treatment centres (RTCs) have prior to placement had contact with professional and non-professional support persons (SPs). By interviewing 46 youths (residents) from 10 Swedish RTCs, the present study aims to investigate the residents’ view of their relationship with SPs, and, in a one-year follow-up, explore obstacles to or possibilities for maintaining the relationship during the stay at the facility. Results show that 20 residents consider the SPs to be significant adults with an emotional involvement component; seven residents describe their SP as having an instrumental involvement attitude, while 19 residents did not report any significant SP at all. Several obstacles and a few possibilities for involving the SPs were found in the one-year follow-up. Both obstacles and possibilities mainly concerned the willingness of facility staff, and in some cases the social welfare agency staff, to encourage SP involvement. A more systematic SP involvement procedure is needed at the RTC, as well as on the part of the handling officer in the social service agency. Further, it is important that when new residents arrive, staff should make an inventory of important SPs as well as other significant members of the residents’ social networks. Keywords: criminality; substance abuse; professional helper; young people; residential treatment centres

Introduction Young people placed in residential treatment centres (RTCs) often have destructive or neglective relationships with parents and other significant members in their social network (Jansson and Björck 2012; Nickerson et al. 2006; Stein 2012). Despite these relational difficulties, it is most often important to include these individuals in the facility’s programme during placement (Degner, Henriksen, and Oscarsson 2007). However, when the youth’s relations to parents and other significant network members fail, professional (e.g. social welfare officers, school counsellors, former institution staff or police officers) or non-professional (e.g. foster parents or contact persons) support persons (SPs) can be of great importance during placement. Further, these SPs can serve as a link between the RTC and the youth’s family of origin (cf. Gavazzi et al. 2003 for discussion of ‘building bridges’ between parole officers and juveniles’ families). Up to date, little is known about how relations between the residents and SPs outside the facility are encouraged and maintained by staff during placement (but see Stein 2006). *Corresponding author. Email: [email protected] © 2014 Taylor & Francis

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Accordingly, the present study aims to investigate how important the SP is to the resident, and how this relationship can be characterised in terms of involvement, reciprocity and trust. Further, we investigate at a one-year follow-up if and how this relationship has been maintained for the last year during placement, and if the quality of the relationship has changed.


SP as a ‘formal relationship’ in the youths’ social networks In Sweden, a preventive intervention support programme based on volunteer work has existed for more than 20 years. If, for instance, a family or client (youth) experiences some kind of crisis and therefore needs social support, a volunteer (contact person) can assist the client on regular basis (see, Andersson and Bangura Arvidsson 2001; Teng 2010; Vinnerljung and Franzén 2005). The professional category of SPs, such as social welfare officers, school counsellors, institution staff and police officers, is mostly involved with the residents because of the residents’ current or prior behaviour; for example, having been referred to the school counsellor and a special teacher after problems in school (e.g. truancy and misbehaviour). Crime prevention initiatives in the community often involve police officers who sometimes take a more personal interest in individual youth than their position demands. These police officers sometimes support or advice the young person as well as the family (cf. Bazemore and Senjo 1997). A social welfare officer administrating the young person’s placement at a RTC, or former key staff members during previous RTC placements, can also serve as important SPs in times of turbulence in the youth’s life situation. Recreation leaders often meet these young people in organised after-school activities – for example, at so-called youth recreation centres (see, e.g. Mahoney, Stattin, and Magnusson 2001), and finally, counsellors in open community care programmes occasionally have contact with these categories of young people before and/or after their placement at a RTC. It is common knowledge today that young people’s psychosocial problems develop in interaction between the person/child and his or her immediate environment – within the youth’s family, as well as in the neighbourhood and school in interplay with antisocial peers (Bronfenbrenner and Morris 2006; also see, Ahonen and Degner 2012). This, in turn, makes it important to include significant persons from the residents’ home environment (ecology) in the treatment structure (cf. Randall, Swenson, and Henggeler 1999). Consequently, when youths residing in RTCs are discharged from the facilities, significant persons such as professional and non-professional SPs can support them in the transition back to their home environments and families (Gavazzi et al. 2003). Theoretically, social support from, for example, professional social workers (formal relationships) can be divided into different categories. In a study of adult female drug abusers for example, Trulsson and Hedin (2004) investigated the significance of social support within close relationships, including with professionals, in exit processes from drug abuse. Professional relationships are divided into three groups: (1) the emotional support group, (2) the instrumental group and (3) the cognitive group. All three groups, though containing different aspects of emotional involvement, consisted of relationships between the clients and social workers based on confidence, openness and mutual trust. In essence, a long-lasting relationship with a reliable social worker, which in several cases developed into an additional friendship, helped – according to the women themselves – their work of recovery.

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SPs as a link between the RTC and the family of origin In cases where the youths experience tensions in relation to parents or significant others, an SP could for a shorter or longer period serve as an significant adult and link between youths and their home environments (cf. Farnfield and Kaszap 1998 for children’s ‘views of professionals in the mental health service’). Theoretically, this initially formed professional or non-professional relationship could be described in terms of a working relationship or therapeutic alliance (see, Duncan et al. 2010; Hill 2005). Initially, therapeutic alliance was seen as including essential core factors such as transference and counter transference, originating from psycho analysis. Recent theoretical standpoints, however, have further operationalised these traditional concepts and now include key concepts such as trust, support, reciprocity and sometimes even unconditionally warm and genuine feelings between the client and the therapist or counsellor (Duncan et al. 2010). What has disappeared slightly in contemporary reciprocity, compared to transference and countertransference are the negative emotions like rage, anger and irritability. A formal relationship between the SP and the youth can be explored with the same key concepts (cf. Hill 2005) but needs to also include negative emotions as a part of the relationship. While the goal of a formal relationship is often to help the youth cope with earlier negative experiences of interaction with parents or caregivers, these concepts create meaning in order to describe the functioning of this dyad, and represent the quality and certain aspects of the SP’s emotional involvement with the youth (cf. Bowlby 1988; Farnfield and Kaszap 1998; Florsheim et al. 2000). Bowlby (1988), for example, viewed the relationship between the therapist and the client as an opportunity to create a secure base. Within the framework of a secure base, the client is given an opportunity to reorganise his or her experiences of earlier relationships with caregivers and other important persons. The product of this process is often referred to as an internal working model, meaning that the individual operates from a schema with predetermined responses to certain situations, based on previous experiences (e.g. Bowlby 1988). The internal working model is often said to be influenced by caregivers and other significant individuals in childhood, and in later interventions professional or non-professional SPs.

Methods Materials The present study is part of a larger project, including three rounds of interviews conducted at approximately one-year intervals with 23 girls and 23 boys, placed in 10 different state RTCs in central and southern Sweden. This paper is based on data from the first and second interviews with the residents. The choice of RTCs was based on the facilities’ theoretical and methodological programme structure: they employ a milieu therapeutic method, and have a psychodynamic base with a network-focused treatment programme. The residents were at interview 1 chosen by purposive sampling (Silverman 2000) and self-selection based on the following criteria: the residents must, (a) be between 14 and 20 years of age, (b) have resided at the facility for at least the most recent 4 months and (c) have an expected period of treatment of at least 12 more months (mean was 15 months). After informing caregivers and the director of each facility about the study and inclusion criteria, the youths could be assigned to take part in the project. All interviews were performed by trained research staff, with previous clinical experience of communicating with juveniles in institutions.

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The interviews During the interviews, the residents were asked to name one or more important SPs. The SPs should have given the youth support for at least two years prior to the current placement. In total, 27 youth mentioned one SP respectively fulfilling this criteria. We used a semi-structured interview manual with two main themes: The residents’ experience of their relationship with the SPs, and obstacles to and possibilities for maintaining the relationship with the SP, while residing at the facility. The first interview focused on the overall relationship between the youth and the SP, and their current contact. The follow-up interview focused on changes in contact and relationship during the placement. Examples of questions at interview 1: How would you describe the relationship between you and (name)? How would you describe (name) – express the first adjective that comes to mind when you think of him or her? Mention especially important things you and (name) use to do together – and why would you mention these occasions in specific? How important is the relationship with (name) for you? How important do you think the relationship with you is for (name)? Examples of questions from the follow-up interview: Do you and your key staff member (at the institution) discuss what contacts, and relationships, you have with various social workers or specific SPs outside the facility? Are you encouraged to invite SPs’ to participate in your treatment programme? Does the institution arrange any contacts with your SP, and if yes, how is this done? Do you and your key staff member discuss how your relationship with your SP will be when you are released? How often did you stay in touch with your SP before placement? Do you think that the relationship with (name) changed since you came here, positive or negative? The questions posed on both occasions were designed to explore the quality of the residents’ perceived contact and relationship with the SPs, and whether this contact had changed during the residential stay. In the follow-up interview, focus was also on obstacles to and opportunities for involving SPs in the treatment. The first round of interviews was all conducted at the RTC. The follow-up interviews took place at a place the respondent chose if they were not still in the institution (e.g. home, restaurant and coffee place). Two girls declined to take part in the second interview, and one boy had moved abroad.

Analysis of data Interviews were recorded and coded shortly after by two different researchers to test for inter-reliability. The material was analysed in the following sequence: (a) developing a coding scheme; (b) condensing statements into meaning-concentrations; (c) interpreting patterns, nuances and content in relation to information provided in the interview as a whole (cf. Kvale 1996, 187–207); and (d) providing the basis for the qualitative categories presented in the results section below. The main concepts used as guiding principles in analysing the resident–SP relationship are trust, support and reciprocity. In the final construction of each category, these concepts came to include variations in their qualitative content or values. For example, trust could have an emotional content (e.g. a close friendship), but could also be fundamentally based on strictly formal, but positive, interaction with a counsellor, staff member or social worker on a professional level.


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Validity and reliability Themes and specific questions in the interview manual emerged from theory and previous research in the topic studied. Examples of literature used for the interview themes and questions are: De Leon (2000), Duncan et al. (2010), Florsheim et al. (2000), Hill (2005), and Larsen (2004). Qualitative researchers normally address validity throughout the data collection and analysis processes (Patton 2002), where validity is related to the transparency of the description of the data analysis and comparisons to other research. In addition, while writing this article, ongoing discussions took place with fellow research colleagues in seminars and social workers in the field, which allowed the authors to remain open to other conclusions and insights throughout the analytical process.

Results The analysis of the residents’ narratives resulted in two categories: The Emotional Involvement and The Instrumental Involvement Category. The categories illustrate the residents’ views of their relationships with the SPs. The one-year follow-up also includes possible obstacles and possibilities in keeping the relationship with their SPs during the stay at the facility intact. Different types of SPs were identified, comprising a total of 21 professionals (e.g. former treatment staff, police officer, social welfare officers, special teacher, school counsellor, etc.) and six non-professionals (contact persons and foster parents).

The emotional involvement category This category includes 20 SPs (14 professionals and 6 non-professionals). The residents’ narratives reveal emotionally significant involvement with the SPs, in which concepts such as trust, support and reciprocity interact over time. In this category, there are 14 residents who have professional SPs who within the scope of their profession have a certain responsibility for working with young persons with psychosocial problems. The residents experience that the SPs do not have the role of authorities in relation to them; instead, the relationship has evolved on a voluntary basis. One of these residents has a key staff mentor who was in charge of the resident at the beginning of the current RTC placement, while two residents have been in contact with the SPs (facility staff) during previous placements. Three residents have SPs who are key staff members from earlier RTCs. The other residents mention SPs such as one police officer, one school counsellor, two special teachers, one recreation leader, two counsellors in open care and finally, one social welfare officer. The remaining six residents have SPs consisting of non-professionals: two foster parents and four contact persons appointed by the social welfare agency. In the following, first to be presented will be the residents’ narratives of the SP’s function as a supporter. Thereafter, the residents’ experiences of obstacles and possibilities in maintaining the relationship with the SPs during the stay at the facility, and in turn, including them in the treatment programme in a one-year perspective, will be presented. The residents describe the SPs as important people in their lives. Through their contact, they have been a support for the residents in various contexts and over time, especially when relationships with other adults have not held. For example, Jenny says of her contact person:

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J. Degner et al. I have had nine social welfare agents. I’ve had my SP for many years. She means a lot to me and is a source of support to me. When everyone else backed out and let me down she was always there. I’ve been angry with her because she has thought differently than me, but she understands me and is wise. She could say that she was worried about me. I was pissed off and said that she shouldn’t bother, but she didn’t give up. (Jenny)

Peter says something similar about his recreational leader.


Stina is the only adult who has cared. Before, I met her every day at the youth recreation centre. We have known each other for years. She knew what it was like at home, dad is crazy and mum is mentally ill. She is the only person I have been able to talk to. (Peter)

The residents’ narratives show that they have utilised their SP’s supportive function in different situations. For instance, when their parents have not been sufficiently supportive, the SPs have filled this function. The residents describe the SPs as deputy parents (in loco parentis). Andreas says of his special teacher: She was a special teacher at a school where I went and had big problems. She helped me after school. When mum couldn’t handle me at home or when she and dad had a fight, she let me come to her. (Andreas)

The supportive function also consists in counselling, at the same time as the support means that the residents develop constructive strategies for handling critical situations. Jenny says of her contact person: I phone her when my mum has kicked me out. I think that it’s better to call her than to go out and do something stupid. She always says to me that I should come over to her place and that I can come whenever I want. (Jenny)

This is illustrated even more clearly in family conflicts. The residents seek support by contacting the SPs. Lisa tells: She has always helped me and I could sleep at her place when there were problems at home with mum and dad. I used to go out in the streets and live it up, but nowadays I call my contact person and spend the night there. She tries to make me realise that things will be ok, I feel her support. (Lisa)

The residents’ narratives show that the SPs have played a supportive role for them in different ways. Because of this supportive function, the relationship between the parties has evolved. Data also indicate that the relationship has developed because the connection has persisted over time. Because of the support from the SPs, the relationship has assumed a more profound quality, characterised by deepened mutuality and trust. Lisa says of her contact person: I’ve known her for a long time and I have had many long conversations with her. She understands me. At first, I did not trust her and I have never trusted adults, but now I know I can trust her. It has been good for me to have someone to talk to and I have long discussions with her. (Lisa)

The residents state that the SPs are anxious to create a respectful relationship with them, which involves taking the residents seriously, and further includes developing trust through a mutual relationship. Lisa continues:


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She takes me seriously. I have been able to tell her things and I know she has taken it in and done what’s best based on that information, then I have felt that I can trust her. It could be about why I have felt bad, things related to my upbringing and to my dad. (Lisa)


The residents describe how they and the SPs formed a trustful relationship, and additionally, developed reciprocity in relation to each other. They describe how the SPs provide a safe, stable and predictable relationship with clear boundaries. Carola tells about her counsellor in open care: She had a girls’ group, which I was part of. She was the one who saw us out in the city late at night and she was the one who went to camp with us. I trust Carina and she was clear with me and said that she had to report to the social service that I was using drugs and that I was being beaten at home. It was good that she did because I was taken into custody. (Carola)

The majority of the residents intend to maintain the relationship with their SPs. Jenny expresses this in the following way: ‘We will become like friends when I get older’ (Jenny). In the one-year follow-up, all the residents in this category still have the intention of maintaining their relationship with the SPs during the stay at the RTC. They describe their relationships with the SPs in terms of support, trust and reciprocity. The relationship has developed over time, and they intend to remain significant persons in the youth’s life. They view, however, the opportunities to maintain their relationships with the SPs during the stay at the RTC in different ways. In the second interview, data show three different kinds of obstacles and possibilities in maintaining the relationship during the stay at the facility and, in turn, including SPs in the treatment programme. A first group (n = 10) consists of residents with non-professional SPs (n = 5, 3 contact persons and 2 foster parents) and professional ones (n = 5, 2 counsellors in open care, 2 special teachers and 1 youth recreation leader). These latter five work professionally with young people suffering from psychosocial problems, while the non-professionals conduct psychosocial work on a voluntary basis. According to the narratives, the residents have not had any opportunities to maintain their relationship with the SPs during the stay at the facility, neither the professionals (counsellor, special teachers and a recreation leader) nor non-professionals (contact persons and foster parents). In these descriptions, neither the social welfare agency nor the RTC staff encourages SPs to participate in the treatment, or even intends to include them. The staffs of the RTCs in particular never take the initiative or show any interest. The residents are steered into the life within the RTC, which implies that significant individuals such as SPs are not included during the stay at the facility. The residents have to rely solely on the relationships within the residential care. Andreas who has been placed at the RTC for almost two years, and has previously been in contact with his special teacher for six years points out: I am not allowed to see her and I have not been allowed to contact her for over a year. I met her when I was in fourth grade and I’ve been contact with her all the time. She is not allowed to come here. I ask why but the staff doesn’t give me any answer. She always asked me if I needed help with anything and if there was anything I needed to talk about. (Andreas)

Peter, who has been in contact with his recreational leader for several years, expresses the same thing:

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J. Degner et al. It was when I came here, that’s when I lost contact. But that’s happened with many people since I came here. Here they always say there’ll be meetings but they (the staff) are just saying that, because nothing happens. They say you have to wait. (Peter)


Common to all the residents’ stories is that the RTC staff are not willing to assimilate their knowledge about the relationships between residents and their SPs. It is implied that the RTCs provide treatment without including significant individuals in general, including the SPs. And the social agencies and RTCs together obstruct the SPs from maintaining their relationships with the residents. Jenny says: ‘We don’t even speak about what important SPs there are’ (Jenny). Carola, who for many years has been in contact with an SP who is a counsellor in open care, states: I was not allowed to have contact with Karin anymore; she was excluded by the social welfare agency; they thought I should concentrate on myself instead. The staff (at the RTC) says the same thing. My social welfare officer didn’t like my counsellor in open care since they had different ideas /…/ [I told the staff] …you cannot exclude important people from my life. She is the only grown up I have had who is an outsider. The RTC staff did not care and I was not allowed to have contact with her anymore. I have not been given any explanation; they only say we think you should think about yourself. (Carola)

It is common that the residents who have had a contact person appointed by the social welfare agency point out that the municipal economy is an obstacle. Jenny states: ‘My social welfare officer is not going to pay for a contact person while I’m here’ (Jenny). However, important opportunities to maintain relationships between residents and SPs are also described. The second group of residents (n = 7) have SPs who consist of professionals such as one school counsellor, two treatment personnel at previous RTC placements, three former key staff members from former placements and one police officer. The residents’ better opportunities to maintain their relationship with the SPs during the stay at the facility are primarily a consequence of the SP’s professional status, which gives them some degree of formal access to the RTC. However, the contact between the parties is maintained because the residents and the SPs take the initiative. The staff does not initiate contact; neither do they encourage the involvement of significant individuals such as SPs in the treatment. Stefan has been in contact with his school counsellor for many years and states: No one has asked me about significant support persons. If there’s something I want, I have to call him myself. I call him sometimes and he calls me too. I’ve known him for many years and we’ve talked a lot about all the problems with mum and dad. (Stefan)

Even though the residents in this group have greater opportunities to maintain contact with important SPs during the stay at the facility, they point out that they first must go through an initial bureaucratic process to make the contact possible. The residents themselves have to initiate the contact. Åsa, who has been in contact with treatment staff at a previous placement, says: The rules state that anyone who wants to call or come visit needs to be approved by the social welfare officer. It took a long time before they allowed her to be on the telephone list. I am the one who has to ask the staff if she can come for a visit, but finally she was allowed to come to the RTC. (Åsa)


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It is usual that the rules at the RTC state that the residents need to complete their activities and behave acceptably in order to be allowed to have contact with significant individuals outside the institution. This also includes important SPs. Their access to important SPs will be restricted as a direct consequence of misbehaviour at the institution. Thus, suspension of the relationship constitutes a part of the institutional system of sanctions. Karin has been at the RTC for more than two years. She previously stayed at another RTC, and has kept in contact with earlier treatment staff since then. I am allowed to have contact with Kerstin, but not if I misbehave at the institution. Once they said that I hadn’t gotten out of bed on time, and then I was not allowed to see her. On another occasion they said I was faking being sick every Monday, and then they didn’t let me go home on vacation, and I was not allowed to see Kerstin. (Karin)

The third group consists of residents (n = 3) whose SPs are a key staff member at the RTC, a contact person and a social worker. They report that they have had plentiful opportunities to maintain their relationships with the SPs during the stay. The narratives illustrate how significant individuals such as SPs have been included in the treatment process by the staff because of their presumed importance to the residents. The residents and the SPs maintain the relationship continuously. The staff at the RTC takes the initiative to maintain the contact between the residents and the SPs. Lisa says of her contact person: I said that I can’t handle being here all day long. The social welfare agency as well as the staff at the RTC thought it was important that I had someone who I could trust and who I liked and who liked me back. I still have her, and we meet once a week and we also call each other. She is invited to the institution to treatment conferences and to school graduations. (Lisa)

Thomas has been at the RTC for more than four years, but during the stay at the facility he moved between different wings. He describes his contact with the key staff member at the former wing: He became like a father to me. I have no family, no relatives. I can call him as much as I want to and I can call him when he is not working, on his vacation. The staff thought it was important for me to stay in contact with him. We get along well and he also takes part in my treatment conferences. When I’ve misbehaved the staff calls Peter and then he also takes part in talking about the problems. (Thomas)

The instrumental involvement category This category consists of seven residents; all of them have SPs who are social welfare officers (professionals). The emotional involvement described in the previous category does not characterise this group. Concepts such as trust, support and reciprocity are also found in this category, but with a distinctly different meaning. The residents in this category consider the SPs to be important because of their position of authority, and their usefulness in various ways. The residents describe their SPs as authority figures, which is not surprising since the relationship has evolved as a result of the SPs’ responsibility to administer the coercive care, and further, since their involvement is based on the routines and regulations that formally comprise the practice of the profession. These residents describe the mutuality of their contacts with the SPs as being based on various compromises about decisions that have been taken, or needing help


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dealing with administrative issues, rather than on an emotional alliance or informal friendship. The residents consider the SPs to be significant in the sense of continuously providing support by facing and dealing with issues that are important to the residents and of relevance for their placement. Per says of his social welfare officer: ‘I need to be on good terms with her in order to get things done. She doesn’t mean anything to me, but I need access to her since I’m in here’. The residents in this category understand that their SPs lack what could amount to a supportive function. Kristian tells about his social welfare officer: ‘She ignores me and doesn’t give a shit about what I am saying. She doesn’t care and can’t give me the help I need’. The relationships between the residents and the SPs have become important mainly due to the youths’ situation of being subject to coercive care. It is primarily a matter of the youths’ benefiting from the relationship. The residents acknowledge the SP’s position of power and are thus anxious to maintain the relationship. Peter says: ‘Göran is important since he is the one who decides what will happen in the future’ (Peter). The contacts between the residents and the SPs primarily take place at predetermined times for meetings of different kinds. The residents consider the SPs to be both important and supportive because they are handling the case, and answering different questions. Personal aspects of the relationships are not significant. The reciprocity consists instead of the SPs’ importance due to their authority to allocate resources in terms of placement decisions or funding. The residents think that the SPs’ supportive function, which for example includes accepting and handling the residents’ disappointments and anger at times when they feel ill-treated at the RTC, is important. Niklas says of his social welfare officer: ‘I need him because he takes part in my treatment conferences, but otherwise I don’t want to have anything to do with him. He can help me by taking my side against the treatment staff when they are actually wrong’. No emotional depth is ever reached and the reciprocity in their relationship is constituted by the contact that occurs when the residents need their social welfare officers in order to, if possible, get their wishes fulfilled. Kristian says: ‘I need her to get things done; it’s nothing more than that’ (Kristian). After the formal assignment, the residents in this category do not intend to maintain their relationships with the SPs – as Per says: ‘After I am discharged from here I do not want to have anything more to do with her’ (Per). The one-year follow-up data reveal both obstacles and possibilities with regard to maintaining the relationship during the stay at the facility. Due to the SPs’ professional status as social welfare officers managing the coercive placement, the subjects in this category naturally have access to the RTCs, since the terms of the placement assignment include attending regular treatment conferences. Apart from the treatment conferences, the residents describe obstacles to maintaining the contact with their SPs. Common to all the residents in this category is that during the placement they often seek contact with their social welfare officers but without results. Peter describes it in the following way: ‘She hasn’t called me a single fucking time since she put me here. I’ve called her and she never fucking answers’ (Peter). Discussion Most of the SPs in this study are important for the residents. The SPs have known the residents for several years prior to the facility placement. In addition, they have supported the residents in times of distress often exemplified by conflicts with parents and



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other member of their social network. Some residents even describe how they spend the night at the SP’s residence when there are conflicts at home: For staff at the facility, or a professional social worker, this kind of personal relationship to a client would not be acceptable. Hence, the difference between a professional social worker – who is responsible for the residents as part of his or her work (e.g. current staff at the facility or the social welfare officer in charge of the residents’ placement) – and an SP, who voluntarily keeps in touch with the resident, becomes apparent. This argument is further supported by Stein (2012) who shows that care leavers benefit from a slow transition with ongoing support. Since professional social workers let go at the time of release, SPs become even more important. These SPs are involved in the residents’ private sphere, and are eager to establish and maintain the relationship with the young person (Degner, Henriksen, and Oscarsson 2010). Bowlby (1988) stresses that the internal working model – also referred to as a schema – through positive interaction with important individuals, changes over the life course. To clarify, a youth’s negative experience from the relationship with his or her parents affects the formation of future relationships (Bowlby 1988; Howe et al. 1999; also see, Bronfenbrenner and Morris 2006). This chain of relational processes will be either negatively or positively reinforced by other significant persons who are emotionally close to the youth: In addition, viewed in the light of ecological theory, Bronfenbrenner (1979), for example, emphasises that personal development takes place in emotional and reciprocal interactions, also with individuals outside the immediate family environment. In this perspective, the residents’ relationships to the SPs could be of crucial importance in terms of creating trust, support and reciprocity and thus influence the young person’s internal working model. This is true for all SP relationships with one exception: the instrumental (non-emotionally involved) category. Nevertheless, for this to happen within the scope of an institutional placement, one main component is missing. There seem to be no structures promoting the involvement of significant persons in the treatment programme in general. Many researchers emphasise the alliance between staff and residents as crucial (De Leon 2000; Florsheim et al. 2000; Larsen 2004). The alliance is important in many respects, and for this study it is crucial in terms of gaining the young person’s trust so that the residents can provide the staff or key staff member with information, which can be used in the resident’s treatment plan at the facility. Finally, this information can be used when staff makes an inventory of members (private as well as formal relationships) of the resident’s social network. Even so, youth and SPs do experience that institutional staff work to engage social networks (Degner, Henriksen, and Oscarsson 2010). Eventually, Social Welfare initiates this contact, but there is seldom a long-term plan for this relationship although studies show the importance thereof (Stein 2012). However, in addition to institutional staff and other professionals, SPs can be an important complement. For example, within the Emotionally Involved Category, volunteers were supportive and created a genuine, reciprocal and authentic atmosphere when meeting with the residents. SPs are involved by their own choice, which is often perceived by the youth as positive and this facilitate the getting-to-know process. As a voluntarily contracted SP, with a long history of being close to the resident, it might be possible to create a secure base from which the SP together with the resident could reflect over parents’ emotional shortcomings or other private or treatment-related issues and problems (e.g. Bowlby 1988). In contrast to this, a formal relationship as found in the Instrumental Involvement category could in one sense be described in terms of being supportive and trustful. That, in turn, includes a role or a function that is of importance for the youth, but there


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is a significant component missing, which in this category would be characterised as an emotional or authentic dimension. This dimension is mostly missing among the professional SPs who work as social welfare officers at the agency (in charge of the youth’s placement) or others working at the facility who are designated key staff members. These SPs who are responsible for the resident on a daily basis resemble any professional working with clients regularly. A professional staff–client relation exists only during a limited period of time, which is both necessary and follows standard procedure. In contrast, the advantage of a voluntary SP is the non-limited time commitment, and the authenticity and reciprocity of the relationship. Data indicate that both the youths and the SPs in most cases view their relationship as emotional, supporting and close, with reciprocal feelings such as happiness and sharing of memories (see, Degner, Henriksen, and Oscarsson 2010 for the interviews with SP). They both describe the relationship as important. Even if the juveniles express a wish to maintain the relationship, there are several obstacles. Most residents, with a few exceptions, find both staff and the social agency unwilling to involve SPs in the treatment programme, despite the resident’s wish to have this contact. In a study by Skårner (2001), 29 current or previous adult drug abusers were interviewed about their private and formal social networks. She found that most of the respondents in her study viewed social welfare officers or treatment staff from different institutional settings as important persons – especially the participants who had vague or desolate social network characteristics. Trulsson and Hedin (2004) made a similar reflection, where a relationship with a professional social worker starts out formally, but develops into a more personal and private involvement. Strengths and limitations Finally, it is important to point out the limitations of this study. One has to do with the interview itself as a tool to gain knowledge. There were differences in how the girls and the boys mediated narratives. The girls in our sample were more verbal when describing feelings and emotions compared to the boys, whom expressed themselves more poorly. For the analysis, this might result in loss of certain aspects, which in the interpretation phase could take on greater or lesser proportions depending on whether they were expressed by a boy or a girl. The second issue is the fact that in situations where young people are under coercive placement, it is common to idealise everything outside of the institution, and to see only the negative inside of the placement. This could in some instances lead to a slightly biased description of how staff at the institution hinders contact with important adults. The third issue is generalisability. The study included 46 residents from the first interview and 43 in the one-year follow-up. The relatively small number of respondents limits the possibility to generalise. But the fact that the residents taken together represent a relatively large number of institutions and social welfare agencies enables the study to give a general idea of how they experience the lack of encouraging strategies from staff in both organisations, which may be transferable to other RTCs and welfare agencies under similar circumstances. The strength of the study links to the field of practice and adds to our understanding of what contributes to a successful transition from the facility back to the community. The results of this article highlight the importance of involving the SP as an important person in the resident’s life. It is essential that the RTC make efforts to strengthen genuine therapeutic relationships between residents and staff, but as shown in this study, efforts should be made to involve both individuals from the resident’s social network


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and SPs in the treatment programme. The SP could here serve as a link between the facility and the community, but also as mediator between the resident and his or her family. Future research should focus on the prevalence of SP involvement in institutional programmes in general, and whether there are differences in treatment outcome when SPs are or are not involved in the treatment programme at the facility.


Final conclusions and implications In sum, the results of the study highlight some important findings. More than half of all residents (n = 27/46) outline that SPs, to some extent, are viewed as important adults, which in many cases (n = 20) also includes a genuine emotional aspect of the relationship. Seven residents describe the SPs’ involvement as instrumental. Notable is that 19 residents do not have any important SP at all. The variety in the existence of important relationships is notable and it is alarming that SPs are not included in treatment. This study shows the importance of including social networks in treatment of juveniles. More focus should be directed towards relationship aspects already at intake at the institution. Further, not only close family members should be considered possible important SPs, but attention should be given to other pro-social adults (professional and not) and sometimes even friends that can have a positive influence on the treatment result. Institutional care is complicated and to achieve behavioural change, all aspects of the juveniles relationship status needs to be taken into account or the release to society will inevitably fail. Acknowledgements The authors are grateful to all of the participants of the study, and to The Swedish National Board of Institutional Care (SiS) who has supported the present study.

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