and reach thousands of daily visitors
6 MAY 2009
NO 1432
Residential treatment
Residential care for children and young people exists nearly all over the world. In Western Europe and North America residential care is primarily for young persons with severe emotional and behavioural problems and often with a history of abuse and/or neglect. The care strategy for these youths varies both between countries and within countries. Social and economic conditions, legislation regulating child welfare and different ideologies are only a few of all the factors that influence the care and treatment of young people with behavioural and emotional problems (Sellick, 1998).
There is a lack of consensus on the characteristics that define residential care and treatment. There is a wide range of different residential settings, varying from small homelike settings located in neighbourhoods to institutions with several different sections that provide access to a number of specialised services that are isolated from community care (Child Welfare League of America, 2004; Sinclair and Gibbs, 1998). There is also a variety of theoretical frameworks, traditions and approaches for the everyday practice. In essence residential care requires that children and youth reside away from home. The purpose is to meet the needs of children and youth who cannot live with their parents and where adults are employed for that purpose (Child Welfare League of America, 2004; Department of Health, 1998).
Traditional residential treatment has emphasised the importance of reliable and sustainable relationships in a nurturing structure of a social and therapeutic milieu (O'Malley, 2004; Rosen, 1999). As a consequence residential treatment for young persons has often been long-term care. Five different models of residential treatment have been described in North America; the psychodynamic milieu approach, "positive peer culture", the behavioural model, the psycho-educational model and the cognitive-behavioural model (Zimmerman, 2004). These models have all influenced residential treatment, overlap to a degree and share some common characteristics. They were child centred, with a focus on the importance of therapeutic relations within the residential milieu and with a tendency to exclude family involvement, with the exception of the re-educational model (Lieberman, 2004). In North America, milieu treatment in group care for adolescents has recently been more under the influence of the behavioural and cognitive-behavioural models and the significance of the psychodynamic model has decreased (Zimmerman, 2004).
Another approach in residential care is based on assumptions about the need for ordinary everyday experiences (Ward, 2004). Instead of treating young persons as different from others according to a medical model where behavioural and emotional problems are understood as disorders (Lyman and Campbell, 1996; Sroufe, 1997), the aim is to normalize both the daily life experiences and the residential setting. The idea is that the daily life should resemble that of an ordinary family and the social environment should be as homelike as possible. This approach has been described in both the UK (Ward, 2004) and in Sweden (Sallnas, 2000).
Little is known about the currently most common approaches to treatment in residential care and the relation that different approaches have to different aspects of care. The aim of this study is to investigate what therapeutic underpinnings are involved in long-term residential care for youths in Sweden. The issue is to identify different approaches and investigate, whether these approaches are related to characteristics in the home, the staff and the type of care. "Approach" refers in this study to an overall orienting view with relatively global concepts that can be applied to many problems and methods of care and treatment (Kazdin, 1999).
B. ANDERSSON, J.
JOHANNSSON AND C.P. HWANG
Andersson, B. Johannsson, J. and Hwang, C.P. (2007).
Long-term residential care for youths in Sweden – approaches to
treatment. International Journal of Child and Family Welfare, 10,
1-2. pp.27-29.
REFERENCES
Child Welfare League of America. (2004). Standards of excellence for residential services. Washington, D.C. CWLA Press.
Department of Health. (1998). Caring for children away from home – messages from research. Chichester. John Wiley and Sons.
Kazdin, A.E. (1999). Current (lack of) status of theory in child and adolescent psychotherapy research. Journal of Clinical Child Psychology, 28, 4. pp. 533-543.
Lyman, R.D. and Campbell, N.R. (1996). Treating Children and Adolescents in residential and inpatient settings. Thousand Oaks. Sage Publications.
O'Malley, F. (2004). Contemporary issues in the psychiatric residential treatment of disturbed adolescents. Child and Adolescent Psychiatric Clinics of North America, 13, 2. pp. 255-266.
Rosen, M. (1999). Treating child welfare children in residential settings. Children and Youth Services Review, 21, 8. pp. 657-676.
Sallnas, M. (2000). Barnavardens institutioner – framvaxt, ideologi och struktur (Residential care in child welfare: Development, ideology and structure). Stockholm. Stockholm University, Department of Social Work.
Sellick, C. (1998). The use of institutional care for children across Europe. European Journal of Social Work, 1, 3. pp. 301-310.
Sinclair, I. and Giggs, I. (1998). Children's Homes – A Study in Diversity. Chichester. John Wiley and sons.
Sroufe, L.A. (1997). Psychopathology as an outcome of development. Development and Psychopathology, 9, 2. pp. 251-268.
Ward, A. (2004). Towards a theory of the everyday: The ordinary and the special in daily living in residential care. Child and Youth Care Forum, 33, 3. pp. 209-225.
Zimmerman, D.P. (2004). Psychotherapy in residential
treatment: Historical development and critical issues. Child and
Adolescent Psychiatric Clinics of North America, 13, 2. pp.
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