Shortcomings in state compulsory care of children and youths

The Swedish National Audit Office (SNAO) has audited care and treatment at the special residential homes for young people of the National Board of Institutional Care. The overall conclusion is that the operations are deficient in numerous different ways.

One of the main problems is that the Government has not provided the National Board of Institutional Care with adequate conditions for creating fit-for-purpose and effective operations. For example, the agency’s remit is unclearly worded, both in terms of the target groups that it is to receive and the care and treatment it is to offer.

SNAO furthermore determines that there are substantial differences between the special residential homes for young people and sometimes also between different wards. Some of the homes have a well-functioning team of staff and a good care environment, while others have constant staff shortages, inappropriate care environments and poorly trained staff.

The audit shows that there are tremendous variations in the extent to which staff have undergone the mandatory training courses that are to form the foundation for care and treatment, as well as in the supply of staff with the skills to lead the treatment programmes to be provided. Guidelines exist for how care and treatment are to be run, but they are not always followed because the agency is deficient in following up on how well the homes implement and adhere to the guidelines.

“The management of the agency has not acquired knowledge about which skills are in place at each special residential home for young people, neither in terms of basic competence nor structured treatment programmes,” comments Maria-Medée Almroth, project leader for the audit.

The National Board of Institutional Care cannot offer young people treatment based on individual needs because the operations are not sufficiently differentiated. For example, there are no treatment programmes aimed at self-harm or eating disorders, despite such problems being common – especially among girls. The fact that there is a shortage in capacity reduces possibilities for differentiation.

“The care and treatment that young people can receive is therefore decided more by the home at which a space happens to be available, rather than the needs of the youth,” explains Maria-Medée Almroth.

The National Board of Institutional Care’s internal structure for its work with treatment programmes is also unclear. It is unclear who is responsible for what, and what determines which programmes are offered at each home. A relatively small proportion of young people participate in treatment programmes and a minority receive sufficient treatment sessions to complete the programme in question.

“Poorly trained and sometimes inappropriate staff, unstructured treatment activities and a dysfunctional care environment mean that far from all young people in compulsory care within the special residential homes obtain the care and treatment they need,” says Auditor General Helena Lindberg.