An outcome evaluation of residential care Malin Hultman malin.hultman@socialstyrelsen.se

Overview Background- why an evaluation of MultifunC is needed Design and process Baseline data, including tests of differences between groups What are the situation for the youths at 12 months follow-up?

The knowledge base of residential care in Sweden Few outcome evaluations of the treatment effects of residential care High recidivism High re-placement in residential care Longitudinal register studies show that: Lower rate of education Bad health Increased risk for early death Therefore, it was decided that MultifunC would be evaluated already at the programme-development stage

Design Has MultifunC reduced serious behavior problem among participants? Quasi – experimental design Experimental group vs control group (MultifunC vs ”Treatment as Usual, TAU”) TAU consists of other equivalent treatment within SiS Pretest/posttest before treatment 12 months 24 months follow-up Register follow-up up to 5 years

Timeline Started in January 2010 Recruitment continued until August 2012 Have completed data collection at: Baseline 12 months 24 month follow-up completed in a year 2019-04-26

Ethical aspects Ethical assessment approved by ethical committee Everyone gets treatment – no waiting list Written consent from the youths Relatively few measurement instruments

Target population Youths 14 – 18 years placed within SiS In need of treatment for severe behavioral problems and meet inclusion criteria for the MultifunC-program Assessed as ”high risk” according to YLS/CMI (cut off 23)

Inclusion process 1. First assessment from inclusion - and exclusion criteria Made by head office 2. Second assessment made with YLS/CMI Conducted by psychologists within SiS 3. Information about research project to youths and inquiry to participate 4. If “yes” to participate baseline measurement Inclusion process was continued until there were 40 individuals in both groups

Outcome/Measurements Instrument Problem area/Outcome ADAD Addiction, family relations friends YSR Psychosocial problems SRD Delinquency Plus baseline data from YLS/CMI National register information on recidivism, out-of-home placements, education, employment, social services.

Study population Gender Boys Girls Total MultifunC 19 21 40 Control We currently know that there were 5 breakdowns in the MultifunC group and 8 in the control group Currently compiling data on later breakdowns

What do control group receive? 12 different units for boys and 10 different units for girls What do both groups receive? ART Individual counselling Token economy Education (but see below) What differs MultifunC from the control group? Aftercare Family therapy Education (MultifunC group attends normal schools, control group often receive education at institutions)

Baseline – are the groups similiar? (ADAD) No group differences in age Average age 16 years No group differences in birth country Approx. 75% born in Sweden No group differences in parents’ civil status Approx. 36% of parents live together

Baseline – are the groups similiar? (ADAD) MultifunC Control Sig? Mother´s employment 73 79 % work 49 % work yes Father´s employment 69 86 % work 55 % work

Baseline- are the groups similar? YLS/CMI Total Score (baseline) No group differences Average score for entire group 27 No gender differences Per area: Majority high risk within: Prior- and current offences (73%) Education/Employment (65%) Peer relations (61%) Leisure/recreation (94%) Remaining areas moderate risk or equal number moderate- and high risk

Baseline- are the groups similar? YSR Internalizing problems: (N=78) No group differences Girls significantly higher scores than boys – for both groups Girls mean 18 Boys mean 11 Externalizing problems: (N=78) Average score for entire group 27 No gender differences - for both groups

Final words Good collaboration between research team and organization Long inclusion period Difficult to find and get in contact with youths at follow- up Large amount of resources… But possible!