Coercive measures (eg, restraint and seclusion) remain common in child and adolescent psychiatric and residential care despite efforts to reduce their use. We conducted a mixed-methods systematic review of interventions to reduce coercive measure use. Eligible studies were published between Jan 1, 2005, and Feb 19, 2025; examined interventions in psychiatric, residential, or juvenile justice settings for people younger than 25 years; and reported quantitative outcomes, qualitative experiences, or both. 26 studies (13 quantitative and 13 qualitative) with low-to-moderate risk of bias were included. Quantitative synthesis associated interventions targeting organisational culture and staff practice with moderate-to-large reductions in coercive measures, whereas child-focused behavioural interventions showed smaller or more uncertain effects. Qualitative thematic synthesis generated four analytical themes emphasising relational care, collaboration, staff reflexivity, and organisational support. Integration indicated organisational and staff-focused interventions aligned most closely with qualitative themes and were associated with the largest effect sizes. Limitations include heterogeneity in interventions, settings, and outcome measures, precluding meta-analysis. Interventions most effective in reducing coercive practices in youth care settings are those that simultaneously address relational dynamics, staff reflexivity, and organisational culture. By aligning with both children's rights and staff perspectives, such multifaceted approaches appear promising, but their success is contingent on sustained structural and institutional support.

BACKGROUND:In most countries, a criminal conviction requires evidence that the individual committed the act and that they had the mental capacity to understand what they were doing and that it was wrong. Youth, as an indicator of brain development, is one factor affecting criminal capacity. Worldwide, this has commonly been managed in part by setting in law an age below which criminal incapacity is presumed, so no prosecution is possible. Considerable variation in the MACR was confirmed across 195 countries. Some countries have no MACR. Otherwise, the MACR ranges from 7 years (some African and South Asian countries) to 18 (some South American countries); many North Asian, European and a few African countries set theirs at 14 which is the most frequently found level, and also the minimum age recommended by the United Nations Convention on the Rights of the Child. Therefore, how do countries set or change their MACR? AIMS:To explore change, efforts to change and impact of change in MACR internationally. METHODS:Between February 1st 2022 and December 31st 2023, members of an international research group (GIRAF-Group of International Researchers in Adolescent Forensics) were asked to complete an emailed questionnaire about changes in the MACR, or efforts to change it, in their country since 2000. Reports were then collated, circulated and discussed within the group. RESULTS:Among the 14 countries responding in detail about the MACR, efforts to raise the MACR had been successful in three, but in nine such efforts had been unsuccessful; in at least two countries pressures were to lower their MACR, but in only one, Denmark, did that happen (from 15 to 14) in the data collection period (though this change was subsequently reversed). Factors most influencing retention of a lower age were exceptional individual cases, which triggered press and political interest in retaining a higher age, and well-evidenced and developed arguments from legal, social and medical or other clinical bodies. CONCLUSIONS AND IMPLICATIONS:The wide differences in the MACR between countries suggest under-use of evidence in deciding it. We need more governmental willingness to bring the MACR at least to the UN-recommended level-but accompanied by research into the impact of this. Efforts targeted exclusively on child and adolescent welfare may have less effect if they also force children through the criminal justice system, with consequent impact on self-identity and sense of citizenship. A low MACR is also likely to be more directly and indirectly costly than a higher one.

This article explores how staff in Swedish secure care value and understand the rights of the children and young people in their care. To be a staff member in secure care means having a professional role that includes viewing and relating to young people as individual rights holders in a setting where care and treatment shall be provided to a group of young people. However, this occurs in an environment characterised by strong coercive and controlling elements. The study shows that the viewing and handling of children's rights is dependent on various trade-offs that staff make. Negotiations about what should be seen as rights frequently take place, leading to tensions regarding children's status as individual rights holders. The study adds knowledge about how staff describe the nature of these tensions in the daily life of secure care units. Implications for practice are discussed.

Conditioned normality - stories of (ab)normal life during and after secure care placements Secure care for young people has an ambiguous mission. It is supposed to socially integrate troubled young people into society by excluding them from the same. As such, young people are supposed to be normalised by abnormal interventions. Young people in secure care also experience the placement as deviant. In this study, we depart from a relational understanding of normality and stories of apology, ‘sad tales’, to explore how young people understand and do normality during and after placement in secure. This interview-based study builds on almost a decade-long engagement with 11 young people, following their lives after institutional placement. The analysis demonstrates three different ways of doing normality: 1) integrating the normalisation practices of the institution in their current life, 2) distancing and, if possible, hiding their experiences from others and, 3) isolating themselves from overly close relationships because of repeated betrayals from adults. Although different in character, these three ways are underpinned by a focus on self-reliance and independence, and an emergent need ‘to behave’. This study is a reminder that institutional practices of normality create a feeling of being deviant many years after leaving the institution. Thus, the need for developing supporting structures and relations that acknowledge and address the young people’s experiences of abnormality and in such way enable them to feel respected, valued and cared for, is emphasised.

AbstractIn this article the authors present a meta-synthesis of their studies on secure institutions in Sweden and Denmark. The aim of the metasynthesis is to explore how the context of confinement shapes the possibilities for providing treatment and positive change for at-risk youth. Drawing on meta-synthesis methodology the authors extract content from nine studies published in 20 articles. We highlight three dimensions, which are a) treatment practices and behavioural regulation, b) the carceral materialities and sociomaterial practices, and c) relations. We argue that while treatment is curtailed by confinement, improvements can be made to support more successful change among at-risk youth and smooth their transition into adulthood. Artiklen præsenterer en metasyntese af ni studier om sikrede institutioner i Danmark og Sverige. Formålet med metasyntesen er at undersøge, hvordan frihedsberøvelse rammesætter behandling og forandringsarbejde med unge i udsatte positioner. Forfatterne analyserer 20 artikler fordelt på ni studier, de selv har gennemført. Analysen har fokus på tre centrale forhold; a) behandlingsarbejde og adfærdsregulering, b) materialitet og sociomaterielle praktikker, og c) relationer. Vi argumenterer for, at behandling påvirkes af frihedsberøvelse, men med forbedringer kan behandling på sikret institution bidrage til at skabe positiv forandring og sikre de unges overgang til voksenliv.

Children's and young persons' rights have received increasing been focus in recent decades, due in a significant degree to the UN Convention on the Rights of the Child. In Sweden, compulsory care in the social-services system is disputed, not least for the forceful measures that facility personnel have at their disposal to control children in certain conflict situations. The general aim of this article is to examine how the increased emphasis in Sweden on children's rights is promoting resilience for children and youth in youth compulsory secure-care settings. A more general question is whether the child-rights discourse leads in practice to increased resilience for children and youth in this setting, or even in general. The empirical material shows that children and young people's perceptions of care and treatment are strongly linked to their interactions with staff and how the staff use restrictive measures. Applying Martha Fineman's vulnerability theory in this context means that achieving resilience demands an analysis of the institutional settings in which children and young persons live their day-to-day lives, including their relationships in this setting. Comparing the legal possibilities of physical constraint with interviews of children and personnel reveals that relevant legislative frameworks and children's-rights discourse should serve as a protection mechanism for children and youths, but in real life, these seem to have limited effect.

Secure care in Sweden is the most intrusive child welfare intervention, and children and their family members have restricted contact. For each child in secure care, there are at least twice as many affected family members and parents who must manage the consequences of this institutionalization. Clearly, it is just as important to understand how secure care affects parents as it is to understand how secure care affects children. To address this issue, we conducted in-depth interviews with 11 parents to eight children who had been placed in secure care during their childhood, focusing on the institutional and societal structures that affected these parents and their parenting. With a narrative approach, stories alluding to a metaphor of war are identified. These stories reveal how all parents (but especially single mothers) are affected by their diverse socio-economic positions and the rigid frames of family life presumed by child welfare interventions. In these narratives, parenting emerges as a social practice rather than a skill. Above all, the stories demonstrate a great deal of vulnerability and sensitivity of parenting. The findings raise critical questions about the meaning and overarching consequences of institutional interventions in a family life.

In this article I reflect on research relationships in a qualitative longitudinal (QL) project from a relational perspective, understanding agency as interdependent and evolving. My reflections are based on a study involving repeated interviews over eight years with young people who have experienced secure care, which is the most intrusive form of intervention for troubled youths in the Swedish child welfare. Research using a QL methodology requires a delicate balance in maintaining professional boundaries in relationships between the researchers and participants and emphasizes how time and place are embedded in relations. I explore the complexities of research relationships over time and the effect of repeated research encounters on understandings of time. My reflections are grouped into three themes: emotional footing, intersections of time and place, and evolving research agencies. While emotions from early encounters became a resource for my reflections as a researcher, return interviews turned me into an embodiment of time, producing linear-time narratives of progress, and the agencies of both me and young people evolved within and beyond the research project. I offer some conclusions for qualitative social work research regarding the effects of emotional, temporal and spatial dimensions on researcher vulnerability and research relationships over time.

BACKGROUND:Estimates suggest that over a million children per year are deprived of their liberty across the world. Little is known about the types, ethos or distribution of secure beds in which they are detained.AIM:This study aims to provide quantitative data with background information, to explore similarities and differences across jurisdictions, and to inform critical inquiry into key concepts and practices.METHODS:Data was obtained using an opportunistic sample of affluent countries, derived from an emerging academic/practice network of senior professionals. Depending on jurisdiction, data was already in the public domain or specifically requested. Data requests were related to the nature and size of health, welfare and criminal justice elements of secure beds and recent occupancy. Key professionals working in child secure settings, within jurisdictions, provided commentary on local approaches.RESULTS:Data was incomplete but allowed for comparisons between 10 jurisdictions. The proportions of the populations of children and young people detained varied by jurisdiction as did their distribution across variations of secure settings. Not all jurisdictions had all three kinds of secure settings. Definitions of secure beds varied depending on the use of relational, procedural or physical security.CONCLUSION:Findings are tentative but suggestion solely considering numerical descriptions of children's detention is misleading; our study highlights ways in which comparative studies may be improved. Within reported jurisdictions, the framework of health, welfare and justice was meaningful but this may not hold true with a wider international application of this method. Open interrogation of this data would be enhanced by the inclusion of children's perspectives.

This study based in Sweden explores family practices and family displays among young adults with a history of secure care, which limits and restricts contacts and therefore causes fundamental changes in relationships. Almost 10 years after institutional placement, narrations of 11 young adults and 11 nominated family members reveal ongoing struggles between imagined and lived realities of family. These struggles are revealed by memories and emotions evoked by the context of secure care and show how deeply the secure care penetrated their family lives. By using the metaphor of shadows, shadows of recalled horror of secure care (reflecting family displacement) and the pressure to make family work (reflecting restricting practices in secure care where only (birth) family were considered as family and relations of (natural) importance) are discerned. We call for more attention to the perversity of secure care arrangements, at both policy and institutional levels.

This article reviews and compares the use of confinement and other restrictive measures against young people under 18 in child welfare and/or the criminal justice systems in Denmark, Sweden, Finland, and Norway. Young people are confined for a variety of reasons, including protection, care, treatment, and punishment. However, confinement of young people is a contested issue because it can be viewed as necessary but also potentially harmful. Comparison of legislation and practices reveals that while there are some similarities in the service provisions for young people, there are also significant disparities among the four countries regarding the organization, function, and frequency of the use of confinement and restrictive measures. While Denmark and Sweden use secure welfare institutions, Finland and Norway apply other restrictive measures. Despite the differences in approaches to confinement in the Nordic countries, the use of confinement is guided by the principle of the child's best interest, and the child welfare system is the main frame for confinement and intervention. The article discusses these disparate practices from the perspective of children's rights and identifies new avenues for research and practice.

This article analyses how young people, with experiences of secure care, relate to the contradictory images of children in child welfare: the child in danger and the dangerous child. The study is based in Sweden and consists of in-depth interviews with 16 youths conducted repeatedly (three times) over a period of 2 years. Using the perspective of relational sociology, we demonstrate how abstract images of children are materialized through the institutional practices of broken, interrupted, forbidden and forced relations. Within this context, young people are found to relate differently to being placed in the institution by negotiating, opposing and transposing. All practices display their unfolding agency and struggle to make sense of the experience. The restrictive practices seem to deny young people relations through which a sense of safety and care can be established. We conclude by putting into question the very foundations of secure care within child welfare services.

This article explores refugee girls’ talk about friendship formation. Friendship is a complex process and a subjective experience. The study participants stressed similarity and cultural affinity as important criteria of forming friendships. Those who attended schools with a mixture of students described their native peers as having different temperaments and interests. Relatives were referred to as being best friends who one could trust and confide in. This suggests the need for a broad conceptualisation of friendship in research and practice.

Anpassningsstrategier och tolkningsforetrade : Ungas erfarenheter av att utredas pa institution

This article explores young people's understandings of assessments conducted in secure accommodation. The concepts of institutional identity' and text-mediated' actions have been used in the analysis. The main empirical material is repeated interviews with assessed young people during a two-year period. In the findings, the stories of three young people display understandings of appreciation, disappointment and self-development. The assessments seem to have made the youths aware of their failings and faults'. An analysis of the written assessments found institutional identities of inner problems and unstructured everyday lives'. In conclusion, the young people's understandings of the meanings and implications of the assessments are suggested to be connected to the caseworkers' text-mediated actions and their position in the assessment process. The young people's stories indicate the need to consider the institutional context of the assessments and to acknowledge young people's efforts in care.

This paper examines caseworkers' efforts to plan and find appropriate interventions for troublesome young people. Strauss's concept of trajectory is applied to analyse how Swedish caseworkers shape and manage the evolving care trajectories using assessments for young people in secure accommodation, i.e. institutional youth assessments. The empirical material consists of surveys to 82 caseworkers concerning 85 institutional youth assessments and interviews with 16 of these caseworkers. The findings reveal ongoing care trajectories that are out of control where the assessments are seen as an opportunity of change for the youths. Diagnoses, confirmations and plans for action are provided through the assessments and used by the caseworkers in negotiations for resources. Three orientations of contributions to the caseworkers' management of care trajectories were found, all reflecting the many uncertainties of child welfare work: child centred, professional and discharge of liability. In conclusion, the caseworkers searched for the right measures to manage change and achieve youth compliance, but it was also a matter of managing professional and organizational contingencies and passing on responsibility.

Unga kan placeras på Statens institutionsstyrelses (SiS) institutioner för att utredas tvärprofessionellt. Utredningarna leder fram till förslag på fortsatt vård som socialtjänsten tar ställning till och beslutar om. I artikeln analyseras en sekvens av utredda ungas banor i samhällsvården.

In Sweden, young people are assessed in institutions at the request of the social services, a situation that can be described as being in limbo, in a state of uncertainty. Using the concepts of self-presentation and institutional processes in total institutions, this research aims to analyse young people's perceptions of being assessed in secure accommodation. The empirical material consists of repeated interviews with 16 adolescents assessed in secure accommodation. Three situations were identified in which the young people felt that their self-presentations were in some way in or out of their control: the placement situation; the assessment situation and the assessment-outcome situation. The youths perceived their self-presentations to be influenced by the setting (i.e., the institution). In addition, there were two parts to being in limbo: being on site in the institution and being distant from the social services. The young people's experience of being assessed in an institution was characterized by feelings of a loss of control over self-presentation and of their perceptions of themselves.