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 ImplicationsThe 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.

In Sweden, children and youths can be placed in secure institutions either through social services or sentenced to closed youth care. These institutions have, in addition to confining the youth, extensive powers to further control them. This study analyzes the development of two such powers—seclusion and care in solitude—over time. These are restrictive measures, particularly seclusion, that may result in traumatic experiences for the youth and can also be perceived as a troublesome aspect of the work for the staff. Interviews with both staff and young people indicate that such events can have a negative impact on the relationship between the youth and the staff, a relationship that is central to the support and treatment the young people are to receive at the institution. It is therefore important to investigate variations in the use of these powers and what the variations may be due to in order to enable a reduced use of these powers.

This paper is based on a comprehensive study of all secure care institutions in Sweden, focusing on all decisions regarding seclusion or solitary care during the years 2008-2022. It examines variations over time between institutions and identifies factors (e.g., age, gender, citizenship, reasons for care, type of placement) that may indicate a higher or lower risk of being secluded or cared for in solitude. The paper also analyzes whether the association between these factors and the interventions remains stable or varies over time. Finally, it addresses whether the interventions are similar or different in these matters.

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.

I denna studie undersöks munhälsan hos unga som är placerade på Statens institutions styrelses (SiS) särskilda ungdomshem. I Sverige har regionerna ett långtgående ansvar att verka förebyggande och uppsökande och samtidigt säkerställa att det finns tillräckliga resurser för patienter som har särskilda behov av tandvårdsinsatser. När barn och unga, mot sin vilja, placeras på särskilda ungdomshem har samhället tagit ett särskilt ansvar för deras liv och hälsa, ett ansvar som delas mellan socialtjänst, region och de särskilda ungdomshemmen. Barn och unga på dessa låsbara institutioner har samma rätt till bästa möjliga hälsa, inklusive en god munhälsa, som andra jämnåriga. Tidigare forskning har dock visat att institutionsvårdade unga löper särskilt hög risk för bristfällig munhälsa. Samtidigt saknas studier som undersökt hur munhälsan är och uppfattas av unga vid särskilda ungdomshem och hur ansvariga verksamheter ser till att deras eventuella vårdbehov blir tillgodosett.

Syftet med studien är att öka kunskapen om munhälsan hos unga placerade på särskilda ungdomshem, hanteringen av konstaterade vårdbehov samt de ungas uppfattningar om munhälsa och stöd före och under placering. Samtliga delar av studien har genomförts på två ungdomshem. Data bygger på klinisk undersökning med mobil tandvårdsutrustning, inklusive röntgen (N=107) samt intervjuer med unga (N=23). Eventuell remisshantering på grund av behandlingsbehov, följdes upp via journaler och återrapportering till forskargruppen. För en enkätundersökning om hälsa, munhälsa och tandvård samlades material in från unga vid ytterligare ett ungdomshem (sammanlagt tre ungdomshem) (N=77).

Resultaten visar att nästintill samtliga undersökta unga uppvisade munhälsoproblem. Mest frekvent var hög förekomst av plack på tänderna. Antalet kariesskadade tänder var mer än det dubbla som för unga i allmänhet. Färre än var femte som undersöktes hade inte behov av lagning av hål i tänderna (manifest karies) och färre än var tionde ung person var helt fri från kariesskada (initial och manifest karies). Tandköttsinflam mation, frätskador och tecken på begynnande tandlossning var vanligt förekommande. Över 80 procent av de unga var i behov av vidare tandvård hos den reguljära tandvården, men av dessa var det färre än hälften som genomgick behandlingen de remitterats för. Enkätsvaren ger indikationer på att de unga hade sämre kostvanor och munhygienvanor än ungdomar i allmänhet. Ett fåtal uppfattade att de under sina olika placeringar fått information om hur de ska ta hand om sin mun och sina tänder. I både intervjuerna och enkäterna framkom att de unga förstod vikten av att ta hand om sin munhygien och ville ha fina tänder. Samtidigt gav de unga i intervjuer uttryck för att de på grund av sitt mående inte själva orkade prioritera sin hälsa. De unga förklarade också att ungdomshemmens säkerhetsrutiner och riskbedömningar kunde försvåra för dem att sköta sin munhälsa på det sätt de önskade, till exempel att använda tandtrådsbygel eller komma till tandvården. Genomgående uppfattade de unga att de saknade stöd från ungdomshemmen och socialtjänsten att ta hand om sin munhälsa. Det stöd de efterfrågade handlade om att få sin munhälsa uppmärksammad, hjälp i att skapa rutiner och möjlighet att komma till tandvården.

Sammanfattningsvis bör grundantagandet vara att unga är i behov av behandling för bristfällig munhälsa när de placeras på särskilda ungdomshem. SiS egna inskrivnings intervjuer underskattar dock gravt omfattningen av behandlingsbehov, där mindre än var tredje inskriven uppger problem med tänderna. Vid remiss till tandvården brister vårdkedjan påtagligt och unga som av socialtjänsten bedömts behöva vård under ytterst begränsande former, tillskrivs i stället ett stort egenansvar då de själva ska ordna så att de får komma till tandvården. Såväl rättsliga, ekonomiska och kunskapsmässiga hinder finns för att unga på särskilda ungdomshem ska behandlas värdigt och beredas tillgång till tandvård samt ges förutsättningar till god hälsa. Studien mynnar ut i flera implikationer för ungdomshem, socialtjänst, region, nationella organisationer och myndigheter (som Socialstyrelsen, Sveriges kommuner och regioner) och lagstiftande politiker.

In this study, the oral health of young people placed in secure residential care is explored. In Sweden, regional authorities hold an extensive responsibility to engage in preventive and outreach dental care efforts while ensuring adequate resources are available for patients with specific dental care needs. When children and young people are placed in secure residential care against their will, society assumes an extended responsibility for their lives and health. This responsibility is shared among child welfare services, regional health care authorities, and secure residential care. Children and young people in these locked institutions have the same right to the highest attainable standard of health, inclu ding good oral health, as their peers. However, previous research has shown that children in out-of-home care are at a significantly higher risk of poor oral health. At the same time, there is a lack of studies exploring the state of oral health among young people in secure residential care, their perceptions of oral health, and how responsible agencies address their potential dental care needs.

The aim of this study is to increase knowledge about the oral health of young people placed in secure residential care, the management of identified care needs, and the young people’s perceptions of oral health and support before and during placement. All parts of the study were conducted at two secure residential care institutions. Data were collected through clinical examinations using mobile dental units, including X-rays (N=107), and interviews with young people (N=23). Any referrals for treatment needs were followed up through dental records and referral responses to the research team. For a survey on health, oral health, and dental care, data were also collected from young people at a third secure residential care institution (a total of three institutions, N=77).

The findings reveal that almost all examined young people exhibited oral health problems. The most frequent issue was a high prevalence of dental plaque. The number of teeth with carious lesions was twice as many in comparison to young people in the general population. Fewer than one in five of those examined did not require fillings for cavities (manifest caries), and fewer than one in ten were entirely free from caries (both initial and manifest). Gingivitis, dental erosion, and signs of early periodontal disease were also common. Over 80% of the young people required further dental care from regular dental services, but fewer than half of these individuals received the treatment for which they had been referred. Survey responses indicate that the young people had poorer dietary and oral hygiene habits compared to the general young people population. Only a few reported receiving information during their placements on how to care for their oral health. Both in the interviews and survey responses, the young people highlighted that they understood the importance of maintaining good oral hygiene and aspired to have healthy teeth. At the same time, the interviews revealed that their mental health often prevented them from prioritising self-care. The young people also explained that the security routines and risk assessments at the secure residential care facilities hindered their ability to maintain oral hygiene as desired, such as using floss picks or attending dental appointments. Consistently, the young people perceived a lack of support from the secure residential care facilities and child welfare services in addressing their oral health. The support they requested involved recognising their oral health needs, assistance in establishing oral health routines, and opportunities to access dental care.

In summary, the main assumption should be that young people placed in secure resi dential care facilities need treatment for poor oral health. However, the intake interviews conducted at the secure residential institutions, severely underestimate the extent of treatment needs. In these interviews, fewer than one-third of the newly arrived young people report dental problems. Access to dental care is notably poor, and young people assessed by child welfare services as requiring out-of-home care under highly restrictive conditions are instead assigned significant personal responsibility to arrange their dental appointments. Legal, financial, and knowledge-related barriers exist, hindering young people in secure residential care facilities from being treated with dignity, granted access to dental care, and provided with the conditions necessary for good health. The study concludes with several implications for secure residential care facilities, child welfare services, regional healthcare authorities, national organisations and policymakers (such as the Swedish National Board of Health and Welfare, and the Swedish Association of Local Authorities and Regions), and legislative decision-makers.

In this paper, we present a relational analysis of young people's participation in a six-year research project focused on prevention and early support. With a relational understanding of agency as something evolving and situated, our aim is to explore boundaries of young people's participation in research.

During 2024, eleven young people, aged 13-18, were recruited to share their expertise in receiving support from professionals. We met with the young people between three and ten times each, both individually and in groups. By using methods such as “splots” and “river-of-experience”, we endeavoured to facilitate the young people's articulation of their learnings from their experiences. The results were presented in an audio documentary, performance, and posters.

In retrospect, we reflect upon our unfolding research-agency as facilitators, translators, and censors of the young people's messages to professionals. We also identified inherent tensions in involving young people in research – our efforts to acknowledge the young people’s competence and embrace participation as a relational process were challenged by context and by being one activity within a larger research project, without any power to influence policies or professional practices. We conclude by raising critical questions about involving young people in research to make a difference.

In Sweden, children and young people can be referred to secure institutions either through social services or sentenced to closed youth care. Staff in these institutions are supposed to provide care and treatment to troubled young people, at the same time as they have a unique authority of offering locked wards and use restrictive measures such as seclusion, care in solitude and bodily search. Restrictive measures, not least seclusion, risk being a traumatic experience for young people and can also be perceived as a troublesome aspect of the work for the staff. In this study, the aim is to analyse scope and variation over time of the most privacy infringing restrictive measures in secure care and how this is related to organisation, target group and staff’s work prerequisites, and, further, to form an understanding of how staff balance their task of providing both safety and treatment for young people.

The first part of the study indicates gender differences in the use of restrictive measures, where girls are more often subjected to seclusion. In this paper, we analyse field visits and interviews with staff and management at five secure care institutions with different target groups and security levels, to understand these gender differences. The paper delves into the question of how gendered perceptions of youth interact with treatment needs and organisation in how staff handle troubled boys and girls.

Berättelser från föräldrar till barn som placeras visar att det är föräldrar som kämpar med sin sårbarhet, att exponeras för samhällets dömande blickar och att omdefiniera relationen till sina egna barn. Institutionsvård behöver ses som ett stöd till de här familjerna och inte som en ersättning för familjer som misslyckats. Viktigast av allt är att bibehålla och stärka banden mellan placerade unga och deras utökade nätverk för att fler kan finnas kvar och stödja familjen även efter avslutad placering. 

This article explores how staff in Swedish secure care value and understand the rightsof the children and young people in their care. To be a staff member in secure caremeans having a professional role that includes viewing and relating to young people asindividual rights holders in a setting where care and treatment shall be provided to agroup of young people. However, this occurs in an environment characterised by strongcoercive and controlling elements. The study shows that the viewing and handling ofchildren’s rights is dependent on various trade-offs that staff make. Negotiations aboutwhat should be seen as rights frequently take place, leading to tensions regardingchildren’s status as individual rights holders. The study adds knowledge about how staffdescribe the nature of these tensions in the daily life of secure care units. Implicationsfor practice are discussed.

In Sweden, 21 different state-run secure care institutions have the unique authority to offer locked wards and use restrictive measures such as solitary confinement, care in solitude and bodily search. During the last decades, inspections have repeatedly revealed poor conditions and malpractice in Swedish secure care and lately an increased use of restrictive measures, such as solitary confinement. In the circumstances of secure care staff’s complex work tasks, poor conditions and the increasing use of restrictive measures (especially of girls), we are carrying out a study with the aim to analyse scope and variation over time of the most privacy infringing restrictive measures at secure care institutions and how this is related to organisation, target group and staff’s work prerequisites, and to form an understanding of how staff balance their task to provide both safety and treatment for young people. This presentation is based on the first part of the study, containing a quantitative analyse of the use of selected restrictive measures 2008-2022. Preliminary results show a great variation between different secure care institutions, along with variation due to young people’s gender and, in some extent, age. In the presentation we will focus on how these variations can be understood in relation to target groups, organisation and policy changes.

Med en utgångspunkt i en kritisk förståelse av barns rättigheter redogör författarna för barnkonventionens innehåll och undersöker dess betydelse för det preventiva arbetet på policynivå.