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Paper

New developments on intensive treatment for young conducted disordered youth in The Netherlands

abstract

Background. It was not until recently that the admission of severely conduct disordered young people under a child protection measure to Dutch young offender institutions and youth prisons was questioned.

Strong pressure in Parliament over the last few years, resulted in the decision to develop new secure institutions especially meant for severely conduct disordered adolescents outside the juvenile justice system and legislative changes.

In financing the new institutions, the government asked for evidence-based interventions.

Purpose. In this presentation recent developments in the Dutch youth care system will be discussed by focussing on three issues:

  • the role of Dutch young offender institutions and youth prisons as providers of secure care until 1-1-2008 (overview of the political discussion on child protection cases, the need of secure care and the decision to increase the amount of secure settings),
  • the lack of knowledge on the needs of young people with severe problem behaviour, based on a review of 13 Dutch studies on the population in young offender institutions and youth prisons since 1990,
  • a review of what works for with young conduct disordered young people and the implications on the organisation of care.

Target population. The newly developed institutions are especially meant for children and young people under a child protection order. Most of them having severe conduct disorders and internalizing problems.

Source of information. The paper will be based on two studies conducted by our centre as a preparation and foundation if the new institutions: a review of population research and a needs analyses on child protection cases in young offender institutions (using the Matching Needs and Services method of the Dartington Social Research unit in England) and a review of 'what works' with conduct disordered young people in residential care.

 Key findings and recommendations. Thirteen Dutch studies on this specific population in about 15 years provide us with information of severe problem behaviour, delinquency, internalising problems and the differences between boys and girls and young people under a child protection measure and young people under a sanction. We could translate the characteristics into needs.

The studies show that all young people are in need of behavioural control: aggression management, acceptance of authority, attentiveness and adherence to rules. In view of the seriousness of the behavioural problems involved, this is not surprising. However, the young people's needs go beyond behavioural management. Among the most common needs for girls for example are the needs to relieve depressive conditions, to tackle self-mutilation and suicidal behaviour and to control drug use.

So far, our study has been the only one focussing on a more explicit description of the needs in child protection cases. In many of them, there is a need for accommodation outside the family setting, for reasons of safety or because the parents had serious problems themselves. In other cases, there is a need to improve the parents' parenting skills, to enhance interaction and communication within the family, or to strengthen the social networks of the young person and the parents. Frequently, it was apparent that the parents and others in the young person's environment needed information about the child's particular disorder or handicap, to enable them to understand more and cope better. Finally, many of the young people involved need help filling their time constructively.

The main difference between the need groups was found in the need for accommodation. For many young people short-term or longer-term residential care seemed necessary. In most cases structured and interdisciplinairy judgement of file-information (the way needs were formulated in our project) didn't lead to the formulation of a need for secure care.

In about a quarter of the admitted youngsters could stay at home, provided that intensive family treatment was arranged for to enhance parental skills and family relations.

Youth care agencies were invited by the Ministry of Welfare to set up new secure settings for conduct disordered young people To provide for evidence based interventions, a literature review was undertaken tot summarise the knowledge on (residential) treatment of severe behavioural problems and internalising psychiatric problems. Only agencies that intended to use evidence based interventions were said to get financed. As most of the thirteen new institutions have only recently opened their doors, exact information on the treatment programmas are not available yet.

Based on a review of literature the following was recommended:

  • a combination of cognitive behavioural therapy (esspecially cognitive skills training, cognitive restructuting and interpersonal problem solving skills training) and family interventions,
  • intensive family and multisystem interventions, like FFT and MST,
  • The use of small groups, fully equiped professionals, coaching and supervision of professionals, focus on prevention of deviancy training and other non-specific elements of effective interventions.

So far, especially the family intervention-component turns out to be difficult to implement in combination with residential care. Next to that the new settings turn out to be large-scale institutions. To close with, we will pay attention to some dilemmas in this new development as the use of security and the legal position of the adolescents admitted and their parents.

Key references

Boendermaker, L. (2006). Crisis admissions in Dutch juvenile justice institutions: finding a solution. Journal of Childrens Services, 4(1).

Ministry of youth and families (2007, June). Every opportunity for every child. Youth and Family programme 2007-2011. http://www.jeugdengezin.nl/english/youth-and-family-programme/.

Contacts: Leonieke Boendermaker, Netherlands Youth Institute (NJi), 3501 DE Utrecht, E-mail: l.boendermaker@nji.nl, Phone (31) 30 2306 778.

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