Stability and change in the field of residential care for children. On ownership structure, treatment ideas and institutional logics

Abstract

The field of residential care for children and youth in Sweden is often termed unstable and turbulent. During recent decades the field has been subject to many changes. In this study, the development and changes in the field of residential care for children and youth in terms of ownership structure and treatment ideas will be analysed. The study is particularly focused on the changes in ownership structure that have taken place during the 2010s. It also analyses changes in treatment ideas, and discusses how these may relate to transformations of ownership structures as well as to dimensions of institutional logics, such as legislation and other types of normative pressure from the environment. The result reveals that of the approximately 450 treatment oriented residential care units (excluding homes for refugee children), close to 80 % are today run by private companies and to a growing extent by large for-profit corporations. Paralleland possibly relatedto the changes in ownership structure, the dominant treatment ideas have changed over time. The changes in the field can be summarised as a transformation from small-scale establishments with a family logic, to large-scale establishments with a professional logic, or more specifically from a domination of small family run units with milieu therapy to big business and a focus on evidence based interventions.

Impression management in the market for residential care for children and youth in Sweden

“…It is not surprising that precisely these two approaches are emphasized. The idea of family‐likeness has had a great importance historically for residential care, and the idea of evidence‐based social work has become increasingly important during recent decades (Johansson, Denvall, & Vedung, 2015; Lundström et al, 2020). The two approaches are, however, not mutually exclusive, and many residential care organizations' descriptions of their treatment appear to belong somewhere on a continuum between an evidence‐based orientation at one end and a family‐like orientation at the other.…”

“…By mentioning either (or both) family and evidence‐based orientations in their self‐promotion, organizations are presumably hoping to gain trust from potential customers. Evidence‐based practice is likely perceived to give an impression of professionalism, whereas family‐likeness is likely perceived to give an impression of a safe and sound “normal” upbringing (Lundström et al, 2020).…”

“…The term care corporations was used to distinguish a subset of large companies with multiple subsidiaries that offer a range of care services, including eldercare and disability services as well as residential care for children 3 . From each subgroup, between one and five organizations were randomly selected, aiming to roughly reflect the market share of each type of organization (e.g., a predominance of small companies, followed by somewhat smaller proportion of large companies, and a very small proportion of not‐for‐profit organizations; see Lundström et al, 2020 for information about the market shares of different organizations). In total, 23 companies were selected from the national register (see Table 1), and their website data were collected between February 8 and 15, 2019.…”

“…The Swedish market for residential care, for children and youth, has been described as turbulent, as major changes in recent years have reshaped the client groups and organizational composition of the field (Lundström, Sallnäs, & Shanks, 2020). The arrival of large numbers of unaccompanied refugee children and youth, especially during 2015 and 2016, prompted growth (now subsiding) of facilities catering to this group, alongside pre-existing therapeutic units targeting children placed for reasons such as maltreatment in the home environment or their own behavioural problems.…”

“…Across both sub-fields, there has been an influx of for-profit providers into the market, although more so among the treatment-oriented units that are the focus of this article, three-quarters (76%) of which are privately owned. Furthermore, large companies have emerged, including care corporations, which are very large companies, listed on the stock exchange, or owned by investment or private equity firms, that offer a wide range of care services and operate multiple subsidiaries (Lundström et al, 2020).…”