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1.	Björkenstam, Emma, et al. (author) Childhood adversity and psychiatric disorder in young adulthood : An analysis of 107,704 Swedes 2016 In: Journal of Psychiatric Research. - : Elsevier BV. - 0022-3956 .- 1879-1379. ; 77, s. 67-75 Journal article (peer-reviewed)abstract Childhood adversity (CA) is associated with increased risks of psychiatric disorder in young adulthood, but details in this association are less known. We aimed to explore the association of a range of CA indicators with psychiatric disorder in young adulthood, and the impact of age at exposure, disorder type and accumulation of indicators. We capitalized on Sweden's extensive and high-quality registers and analyzed a cohort of all Swedes (N = 107,704) born in Stockholm County 1987-1991. Adversities included familial death, parental substance misuse and psychiatric disorder, parental criminality, parental separation, public assistance recipiency and residential instability. Age at exposure was categorized as: 0-6.9 years (infancy and early childhood), 7-11.9 years (middle childhood), and 12-14 years (early adolescence). Psychiatric disorders after age 15 were defined from ICD codes through registers. Risks were calculated as Hazard Ratios (HR) with 95% confidence intervals (CI). Results showed that exposure to at least one CA was associated with an increased risk of psychiatric disorder (HR 1.4, 95% CI: 1.3-1.4). Risks were increased for mood, anxiety, and psychotic disorders and ADHD but not for eating disorders. The risk varied with type of disorder but was similar for all exposure periods. Individuals with multiple (3+) CAs had a two-fold risk of psychiatric disorder (HR 2.0, 95% CI: 1.9-2.1). In conclusion, our findings support the long-term negative impact of CA on mental health, regardless of developmental period of exposure. Given that experience of CA is common, efforts should be put to alleviate the burden of childhood adversities for children, particularly among the most disadvantaged.
2.	Björkenstam, Emma, et al. (author) Childhood household dysfunction, school performance and psychiatric care utilisation in young adults : a register study of 96 399 individuals in Stockholm County 2016 In: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 70:5, s. 473-480 Journal article (peer-reviewed)abstract Background Exposure to childhood household dysfunction increases the risk of psychiatric morbidity. Although school performance also has been linked with psychiatric morbidity, limited research has considered school performance as a mediating factor. To address this gap in the literature, the current register study examined whether school performance mediates the association between childhood household dysfunction (experienced between birth and age 14 years) and psychiatric care utilisation in young adulthood.Methods We used a Swedish cohort of 96 399 individuals born during 1987–1991. Indicators of childhood household dysfunction were familial death, parental substance abuse and psychiatric morbidity, parental somatic disease, parental criminality, parental separation/single-parent household, public assistance recipiency and residential instability. Final school grades from the 9th year of compulsory school were used to create five categories. Estimates of risk of psychiatric care utilisation (measured as inpatient, outpatient and primary care) after the age of 18 years were calculated as HRs with 95% CIs. Mediation was tested with the bootstrap approach.Results Cumulative exposure to childhood household dysfunction was positively associated with psychiatric care utilisation. Specifically, individuals exposed to three or more indicators with incomplete school grades had the highest risk (HR=3.7 (95% CI 3.3 to 4.1) after adjusting for demographics), compared to individuals exposed to no indicators with highest grades. School performance was found to mediate the relationship.Conclusions Our findings suggest that future efforts to prevent or mitigate the negative effects of childhood household dysfunction on psychiatric morbidity may benefit from integration of strategies that improve school performance among vulnerable youth.
3.	Björkenstam, Emma, et al. (author) Cumulative childhood adversity, adolescent psychiatric disorder and violent offending in young adulthood 2019 In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 29:5, s. 855-861 Journal article (peer-reviewed)abstract BackgroundChildhood adversity (CA) is a risk indicator for psychiatric morbidity. Although CA has been linked to violent offending, limited research has considered adolescent psychiatric disorder as a mediating factor. The current study examined whether adolescent psychiatric disorder mediates the association between CA and violent offending.MethodsWe used a cohort of 476 103 individuals born in 1984–1988 in Sweden. Register-based CAs included parental death, substance abuse and psychiatric disorder, parental criminal offending, parental separation, public assistance, child welfare intervention and residential instability. Adolescent psychiatric disorder was defined as being treated with a psychiatric diagnosis prior to age 20. Estimates of risk of violent offending after age 20 were calculated as incidence rate ratios (IRRs) with 95% confidence intervals (CIs). Mediation was tested with the bootstrap method.ResultsExposure to CA was positively associated with violent offending, especially when accumulated. Individuals exposed to 4+ CAs who were also treated for psychiatric disorder had a 12-fold elevated risk for violent offending (adjusted IRR 12.2, 95% CI 10.6–14.0). Corresponding IRR among 4+ CA youth with no psychiatric disorder was 5.1 (95% CI 4.5–5.6). Psychiatric disorder mediated the association between CA and violent offending.ConclusionCA is associated with elevated risk for violent offending in early adulthood, and the association is partly mediated by adolescent psychiatric disorder. Individuals exposed to cumulative CA who also develop adolescent psychopathology should be regarded as a high-risk group for violent offending, by professionals in social and health services that come into contact with this group.
4.	Björkenstam, Emma, et al. (author) Cumulative exposure to childhood stressors and subsequent psychological distress. An analysis of US panel data 2015 In: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 142, s. 109-117 Journal article (peer-reviewed)abstract Research has shown that childhood stress increases the risk of poor mental health later in life. We examined the effect of childhood stressors on psychological distress and self-reported depression in young adulthood. Data were obtained from the Child Development Supplement (CDS) to the national Panel Study of Income Dynamics (PSID), a survey of US families that incorporates data from parents and their children. In 2005 and 2007, the Panel Study of Income Dynamics was supplemented with two waves of Transition into Adulthood (TA) data drawn from a national sample of young adults, 18-23 years old. This study included data from participants in the CDS and the TA (n = 2128), children aged 4-13 at baseline. Data on current psychological distress was used as an outcome variable in logistic regressions, calculated as odds ratios (OR) with 95% confidence intervals (CI). Latent Class Analyses were used to identify clusters based on the different childhood stressors. Associations were observed between cumulative exposure to childhood stressors and both psychological distress and self-reported depression. Individuals being exposed to three or more stressors had the highest risk (crude OR for psychological distress: 2.49 (95% Cl: 1.16-5.33), crude OR for self-reported depression: 2.07 (95% CI: 1.15-3.71). However, a large part was explained by adolescent depressive symptoms. Findings support the long-term negative impact of cumulative exposure to childhood stress on psychological distress. The important role of adolescent depression in this association also needs to be taken into consideration in future studies.
5.	Hjern, Anders, et al. (author) Children as next of kin in Sweden 2017 Reports (other academic/artistic)abstract Översikten är en sammanfattning av åtta rapporter om barn som anhöriga i Sverige. Rapporterna har gjorts inom ramen för ett regeringsuppdrag om ett brett nationellt utvecklingsarbete där Socialstyrelsen, Folkhälsomyndigheten och Sveriges Kommuner och Landsting samarbetar för att stärka stödet till barn och unga i familjer med missbruk, allvarlig sjukdom eller psykisk ohälsa, eller då en förälder avlider.
6.	Almquist, Ylva B., et al. (author) A decade lost : does educational success mitigate the increased risks of premature death among children with experience of out-of-home care? 2018 In: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 72:11, s. 997-1002 Journal article (peer-reviewed)abstract Background: Past research has consistently identified children with experience of out-of-home care (OHC) as a high-risk group for premature mortality. While many have argued that educational success is a key factor in reducing these individuals’ excessive death risks, the empirical evidence has hitherto been limited. The aim of the current study was therefore to examine the potentially mitigating role of educational success for the association between OHC experience and premature mortality.Methods: Drawing on a Stockholm cohort born in 1953 (n=15,117), we analysed the associations between placement in OHC (ages 0-12), school performance (ages 13, 16, and 19), and premature all-cause mortality (ages 20-56) by means of Cox and Laplace regression analysis.Results: The Cox regression models confirmed the increased risk of premature mortality among individuals with OHC experience. Unadjusted Laplace regression models showed that these children died more than a decade, based on median survival time, before their majority population peers. However, among individuals who performed well at school, i.e. scored above-average marks at age 16 (grade 9) and age 19 (grade 12), respectively, the risks of premature mortality did not significantly differ between the two groups.Conclusion: Educational success seems to mitigate the increased risks of premature death among children with experience of OHC.
7.	Axberg, Ulf, 1961, et al. (author) SBU har ordet: metoder som används i Sverige bör prövas vetenskapligt 2018 In: Socionomen. - 0283-1929. ; 2018:5 Journal article (other academic/artistic)
8.	Berg, Lisa, et al. (author) Parental alcohol-related disorders and school performance in 16 year olds - a national cohort study 2016 In: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 111:10, s. 1795-1803 Journal article (peer-reviewed)abstract To study the links between parental alcohol-related disorders and offspring school performance and, specifically, whether associations vary by gender of parent or child and whether associations are mediated by other adverse psychosocial circumstances commonly appearing together with parental alcohol problems, such as parental mental health problems or criminal behaviour.Register study in a national cohort.SettingSweden.740 618 individuals born in Sweden in 1990-1996.Parental hospital admissions for alcohol-related disorders and school performance in their offspring, in the final year of compulsory school at age 15-16, was analysed in relation to sociodemographic confounders and psychosocial covariates, using linear and logistic regressions.Both mothers’ and fathers’ alcohol-related hospital admissions were associated with lower z-scores of grades and national mathematic tests scores. After adjustment for parental education and sociodemographic confounders, beta-coefficients of z-scores of grades were -0.42 (95% CI -0.45, -0.39) and -0.42 (95 % CI -0.43,-0.40), and beta-coefficients of mathematic tests scores were -0.36 (95% CI -0.39, -0.33) and -0.31 (95% CI -0.33, -0.29), for mothers’ and fathers’ alcohol-related disorders, respectively. Adjusted ORs for not being eligible for secondary school were 1.99 (95% CI 1.84-2.15) and 2.04 (95% CI 1.95-2.15) for mothers’ and fathers’ alcohol-related disorders, respectively. Adjusting the analyses for psychosocial factors in the family almost eradicated the statistical effects of parental alcohol-related disorders on offspring school performance to beta-coefficients of 0.03 to -0.10 and ORs of 0.89 to 1.15. The effect of a mother's alcohol-related hospital admission on school performance was stronger in girls than in boys, whereas no gender differences were seen for a father's alcohol-related hospital admission.ConclusionsIn Sweden, alcohol-related disorders in both mothers and fathers are associated with lower school performance in their children at age 15-16, with most of the statistical effects being attributed to psychosocial circumstances of the family, such as parental psychiatric disorders, drug use, and criminality and receipt of social or child welfare interventions.
9.	Bergström, Martin (creator_code:cre_t) Insatser för bättre psykisk och fysisk hälsa hos familjehemsplacerade barn 2017 Reports (other academic/artistic)
10.	Bergström, Martin, et al. (author) Insatser för bättre psykisk och fysisk hälsa hos familjehemsplacerade barn: En systematisk litteraturöversikt och utvärdering av ekonomiska, samhälleliga och etiska aspekter. 2017 Book (other academic/artistic)abstract Barn i utsatta situationer kan under kortare eller längre perioder behöva place- ras i en annan familj. Bland barn som växer upp i familjehem är det vanligare med psykisk och fysisk ohälsa. Det är därför viktigt att veta om stödinsatser till barn och familjehemsföräldrar kan hjälpa barnen. Slutsatser X Insatser till familjehemsplacerade barn och familjehemsföräldrar kan för- bättra barnens psykiska och fysiska hälsa, sociala situation, livskvalitet samt placeringars stabilitet. På grund av olikheter mellan insatserna och studier- nas vetenskapliga utformning går det inte att avgöra vilka insatser eller vilka delar av insatserna som är verksamma. X För följande tre specifika insatser finns något säkrare kunskap om effekter: • Attachment and Biobehavioral Catch-up är en utbildning för familje- hemsföräldrar som kan minska vissa psykiska symtom hos barnen • Föräldradelen av programmet Incredible Years kan minska barns beteendeproblem och öka familjehemsföräldrars förmåga att klara föräldrarollen • Take Charge är en specialpedagogisk insats till ungdomar som kan förbättra deras självbestämmande, utbildningsgång och möjligheter till arbete. X Ingen av de insatser som används i Sverige har utvärderats i en studie. I Sverige läggs tonvikten på att utreda familjers lämplighet och att utbilda dem. Att erbjuda stödinsatser till barn eller familjehemsföräldrar under barnens placering är mindre vanligt. Personer som har växt upp i familje- hem, deras föräldrar och familjehemsföräldrar efterlyser stöd till barn och familjehem under placeringen. X Det behövs forskning som undersöker effekten av insatser inom familje- hemsvård. Samtliga insatser som identifierades i litteraturöversikten bör rimligtvis kunna användas i Sverige men deras effekter behöver följas upp och utvärderas i en svensk kontext. De insatser som redan förekommer i Sverige behöver också utvärderas och undersökas vetenskapligt. Det behövs även studier som belyser kostnadseffektivitet i insatser för svenska förhållanden. Bakgrund och syfte Mellan 3 och 4 procent av alla barn i Sverige placeras någon gång i ett familje- hem eller på en institution. Under sitt liv har dessa barn en förhöjd risk för suicid, psykisk och fysisk ohälsa, missbruk, kriminalitet och behov av långvarigt försörjningsstöd. Syftet med denna rapport är att granska och sammanställa det vetenskapliga underlaget för stödinsatser till barn i familjehem och till familje- hemsföräldrar för att minska dessa risker. Metod Den systematiska utvärderingen genomfördes i enlighet med SBU:s metodik. Studierna skulle behandla insatser som utvärderats i kontrollerade studier med hög eller medelhög studiekvalitet. Studierna skulle vara publicerade mellan åren 1990 och 2017 och inkludera minst 40 personer. Uppföljningstiden skulle vara minst tre månader för barn två år eller äldre, och minst en månad för barn yngre än två år. Studier uteslöts om jämförelsegruppen utgjordes av grupp- boende eller om den till stor del bestod av barn som var placerade i släkting- hem. Den systematiska utvärderingen inkluderar även ekonomiska aspekter, en inventering av vilka insatser som används i Sverige, erfarenheter från brukar- organisationer samt en etisk analys. Resultat Effekter av insatser Sammanlagt granskades 5 298 artikelsammanfattningar. Relevans- och kvali- tetsgranskningen identifierade 23 studier av 18 insatser som motsvarade våra kriterier. Sammantaget visar de 23 studierna att det går att påverka familje- hemsplacerade barns psykiska och fysiska hälsa, sociala situation, livskvalitet samt placeringars stabilitet. På grund av olikheter mellan insatserna och studier- nas vetenskapliga utformning ger resultaten inte entydiga svar på vilka insatser eller vilka delar av insatserna som är verksamma. För tre av insatserna finns ett begränsat vetenskapligt stöd för att de har effekt: Attachment and Biobehavioral Catch-up kan förbättra barns psykiska hälsa (t.ex. minskad stress); Take Charge kan förbättra barns förmåga till självbestäm- mande samt sociala situation (t.ex. fullföljd utbildning) och Incredible Years kan öka familjehemsföräldrars förmåga att klara föräldrarollen och minska barnens beteendeproblem. Effekterna av de övriga 15 insatserna går inte att bedöma eftersom de endast utvärderats i en studie vardera. Det saknas helt studier som belyser barns tandhälsa och förebyggande av ton- årsgraviditeter. Det saknas också studier av eventuella skadliga eller oönskade effekter av insatserna. Praxisundersökning En enkät skickades ut till ett slumpvis urval kommuner (svar från 80 av 106) och samtliga enskilda företag som arbetar på kommuners uppdrag (svar från 34 av 38). Enkäten identifierade 30 insatser. Ingen av insatserna återfinns i littera- turöversikten. Det framkom bland annat att insatserna fokuserar på bedömning av lämplighet av familjehemsföräldrar och på allmän utbildning av dem före barnen placeras. Det var mindre vanligt med stöd till barn eller familjehems- föräldrar under placeringen. Att döma av de insatser som används saknas kon- sensus om vilka insatser som uppfattas som effektiva. Kostnadseffektivitet Totalt granskades 2 120 artikelsammanfattningar. Två relevanta artiklar hittades men ingen uppfyllde SBU:s krav på kvalitet i den ekonomiska utvärderingen. Studiernas resultat går inte att överföra till svenska förhållanden. Brukar- och anhörigperspektiv Fyra organisationer som företräder barn med erfarenhet av familjehemsvård, deras föräldrar samt familjehemsföräldrar besvarade enkäter eller intervjuades. De efterlyser mer stöd utöver själva placeringen. Dessutom önskar familjehems- föräldrar bättre kunskap om barnets behov vid placeringen och ursprungsför- äldrarna efterlyser stöd för att få vara delaktiga i sina barns liv. sammanfattning och slutsatser 9 insatser för bättre psykisk och fysisk hälsa hos familjehemsplacerade barn Etiska och sociala aspekter När samhället övertar ansvaret för barns vårdnad så finns en särskild skyldighet att tillgodose barnens bästa. Att samhället inte alltid tagit sitt ansvar visar bland annat den så kallade Vanvårdsutredningen (SOU 2011:61). Ett problem är bristen på vetenskaplig kunskap om insatsers för- och nackdelar vilket äventyrar barns rättigheter. Ett annat problem är bristande dokumentation och uppfölj- ning av de insatser som används. Diskussion Vi bedömer att insatserna från litteraturöversikten kan användas i svensk familjehemsvård med överförbara resultat för barnen. Om beslut fattas att införa nya insatser bör man vara uppmärksam på att många kommuner är små med få placerade barn, vilket kan skapa problem med att upprätthålla tillräcklig kompetens. De som arbetar i familjehemsvården är många gånger ovana vid den systematik som insatserna kräver. Även med ökad tillgång på vetenskaplig kunskap om insatsers effekter behövs rutiner för att på ett ordnat sätt införa, vidmakthålla och utmönstra insatser inom familjehemsvården. Detta kan ske genom lokal uppföljning där både positiva och negativa effekter följs upp syste- matiskt och dokumenteras. I förlängningen ger det möjlighet till uppbyggnad av kvalitetsregister. Framtida forskning bör inriktas på att undersöka nyttan av de insatser som används idag eller som kan komma att införas.
11.	Bergström, Martin, et al. (author) Interventions to improve foster children’s mental and physical health: A systematic review and assessment of the economic, social and ethical aspects. Executive summary. 2017 Reports (other academic/artistic)
12.	Berlin, Marie, et al. (author) Dental health care utilization among young adults who were in societal out-of-home care as children : a Swedish national cohort study 2018 In: International Journal of Social Welfare. - : John Wiley & Sons. - 1369-6866 .- 1468-2397. ; 27:4, s. 325-336 Journal article (peer-reviewed)abstract We used Swedish national registers to analyse dental health care among young adults with childhood experience of out‐of‐home care (OHC), in Cox regression analyses. All 1.7 million Swedish residents born in 1980–1994 were included, of whom 4% had been in OHC. The population was followed up in the Dental Health Register from age 20 to 29, during the period 2009–2014. We found that persons with short or long OHC experience made emergency dental care visits more often than their majority‐population peers: 17–23% versus 9–10%, (adjusted Hazard ratios [HR:s] 1.60–2.02); they more often had tooth extractions, 9–12% versus 3% (HR:s 2.33–3.03); but less regularly visited a dentist for planned check‐ups, 61–77% versus 80–87% (HR:s 0.76–0.78). Since dental health in young adulthood reflects dental health and dental care in childhood, the findings of this study call for improved preventive dental health care for children in OHC.
13.	Berlin, Marie, et al. (author) Educational outcomes of children from long-term foster care : Does foster parents’ educational attainment matter? 2019 In: Developmental Child Welfare. - : SAGE Publications. - 2516-1032 .- 2516-1040. ; 1:4, s. 344-359 Journal article (peer-reviewed)abstract Parental education is a robust predictor of children’s educational outcomes in general population studies, yet little is known about the intergenerational transmission of educational outcomes in alternative family settings such as children growing up in foster care. Using Swedish longitudinal register data on 2,167 children with experience of long-term foster care, this study explores the hypothesized mediating role of foster parents’ educational attainment on foster children’s educational outcomes, here conceptualized as having poor school performance at age 15 and only primary education at age 26. Results from gender-stratified regression analyses suggest that there was an association between foster parental educational attainment and foster children’s educational outcomes but that the educational transmission was weak and inconsistent and differed somewhat between males and females. For males, lower educational attainment in foster parents was associated with poor school performance but was not associated with educational attainment at age 26. The reverse pattern was found among females: the educational gradient was inconsistent for poor school performance but appeared in educational attainment. The results indicate that supported interventions for improving foster children’s educational achievements are needed, even when placements are relatively stable and foster parents have a long formal education.
14.	Björkenstam, Emma, et al. (author) Adverse childhood experiences and disability pension in early midlife : results from a Swedish National Cohort Study 2017 In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 27:3, s. 472-477 Journal article (peer-reviewed)abstract Background: Few studies have examined the association between adverse childhood experiences (ACEs) and disability pension (DP). The current study aimed to investigate the relationship between different ACEs, cumulative ACEs, and DP, and the mediating role of school performance. Methods: We used a Swedish cohort of 522 880 individuals born between 1973 and 1978. ACEs included parental death, parental substance abuse and psychiatric disorder, substantial parental criminality, household public assistance, parental DP and child welfare intervention. Estimates of risk of DP in 2008 were calculated as odds ratios (OR) with 95% confidence intervals (CIs). Results: A total of 2.3% (3.0% females, 1.7% males) received DP in 2008. All studied ACEs increased the odds for DP, particularly child welfare intervention and household public assistance. Cumulative ACEs increased the odds of DP in a graded manner. Females exposed to 4+ ACEs had a 4-fold odds (OR: 4.0, 95% CI 3.5-4.5) and males a 7-fold odds (OR: 7.1, 95% CI: 6.2-8.1). School performance mediated the ACEs-DP association. Conclusion: This study provides evidence that ACEs is associated with increased odds of DP, particularly when accumulated. The effects of ACEs should be taken into account when considering the determinants of DP, and when identifying high-risk populations.
15.	Björkenstam, Emma, et al. (author) Impact of childhood adversities on depression in early adulthood : A longitudinal cohort study of 478,141 individuals in Sweden 2017 In: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 223, s. 95-100 Journal article (peer-reviewed)abstract Objective: Although the relationship between childhood adversity (CA) and depression is widely accepted, there is little information on what proportion of depression is attributable to CA. Method: We used a Swedish cohort of 478,141 individuals born in 1984-1988 in Sweden. Register-based CA indicators included parental death, parental substance abuse and psychiatric morbidity, parental criminality, parental separation, public assistance recipiency, child welfare intervention, and residential instability. Estimates of risk of depression, measured as retrieval of prescribed antidepressants and/or psychiatric care with a clinical diagnosis of depression, between 2006 and 2012 were calculated as Hazard Ratios (HR) with 95% confidence intervals (CI), using a Cox regression analysis. Results: All CAs predicted depression in early adulthood. Furthermore, the predictive association between the CA indicators and depression was graded, with highest HRs observed for 4+ CAs (HR: 3.05 (95% CI 2.83-3.29)) for a clinical diagnosis for depression and HR: 1.32 (95% CI 1.25-1.41) for antidepressant medication after adjustments were made for important confounding factors. Of the studied CAs, child welfare intervention entailed highest HR for depression. Conclusion: Regardless of causality issues, children and youth with a history of multiple CA should be regarded as a high-risk group for depression by professionals in social, and health service's that come into contact with this group.
16.	Brännström, Lars, et al. (author) Child welfare clients have higher risks for teenage childbirths : which are the major confounders? 2016 In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 26:4, s. 592-597 Journal article (peer-reviewed)abstract Background: Aiming to support effective social intervention strategies targeting high-risk groups for teenage motherhood, this study examined to what extent the elevated crude risks of teenage childbirth among child welfare groups were attributable to the uneven distribution of adverse individual and family background factors. Methods: Comprehensive longitudinal register data for more than 700 000 Swedish females born 1973–1989 (including around 29 000 child welfare clients) were analysed by means of binary logistic regression. The Karlson/Holm/Breen-method was used to decompose each confounding factor’s relative contribution to the difference between crude and adjusted odds ratios (ORs). Results: Elevated crude risks for teenage childbirth are to a large extent attributable to selection on observables. Girls’ school failure was the most potent confounder, accounting for 28–35% of the difference between crude and adjusted ORs. Conclusion: As in majority populations, girls’ school failure was a strong risk factor for teenage childbirth among former child welfare children. At least among pre-adolescents, promoting school performance among children in the child welfare system seems to be a viable intervention path.
17.	Brännström, Lars, et al. (author) Childhood risk factors for disability pension among adult former Swedish child welfare clients : Same or different as for majority population peers? 2018 In: Children and youth services review. - : Elsevier BV. - 0190-7409 .- 1873-7765. ; 84, s. 94-102 Journal article (peer-reviewed)abstract This study contributes to the literature on preventing social exclusion, here indicated by collecting disability pension in adulthood, by asking whether the pattern and strength of childhood related risk factors is the same for high-risk child welfare clients, as for their peers in the majority population. Longitudinal register data on > 500,000 Swedes, including around 18,000 former child welfare clients, were analyzed by means of linear probability models and calculations of population attributable fractions. Systematic comparisons of effect sizes suggest that the differences in pattern were marginal, but there were significant differences in strength. Overall, poor educational achievement and low educational attainment were the two most prominent risk factors across all groups, also when prevalence was taken into account. In the majority population, the hypothetical reduction of collecting disability pension was on the scale of 20% if either of the two risk factors could be eliminated. Among child welfare alumni, however, the hypothetical reduction was even larger, nearly 30% on average. Prevention strategies targeting poor school performance and low educational attainment may thus substantially reduce the prevalence of disability pension among adults with a history of child welfare involvement.
18.	Brännström, Lars, 1972-, et al. (author) Children Placed In Out-of-Home Care as Midlife Adults : Are They Still Disadvantaged or Have They Caught Up With Their Peers? 2017 In: Child Maltreatment. - : SAGE Publications. - 1077-5595 .- 1552-6119. ; 22:3, s. 205-214 Journal article (peer-reviewed)abstract International research has consistently reported that children placed in out-of-home care (OHC) have poor outcomes in young adulthood. Yet, little is known about their outcomes in midlife. Using prospective data from a cohort of more than 14,000 Swedes born in 1953, of which nearly 9% have been placed in OHC, this study examines whether there is developmental continuity or discontinuity of disadvantage reaching into middle age in OHC children, compared to same-aged peers. Outcome profiles, here conceptualized as combinations of adverse outcomes related to education, economic hardship, unemployment, and mental health problems, were assessed in 1992–2008 (ages 39–55). Results indicate that having had experience of OHC was associated with 2-fold elevated odds of ending up in the most disadvantaged outcome profile, controlling for observed confounding factors. These findings suggest that experience of OHC is a strong marker for disadvantaged outcomes also in midlife.
19.	Brännström, Lars, 1972-, et al. (author) Effectiveness of Sweden's Contact Family/Person Program for older children 2015 In: Research on social work practice. - : SAGE Publications. - 1049-7315 .- 1552-7581. ; 25:2, s. 190-200 Journal article (peer-reviewed)abstract Objectives: To estimate the impacts of Sweden’s Contact Family/Person Program (CFPP) for older children on participants’ long-term outcomes related to mental health problems, illicit drug use, public welfare receipt, placement in out-of-home care, educational achievement, and offending. Method: We analyzed longitudinal register data on more than 1,000,000 individuals born between 1973 and 1984, including 6,386 individuals who entered CFPP at 10–13 years of age, with a follow-up until 2008. The program impact was estimated by means of propensity score matching. Results: Outcomes for those who had received the intervention were not better than that for matched peers who did not receive the intervention. Conclusions: The results did not find support for CFPP effectiveness in reducing risks of compromised long-term development in older children.
20.	Brännström, Lars, et al. (author) Kontaktfamilj/person för yngre och äldre barn : Har insatsens varaktighet och ansamlingar av ogynnsamma omständigheter under barnens uppväxt någon betydelse för utfall på lång sikt? 2015 Reports (pop. science, debate, etc.)abstract I denna rapport undersöks om insatsens varaktighet och ansamlingar av ogynnsamma omständigheter under uppväxten har ett samband med hur det går på längre sikt för de barn där insatsen kontaktfamilj eller kontaktperson inleddes under småbarnsåren och/eller förpuberteten. Analyserna omfattar alla de barn födda i Sverige 1973-1990 där insatsen påbörjades när de var 2-5 år (n=6 693) och/eller när de var 10-13 år (n=6 389).Med hjälp av avancerade regressionsanalyser ser vi att sammansättningen av bakgrundsproblem inte verkar ha något tydligt specifikt samband med hur det går i framtiden. Det är antalet problem som verkar betyda något. I den yngre gruppen verkar barnen med flest problemfaktorer i hembakgrunden ha dragit nytta av längre insatstid. Där är det med andra ord möjligt att en långvarig tillgång till en kompenserande vuxenmiljö utanför den egna familjen kan ha påverkat de mest utsatta barnens utveckling på sikt. För barn med färre problemfaktorer fanns det ingen sådant samband, snarare tendenser till det omvända. Det verkar med andra ord som om en långvarig insats för de yngre barnen fungerar bättre för de ’svåraste fallen’.För de äldre barnen ser vi svaga tendenser till ett motsatt mönster. De med lägst antal problemfaktorer är de som verkar ha fått svag nytta av lång insatstid. Här är det viktigt att vara medveten om att vi bara har tillgång data som tyder problem i hemmet, inte hos barnet själv (t.ex. förekomsten av beteendeproblem). Det verkar med andra ord som om insatsen var för svag för de mest utsatta barnen. Den äldre gruppen hade generellt mer tecken på problem i barndomen (t.ex. höga förekomster av psykisk ohälsa hos föräldrarna) än den yngre gruppen barn. Den äldre gruppen barn verkar också ha klarat sig betydligt sämre i tonåren och i ung vuxen ålder.Eftersom våra sambandsanalyser inte har någon jämförelsegrupp av barn som inte fått någon insats (alla som ingår i analysen har fått mer eller mindre av insatsen) är det viktigt att påpeka att vi med det här sättet att analysera inte kan säga något om insatsen är effektiv eller inte. De mönster vi alltjämt har funnit ska därför tolkas som ’tendenser till dämpad försämring’ över tid. Det finns dock ingenting som tyder på att socialtjänsten bör vara restriktiv med att ge yngre barn från utsatta familjer en kontaktfamiljsinsats under lång tid. För de äldre barnen finns det dessvärre inga resultat som är tillräckligt handfasta för att tjäna som underlag för rekommendationer.
21.	Brännström, Lars, et al. (author) Risk factors for teenage childbirths among child welfare clients : Findings from Sweden 2015 In: Children and youth services review. - : Elsevier BV. - 0190-7409 .- 1873-7765. ; 53:6, s. 44-51 Journal article (peer-reviewed)abstract This study contributes to the literature on preventing teenage childbirths by asking whether the pattern and strength of risk factors is the same for high-risk child welfare clients, as for their peers in the majority population. Longitudinal register data on more than 700,000 Swedish females, including around 29,000 child welfare clients, were analyzed by means of linear probability models and calculations of population attributable fractions. Comparisons of effect sizes suggest that the differences in pattern were marginal, but there were notable differences in strength. The girls' school failure was the most prominent risk factor across all groups, also when prevalence was taken into account. In the majority population, the hypothetical reduction of teenage childbirths is on the scale of 30% if this risk factor could be eliminated. In the child welfare subgroups, however, the hypothetical improvement was even larger, around 40%. Reducing the high rate of school failure could thus yield a profound reduction in teenage childbirths in child welfare subgroups, where the incidence of teenage childbirth is substantially higher compared to other peers.
22.	Brännström, Lars, et al. (author) The truly disadvantaged? Midlife outcome dynamics of individuals with experiences of out-of-home care 2017 In: International Journal of Child Abuse & Neglect. - : Elsevier BV. - 0145-2134 .- 1873-7757. ; 67, s. 408-418 Journal article (peer-reviewed)abstract Little is known about developmental outcomes in midlife of persons who were placed in out-of-home care (OHC) in childhood. Utilizing longitudinal Swedish data from a cohort of more than 14,000 individuals who we can follow from birth (1953) to the age of 55 (2008), this study examines midlife trajectories of social, economic, and health-related disadvantages with a specific focus on the complexity, timing, and duration of disadvantage in individuals with and without childhood experience of OHC. Roughly half of the OHC alumni did not have disadvantaged outcomes in midlife. However, experience of OHC was associated with a two-fold risk for various forms of permanent disadvantage, net of confounding factors. Implications for research, policy, and practice are discussed.
23.	Forsman, Hilma, 1985- (author) Addressing poor educational outcomes among children with out-of-home care experience : Studies on impact, pathways, and interventions 2019 Doctoral thesis (other academic/artistic)abstract Children with out-of-home care (OHC; foster family/residential care) experience is a high-risk group for future adverse outcomes. With an ambition of supporting the design of effective preventive child welfare measures targeting children in OHC, the overall aim of this thesis is to examine education as a possible intervention path for improving their development and overall life chances.The thesis consists of four interrelated empirical studies that address different aspects of poor educational outcomes among children with OHC experience by means of analyses of longitudinal survey and register data, and evaluations of two interventions aimed at improving their basic academic skills.Study I examined the hypothesized causal effect of poor school performance on adverse outcomes in young adulthood among children with OHC experience. The results showed that poor school performance has an impact on later psychosocial problems net of observed and unobserved factors, suggesting that the estimated effects allow for causal interpretations.Study II explored educational outcomes at different stages in the educational career, and pathways to varied educational outcomes for children with OHC experience and their peers. The results showed that the OHC group had lower educational outcomes across the life course. Yet, by large, their educational pathways did not differ significantly from their peers – cognitive ability and previous school performance had the largest associations with the outcomes in both groups. However, the influence of these factors were weaker in the OHC group whilst the influence of the birth family’s attitude towards higher education was stronger.Study III aimed at furthering our understanding of the book-gifting program the Letterbox Club’s potential impact on foster family children’s reading skills. The results showed that participation in the program was associated with small improvements. In general, the program was well received by children and carers, and could result in increased reading. The study furthermore suggested that promotion of carer involvement may improve its potential impact.Study IV explored the process of conducting a structured paired reading intervention involving foster family children and their carers. Findings showed that it is possible to engage carers in interventions targeting the education of children in OHC, but that this is no automatic process – carers need a rationale for getting involved, and support in delivering the intervention.In sum, this thesis shows that improving the educational outcomes of children in OHC may be a viable intervention path in supporting their life course development, a path that historically has been overlooked. The thesis furthermore shows examples of promising interventions which may improve the basic academic skills of children in OHC. The results also point out that the child welfare system should provide early and continuous educational support, and highlight the importance of addressing adults’ attitudes, expectations, and involvement in these children’s education.
24.	Forsman, Hilma, et al. (author) Does poor school performance cause later psychosocial problems among children in foster care? Evidence from national longitudinal registry data 2016 In: International Journal of Child Abuse & Neglect. - : Elsevier BV. - 0145-2134 .- 1873-7757. ; 57, s. 61-71 Journal article (peer-reviewed)abstract Research has shown that children in foster care are a high-risk group for adverse economic, social and health related outcomes in young adulthood. Children's poor school performance has been identified as a major risk factor for these poor later life outcomes. Aiming to support the design of effective intervention strategies, this study examines the hypothesized causal effect of foster children's poor school performance on subsequent psychosocial problems, here conceptualized as economic hardship, illicit drug use, and mental health problems, in young adulthood. Using the potential outcomes approach, longitudinal register data on more than 7500 Swedish foster children born 1973–1978 were analyzed by means of doubly robust treatment-effect estimators. The results show that poor school performance has a negative impact on later psychosocial problems net of observed background attributes and potential selection on unobservables, suggesting that the estimated effects allow for causal interpretations. Promotion of school performance may thus be a viable intervention path for policymakers and practitioners interested in improving foster children's overall life chances.
25.	Forsman, Hilma, 1985-, et al. (author) Skolstödjande insatser för socialt utsatta barn 2017 In: Skolsocialt arbete. - Malmö : Gleerups Utbildning AB. - 9789140695789 ; , s. 195-205 Book chapter (other academic/artistic)

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