Child protection is the process that aims to find, investigate and help maltreated children. In many countries this process is initiated by professionals who compile mandated reports that are then submitted to a designated agency that in many cases is part of a separate child protection system. In Sweden there is no separate child protection system. In Sweden, the child protection process is part of the family-service organization system. The system has two main objectives, one is voluntary (provide family service), the other coercive (provide child protection). This system is administered by the municipal social services agencies (referred to throughout as Social Services). Aim: The overall purpose of this study was to gain knowledge of the child protection process in Sweden. The aim was two fold, one to carry out an in-depth study of a population of reports, the other to analyse the results of the findings in relation to the child protection system. The child protection system consists of elements outlined in the macro system: the underlying ideology and the framing of the problem, and the legislation, administration and the demands placed on professionals. Method: A total population of reports made to one municipality during 1998 was followed to a final decision. The reports were collected in 2000.´There were 1 570 reports made regarding 1 051 children, which composed 4 % of children age 0-18. This initial study was used in four papers where data were analysed covering four different issues. In 2003 a follow-up study was conducted in order to determine the extent to which the child appeared in the database of Social Services. In the first paper the children’s age, gender and contacts with Social Services were described as were the content of the reports and the outcome of reporting. The objective of the second paper was a description of the reporter, and the measurement of the extent to which the reports indicated child maltreatment. The third paper aimed at analysing how the first decision, the decision not to investigate reports, was made in the child protection process. Then a re-evaluation of these decisions was made to see how well the decision was justified. The contacts taken were described. In the fourth paper the influence of the socio-economic load on the child protection process was measured. Findings: Few reports (16 %) led to an intervention being provided, and 41% of the reports were not investigated further. In the follow-up study 61% of all 1 051 children appeared in the files of Social Services. As Sweden lacks a juvenile delinquency system these cases are automatically passed from the police to Social Services and are there registered as mandated reports. Hence the police became the largest report group of reporters, followed by professionals. Of the professionals’ reports 22 % were not investigated. In the follow-up study 53 % of these re-occurred at the Social Service and were then investigated. Seventy six percent of the reports not investigated were when re-evaluated found to indicate child maltreatment. The social worker used the parents as the main source for information in 74 % of the cases. The social worker did not contact the child at all in 53 % of the cases and only nine of the reporters were contacted. In the follow-up study 45 % of the children investigation re-appeared in the files of Social Services. Children from high socio-economic load districts were more often reported than those from middle or low (4.3%, 3.1% 2.3%). The socio economic load when measured in logistic regression was not found to correlate with the decision to investigate. A main finding in this study was that the child protection process was difficult to separate from other systems within the family service. This makes it much more difficult to evaluate the child protection process. The reports filed by professionals were not investigated adequately, and the lack of criteria of specifying how reports are to be evaluated creates a risk that maltreated children will not be found. The professional reports were handled in a way that increased the risk that professionals will have negative experiences with Social Services that consequently can lead them to refrain from filing eports. Conclusion: These findings suggest the following: Pass new legislation that makes it easier to separate each of the three systems from the other. Create a national database in which data on the handling of child-protection cases is systematically recorded. Develop a national reporting form that is to be used by all who file mandated reports of suspected maltreatment. Create clear criteria that specify how a report is to be handled to ensure that the reporting professionals are met with appropriate respect and that the quality of the decisions is guaranteed all over the country.

The comprehensive purpose of the thesis was to study the health and experiences, with a main focus on mental health, of a group of grown-up children of divorced parents in comparison to a group of persons without this experience. Mental health, experienced life events, narratives of divorce related experiences and personal resources were therefore examined in a group of young adults (age 22-33 years) whose parents divorced 15 years before the start of the first three studies. In addition to this, the presence of a child/adolescent and/or an adult psychiatric record and ten years of diagnosed physical health visits in the same but extended group (age 21-38 years) was examined 20 years after parental divorce. The outcomes of these examinations were compared with the outcomes of a group with married parents still living together, matched with the divorce group on age gender and living area. The results showed no major differences in mental health between the divorce and the non-divorce group, with the exception of women age 22-27 showing poorer mental health than the others in the study. Personal resources in this case SOC (Sense of Coherence) followed the same pattern, with no significant differences between the divorce and the non-divorce group, but with women age 22-27 showing lower SOC. The experiences/narratives told by the divorce group fell into one of two categories: one disappointment, the other contentment, with the first indicating non-optimal chances for adjustment to parental divorce and the other good. The run-through of psychiatric records showed no significant differences between the number of persons in need of adult psychiatric care in the divorce and the non-divorce group. A significant difference was present, however, in child- and adolescent psychiatric care pointing to a larger need for psychiatric care in the divorce group, a need most pronounced among girls. As concerned the number of diagnosed physical health care visits, only small differences between the groups were found. The main conclusion of the study was that experience of parental divorce in childhood is not found for a majority to be an experience determining poorer mental or somatic health in young adulthood.

Diagnosen Asperger syndrom är ett relativt nytt begrepp inom autismspektrumet. För bara 20 år sedan var syndromet relativt okänt världen över. År 1988 hölls den första internationella kongressen i London och där presenterades de första diagnoskriterierna av makarna Gillberg. Efter kongressen har ytterliggare tre kriterier uppkommit. Vi vill undersöka hur elever med Asperger syndrom uppfattar sin skolgång. Vi vill även undersöka hur lärare och föräldrar till barn med diagnosen upplever barnets skolsituation. Vi har utfört en kvalitativ studie, där vi med hjälp av sju ungdomar med diagnosen Asperger syndrom, fyra lärare som arbetar med barn i behov av särskilt stöd och två föräldrar som har barn med diagnosen Asperger syndrom. Resultatet av intervjuerna visar att eleverna är väl medvetna om vad som krävs av skola och lärarna för att de ska känna delaktighet i undervisningen. Vår studie visar att regelbunden kontakt med hemmet är mycket viktigt för både barnet, föräldern och läraren. Denna studie ger tänkvärd information för pedagoger och föräldrar som antingen arbetar eller kommer i kontakt med barn med diagnosen Asperger syndrom.

Lås in pedofilerna och kasta bort nyckeln. Tvångskastrera våldtäktsmännen. Samhällets dom mot sexualbrottslingarna är hård och vägen tillbaka för många omöjlig. Möt sexualbrottslingen och de som arbetar med män vars handlingar väcker avsky.

The aim of the study was to examine individual staff experience and management of threats and violence in the acute psychiatric department for children and teenagers in Uppsala. Previous research shows that the experience of threats and/or violence is individual, and that it is difficult to distinguish between these concepts. Research shows that it is particularly vulnerable to work in psychiatry when mental illness is a cause when threats and violence occurs. Threats and violence can result in different consequences for the individual. The study is based on qualitative interviews and the material was collected in the autumn of 2012 at Akademiska sjukhuset. The qualitative interviews was transcribed and carefully analyzed. The result had an outcome in four different themes: The diffuse definition between threats and violence that showed how difficult it is to define threats and violence. Causes and staff reaction showed that mental illness, how you treat someone and compulsive cares are contributing factors to threats and violence occurs. This theme also shows ambivalence within the staff, that the behavior is unacceptable meanwhile he or she is mentally ill. Management and reporting showed that the staff has different coping strategies when they deal with threats and violence and that it is different how functional the reporting is. The theme working environment showed that it is a vulnerable environment to work in. Therefore, it is important to get support from colleagues and managers but the staff has different opinions whether they feel supported from managers. There is a need to develop routines for incidents when threats and/or violence have occurred. / Syftet med studien var att undersöka personalens enskilda upplevelse och hantering av hot och våld på Barn- och ungdomspsykiatrins (BUP) akutmottagning i Uppsala. Tidigare forskning visar att det är individuellt hur man upplever hot och våld samt att det är svårt att hålla isär dessa begrepp. Forskning visar även att det innebär en särskilt utsatthet att arbeta inom psykiatrin, då psykiska sjukdomar är en bakomliggande faktor till att hot och våld uppstår. Att bli utsatt för hot och våld kan resultera i olika konsekvenser för den enskilde. Studien baseras på kvalitativa intervjuer och materialet samlades in hösten 2012 på BUP på Akademiska sjukhuset. De kvalitativa intervjuerna transkriberades och analyserades noggrant. Resultatet utmynnade i fyra teman: Den diffusa gränsen mellan hot och våld som visade hur svårdefinierat hot och våld är samt var gränsen mellan dessa går. Orsaker och personalens reaktion tog upp att psykiska sjukdomar, bemötande och tvångsvård är bidragande faktorer till att hot och våld uppstår. I en hot- och/eller våldshändelse uppstår en reaktion hos personal, en ambivalens mellan att personen är psykiskt labil och att beteendet är oacceptabelt.  BUP akutens hantering och rapportering visade att personalen har olika copingstrategier när de ska hantera en hot och/eller våldssituation samt att det är olika hur rapporteringen av dessa situationer fungerar. Det sista temat Arbetsmiljön visade att det är en utsatt miljö att arbeta i och att det är viktigt att få stöd i arbetet, men huruvida personalen upplever att de får stöd ser olika ut. Det finns ett behov för att utveckla rutiner kring samtal efter en hot- och/eller våldshändelse.

Syftet med denna studie var att belysa hur sjuksköterskor kan upptäcka och identifiera signaler hos barn som växer upp i en destruktiv miljö av alkoholmissbruk. Metod som användes för att belysa syftet var beskrivande litteraturstudie. Databaser som användes vid sökningen av valda källor var Medline(PubMed) och Cinahl. Andra sökstrategier var manuellsökning i valda källor. Huvudresultatet visade att barn till föräldrar med tungt alkoholmissbruk framförallt mådde psykiskt dåligt, det tog sig uttryck som depression och utåtagerande beteende. Barns ohälsa i samband med att växa upp i dysfunktionella miljöer relaterat till alkoholmissbruk tog även sig uttryck i återkommande psykosomatiska symtom samt kognitiva brister. Risken för att barn skulle fara illa kopplades även till den känslomässiga miljön som rådde i hemmet. Tecken på ohälsa behövde dock inte vara en följd av en ogynnsam uppväxtmiljö utan kunde härledas till genetiska faktorer. Slutsatsen är, för att kunna identifiera barn som befaras fara illa i sitt hem krävs goda kunskaper om problemets komplexitet. För att utgöra en viktig länk i detta arbete som sjuksköterska krävs förutom kunskap även utarbetade riktlinjer. Virginia Hendersons omvårdnadsteori kan enligt författarna utgöra ett gott stöd i att bedöma varje enskild situation, utifrån dess orsak och verkan baserade tänkande.

Under åren 2008-2010 pågick ett familjeprojekt på barn- och ungdomspsykiatriska kliniken i Stockholm. Tjugofyra familjer skrevs in i projektet och sex behandlare medverkade. Projektets struktur byggde på att familjer, även syskon, till de inskrivna patienterna i högre grad än i vanlig slutenvård skulle närvara och delta i vården. Sessionerna var av en intensitet av tre timmar per dag, tre dagar i veckan, i tre veckor. Genom en kvalitativ studie med intervjuer med ett antal av de som var med, inventeras projektets genomförande och konsekvenser. De som svarat redogör för positiva förändringar, i synnerhet vad gäller relationerna i familjen. Föräldrarna uttrycker att de fått en annan förståelse för sitt barn och barnen att de känner sig mer förstådda. Samarbetet mellan familjerna och de professionella på kliniken verkar ha haft stor betydelse. Självskattningar på Client Satisfaction Questionnaire bekräftar de allmänt goda behandlingsresultaten. / During the years 2008-2010 a family treatment project was run at the child and adolescent psychiatric clinic in Stockholm. Twentyfour families were enrolled in the project and six therapists were involved. The project involved families, including siblings, related to the identified patients to a greater extent than in conventional inpatient care. The sessions had an intensity of three hours a day, three times a week, for three weeks. Through a qualitative study involving interviews with a sample of the participants the experiences and consequences of the project was explored. Respondents described positive changes, especially as regards the relations in the family. Parents expressed that they acquired a different understanding of their children while the children felt more understood than before. The collaboration between the families and the professionals at the clinic seems to have been of great significance to the participants. Ratings on the Client Satisfaction Questionnaire corroborate the positive results of the interviews.

Väntelistor till barnpsykiatrisk vård är vanligt förekommande och tiden på väntelista har visats vara påfrestande för familjerna som väntar. Denna studie har undersökt hur föräldrar upplever tiden på väntelista till Barn- och ungdomspsykiatrin (BUP), samt vilka behov av stöd de upplever sig ha under tiden de väntar. Sju föräldrar vars barn väntade på utredning inom BUP intervjuades. Data bearbetades genom tematisk analys. Resultatet visar att föräldrarna upplevde brist på kontroll och hopplöshet, delvis på grund av att de befann sig i ovisshet under väntetiden. Vidare visar resultatet att stödinsatser som innefattar information, konsultation, avlastning och behandling efterfrågades. Resultatet diskuteras med hjälp av teorin om Locus of Control (LOC) och begreppet ovisshetsdiskrepans. Vidare forskning behövs för att öka förståelsen för hur information gällande väntetiden påverkar upplevelsen av väntetiden. Därtill behövs forskning som undersöker om och hur upplevelsen av väntetiden påverkar kommande utredning eller behandling. / Waiting lists in child and adolescent psychiatry are common and waiting for mental health services has been shown to be challenging for the families involved. This study aimed to explore how parents of children on a waiting list for an assessment experienced the wait. The study also explored what kind of support the parents felt that they needed during this period. Interviews were conducted with seven parents of children on waiting lists and data was analyzed using thematic analysis. Results showed that the parents experienced a lack of control and hopelessness during the wait, partly because of the uncertainty that characterized the waiting time. Results concerning parental support showed that information, consultation, social support and treatment were requested. Results were discussed using the theoretical framework Locus of Control (LOC) and uncertainty discrepancy. Future studies exploring how information about the waiting time affects the waiting list experience are needed. In addition, future studies that explore if and how the waiting list experience affects the coming assessment or treatment are needed.

<b>Introduction</b>: Maternal antenatal depression has been associated with an increased risk of offspring psychopathology and more recently with disturbed infant sleep; in particular, shorter sleep duration, more awakenings and sleep problems. The exact mechanisms through which risk may be transmitted remain unknown, as does the question of whether all infants are equally susceptible to the effects of antenatal depression. The primary objectives of this thesis were to examine: i) The role of two potential moderators on the association between antenatal depression and infant sleep: infant reactive temperament and the serotonin transporter polymorphism 5-HTTLPR ii) The association between antenatal depression and infant sleep using objective behavioural and physiological measures. iii) Infant sleep and temperament in a pilot randomised controlled trial (RCT) following treatment of antenatal depression <b>Methods</b> i) The role of infant reactivity and 5-HTTLPR as potential moderators was examined in two large longitudinal cohorts: the Avon Longitudinal Study of Parents And Children (ALSPAC) and the Generation R study, based in the UK and The Netherlands respectively (n=8,991 and n=2,441). ii) An Oxford based pilot longitudinal family study (n=16) iii) A pilot randomised controlled trial of women with antenatal depression who received Cognitive Behavioural Therapy (CBT) or Care as Usual (n=25). <b>Results</b> i) There was evidence that reactive temperament moderated the association between antenatal depression and infant sleep; boys seemed to be most affected exhibiting more awakenings, sleep problems and shorter sleep duration. 5-HTTLPR did not moderate this association. ii) Antenatal depression was associated with shorter infant sleep duration 5 months postpartum iii) Improvement in depression was associated with shorter infant sleep duration and easier temperament 2 months postpartum <b>Conclusion</b>: This thesis suggests that not all infants are equally susceptible to environmental influences and this may prove important in targeting interventions. The role of genetic factors in conferring any susceptibility remains unclear. Actigraphy offering accurate representation of activity levels and timing during the day and night was a significant methodological advantage, but recruitment to a study incorporating these proved challenging. Finally, psychological interventions during pregnancy appear to have beneficial effects for child development.

This thesis investigated (1) social status and shaming experiences in relation to aggressive behaviour and depression, and (2) gene-environment interactions between two genetic polymorphisms related to the serotonergic system – MAOA-VNTR and 5HTTLPR – and experiences of maltreatment in relation to delinquent behaviour and depression among adolescents. The four included studies are based on questionnaire data from the Survey of Adolescent Life in Vestmanland 2006 (SALVe-2006). A total of 5396 students in 9th (15-16 years old) grade of elementary school and 2nd (17-18 years old) grade of high school comprised the target population. The students in 2nd grade of high school also provided a saliva sample for gene extraction. There were strong associations between shaming experiences and both aggressive behaviour and depression. In addition, individuals who reported many shaming experiences and had either low or high social status had increased risks of physical aggression or depression, whereas medium social status seemed to have a protective effect. Gene-environment interactions were found between experiences of maltreatment and the MAOA-VNTR in relation to delinquent behaviour. Moreover, the direction of the gene-environment interaction differed depending on sex: boys with the short (S) variant of the MAOA-VNTR, in contrast to girls with the long (LL) variant, had the highest risk of delinquency in combination with maltreatment. Gene-environment interactions were also found between experiences of maltreatment and the 5HTTLPR in relation to depression among girls. The girls that were homozygous for the S allele (SS) had the highest risk of depression in combination with maltreatment. Among boys however, no gene-environment interaction was found between the 5HTTLPR and maltreatment in relation to depression. In conclusion, it is important to consider both genetic effects, and psychosocial factors such as social status, shaming experiences, and experiences of maltreatment when investigating different aspects of health and behaviour among adolescents.