The dissertation analyses access to welfare resources within the areas of schooling, leisure and peer relations for youth in out of home care. The study was conducted in three counties in mid Sweden and is a replication of the recurrent Swedish surveys of living condition of children in general populations. By using the same design, children aged 13–18 (n=272) in foster care and residential care were approached. Throughout the analysis results are compared with conditions for peers living at home, based on data from the 2004/2005 survey on living conditions for children (Child-ULF). Furthermore the results are linked to the young people’s experience of psychosomatic complaints and emotional wellbeing and discussed within the theoretical framework of childhood sociology. Questions regarding society’s ability to convey resources to youth while in care as well as young persons’ potential to exercise determination while in care are also discussed. The study shows that youth in care in general have access to fewer resources than those in general populations in the studied areas. For youth in residential care the differences compared to peers living at home are substantial, while conditions for youth in foster care are more alike those of young people in general. Youth in residential care have fewer school related resources and fewer contacts with friends than peers living at home. Youth in foster and residential care are more subjected to bullying than the general population. The overall conclusions are that society, in the form of foster parents and residential staff fails in certain areas to convey resources to youth in care. The young people’s lack of resources poses limitations to their potential to exercise self-determination while in care. The study points out areas where targeted efforts might be needed to improve the living conditions for youth in out of home care and perhaps broaden their potential to exercise self-determination while in care as well as after. / Välfärd i samhällsvården? En levnadsnivåundersökning av barn och ungdomar i socialtjänstens dygnsvård

Avhandlingens syfte är att fördjupa kunskapen om skolsituationen för barn och ungdomar i samhällsvård samt att fördjupa kunskapen om de processer varigenom de unga finner vägar genom skolan och samhällsvården mot ett självständigt liv som unga vuxna. Studien har genomförts i fem svenska storstadskommuner. Materialet består huvudsakligen av upprepade intervjuer med unga som själva har erfarenhet av att vara placerade i samhällsvård. Som en bakgrund genomfördes en kartläggande aktstudie gällande alla de ungdomar från dessa kommuner, som under 2003 hade placerats i samhällsvård. Intervjudeltagarna valdes ut från denna kartläggning. I analysen av intervjuerna användes en narrativ livsberättelseansats. Fokus i analysen har riktats både mot att förstå de ungas erfarenheter av att leva i skola och samhällsvård och mot att förstå hur de unga, genom sina berättelser, tolkar dessa erfarenheter och på så sätt skapar en meningsfull berättelse om sig själva och sina liv. Resultatet visar att livet i samhällsvård för de unga är präglat av utsatthet på flera nivåer. Socialtjänstakterna pekar mot ett samband mellan svårigheter i hemmet och svårigheter i skolan för de ungdomar som placerades i samhällsvård. Livsberättelserna synliggör hur skolan, familjen och samhällsvården utgör en komplex helhet i de ungas vardag och hur utsatthet inom någon av dessa praktiker därmed tenderar att spridas vidare i en process av överförd utsatthet. I sin kamp för att undkomma denna utsatthet navigerar de unga mot arenor där de kan finna hemmatillhörighet, det vill säga en upplevelse av att förstå och ”höra hemma” i en socialt delad vardagsverklighet. Ett viktigt redskap i de ungas strävan efter hemmatillhörighet är deras förståelsearbete, det vill säga det kontinuerliga tolkningsarbete varigenom de – inom ramen för socialt delade hemmatillhörigheter – knyter ihop sina erfarenheter till en sammanhängande förståelse av sig själva och sina liv. / The aim of this thesis is to gain further knowledge about the school situation for children and youths in out-of-home care; about the processes by which these children and youths find their way through family life, school and care settings; and about their transitions from out-of-home care to an independent life as young adults. The study was conducted in five municipalities in Sweden. The main empirical data was generated through repeated interviews with young people who had the experience of staying in out-of-home care. As a background social services case files concerning all youths from the five municipalities, who during 2003 were placed in out-of-home care, were analysed. The interviewees were selected from this overview. In the analysis of the interviews a narrative life story perspective was used. Focus was directed both towards the understanding of the young people’s school and in-care experiences and at the understanding of how they, through their narratives, interpret these experiences and create a coherent story of meaning about themselves and their lives. The result indicates that life for young people placed in out-of-home care is characterized by vulnerability and exposure on several levels. The case files indicate that there is a connection between the degree of difficulties at home and in school for youths placed in out-of-home care. The life stories show that school, home and care settings, for the youths seem to represent a complex pattern of everyday practices in which their vulnerability tend to spread in a process of transferred exposure. In their struggle to avoid this exposure they strive to find spaces that provide them with a sense of belonging. An important tool in this struggle is their comprehension work, that is to say the continuous interpretive work by which they connect their experiences into a meaningful understanding of whom they are and which life they ought to live.

In research, the transition from foster care to adult life has been pointed out as a significant and problematic period in young people´s lives. However, we know less about how this transition is handled professionally. Through qualitative interviews, this study examines social worker´s views and experiences of this transition process. The research questions focus on what needs social workers see in young people´s transition, how they describe their own work, and what strategies and tools that may promote the transition. The results are analyzed using the following theoretical concepts – discretion, emotional support, informative support,instrumental support and evaluative support. The study shows that young people need long-term relationships, certain practical skills and each type of support. Work with the transition is based on these needs. Here, social workers have an exploratory and coordination role thatconsists of many tasks. While they describe some specific strategies and tools, the results show that there are difficulties within this work. The roles of foster carers and social workers in young people´s transition to adulthood are discussed.

Background: In Sweden, health outcomes for children placed in care have been disappointing. ‘Placed in care’ refers to social out of home care (OHC). Hälsofam is a medical home model for healthcare of children in OHC currently delivered in Uppsala. Aim: To explore how social workers perceive and experience the Hälsofam model. Methodology: A qualitative explorative study with ten semi-structured individual telephone interviews. The criteria for inclusion in the study sample were employees within the social service, working in a specialised case unit and having experience of referring children and/or adolescents to Hälsofam. Results: Working with Hälsofam has offered social workers a way into the health care sector, which is something that previously has been limited. The Hälsofam model has offered the social workers an active collaborative working situation, where focus has been given to organised work across the ‘silos’ of care services for these children. However, the findings raised the question of whether or not all children and adolescents have the same possibility to receive care from Hälsofam. Conclusion: The Hälsofam model appears to have had a positive impact on the interrelations between the social service and the health care sector. Social workers perceive it to facilitate necessary support for children and adolescents in OHC. Yet, findings show that personal views of the social worker and the societal situation in which they operate create limitations for providing care for every child and adolescent. / Bakgrund: I Sverige har hälsoutfallen för barn och ungdomar inom socialtjänstens placeringar utanför det egna hemmet varit bristande. Hälsofam är en organisatorisk modell inom hälso- och sjukvård för barn i placeringar utanför det egna hemmet i Uppsala. Syfte: Syftet med denna kvalitativa studie är att undersöka hur anställda inom Socialtjänsten har upplevt och erfarit Hälsofam-modellen. Metod: En kvalitativ explorativ studie med tio semi-strukturerade individuella telefonintervjuer användes. Kriterier för inkludering i studieurvalet var att personen skulle vara anställd inom Socialtjänsten, arbeta med denna typ av fall samt ha erfarenhet av att remittera barn och unga till Hälsofam. Resultat: Arbetet med Hälsofam har erbjudit anställa inom socialtjänsten en väg in till hälso- och sjukvården, vilket tidigare upplevts begränsat. Hälsofam har erbjudit anställda inom socialtjänsten ett aktivt samarbete, där fokus har lagts på organiserat interprofessionellt arbete. Frågan har också rests, huruvida alla barn och ungdomar har samma möjlighet till vård inom Hälsofam. Slutsats: Hälsofam-modellen har haft en positiv inverkan på det inbördes förhållandet mellan Socialtjänst och hälso- och sjukvårdssektorn. Anställda inom socialtjänsten upplever även att arbetet med att stödja de barn och unga som får vård utanför hemmet, har blivit lättare i och med Hälsofam. Resultatet visar dock att det personliga perspektivet hos den anställda samt den samhälleliga situationen där de arbetar, skapar begräsningar för att erbjuda vård till alla barn och unga.

La réussite éducative est une priorité au cœur des politiques québécoises en matière d’éducation. Malgré les efforts déployés, certains indicateurs de réussite demeurent préoccupants. Ceci est encore plus vrai pour certaines populations qui vivent dans un contexte de vulnérabilité, notamment, les jeunes en situation de placement pour qui les données sont les plus inquiétantes. Il est donc impératif d’identifier les meilleures stratégies pour soutenir la réussite des jeunes de la population générale, mais également ceux qui sont les plus à risque de vivre des échecs. La présente thèse a ainsi pour but d’identifier ces stratégies en s’attardant à deux cibles importantes, l’engagement et le rendement scolaires. Plus précisément, deux revues systématiques ont été réalisées : l’une portant sur les interventions ayant pour but de favoriser l’engagement comportemental, cognitif et affectif des élèves du primaire (étude 1) et une seconde portant sur les interventions favorables au rendement des jeunes en situation de placement (étude 2). Les résultats des interventions identifiées ont été synthétisés via des méta-analyses afin d’identifier les stratégies d’intervention les plus efficaces. Le premier chapitre de la thèse permet de bien positionner les concepts à l’étude et les objectifs de la thèse. Quant au second chapitre, il présente les étapes d’une recension systématique, l’approche méthodologique au cœur de cette thèse. La première étude est présentée au chapitre III. Cette étude a permis d’identifier 38 interventions visant à soutenir l’engagement scolaire des élèves du primaire. Parmi les différentes stratégies, le soutien offert à l’enseignant est parmi les plus prometteuses; aider les enseignants à mettre en place des pratiques efficaces en matière de gestion des comportements et à établir des relations positives est hautement favorable à l’engagement des élèves. Parmi les interventions directement mises en place auprès des élèves, il semble particulièrement efficace de les aider à développer des stratégies pour mieux planifier et organiser leurs apprentissages, ainsi que d’intégrer des activités physiques durant les activités d’apprentissage. Toutefois, les ateliers d’habiletés sociales adressés aux élèves ne semblent pas contribuer à leur engagement. Finalement, pour les jeunes qui rencontrent davantage de difficultés, les interventions multimodales visant à soutenir directement l’élève ainsi que ses différents environnements, scolaire et/ou familial, se sont également révélées efficaces pour favoriser l’engagement. Le deuxième article de la thèse (Chapitre IV) a permis de répertorier 21 interventions soutenant le rendement scolaire des jeunes en situation de placement. Parmi les différentes interventions recensées, le tutorat s’impose comme la stratégie la plus efficace et la plus rigoureusement évaluée. Les interventions qui reposent sur la collaboration entre le parent, biologique ou d’accueil, les services sociaux et l’école montrent également des effets bénéfiques. Toutefois, devant d’importants biais méthodologiques, les résultats des études sur le sujet doivent être interprétés avec prudence. En somme, cette thèse souligne la variété de stratégies pour soutenir l’engagement et le rendement scolaires. Tel qu’abordé dans la discussion générale (Chapitre V), auprès des jeunes de la population générale, il semble particulièrement important de mettre en place un environnement scolaire positif. Pour les jeunes confrontés à des difficultés plus importantes, il semble nécessaire d’offrir un soutien ciblé sur les difficultés. Malgré les limites de la thèse, ces résultats ont des implications importantes pour la recherche, mais particulièrement pour les intervenants qui œuvrent dans les milieux scolaires et des services sociaux. Ces dernières sont abordées en conclusion. / School success is a priority at the heart of Quebec’s education policies. Despite the efforts made, some success indicators remain concerning. This is even more true for certain populations living in a context of vulnerability, notably children in out-of-home care, for whom the data is most concerning. It is therefore imperative to identify the best strategies to support student success in the general population, as well as for those who are most at risk of failure. Thus, the purpose of this thesis is to identify these strategies by focusing on two important targets: student engagement and academic achievement. To this end, two systematic reviews were conducted: one focusing on interventions aimed at promoting behavioral, cognitive, and affective engagement of elementary school students (study 1), and the other targeting interventions to improve the academic achievement of children in out-of-home care (study 2). The results of the identified interventions were synthesized through meta-analyses to determine the most effective strategies. The first chapter of the thesis provides an overview of the concepts under study and the thesis objectives. The second chapter presents the steps of a systematic review, the methodological approach at the core of this thesis. The first study is presented in Chapter III. This study identified 38 interventions aimed at supporting elementary students’ engagement. Among the various strategies, indirect support provided to teachers is among the most promising. Assisting teachers in implementing effective behavior management practices and establishing positive relationships is highly conducive to student engagement. Among the student-directed interventions, it appears particularly effective to help students develop strategies to better plan and organize their learning, as well as to integrate physical activities during learning activities. However, social skills workshops do not seem to contribute their engagement. Finally, for young people facing more difficulties, multimodal interventions aiming to support the student directly as well as their different environments, both school and/or family, have also proven effective in promoting engagement. The second article of the thesis (Chapter IV) allowed the identification of 21 interventions aimed at supporting the academic achievement of children in out-of-home. Among the various interventions identified, tutoring stands out as the most effective and rigorously evaluated strategy. Interventions based on collaboration between the natural or foster parent, social services, and the school also show beneficial effects. However, given significant methodological biases, the results of these studies should be interpreted with caution. In summary, this thesis emphasizes the variety of strategies to support engagement and academic achievement. As discussed in the general discussion (Chapter V), it seems particularly important to create a positive school environment for students in the general population. On the other hand, for those facing more significant difficulties, targeted support for their specific challenges seems necessary. Despite certain limitations, these results have important implications for research and particularly for practitioners working in school and for social services. These are addressed in the conclusion.

Les jeunes qui réalisent la transition à l’autonomie à partir d’un milieu de vie substitut rencontrent plusieurs difficultés au début de l’âge adulte. Afin d’encadrer et préparer ces jeunes en lien avec cette étape cruciale de leur vie, plusieurs pays ont développé des programmes de préparation à l’autonomie. Toutefois, l’efficacité de ces programmes demeure méconnue. Objectif : Afin de contribuer aux connaissances actuelles, la présente recherche a pour objectif de mesurer l’efficacité des programmes de préparation à l’autonomie pour les jeunes placés en milieu de vie substitut. Méthodologie : Des méta-analyses ont été réalisées afin de mesurer les tailles d’effet pondérées pour trois dimensions reliées au passage à la vie adulte soit l’emploi, le logement et le réseau social. Les tailles d’effet ont été calculées sous forme de différences de moyennes standardisées ou Hedge’s g. Le modèle à effet fixe a été utilisé dans les analyses. Résultats : La revue systématique a permis d’identifier k = 9 études totalisant n = 7127 participants avec des données suffisantes pour réaliser une méta-analyse. Les résultats indiquent que les programmes de préparation à l’autonomie ont un très faible effet favorisant le groupe traitement comparativement aux jeunes ayant reçu les services habituels pour les dimensions de l’emploi (k = 5, n = 5778) et du logement (k = 5, n = 2467). Ces résultats ont été constatés un an à quatre ans après le temps zéro. Aucun effet significatif n’a été observé pour la dimension du réseau social (k = 5, n = 1797). Discussion : Devant la complexité des trajectoires de vie et des besoins des jeunes qui transitent à l’autonomie à partir d’un milieu de vie substitut, il est impératif que les programmes actuels prennent davantage en considération la réalité actuelle du passage à la vie adulte ainsi que les besoins particuliers de ces jeunes. Il s’agit notamment d’offrir des services qui s’étendent jusqu’à 25 ans et de mettre de l’avant une vision interdépendante du passage à la vie adulte dans les interventions. / Youth in out-of-home care face an uncertain future and disproportionate difficulties when aging out of care and into independent life as an adult. The difficulties these youth face have prompted governments in several countries to develop programs in order to prepare these youth for this critical period in their life. However, the effectiveness of these programs remains unknown. Objective: The main objective of the present study is to fill this gap in knowledge by measuring the effectiveness of independent living programs to prepare young people aging out of care for adulthood. Methodology: A series of meta-analysis were performed in order to measure the weighed effect sizes on three outcomes related to adulthood: employment, housing, and social support. The effect sizes were calculated using standardized mean differences or Hedge’s g. A fixed effect size model was used to perform the analyses. Results: k = 9 studies including a total of n = 7127 participants met the inclusion criteria for the systematic review and had sufficient data to conduct a meta-analysis. The results of the meta-analysis for the employment outcome (k = 5, n = 5778) and for the housing outcome (k = 5, n = 2467) show a very small effect favoring the treatment group compared to services as usual for these two outcomes, 1 to 4 years post baseline. No significant effect was found for the social support outcome (k = 5, n = 1797). Discussion: Considering the complex trajectories and needs of youth in out-of-home care, it is imperative that independent living programs better reflect today’s socioeconomic realities to better prepare youth for adulthood, and take into consideration the particular needs of these youth. It is recommended to extend the services until 25 years old and to put forward an interdependent vision of autonomy in the interventions provided to these youth.