Rehabilitating delinquent youth is associated with enormous difficulties. In fact, up to 80- 90% relapse within one or two years of ending treatment. Opinions on what that is due to, and what should be done, differs widely. Ideology often takes precedence over empirical data and there have been many fluctuations over the years. Internationally, there are hundreds of studies on the effects of treatment with several meta- analyses that can point out important components in the treatment of juvenile delinquents.
There are methods and programs that can have a decisive impact on the lives of young offenders. Therefore, if you want to build effective programs, you must start from the knowledge that is available. Placing a young person in a locked institution is a harsh, but sometimes necessary, intervention. However, successfully treating young criminals in an institutional environment has proven to be a hard, if not impossible, task. One cannot rule out the fact that the effects may be the opposite of those intended. One of the most important reasons, in addition to the lack of appropriate methods and trained staff, is that the treatment environment is very different from the outside world.
Any changes achieved in an institution quickly fade away when the return to the natural living environment occurs.
Meta-analyses show that treatment programs implemented under more open forms can have a better effect than institutional treatment. Interventions that tackle the problem directly in its social context appear to be the most promising. The research also underlines the importance of early intervention and the role of the family in preventing norm-breaking behaviour. To be effective, institutional treatment must be linked to interventions in the community. Achieved changes must gradually be transferred to everyday life in order to survive.
If institutional treatment is to be reasonably effective, the following components should be included:
1. Management and managers at all levels must be familiar with appropriate research so that the right investments and priorities are made. The methods used should be evidence and/or knowledge based as much as possible. The basis for the treatment should be based on social learning theory and CBT because it has the best research support. The treatment should be skill-building with the aim of replacing antisocial behaviour, lack of self-control and antisocial values with prosocial equivalents. Other important ingredients of a treatment program are education, job training, cultivating leisure activities, and healthy lifestyles. Methods that are trendy, untested or even counterproductive should be avoided. There is always an allure in trying new and popular methods. However, there is no “silver bullet”, i.e. simple solution to difficult and persistent problems.
2. Methods and working methods must be carefully implemented. Clear leadership, awell-tuned and well-trained workforce with a common approach are a prerequisite for a positive outcome. Staff must be trained and supervised in the methods and working styles used. Good relationships are necessary to deliver good treatment. All staff must function as credible models of social behaviour. The approach should be respectful but also active and controlling. As a staff, you must be socially competent, clear and consistent. There are many stresses that staff can experience. In the role of staff, you often meet clients with challenging and aggressive behaviors. Staff turnover in institutions and treatment homes is usually very high. Perhaps the biggest challenge lies in recruiting suitable staff that can be trained and retained over time.
3. The treatment should initially be characterized by a high structure in both form and content around the clock. Of course, there should not be free access to violent games, the internet, tablets and mobile phones. Progression in the treatment must take place via achieved and readable criteria. The young person can thus influence his or her own situation. Predictability, when you know what is expected, creates security. As the treatment progresses, there is a gradual progression towards lower structure and increased autonomy. There should also, however, be the opportunity to repeat the program when necessary.
4. There must be an active norm culture that permeates the treatment environment. There should be low (zero) tolerance for aggressive, acting out and antisocial behaviour. Acting out behaviours tend to escalate if they are not stopped in time. Premises and buildings must be safe and fit the purpose. It is important to combine a safe environment with pleasant living. The buildings will allow for flexible and individual solutions with the possibility of scattered housing.
5. Much of what applies at a treatment institution includes everyone, but the treatment content must be based on individual treatment plans. High-risk adolescents should receive intensive and highly structured treatment. Low-risk individuals should not be mixed with high-risk ones as they risk accelerating in their antisociality. So-called “behavioural contagion” must be avoided. The individual assessment must also carefully screen for various conditions: traumatic experiences, substance abuse and neuropsychiatric diagnoses, including psychopathic traits. Compliance in treatment and daily routines should be high. There must be motivating consequences in the form of clear arrangements where desirable behaviours receive positive reinforcement. To this end, there is a documented use of effective tools such as contingent contracts, token economy and point or level systems. For girls, treatment must be adapted to the specific needs of this group. Gender-Responsive Interventions for Girls need to be developed that better meet their unique needs.
6. Treatment must never be interrupted abruptly in the final phase. Placement in a locked institution alone does not result in lasting change. The return to society must last for a long time. The transfer should take place gradually in care chains: treatment must be linked to community-based interventions. The young person must learn to deal with risk situations and setbacks and create a new social situation and a supportive environment. Important people in the young person’s life should be involved early in the treatment. CBT-based work with parents, family, peers and networks is required. To know whether the treatment is effective, follow-up and evaluation of the treatment must always be included. It’s as simple as that!
A well-functioning treatment program does not suddenly appear by itself overnight. Careful preparation and detailed planning are required. The most effective programs are characterized by high integrity (“treatment integrity”). Treatment integrity is about implementing programs in practice in the way they are intended in terms of theory, methods, structure, and design. Of course, there are and have been many commendable initiatives in many places over the years. The difficulty is to maintain commitment and quality over time.
Bengt Daleflod, August 2025