Children can need the help of an interpreter if they are victims of a crime and need to be forensically interviewed in another language. Recent findings from practitioners raise concerns about the state of interpreter-mediated interviews with children. The current study aimed to explore how Swedish criminal courts reason when assessing interpreter-mediated and interpreter-absent (with children who are not fluent in Swedish) child investigative interviews. We conducted qualitative and descriptive analyses of written court verdicts involving 108 child victims who were evaluated to need an interpreter during their investigative interview. The courts frequently discussed issues regarding possible misinterpretations, language difficulties, and confusion. These perceived deficiencies in the interviews were often mentioned as a cause for assessing the childs testimony with caution and, in some cases, as lowering the evidential value of the child interview. Possible implications for childrens legal rights are discussed.

Background: Legal practitioners have expressed concerns regarding the quality of interpreter mediated forensic interviews with child witnesses. Objective: This mixed-methods study aimed to examine Swedish forensic interviewers experiences of conducting child interviews via a language interpreter. Participants and setting: Forty-one forensic interviewers from the Swedish Police Authority with experience conducting interpreter-mediated child interviews participated in a digital survey. Methods: Their responses were analyzed using both qualitative (thematic and content analyses) and quantitative (descriptive and inferential statistics) approaches. Results: The forensic interviewers general experiences of conducting interpreter-mediated child interviews were negative. Limited access to authorized legal interpreters and doubts regarding the accuracy of interpretation were described as major obstacles in these investigations. The presence of an interpreter could negatively impact childrens disclosure process and limit their chances of expressing their views during legal proceedings. Conclusions: According to Swedish forensic interviewers, the quality of interpreter-mediated child interviews urgently needs to be addressed. Our results are consistent with previous surveys from Australia and the United States, highlighting the international relevance of these topics. Future improvements are vital to ensure that all children are provided an equal right to be heard during criminal investigations, regardless of the native language.

BackgroundEmotion regulation difficulties underlie several psychiatric conditions, and treatments that focus on improving emotion regulation can have an effect on a broad range of symptoms. However, participants in-depth experiences of participating in emotion regulation treatments have not been much studied. In this qualitative study, we investigated participants experiences of a joint emotion regulation group skills training in a child and adolescent psychiatric outpatient setting.MethodsTwenty-one participants (10 adolescents and 11 parents) were interviewed about their experiences after they had participated in a seven-session transdiagnostic emotion regulation skills training for adolescents and parents. The aim of the skills training was to decrease emotion regulation difficulties, increase emotional awareness, reduce psychiatric symptoms, and enhance quality of life. The skills training consisted of psychoeducation about emotions and skills for regulating emotions. The interviews were transcribed and analysed using reflexive thematic analysis.ResultsThe analysis resulted in three overarching themes: Parent - Child processes, Individual processes, and Group processes. The result showed that participants considered an improved parent-child relationship to be the main outcome. Increased knowledge, emotion regulation skills and behavioural change were conceptualised as both mechanisms of change and outcomes. The group format, and the fact that parents and adolescents participated together, were seen as facilitators. Furthermore, the participants experienced targeting emotions in skills training as meaningful and helpful.ConclusionThe results highlight the potential benefits of providing emotion regulation skills training for adolescents and parents together in a group format to improve the parent-child relationship and enable the opportunity to learn skills.

Background

Adults with attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) face multiple challenges in obtaining and maintaining employment.

Aims

To identify and describe how adults with ADHD or ASD experienced their ability to work and what factors affected their ability to find a sustainable work situation over time.

Methods

Individual in-depth interviews were performed with 20 purposively sampled participants with ADHD/ASD. Data were analysed inductively using reflexive thematic analysis.ResultsThree themes were identified, describing (1) one’s own cognitive abilities and challenges, (2) enablement by flexibility and acceptance in the work environment, and (3) accumulated stress that makes the work situation unsustainable over time.

Conclusions

Over time, a lack of continuity and predictability of support measures caused great stress and exhaustion, with severe consequences for working life and in life in general. Adaptations needed to be individually tailored and include nonoccupational factors.

Significance

The study shows that adults with ADHD/ASD need long-term interventions that flexibly adapt to individual needs, as they vary over time. The findings suggest that occupational therapists and other health care providers, employers, employment services and other involved agencies should pay a greater deal of attention to stability and predictability over time.

Swedish society has systematically worked to improve children's health and well-being since the early twentieth century and is considered a leading figure globally in battling violence against children. Awareness of violence against children and its detrimental effects on development and health is generally high in Sweden. Violence is also broadly recognised as a violation of human rights. A ban on corporal punishment was enacted in 1948 in social childcare institutions, in 1958 in schools, and in 1979 at home. The more recent landmark was the United Nations Convention on the Rights of the Child, established as law on 1 January 2020. In line with convention's Article 12, stating that a child has the right to express their views in all matters affecting them, more attention to child participation has been paid since 2020. This chapter provides several recent examples of strategic measures that have been used to enhance child participation in governmental assignments and enquiries and state-funded research. We discuss the examples considering the United Nations convention and child participation methods and pinpoint opportunities and obstacles to further develop and consolidate child participation as a norm in publicly funded societal activities.

The population of internationally forcibly displaced people, which includes refugees and asylum seekers, is large and heterogeneous. To determine the varying reasons for and experiences during the migration journey, including exposure to violence and health- and integration-related needs, there is an urgent need to involve children with refugee backgrounds in research and development activities. This chapter describes a model for the child participatory approach developed at Barnafrid, a national competence centre on violence against children at Linköping University in Sweden. The model has been tested in the Long Journey to Shelter study, which investigated exposure to violence and its consequences on mental health and functional ability among forcibly displaced children and young adults. As part of this project, we conducted workshops with children (n = 36, aged 13–18 years) to design a questionnaire on exposure to community violence in the country of resettlement. Experiences recounted during the child participatory workshops indicated no problems involving newly arrived children with refugee backgrounds and Swedish-born adolescents in research activities. However, attention should be paid to proper preparatory work and the need for adjustments. We discuss the results in light of other studies on refugee child participation, the United Nations Convention on the Rights of a Child and diversity considerations.

Background: Studies show considerable variability in the definitions and operationalization of child maltreatment (CM), which limits research, policy formation, surveillance, and cross-country and cross-sector comparisons.Objective: To review the recent literature (2011-2021) to understand current issues and chal-lenges in defining CM, to assist in the planning, testing and implementing of CM conceptualizations.Methods: We searched eight international databases. Articles were included if the substantive content was related to issues, challenges, and debates in defining CM, and the article was an original study, review, commentary, report, or guideline. The review followed methodological guidance for the conduct of scoping reviews and was reported in accordance with the PRISMA-ScR checklist. Four experts in CM conducted a thematic analysis to summarize findings. Meth-odological rigor of the included studies was not formally assessed. Results: We identified 7372 potentially relevant articles; 55 full-text studies were assessed for eligibility, 25 satisfied the inclusion criteria. We identified three themes: 1) strategies to define CM, including the integration of child and victim perspectives; 2) difficulties in defining specific CM types; and 3) real-world implications for research, prevention and policy.Conclusions: Despite longstanding concerns, challenges regarding the definitions of CM persist. A small minority of studies have tested and implemented CM definitions and operationalizations inpractice. The findings will inform international multi-sectoral processes to develop uniform definitions of CM, for example by highlighting the need to acknowledge challenges in defining some CM types and emphasizing the importance of considering the perspectives of children and CM survivors.

Purpose Research-based interviewing techniques typically rely upon suspects being, at least partially, responsive and engaged in the conversation. To date, the scientific literature is more limited regarding situations where suspects exercise their legal right to silence. The present study aimed to examine Swedish police officers self-reported strategies when interviewing suspects who decline to answer questions. Methods A total of 289 police officers responded to a national survey that included questions about handling silence. The participants worked with a wide range of criminal cases, including financial crimes, fraud, violent offences, domestic abuse, volume crime and traffic violations. We used content analysis to examine their written responses to the open-ended question: What, if any, strategies do you use when interviewing suspects who speak very little or not at all? Results Four main categories were identified relating to (1) question strategies (e.g. asking the questions anyway, using silence), (2) information strategies (e.g. emphasizing the benefits of cooperating and informing about their legal right to silence), (3) supportive strategies (e.g. being friendly and asking about reasons for silence) and (4) procedural strategies (e.g. changing interviewers and conducting multiple interviews). Practitioners working with violent crimes reported meeting silent suspects more frequently compared with practitioners working with other criminal offences. Conclusions The results provide an initial exploration into the various strategies used by police interviewers when questioning suspects who decline to answer questions. Further research is necessary for understanding and evaluating the ethics and effectiveness of such strategies.

Background To examine health and health-related behaviors in migrant and refugee individuals who identify as sexual or gender minority, and in comparison to their heterosexual peers. Methods The study included 168,952 individuals (aged 16-84 years, males: 45.9%, sexual or gender minorities: 3.1%) who answered the Swedish National Public Health Survey in 2018 and 2020. Participants were grouped into Swedish-and Western-born (White) heterosexual, White sexual- or gender minority, migrant heterosexual, migrant sexual- or gender minority, refugee heterosexual, and refugee sexual- or gender minority. Outcomes included mental health (for example suicidal ideation, wellbeing), general health, risky behaviors (risk alcohol use, risk gambling, and substance use), and experiences of violence. Associations between 1) sexual- or gender -ethnic identities and 2) gender-ethnic identities and all outcomes were analyzed using logistic and linear regression adjusting for sex, age, and educational level. Findings Being a sexual- or gender minority, regardless of ethnic minority status, was associated with worse general health and mental ill-health compared to heterosexual peers including suicidal ideation in refugee sexual- or gender minority individuals (OR 2.42, 95 % CI 1.44-4.08). Ethnic minorities (heterosexual and sexual- or gender minority migrants and refugees) had lower odds of drug and risk alcohol use compared to White heterosexual peers but higher odds of risk gambling (1.88, 1.49-2.37 for refugee heterosexuals). Transgender refugees had high odds for risk gambling (8.62, 1.94-38.40) and exposure to physical violence (7.46, 2.97-18.70). Interpretation In this national population-based study, sexual and gender minority individuals have worse mental and general health regardless of ethnic minority status. We did not find evidence for worse health in sexual- or gender minority refugees in comparison to migrant, and White sexual- or gender minorities and their heterosexual peers. Transgender individuals (White and ethnic minority) experienced significantly higher levels of physical violence. Public health policy should emphasize preventive measures to reduce exposure to violence and discrimination in sexual- and gender minority individuals, increase access and use of mental healthcare services and sensitise healthcare professionals about higher rates of health and related issues faced by sexual- and gender minority individuals including those with multiple minority identities.

Introduction According to the UN Refugee Agency (UNHCR), around 40% of the 79.5 million forcibly displaced persons in the end of the year 2019 were children. Exposure to violence and mental health problems such as posttraumatic stress disorder are frequently reported among migrant children, but there is a knowledge gap in our understanding of the complex longitudinal interplay between individual, social and societal risk and resilience factors that impact mental health and well-being, quality of life and ability to function and adapt. There is also an urgent societal need to facilitate interdisciplinary and intersectoral collaborative efforts to develop effective methods to prevent, detect and respond to the needs of the migrants. This project will study adolescent and young adult migrants in Sweden using multiple methods such as quantitative analysis of data from a prospective cohort study and qualitative analysis of data gathered from teller-focused interviews. The aim is to understand how different factors impact mental health and integration into the Swedish society. Furthermore, individual experiences related to the migration process and exposure to violence will be studied in detail. Methods and analysis Study participants will include 490 migrants aged 12-25 years recruited through social services, healthcare, social media and the civil society. A subsample of adolescents (n=160) will be re-interviewed after 1 year. Data are collected using structured and semi-structured interviews along with saliva and hair sampling. Measures include sociodemographic data, longitudinal data on mental health and its determinants, including genotypes and stress-hormone levels, access to healthcare and the process of migration, including settlement in Sweden. Ethics and dissemination The Regional Ethics Board of Linkoping (2018/292-31 and 2018/504-32) and the National Ethics Board (2019-05473,2020-00949 and 2021-03001) have approved the study. Results will be made available to participants, their caregivers, professionals working with migrants, researchers and the funders.

The Nordic welfare model is often used as an example for the promotion of health and wellbeing, even in vulnerable groups of children, such as refugees. Nonetheless, there are no published reviews on resilience and/or risk and protective factors for physical and mental health among refugee children living in Nordic countries. In this systematic review, we identified 5181 studies on the topic, screened titles, and abstracts, viewed 632, and finally included 26 studies. These studies described 18 samples with a total of 34,080 individuals ranging in ages 0–18 years. Overall, the studies were of good quality. Nearly all studies assessed adversity. Six studies reported physical health outcomes and all studies mental health outcomes, most often post-traumatic stress disorder and anxiety. None explicitly studied resilience. While we found that age and sex are the most frequently studied  risk- and protective factors, findings are inconclusive, since the direction of the associations was different in the different studies. This systematic review indicates that there is still a need for well-designed and -powered studies using clear definitions of key study concepts to examine health outcomes and resilience among refugee children in Nordic countries.

ObjectiveTo describe characteristics of suspected child abuse and neglect (CAN) cases associated with the decision of paediatric departments (PDs) in Vienna, Austria, to involve services of a regional tertiary child protection service programme (Forensische Kinder- und JugendUntersuchungsStelle, FOKUS). DesignRetrospective cohort analysis of a regional data collection of CAN cases over the first 2 years of FOKUSs operational period (1 July 2015-30 June 2017). SettingAll CAN cases reported to the PDs of six public hospitals in Vienna. Five of these public hospitals were secondary heath care centres and one was a tertiary healthcare centre. ResultsOverall, 231 cases (59.1%) were treated without and 160 (40.9%) with additional involvement of the FOKUS service programme. The odds of a case to be treated without FOKUS involvement were higher if neglect was suspected (OR 3.233, 95% CI 2.024 to 5.279). In contrast, when sexual abuse was suspected, the odds for involvement with FOKUS were significantly higher (OR 7.577, 95% CI 4.580 to 12.879). The odds of being managed with FOKUS services nearly doubled when multiple forms of abuse were suspected (OR 1.926, 95% CI 1.136 to 3.285). The odds for additional FOKUS involvement were significantly lower for patients treated as inpatients (OR 0.239, 95% CI 0.151 to 0.373). CAN patients managed with FOKUS involvement were significantly more often reported to law enforcement (LE) (OR 3.234, 95% CI 2.078 to 5.002). Concurrently, suspected sexual abuse cases and cases reported to LE were more frequently treated in the PD of the tertiary centre than in other PDs (& chi;(2) p<0.001). ConclusionCAN case characteristics significantly influenced if PDs involved a tertiary child protection programme. Suspected sexual abuse, if more than one form of CAN was suspected and cases reported to LE required additional specialist expertise. For suspected neglect involvement of tertiary services seemed less important.

Artikelns syftar till att undersöka hur examensmålet fokus på barns våldsutsatthet tolkas och implementeras i professionsutbildningar. Det empiriska materialetutgår från en högskolepedagogisk kurs som Barnafrid, Linköpings universitethar genomfört på uppdrag av JÄMY samt två fallbeskrivningarResultat visar på pedagogiska och didaktiska utmaningar som dels handlar omhur ett nytt examensmål ska kunna integreras i fulltecknade utbildningsplaner,dels om hur examensmålet innehåll ska tolkas. I examensmålet finns en hierarkisk ordning där olika våldsformer exempelvis våld mot barn är underordnatmäns våld mot kvinnor. Det krävs därför prioriteringar av vilket våld och målgrupp som ska ingå i undervisningen. Om blivande professioner redan i sinutbildning får uppfattningen att olika former av våld kan särskiljas och vägasmot varandra kan det ge en endimensionell och förenklad syn på våldsutsatthet.

Socialtjänsten har en viktig roll för att barn och unga ska kunna växa upp under de trygga förhållanden som de har rätt till. Detta förutsätter att socialtjänsten får kännedom om barn som kan behöva skydd och hjälp i form av en orosanmälan. Man kan även behöva göra polisanmälan vid till exempel allvarliga brott.

Introduction Childhood sexual abuse (CSA) is a global public health problem with potentially severe health and mental health consequences. Healthcare professionals (HCPs) should be familiar with risk factors and potential indicators of CSA, and able to provide appropriate medical management. The WHO issued global guidelines for the clinical care of children with CSA, based on rigorous review of the evidence base. The current systematic review identifies existing CSA guidelines issued by government agencies and academic societies in the European Region and assesses their quality and clarity to illuminate strengths and identify opportunities for improvement. Methods and analysis This 10-database systematic review will be conducted according to the Centre for Reviews and Dissemination guidelines and will be reported according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Guidance for HCPs regarding CSA, written by a national governmental agency or academic society of HCPs within 34 COST Action 19106 Network Countries (CANC) and published in peer-reviewed or grey literature between January 2012 and November 2022, is eligible for inclusion. Two independent researchers will search the international literature, screen, review and extract data. Included guidelines will be assessed for completeness and clarity, compared with the WHO 2017/2019 guidelines on CSA, and evaluated for consistency between the CANC guidelines. The Appraisal of Guidelines for Research and Evaluation II tool and Grading of Recommendations Assessment, Development and Evaluation methodology will be used to evaluate CANC guidelines. Descriptive statistics will summarise content similarities and differences between the WHO guidelines and national guidelines; data will be summarised using counts, frequencies, proportions and per cent agreement between country-specific guidelines and the WHO 2017/2019 guidelines. Ethics and dissemination There are no individuals or protected health information involved and no safety issues identified. Results will be published in a peer-reviewed medical journal.

Background Despite the existing evidence regarding the interrelated relationship between pain and obesity, knowledge about patients perspectives of this relationship is scarce, especially from patients with chronic pain and obesity after completing Interdisciplinary Pain Rehabilitation Program (IPRP). Aims This qualitative study expands the understanding of patients perspectives on how chronic pain and obesity influence each other and how the two conditions affect the ability to make lifestyle changes. Method A purposive sample of patients with Body Mass Index (BMI) >= 30 kg/m(2) and who had completed an IPRP were recruited for individual semi-structured interviews. The transcribed interviews were analysed using latent content analysis and a pattern of theme and categories was constructed based on the participants perspectives. Results Sixteen patients (aged 28-63 years, 11 female, BMI 30-43 kg/m(2)) shared their experiences of chronic pain, obesity and lifestyle changes after IPRP. The analysis revealed one overall theme (lifestyle changes are burdensome with a body broken by both pain and obesity) and four categories (pain disturbing days and nights worsens weight control, pain-related stress makes lifestyle changes harder, a painful and obese body intertwined with negative emotions and the overlooked impact of obesity on chronic pain). Most participants perceived that their pain negatively impacted their obesity, but they were uncertain whether their obesity negatively impacted their pain. Nevertheless, the participants desired and struggled to make lifestyle changes. Conclusion After IPRP, patients with chronic pain and obesity perceived difficulties with self-management and struggles with lifestyle changes. They experienced a combined burden of the two conditions. Their perspective on the unilateral relationship between pain and obesity differed from the existing evidence. Future tailored IPRPs should integrate nutritional interventions and address the knowledge gaps as well.

Children in out-of-home care (OHC) have higher risks for developing poorer health and school achievement, being subjected to more abuse experiences, as well as negative long-term outcomes related to occupational performance, socioeconomic status, addiction, and criminality. Research related to OHC children is fragmented and the effects of interventions are under-studied.

This thesis aimed to explore health, abuse, support, and preconditions for school among children in OHC and to assess changes after an intervention targeting foster children’s school performance.

Paper I compared OHC pupils in last year high school to non-OHC peers in a national survey with 5 839 pupils. The study showed that risks of abuse and poor mental health are evident for adolescents in out-of-home care. Also, results indicated a lower disclosure rate of sexual abuse, particularly to police or social services.

Paper II compared OHC pupils to peers in birth parent care by analyzing responses in four consecutive year surveys in a regional sample comprising 23 798 pupils in 8th-year compulsory and 2nd-year high school. Responses from the 311 pupils in OHC showed poorer outcomes than did birth-parent care peers in perceived satisfaction with social life and relations, trust to other persons in different relations, abuse experiences online, and sense of security in the school and at home. These results also applied when compared to a subset of pupils living with a single birth parent.

Paper III analyzed prospective test and questionnaire data of intelligence, adaptive behavior, mathematics, literacy skills, and psychosocial wellbeing from 856 children in foster care. Results revealed poorer preconditions for school performance of between 0.5 and 1.0 standard deviations below age-standardized norms. The analysis also provided results regarding different intelligence domains, where working memory showed the lowest scores while perceptual functioning were close to norms. Boys generally scored poorer than girls except in mathematics.

Paper IV explored the effects of a school-based intervention, Skolfam, on a subset of Paper III cohort (n= 475). Results showed improved skills in higher-order cognitive executive functions such as reading comprehension, sentence chains, mathematics, and intelligence. For less complex cognitive functions, affective functioning or psychosocial symptoms, no improvements were seen, except for reduced hyperactivity.

Conclusion: The studies confirm that children in OHC have poorer mental health, are less satisfied with social life, have more adverse experiences both online and in real life and have poorer preconditions for school performance than do non-OHC peers. Importantly, Skolfam intervention can partially enhance preconditions for school performance. Further studies on longitudinal risk, with a design to identify specific protective factors, development of school-related competencies and ways to support OHC children in school are needed.

Children in foster care constitute a vulnerable group with higher risks for exposure to poorer health, adverse experiences during childhood and poor performance in school. School success is considered one of the most important factors to prevent future adversity and there is a growing interest in society for school results for children in foster care or other out-of-home care arrangements. The purpose of this study was to outline prerequisites for interventions aimed at school performance for children in foster care, related to those in normal population studies. In this study assessments of intelligence, literacy and numeracy skills, mental and behavioral conditions were compiled from 856 children in foster care, between preschool class and 7th grade from 22 Swedish municipalities. Results show lower scores in intelligence, most prominent in working memory, adaptive behavior, literacy and numeracy, and more behavioral problems. Ingroup comparisons showed less favorable scores for boys than girls in general, except in mathematics. These findings call for a need to adapt learning conditions in school by individual assessments of children in out-of-home care, rather than assuming age-typical prerequisites.

Interventions aimed at improving school performance for children in foster care are few and are generally not implemented. By preventing failure in school, the prospect of reducing the risk for future poor health, substance abuse, unemployment, and other detrimental social conditions are met. This paper focuses on the change of preconditions for compulsory school performance in out-of-home care children, following an intervention called “Skolfam” that aims to improve school performance by individual assessments and school-based interventions. In this study, data were compiled from prospective repeated tests of 475 children in foster care in Sweden. Educational preconditions were analysed for compulsory school performance, such as intelligence (WISC-IV), psychosocial (SDQ) and adaptive behavior (ABAS-II), literacy (Reading Chains) and mathematical skills (Magne Mathematic Diagnoses) before and after the first 2 years of the “Skolfam” intervention. All tests were age-standardized and performed by experienced professionals. The results showed improved skills in complex aspects of literacy, mathematics, and cognitive performance, but no improvement in less complex literacy skills, adaptive behavior or mental health symptoms. In conclusion, higher-order cognitive functions can develop positively when appropriate school support is provided. Affective function, adaptive behavior, and psychosocial well-being present a more pervasive challenge for children in foster care. Implications for future research, practice in social services, and school is that further development of methods to aid future prospects for children in out-of-home care should aim to improve both cognitive higher-order executive-, and affective functions.