Families at risk and the role of the care system

Family-related adversities (FRA), including the death of a parent, parental substance abuse, violence between parents and divorce, have a detrimental effect on youth development. As such a family is no longer able to cope with adolescents´ problems, they frequently become users of psychosocial care. Psychosocial care providers and parents are important actors in the care process for adolescents and to some extent outcomes of care depend on them. We assessed first, the associations of FRA with developmental outcomes, and second, the perspectives of professionals working with adolescents on the roles of parents and their own roles. We found FRA to be associated with lower scores on the Positive Youth Development questionnaire. This association was mediated by both individual and parental factors. Next, we found FRA to be associated with more frequent violent behaviour in adolescents; this was mediated by hopelessness. This thesis also identified four different perceptions on the role of parents in the care: first, parents as a cause of the adolescents´ problems; second, parents trying to escape from the responsibility for their child; third, parents as an active part of care; and fourth, parents as barriers to effective care. Last, we identified six different roles of mental healthcare providers. These roles can be divided into three categories: those related to direct work with clients (expert, diagnostician, therapist), those related to cooperation with other professionals (participant in intra-institutional cooperation, a participant in inter-institutional cooperation), and those related to the functioning of the institution (businessman). Moreover, we identified nine discourses in the background of these roles, namely biomedical, biopsychosocial, psychotherapeutic, a discourse of behaviourism, humanism, institutional care, patients’ rights, and multi-disciplinarity, and economic discourse.