Aggression Replacement Training (ART) i Sverige - spridning, programtrohet, målgrupp och utvärdering

Sammanfattning: The manual- based prevention program Aggression Replacement Training (ART) is used in treatment of young people with behavioral problems. This thesis is based on two attempts to evaluate ART in Sweden. Using ART as an example, the aim of the thesis is to describe and analyze how a manual-based program is spread and applied within Swedish social services. The aim is also to discuss the conditions for conducting efficacy studies of manual-based programs in regular in-home care and in secure institutional youth care. In addition, the thesis includes a systematic review of existing international and Swedish effect and efficacy studies of ART (Brännström, Kaunitz, Andershed, South & Smedslund 2016).The first sub-study presented in the thesis consists of two different surveys of how and to what extent ART was used within the Swedish municipal social services in 2006 and 2012. The results show that ART has been widely spread within local social services though the program adherence has been low and the variations of ART used in practice have been far from adherent to the original manual-based program.The second sub-study examines and describes the target group of youth receiving ART within the Swedish social services. Results show that program participants are a crime active group but the variation is large in terms of seriousness and extent. According to self-reported data, program participants neither use alcohol or drugs to any greater extent than other peers. Furthermore they seemed to have social skills (interpersonal skills, ability to assert themselves, self-control and empathy) within the normal range for young people of the same age. Roughly one in three participants did not complete the ART training as planned.The third sub-study describes two aborted attempts to carry out efficacy studies of ART within regular in-home and secure youth care in Sweden. A number of factors such as low adherence to the program - which affects the ability to carry out efficacy studies in this research field - are reported and discussed.According to the systematic review of effect and efficacy studies of ART, most international studies show more or less positive results. After checking the quality of the studies and risk for bias, it appears that all of the studies - in varying degrees - have substantial methodological flaws. The scientific evidence is therefore insufficient for drawing conclusions about effects of ART.Finally the results are discussed in relation to contemporary demands and expectations of an evidence-based youth care, in relation to other studies that have been carried out in this field, and in relation to the existing conditions for using manual-based programs in youth care regular practice.