This article analyzes the transformation of Swedish residential care for children from a regionally coordinated, public social service system into a thin, but highly profitable, national spot market in which large corporations have a growing presence. Marketization and privatization are theorized as complex processes, through which the institutional structure and logics of this small, but significant, social policy field changed profoundly. Using official documents, register data, media reports and existing research, three consecutive phases in the development of the children's home market are identified since the early 1980s. Change was driven on one hand by policies inspired by New Public Management, which shifted public authority horizontally to the private sector, and vertically to local authorities (funding) and to the state (regulation). On the other hand were the responses of local authorities and private actors to the changing incentives that policy shifts entailed. During the first two phases, both the proportion and size of for‐profit providers increased, and the model of family‐like care was replaced by a professional model. Cutting across the trend of privatization in the third phase was establishment of a parallel system of homes for unaccompanied refugee children – mostly in public ownership. Similarities with privatization in the English system of children's care homes are noted. By showing how the Swedish market for residential care has been created by policy and by actors’ responses to those reforms, the article provides a foundation for thinking through how the predictable, significant and well‐documented problems of such care markets might be addressed.

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BackgroundPreventing externalizing problems in children is a major societal concern, and a great number of intervention programs have been developed to this aim. To evaluate their preventive effects, well-controlled trials including follow-up assessments are necessary.MethodsThis is a systematic review of the effect of prevention programs targeting externalizing problems in children. The review covered peer reviewed publications in English, German, French, Spanish and Scandinavian languages. Experimental studies of standardized programs explicitly aiming at preventing externalizing mental ill-health in children (2–19 years), with outcome assessments at ≥6 months post intervention for both intervention and control groups, were included. We also included long-term trials with consecutive observations over several years, even in the absence of follow-up ≥6 months post intervention. Studies of clinical populations or children with impairments, which substantially increase the risk for mental disorders, were excluded.ResultsThirty-eight controlled trials assessing 25 different programs met inclusion criteria. Only five programs were supported by scientific evidence, representing selective parent training (Incredible Years and Triple-P), indicated family support (Family Check-Up), and school-based programs (Good Behavior Game, universally delivered, and Coping Power, as an indicated intervention). With few exceptions, effects after 6–12 months were small. Long-term trials showed small and inconsistent effects.ConclusionsDespite a vast literature, the evidence for preventive effects is meager, largely due to insufficient follow-up post intervention. Long-term follow up assessment and effectiveness studies should be given priority in future evaluations of interventions to prevent externalizing problems in children.