Elien Neimeijer

68 Method Setting and participants The present study was conducted at Trajectum, a Dutch secure forensic treatment facility for adults with MID-BIF and externalizing behaviour problems and/or internal- izing problems. Due to a combination of MID-BIF, severe challenging behaviour, mental health problems, and/or a history of substance abuse all residents need intensive care and monitoring in a specialised and secure setting. Most residents have committed a serious crime and are admitted by means of a disposal to be treated on behalf of the state (in Dutch: Terbeschikkingstelling or tbs) as they were considered not to be legal- ly accountable for their crime because of severe psychopathology. Other residents are placed in the facility under criminal law, civil law or were voluntarily admitted. Treatment is provided by sociotherapists during daily routines, work and educational activities, individual and group therapy sessions and leisure activities in collaboration with psychologists, psychiatrists and psychotherapists, who supervise the sociothera- pists and provide additional one-to-one treatment. Based on the psychopathology of the residents and the phase of the treatment (i.e., observation, treatment, and rehabilitation), treatment programs (e.g. aggression, addiction, or sexual offending behaviour), the secu- rity levels and care intensity vary over the units (i.e., observation, treatment and reha- bilitation). While in some units the support is more distant, in other units the residents receive one to one guidance throughout the day. Depending on the risk of (re)offending, legal status and treatment phase, residents move to living groups with different levels of restrictions and levels of security. Based on variability in characteristics on participant level (gender, age, diagnosis, legal status, treatment duration at the living group and the facility, treatment phase) and group level (security level, care intensity, group composition, group size, treatment program) participants were invited to participate. A purposive sampling strategy was applied to ensure variability in experiences amongst the participants. Twelve individ- uals (4 women; 8 men) with MID-BIF participated in the study. Their pseudonyms and characteristics are provided in Table 1 (see page 72/73).