Young people leaving care: health, well-being and outcomes

This paper focuses on the health and well‐being of young people making the transition from care to independent adulthood. It draws on findings from a wider study of outcomes for young people leaving care in England. Notably, the study used, as its key outcome indicators, measures of general and mental well‐being. In doing so, it was able to explore the interrelationship between these areas and young people's overall progress after care. The paper explores the extent to which young people experience difficulties related to physical and mental health, disability and emotional and behavioural problems. It will show that such difficulties can impact upon and be influenced by overall well‐being and post‐care progress in more traditional outcome areas such accommodation and career, and will suggest that the transition from care itself can adversely affect health and well‐being. The paper considers these issues within the context of a changing policy framework which has given increased priority to the health and well‐being of young people in and leaving care, particularly in light of the Children (Leaving Care) Act 2000. It considers the ways that young people are supported to address health and well‐being and the implications for and impact on leaving care services.     

Mental health and wellbeing of care leavers: Making sense of their perspectives

Despite considerable quantifiable data about the circumstances of care leavers in the United Kingdom, there is less qualitative data about how these circumstances are experienced. This article is underpinned by positioning theory, with a particular focus on the unfolding personal narratives of young care leavers in relation to their mental health and wellbeing and the role of a life‐skills programme in supporting them in this respect. The research illustrates that leaving care projects, such as the one in the current study, are more focused on employment and housing issues than on addressing the mental health and wellbeing needs of young people. Our analysis of interviews with young people illustrates the ambiguity of understandings of concepts such as “mental health” and “wellbeing,” and the complexity of responses to questioning around this area. This illustrates one of the major problems in evaluating the outputs and outcomes of such projects in terms of simplistic targets, where mental health and wellbeing are not clearly defined or understood by young people themselves. The current research provides a more complex picture. More research is needed that involves in‐depth and longitudinal assessment of specific mental health needs of care leavers and how they can be addressed successfully.     

The school to work transition for young people in state care: perspectives from young people,carers and professionals

Workforce participation has many positive effects on quality of life. However, as young people in care have generally below‐average levels of educational participation and attainment, they may be ill‐equipped for the transition to further education and work. A mixed‐method study conducted in Australia about career development for young people in care investigated how this population develops ideas about future work: the social and cognitive variables that influence career decision‐making; practices for preparing young people in care for the transition to work or further education; and factors that support or impede the transition. Findings from the qualitative study are reported in this paper. Interview data were obtained from the multiple perspectives of young people in care, foster carers, caseworkers and school personnel. The overall picture was one of young people in care lacking the encouragement, resources and capacity to realistically plan for the job they want. Specific interventions are required to enhance career development and employment outcomes for this population.     

Early access and use of housing: care leavers and other young people in difficulty

This paper presents findings from a study of how care leavers access and use housing services, and what they said had helped them to do so. The sample comprised 80 care leavers, and, for comparison, a group of 59 young people (termed ‘in difficulty’) who met certain criteria of disadvantage. Care leavers were found to have fewer crisis transitions and less experience of homelessness, together with a much higher level of autonomy and support in their first accommodation, relative to other young people in difficulty. Several factors are identified that, from the care leavers' point of view, contributed to their better access and use of housing services, including having family and friends to turn to, and leaving care teams that negotiated on their behalf with housing services. The paper concludes that care leavers had more positive housing experiences than other young people in difficulty, helped by the improved preparation for independence and ongoing support available to them from leaving care teams.     

Into adulthood: a follow-up study of 718 young people who were placed in out-of-home care during their teens

In this study, national register data were used to analyse long‐term outcomes at age 25 for around 700 Swedish young people placed in out‐of‐home care during their teens. The sample consisted of 70% of all 13‐ to 16‐year olds who entered out‐of‐home care in 1991. Results revealed a dividing line between young people placed in care for behavioural problems and those placed for other reasons. Young woman and men from the first group had – in comparison with peers who did not enter care – very high rates of premature death, serious involvement in crime, hospitalizations for mental‐health problems, teenage parenthood, self‐support problems and low educational attainment. Young people who were placed for other reasons had better outcomes, but still considerably worse than non‐care peers. Young women tended to do better than young men, regardless of reasons for placement. Very high rates of hospitalizations for mental health problems were found among young people placed for behavioural problems. Breakdown of placement was found to be a robust indicator of poor long‐term prognosis.     

Predicting after-care outcomes: the importance of 'felt' security

Young people who ‘age out of care’ generally do not have the continuing source of emotional, social and financial support that is available to most young people in their transition to early adulthood. They therefore face the challenges of making various transitions with fewer resources and less support, and at an earlier age and in a less graduated way than young people of the same age in the general population. Some, however, manage this process more successfully than others. The current study examines the links between stability, perceived or ‘felt’ security and later outcomes for young people 4–5 years after leaving care. It is based on a four‐wave longitudinal study over 5 years of 47 young people leaving care in New South Wales, Australia. Felt security in care, and continuity and social support beyond care were the main significant predictors of these young people’s outcomes 4–5 years after leaving care. While stability in care was important, this may be as a means to an end–building a sense of security, belonging and a network of social support.     

Research review: Aging out of residential care in South Africa

Approximately 21,000 children were accommodated in residential care in South Africa in 2011/2012. Despite this large number, and the state's substantial financial investment in residential care, there has, until recently, been little research on care‐leaving: the transition out of care due to reaching adulthood. Furthermore, much of the research available has not been published in international journals. This article reports on a systematic review of research on residential care‐leaving in South Africa, from 2003 to 2016. A thematic analysis of the resulting 40 research outputs maps the scope of findings from South African research, in relation to theory of leaving care, measurement tools developed, young people's experiences of leaving care, transitional outcomes, processes of leaving care, facilitators of improved outcomes, care‐leaving services, and policy on leaving care. Critical gaps in the current research opus are identified, with a view to refining future research on young people aging out of care in South Africa.     

Interpretative phenomenological analysis of young people's lived experiences of therapeutic residential care

Concerns of maltreatment and poor outcomes persist in residential care despite numerous government inquiries and recommendations. Young people in residential care continue to be the most vulnerable and marginalized group in the out‐of‐home care population. Young people's voices are also underrepresented in research. Existing studies predominantly focus on service evaluations in which individual voices of young people are overshadowed by adults' perspectives. Other studies examine the perspectives of young people in out‐of‐home care as a homogenous population, limiting understandings of the subjective experiences of young people in residential care. This study focused exclusively on young people's lived experiences in Australian therapeutic residential care, utilizing interpretative phenomenological analysis. The young people in this study revealed experiences of peer victimization, ambiguous loss and uncertainty during transitions. These findings suggest that more work is required in order to provide safe and healing environments and experiences for young people in therapeutic residential care. Each individual voice captured in this study offers valuable insights into how residential care practitioners can strengthen practice to enhance protection, engagement, connection with families and leaving care support.     

Professionals' perceptions of the rocky routes to successful outcomes for young people in a children's residential school

Poor outcomes for young people in and leaving care have been well documented and research has indicated that the expectations of professionals working with children and young people looked after is a significant influence, particularly in relation to education. An evaluation of an independent children's residential school in Scotland provided a rare opportunity to analyse and compare the views of different kinds of staff about desirable outcomes and how successful outcomes could be achieved. Care workers, teachers and specialist support staff shared some views, but also held contrasting expectations, which appeared to be linked to differing emphases in their models for working with young people. This paper offers tentative explanations for such differences and concludes with suggestions on how to help align service staffs' expectations of young people leaving their care.     

The complexities of cultural support planning for Indigenous children in and leaving out‐of‐home care: the views of service providers in Victoria,Australia

Indigenous children and young people are over‐represented at all stages of the Australian child protection system. Policy and legislative initiatives exist in the state of Victoria, Australia aiming to support the connection between Indigenous children and young people in state care and their culture and community. This exploratory research involved focus group consultations with seven child and family welfare agencies to investigate the impacts, barriers, benefits and limitations of cultural support planning for Indigenous young people in, and leaving care in, Victoria. Findings indicated that cultural planning was of value when it could be completed. However, various shortcomings of current systems were identified including limited resourcing of Aboriginal Community Controlled Organisations to generate plans and provide direct and secondary consultation services to implement plans, difficulty gathering information for plans and some Indigenous young people expressing disinterest in connecting to their culture and community. Complexities in the relationships between the Indigenous and non‐Indigenous agencies that aimed to support Indigenous young people in care were also acknowledged. Participants identified a number of strategies to improve outcomes, such as facilitating better relationships between agencies, promoting opportunities for ongoing cultural training for staff in mainstream agencies and improving the resourcing of Aboriginal Community Controlled Organisations to deliver planning and to support cultural connections.     

Economic self-sufficiency and the employment outcomes of care leavers: A 10-year follow up

Gaining employment and reaching a stable and self-sufficient livelihood are essential life tasks, especially for young people ageing out of public care. This longitudinal study followed alumni of welfare and educational residential care settings in Israel for 10 years after leaving care. Here, we describe care leavers' employment and economic self-sufficiency outcomes and examine differences over time in their experiences. They were interviewed at the age of 19, 1-year post-care (N = 235), 3 years later (N = 222) and 10 years after ageing out (N = 151). Results paint a mixed picture. While the majority of participants were employed, many in stable jobs, their wages were low even as they grow older. At the same time, they experienced significant economic hardships. For some, economic hardship decreased with time, but for others it remained a cause for concern. Our findings highlight the inherent dependency between experiences at different life stages and suggest that providing more support to care leavers would improve their economic outcomes.     

The Ties that Bind: Support from Birth Families and Substitute Families for Young People Leaving Care

This paper draws on findings from a study of outcomes for youngpeople leaving care funded by the Department for Education andSkills. It explores the informal support networks availableto a sample of 106 young people over a period of 12–15months after leaving care. It examines patterns of contact withbirth families and caregivers, the support that emanated fromthese links and the strategies of leaving care professionalsto strengthen these connections. It also considers the new familiescreated by many young people through relationships with partnersand the onset of parenthood and discusses the continuing supportneeds of young parents. The paper situates the needs and experiencesof care leavers in a wider youth transitions framework and highlightsthe need for continuing professional attention to be given tostrengthening family links as one strategy for helping careleavers to negotiate the transition to adulthood.     

Participation in social,leisure and informal learning activities among care leavers in England: positive outcomes for educational participation

Against a background of research and national statistics that consistently show that educational participation and achievement of young people in and leaving care is significantly lower than is the case for the non‐care population, previous research has shown the positive impact that social, leisure and informal learning activities can have on the educational participation and achievements of young people, and particularly those from disadvantaged backgrounds. The UK: Care Matters Green Paper stated that involvement in leisure and social activities can have a positive impact on the self‐esteem of young people in and leaving care and upon their educational attainment and later success in the labour market. This paper reports on the English results of a cross‐national study of young people from a public care background and their pathways to education in Europe. Using case study examples it explores the impact that social, leisure and informal learning activities can have on educational participation and educational pathways of young people in and leaving care. The paper argues that, in view of these findings, encouraging and supporting young people in and leaving care into these types of activities should be a priority for social care professionals, carers and teachers.     

Care leavers: A British affair

Individuals in and leaving care within the UK experience numerous dilemmas that include a lack of supportive housing and potential homelessness, lower educational attainment and occupational status, and greater likelihood of moving into poverty. These adverse situations—all of which are interrelated—shape their present and future health status. Models of these processes usually focus on individual behaviours/characteristics, the consolidation of positive identities through the development of supportive networks, and specific social policies germane to this group. Although informative, these models neglect many key contextual factors that shape these outcomes. In this paper, we present a model of care‐leaving that incorporates developments in the political economy of health literature to show how differing welfare state arrangements shape health by mediating the distribution of economic and social resources over the life course for populations in general and for those in and leaving care specifically. The key recommendation suggested by this model is to focus upon developing public policies to address the vulnerable situations care leavers experience associated with skewed income distributions, lack of housing affordability, weak employment standards, and lack of access to higher education typical of liberal welfare states such as the UK.     

Graduating from the child welfare system: a comparison of the UK and Australian leaving care debates

Historically, insufficient resources and assistance have been provided to young people leaving state care. Care leavers have been found to experience significant health, social and educational deficits including homelessness, disproportionate involvement in juvenile crime and prostitution, poor social supports and early parenthood. This paper compares the UK and Australian debates around improving outcomes for care leavers. Whilst there are some minor differences in the respective legislative frameworks and responses, the similarities are far greater. Both countries have failed to provide the range of in-care, transitional and post-care supports and services required to ensure improved outcomes for care leavers.     

Needs and availability of support among care‐leavers: A mixed‐methods study

Data are scarce on the long‐term needs of care‐leavers and on the support resources that are available for them in the years after leaving care. This mixed‐methods study presents data on the needs and availability of support of 222 Israeli care‐leavers, suggesting that the most urgent needs of care‐leavers are a lasting need for a stable and available support figure and assistance with educational issues. For some care‐leavers, these needs are fulfilled by their mentors. Parents and other familial figures were found to be the most common support resource for care‐leavers, which highlights the need for the intervention of social workers to improve relationships within families while the children are still in care. Due to high rate of young people who have no support resources and a low rate of services utilization, social services should provide a platform to support this group, using mentors and other supporters. The longitudinal data of up to 4 years after leaving care indicated that the availability of various types of informal support improved over the years, and the reports on difficulties in relationships of the care‐leavers with their parents were significantly fewer 4 years after leaving care than on the verge of leaving care.     

‘Replacement Care’ for Working Carers? A Longitudinal Study in England, 2013–15

In the context of rising need for long‐term care, reconciling unpaid care and carers’ employment is becoming an important social issue. In England, there is increasing policy emphasis on paid services for the person cared for, sometimes known as ‘replacement care’, to support working carers. Previous research has found an association between ‘replacement care’ and carers’ employment. However, more information is needed on potential causal connections between services and carers’ employment. This mixed methods study draws on new longitudinal data to examine service receipt and carers’ employment in England. Data were collected from carers who were employed in the public sector, using self‐completion questionnaires in 2013 and 2015, and qualitative interviews were conducted with a sub‐sample of respondents to the 2015 questionnaire. We find that, where the person cared for did not receive at least one ‘key service’ (home care, personal assistant, day care, meals, short‐term breaks), the carer was subsequently more likely to leave employment because of caring, suggesting that the absence of services contributed to the carer leaving work. In the interviews, carers identified specific ways in which services helped them to remain in employment. We conclude that, if a policy objective is to reduce the number of carers leaving employment because of caring, there needs to be greater access to publicly‐funded services for disabled and older people who are looked after by unpaid carers.     

Early outcomes for young adults transitioning from out-of-home care in the USA

This paper describes the well‐being of participants in the Midwest Evaluation of the Adult Functioning of Former Foster Youth (n = 603), a study of youth leaving out‐of‐home care in the USA, at the point where they have been ‘young adults’ for about 1 year. Although some of these young adults are in stable situations and either moving forward with their education or employed in promising jobs, more of them are having significant difficulties during the early stages of the transition to adulthood. Too many are neither employed nor in school, have children that they are not able to parent, suffer from persistent mental illness or substance use disorders, find themselves without basic necessities, become homeless, or end up involved with the criminal justice system. They are doing worse than other young adults across a number of important dimensions. Most of these young adults continue to maintain relations with members of their family of origin, with many finding themselves living with family at age 19. Importantly, those young people who chose to remain under the care and supervision of the child welfare system experienced better outcomes than those who either chose to or were forced to leave care.     

Research Review: Independent living programmes: the influence on youth ageing out of care (YAO)

Independent living programmes (ILPs) aid in promoting productive outcomes for youth ageing out of care (YAO). This narrative review aimed to determine if sufficient evidence exists to substantiate statements regarding the effectiveness of ILPs based upon outcome studies published from January 2006 through December 2012. Are current ILPs effectively promoting independent living and productive outcomes among youth leaving foster care, relative to similar youth who do not participate in an ILP? Six studies published in English, in the USA and in peer‐reviewed journals included non‐experimental design (n = 1), quantitative designs (n = 2), mixed methods design (n = 2) and randomized design (n = 1). Five outcomes addressing education, employment, housing, mental health, and living skills emerged. Weak evidence that ILPs effectively aid YAO exists. Additionally, inconsistencies exist in methodology. Finally, differences in important components in the ILPs exist, making comparisons difficult.     

Supporting foster and kinship carers to promote the mental health of children

The majority of children and young people removed from the care of their parents by the state of Victoria, Australia, reside in foster or kinship care. These children have experienced a broad range of adverse conditions and are up to 4 times more likely to experience problems with mental health than their mainstream peers. This paper draws on the perspectives of foster and kinship carers, describing the disconnection between their role as mental health advocates and their interest in early intervention in a field which is dominated by crisis and the historic marginalisation of foster and kinship carers. Thirty‐one foster and kinship carers across greater metropolitan Melbourne, Australia, contributed to this study through interviews and focus groups. Participants demonstrated a practical understanding of mental health and an ability to identify a range of conditions that have an adverse impact on the mental health of children and young people in their care. The paper concludes that there is a lack of systemic support and even a range of barriers that affect the capacity of foster and kinship carers to promote the mental health and well‐being of the children and young people in their care.