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.     

A comparison of youth resilience across seven South African sites

The resilience of children and youth is an increasingly important area of research. Young people growing up in distressed communities, characterized by poverty, crime and family troubles, are particularly vulnerable. Resilience can assist these young people in navigating through these challenges towards independent living, particularly as they transition out of adolescence and into young adulthood. Children in South Africa are almost universally vulnerable, but children growing up in residential care facilities and children from poverty‐stricken communities are particularly in need of resilience. This quantitative study of 575 South African children compared their resilience in terms of individual, family and community protective factors across seven sites, including child and youth care centres, schools in poor communities and schools in middle‐class suburban communities. Contrary to expectations, the study found that children in one of the children's homes and one of the poor communities had the highest levels of resilience. Moreover, all but one of the sites scored very high on at least one of the resilience variables, suggesting unique profiles of resilience across the sites. Practice implications for child and family social work are discussed.     

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.     

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.     

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.     

Young people leaving care in Sweden

The transition from a placement in care to an independent life can be a problematic phase for young people. In Sweden, special care‐leaving services are almost non‐existent. What then happens to young people when they leave a placement in out‐of‐home care? This paper draws on the results of a study in which 16 young care leavers between the ages of 18 and 22 years were interviewed. Telephone interviews were also performed with the young care leavers' parents, social workers, foster carers and institutional staff. The aim of the study was to investigate how young care leavers perceive the transition from care to an independent life. The Swedish welfare model, the prolonged transition to adulthood and the family‐oriented welfare discourse have been used as analytical perspectives. The results show that young care leavers have a pronounced need for social, emotional, practical and financial support. Whilst such support is occasionally provided by foster carers and residential staff, it is seldom given by social services or biological parents. This group is at risk of facing severe problems in the transitional phase from care to independent life, a fact that is not acknowledged by the Swedish welfare system.     

Making a home, finding a job: investigating early housing and employment outcomes for young people leaving care

This paper presents findings from a new study of outcomes for young people leaving care funded by the Department for Education and Skills. It reports findings for a sample of 106 young people in relation to progress made in housing and employment some 12–15 months after leaving care. The generally poor employment outcomes of care leavers are acknowledged, but ingredients that make for success are also highlighted, including the value of settled care and post‐care careers, sound career planning and, significantly, the value of delaying young people’s transitions from care. Early career paths also interconnect with how young people fare in housing, in developing life skills and with other problems in their lives after leaving care. Housing outcomes were more encouraging and predominantly shaped by events after leaving care, and faring well in housing was the factor most closely associated with positive mental well‐being in young people. Some groups that are at risk of faring badly are identified, including young people with mental‐health problems, young people with persistent offending or substance misuse problems and, in some respects, young disabled people. The implications of these findings for leaving care services are considered.     

Policy transfer,social pedagogy and children's residential care in England

Much concern has been expressed about the quality of care and poor outcomes for looked‐after children (‘children in care’) in England, especially regarding residential homes. This paper builds on a recent evaluation of the piloting of the continental European model of social pedagogy (SP) in English residential care. It does three things: it considers the theoretical social policy literature on policy transfer and its implications; discusses European residential care for children and the discipline of SP; and reflects on these debates and the situation of children's residential care in England. The paper concludes that there are some major hurdles to a widespread implementation of SP in England. This particularly concerns the differing social, professional and political context of children's residential services across neighbouring countries.     

Offending behaviour in care: is children's residential care a ‘criminogenic’ environment?

This paper focuses on offending behaviour and children in residential care. The paper considers whether children's residential care is a ‘criminogenic’ environment, i.e. whether this type of care environment helps to provide the conditions that produce crime or criminality. The paper draws on the findings from recently completed research on 10 children's homes in a large county local authority in England. This paper focuses on the patterns shown in trend data collected on problematic and offending data across these homes over a 7‐year period (2001–2007) and a 1‐year cohort study of 46 young people. Interviews with care staff and young people are used to contextualize these patterns. The data provide evidence of an environment where conflict and offending behaviour are common. It is argued that the residential care environment, particularly for older teenagers, often presents a set of risks that tend to reinforce offending behaviour and that this is in part due to its ‘last resort’ status.     

Supporting young people from care to adulthood: International practice

This paper explores practice examples relating to young people's transitions from care to adulthood. It discusses examples drawn from young people's pathways to adulthood, leaving care law and policy and participation. The paper concludes with a discussion of the research evidence on promoting the resilience of young people from care to adulthood, by proposing a framework for evaluating the impact of practice. It is suggested that practice should be interrogated in respect of the contribution made to stability and continuity, educational achievement, involving young people, preparation and support into adulthood, and health and well‐being.     

Life satisfaction in the transition from care to adulthood: the contribution of readiness to leave care and social support

This research explores whether readiness to leave care mediates the association between social support – from peers, staff and biological parents – on the verge of leaving care and life satisfaction a year after among young people ageing out of care in Israel. The results represent two waves of a longitudinal study. Two hundred seventy‐two adolescents from residential settings in Israel completed a self‐administered questionnaire shortly before they left care, and one year later, 234 of them were interviewed to assess their life satisfaction. Readiness to leave care was found to mediate the relationship between most social support measurements and life satisfaction. At the same time, the findings also suggest that this mediating effect varies for different types of support and has a lesser amount of influence for profound emotional support than other types of support. These findings highlight the need to include both the preparation to leave care and the reinforcement of emotional support available to young people who aged out of care, before and throughout the transition from care to adulthood.     

Lessons learnt? Abuse in residential child care in Scotland

This paper draws on work carried out by Sen, Kendrick, Milligan and Hawthorn commissioned as pert of the Historic Abuse Systemic Review by the Scottish Executive in 2007. It considers the evidence‐based regarding abuse in residential child care from 1945 with a specific focus on Scotland. It reviews the context set for residential child care post‐1945 by the Clyde and Curtis reports, outlines how the residential child care sector developed following this, provides an overview of evidence and awareness of abuse in residential child care establishments after the 1948 Children's Act, giving particular consideration to the public inquiries and reviews of residential child care which there have been in Scotland, explores research evidence regarding the safety of convictions of residential child care workers found guilty of child abuse, and provides an overview of the main policy and practice developments which there have subsequently been in Scotland. The paper concludes by considering the progress that has been made in developing safeguards in Scotland and identifying areas where further research and development are required.     

Resilience of Young People in Residential Care

Children and young people in residential care may have experienced or may experience various difficult, life-threatening events, such as neglect, abuse, or violence and maltreatment known as adversities. Despite this, some of them are able to function and even prosper and this has been attributed to the development of resilience. In this qualitative empirical study, we focus on the under-researched area of how young people in care reflect on and cope with such adversities. The exploratory research comprised of semi-structured interviews with young people in two different care settings – re-education centres and children’s homes. The results showed that the sample of 34 young people had experienced 73 adversities prior to leaving residential care and that half of them were not able to resolve some of these adversities. It was found that methods for dealing with adversity change during time spent in care and that a combination of various individual strategies, adaptation and accepting support are effective. The findings also indicate that the development of resilience may vary according to type of residential care setting specifically, whether these facilities allow the development of multiple individual strategies for dealing with adversities, or whether they provide social support. The article discusses implications for future research and practice in residential care.     

Peer violence in foster care: a review of the research evidence

Whilst a small amount of research has been undertaken on peer violence in residential settings, very little is known about peer violence in foster care. This paper reviews the published research since 1995 about the nature and extent of peer violence in foster care and interventions for preventing and managing these negative peer interactions. The evidence indicates that young people in foster care can be the instigators and recipients of peer violence, but the limited number of studies found means that conclusions cannot be drawn about the extent of the problem. There is some evidence about the impact of this type of violence on young people and fostering households. However, there remain gaps in the evidence about the full extent of all forms of exploitation and violence that are experienced and instigated by young people in foster care, the circumstances in which it takes place, the young people affected and its co‐occurrence with other difficulties. Critically, young people's views were largely absent from included studies, an important area that requires further research.     

Dialogic literary gatherings and out‐of‐home child care: Creation of new meanings through classic literature

Research on out‐of‐home child care has revealed that foster care programmes focused on educational attainment and reading have the potential to improve the academic outcomes of children in care. However, no studies have examined which elements of these programmes positively benefit children's emotional well‐being. This article presents evidence of the positive effects of implementing a successful educational action, dialogic literary gatherings, in a children's residential care institution. A qualitative study using a communicative‐oriented methodology was conducted and involved five participant observations and eight daily life stories with children in out‐of‐home care in Catalonia (Spain). The children's reflections demonstrated that reading classic books, such as Dickens' Oliver Twist, deeply influenced their feelings and self‐conceptions and created new and exciting meaning in their lives.     

Driving outcomes: learning to drive,resilience and young people living in residential care

There are continuing concerns about the experiences offered to older adolescents being looked after (‘in care’) in the UK and, especially, to care leavers. Questions are asked about the limitations of State care compared with normal family life. This paper reports on an initiative to provide driving lessons to a group of six young men living in residential homes in one city. It links with resilience theory – how individuals can have relatively good outcomes despite early adversity. A qualitative study was undertaken to explore the effects of the initiative, including individual interviews with young men, heads of homes in which they lived and children's services managers. The overall results indicated that the initiative was very worthwhile. The lessons were a significant part of young people's lives. Possible effects on young people were divided into personal, instrumental and social. Benefits were reported from all parties concerning young people's self‐esteem and self‐confidence, as well as in forging close relationships with supportive adults. Driving would not be seen as a panacea for complex personal histories and structural problems, yet this small experiment suggests that driving lessons could be of disproportionate benefit and there is a moral obligation to provide them in any case.     

Therapeutic residential care in Spain. Population treated and therapeutic coverage

Therapeutic residential care (TRC) is the name given to specialized children's homes for treating cases with severe emotional and behavioural problems that have been placed in residential care. A recent international review has revealed great diversity in the referral criteria of cases and in the models of intervention carried out. The goal of this study is to describe the population treated in these types of facilities in Spain and the therapeutic coverage given. The sample is made up of 215 young people in children's homes, of whom 93 are in TRC. The cases referred to TRC have been in residential care for less time but have gone through a greater number of placements. These young people also exhibit more problems of drug use, and there is a larger percentage of clinical‐range cases in the Child Behaviour Checklist scales of attention problems and aggressive behaviour. Nevertheless, the results of logistic regression indicate that the only variables that significantly increase the probability of being referred to TRC are drug use and changes of care placements. With regard to therapeutic care, there is a higher percentage in the TRC group receiving psychiatric care, and the sessions are also more frequent.     

Transitions of Youth in Mental Health Residential Care to Less Restrictive Settings: The Role of Strengths and Gender

ABSTRACT

Changes in youth's behavioral/psychosocial functioning has been found to play an important role in the transitions from mental health residential care to less restrictive settings, and this functioning differs significantly by gender. However, there has been little attention paid to the roles played by psychosocial strength and gender in transitions out of residential care. The current study examined gender differences in the role of strengths in transitions to less restrictive settings using data on 675 youth's admission and discharge records collected from Illinois Residential Treatment Outcome System during 2005–2007 (Mean age = 15 years, SD = 2.0; 57.5% = boys). The results of multivariate logistic regression model indicated that positive recreational activities and lack of chronic illness were related to a higher likelihood of transitions to less restrictive settings among girls, while appropriate sexual development, psychological strengths, and strong spiritual/religious strengths were related to the transitions among boys. This study demonstrates the potential importance of youth strengths in the provision of mental health services and suggests a need to develop models of outcomes that take gender into account. Additional research based on multiple informants including youth self-report is needed to understand the role of gender in transitions out of residential care.     

Use of population measures and norms to identify resilient outcomes in young people in care: an exploratory study

The purposes of this study were to derive a new method for identifying resilience (i.e. positive adaptation in spite of serious adversity) among young people in care and to determine the percentage of the latter who experienced resilience on selected outcomes, as conceptualized from within the developmental approach of Looking After Children. The participants comprised two samples of young people who were living in out‐of‐home care (mainly foster care) in the province of Ontario, Canada, 340 aged 10–15 years and 132 aged 5–9 years. Virtually all had experienced severe adversity in their families of origin, such that in most cases the legal custody, care, and control of the young people had been permanently transferred from their parents to a local Children's Aid Society. Corresponding to each in‐care sample was a general‐population sample of the same age range that served as a normative comparison group and was drawn from the National Longitudinal Survey of Children and Youth (NLSCY). The NLSCY is an ongoing, long‐term social‐policy study of the development of a nationally representative sample of Canadian children into adolescence and early adulthood. The general‐population samples were composed, respectively, of 5539 young people aged 10–15 years and 11 858 children aged 5–9 years. Resilience among the young people in care was operationally defined, on each outcome variable, as average or above‐average functioning relative to that of the general‐population sample of the same age range. The percentage experiencing resilience was relatively high on the outcomes of health, self‐esteem, and pro‐social behaviour, moderate on the outcomes of relationship with friends and anxiety and emotional distress, and low on the outcome of academic performance. The implications of the findings are discussed.