Transitions from Residential Care
This article appeared in the Spring 2015 edition of Relational Child and Youth Care Practice – http://www.cyc-net.org/Journals/rcycp/rcycp-28-1.html
Abstract: This article addresses some key areas relating to care leaver’s transitions from residential care. These include the connection between beginnings and endings as well as misconceptions around terminology, including the usage of the term ‘independence’ for care leavers with ‘interdependence’ being identified as more appropriate. The debilitating impact of loneliness is also explored. Transition processes with reference to Bridges Model of Transition (2004) and the misconceptions associated with the usage of the term ‘care leavers’ are considered within what are identified as residualised residential services. It is proposed that the term ‘care losers’ is more accurate for these children with ‘care seekers’ being identified as a more acceptable term.
The impact of stress on care seekers is identified where non-conforming behaviours are seen as symptoms of the overarching malaise of stress. This is further explored within an examination of focal theory together with the potential for healthy adolescent psychological development.
“What we call the beginning is often the end
and to make an end is to make a beginning.
The end is where we start from.” (T.S. Eliot)
T.S Eliot’s verse resonates within residential care and life today as much as when he wrote it. Both comprise transitions of intertwined beginnings and endings as we move along the continuum of life, transitioning between locations, contexts, generational groupings, relationships, life-stages of physical, emotional, spiritual and mental wellbeing, and dependence/independence/interdependence.
This paper addresses some key areas relating to care leavers’ transitions from residential care: independence and interdependence, loneliness, stress and the less recognised, but equally relevant, focal theory of adolescence.
Sadly, care leavers today can be marginalised and socially excluded (Harder et al., 2011; Stein, 2012) just as they were over 20 years ago when I first started working with this group of young people. With the focus of aftercare support services shifting more and more to models of independence (mainstreaming into adult services with a focus on certain skills or competencies needed to function autonomously) rather than interdependence (the nurturing of autonomy within webs of dependence utilising specialist services allowing for developmental work and for care leavers to depend on others in areas where they lack the capacity to function on their own), increasing numbers of care leavers in Ireland are experiencing poverty and homelessness. (EPIC, 2012)
“..interdependence models saw leaving care more as a psychosocial transition, a high priority placed on interpersonal skills, developing self-esteem and confidence, and receiving ongoing support after a young person leaves care (Stein & Carey, 1986).” (Stein, 2012, p. 31)
The conception of independence itself can be confusing and benefits from a qualification of its intended meaning.
What is the individual becoming independent from? Is it the residential or foster home – in which case the appropriate qualification might be independent living arrangements or independent accommodation? Or is it independent from Child and Family Services and/or the state that is the goal, and here the broadest and unqualified interpretation of independence might be seen to support such a position?
The definition of independence as listed in Cambridge Dictionaries Online tends to lend support to this latter interpretation:
Does any child become truly independent of their family if they move out of the family home to live in independent accommodation when, in 2014, so few have the means to do this before their mid- to late-twenties?
“In most Member States in the EU28, more young people were living with their parents in 2011 than in 2007, the proportion of 18–29 year-olds doing so rising from 44% to 48%…this increase is significant for both the younger age group (those aged 18–24 years) and the older group (aged 25–29), for both men and women. Young men are more likely to live with their parents than young women, and, as expected, those aged below 25 are significantly more likely to live with their parents than those aged between 25 and 29.” (Eurofound, 2014, P. 6)
American terminology is notable with regard to leaving care. There the leaving care process is referred to as the emancipation of young people. This has specific connotations of freedom and oppression (couched as protection) with arguably an implicit validation for the separation between oppression (from state care and therefore ongoing state support) and newfound freedom. The use of language can be of profound importance in social care and social policy (Hartman, 1991) and in Ireland, The Ryan Report (2009) can be commended on its referencing to aftercare as a vital service to assist care leavers in the transition to independent living, rather than merely stating independence. However, the addition of the word arrangements, thereby encompassing the pluralistic and interdependent dimensions implicit in such settings, might have been more appropriate. Bullock et al., (2006, p. 17) make the well-founded point that “The withdrawal of support, and sometimes the loss of a home, produce a new set of problems for young people that are often glossed over in euphemistic talk about independent living”. Clearly, living in independent accommodation is a very different thing from being totally independent of or from whatever support may be needed to aid the person to sustain themselves.
Current practice in preparation for leaving care does not always address the area of psychosocial and emotional wellbeing in young peoples’ lives (Dixon, 2008; Hannon et al., 2010). Research by Iglehart & Becerra (2002) supports this assertion with the finding that young people themselves stated how critical relationships with adults were to them in their preparation for leaving care. The young people in this study placed such relationships above the skills development aspects of independent living programs with regard to the importance of their well-being. Loneliness can have serious consequences for mental, physical and emotional health (Hawkley & Cacioppo, 2007) casting a malignant far-reaching shadow on the life of care leavers. Adolescents’ vulnerability to loneliness, loneliness formerly acknowledged as vulnerability associated with old age, has been identified within research (Hawkey & Cacioppo, 2010). However, this area remains under-researched within Ireland and the UK (Murphy & Shelvin, 2012). I have too often witnessed some of the consequences of this loneliness where ‘bad’ friends are to the lonely care leaver better than no friends. Meg Lindsay poignantly captured the essence of this hidden hardship in her beautifully composed, yet pain-laden, line, recounting the experience of a care leaver named ‘Mary’:
“Her loneliness couldn’t close the door on “friends,” who spent her cash for her, and alienated her new neighbours.” (Lindsay, 2000)
Research by Dima & Skeghill, (2011) and Anghel, (2011) utilising the Bridges (2004) model, has identified that transition is composed of two distinct processes – the physical and the psychological, and has three distinct stages – endings, a neutral zone and new beginnings.
The significance of transitions in successful outcomes for children in care is made explicit in the influential Demos In Loco Parentis report, which states:
“A strong body of evidence and our own primary research shows the most positive experiences of care, and the best outcomes for looked-after children, to be associated with the following three factors:
- early intervention and minimum delay;
- stability during care;
- supported transitions to independence.”
(Hannon et al., 2010, p. 9)
What I have learned in regard to transitioning young people from one service to another is that ideally, the levels of support in the new placement need to be kept the same as in the one being transitioned from. This allows the time and space for young people to process the first two stages. This is easily conceptualised with an analogy that we all encounter daily when using doors between rooms or spaces at different levels. Building regulations require that when you step through a doorway you step across the door saddle onto a step at the same height so that both feet, either side of the door saddle, are at the same level. Then you may take a step down. If this was not the case and you stepped through a door to a lower level it is quite possible that you might fall and thus building regulations – and common sense – prohibit this. Similarly, when transitioning between placements it is only when the step encompassing the first two stages of transition has been accomplished that the levels of support can be reduced appropriately for the new setting in the new beginnings stage. This is especially important when dealing with Step-Down type services.
There is more than one step within a transition and the one least allowed for in leaving care is the neutral stage, where the opportunity to ‘space out’ within what anthropologists term the ‘liminal state’ provides a time for freedom, exploration, reflection, risk-taking and identity search (Stein, 2012).
Whilst the transition process can allow for co-existence of the beginning and ending states, for example, we all have the inner child co-existing with our adult self and we cannot exist in both simultaneously. We must be one or the other at any single moment in time. We may retain the potential for both but there are strong elements of separation, loss and acquisition inherent within the transition process. The leaving behind of our former position is necessary in order to make room to acquire our new state.
This holds particular significance for care leavers when we consider the aforementioned importance of the use of language. Here, the term ‘care leavers’ can be seen to be misleading for children leaving residential care who, for a range of reasons associated primarily with the residualisation of residential care (Smith, 2009) within many jurisdictions, often receive the least aftercare support (Fenton, 2014). For these care leavers it is the care that leaves them, whether they are ready or not, thus making the term ‘care leavers’ misleading and in reality ‘care losers’ more accurate. The term ‘care leavers’ implies it is the young people who possess the agency in the leaving event. They do not. For them, care is lost but their needs and vulnerability remain and are, in fact, multiplied and magnified by this loss of care. They must seek the essential resources, formerly available to them as care, to meet their needs, which renders them ‘care seekers’ or ‘support seekers’. Aftercare for these young people really means after care has gone, posing the question – what and who is left after care is gone?
Considered from this perspective it can be seen that the inability to ‘acquire’ the new state following the loss of the old, consigns the care seeker to what Ward (2002) terms the ‘betwixt and between’ state, neither one nor the other. They are ‘transitionally-blocked’ and therefore unable to progress developmentally. This perspective also reveals the potential role that loss, including the anticipation of loss, plays in the care leaving process. This is in addition to the role of the compound concept of stress in transitions.
Stress is especially salient when considering care leavers who are experiencing ‘accelerated and condensed’ transitions (Biehal & Wade 1996, p. 443)) laden with uncertainty and therefore, in many cases, anxiety. (Cashmore & Paxman, 2006; Kilkelly, 2008)
“Making the transition from care to independence may prove to be one of the ‘betwixt and between moments’ when young people find themselves between stages, which leaves them without a successful means of justifying their own continuity across time.” (Ward, 2011, p. 2516)
In Ireland, I have witnessed the stress which care leavers are subjected to and recognise it as a major issue they face when leaving care. This can be exacerbated by a lack of preparation, loneliness, isolation, fear of the unknown, pre-existing trauma, separation and loss (Biehal et al., 1995). Over the years, I have witnessed the complex and apparently self-defeating behaviours of care leavers, at times accompanied with declining mental health, as they approach their eighteenth birthday and, almost overnight, step into the unknown. These behaviours are, I believe, the symptoms of the underlying malaise of stress. In the UK estimates of children in foster care diagnosed with mental health difficulties are as high as 50% while in residential care the figure is a high as 70%, which clearly pre-disposes this cohort of young people to be vulnerable to mental health difficulties as they leave care. (Meltzer, 2003)
“Research with young people in care highlights that leaving care is a major source of anxiety and stress. This appears to stem from the lack of planning and a general uncertainty about what is happening to them when they leave care…Many children turn 18 when preparing for their Leaving Certificate examinations, meaning that the stress about leaving care compounds existing worry and tension about their future.” (Kilkelly, 2008, p. 339/340)
“At different ages, certain relationship patterns emerge or come into focus, in the sense of being most prominent, but that no pattern is specific to one age only.” (Coleman & Hendry, 1999, p. 14)
Focal theory offers valuable perspectives on adolescent psychological development and is an integrated theory of adolescent development founded on empirical research which argues “that transition between childhood and adulthood cannot be achieved without substantial adjustment of both a psychological and social nature” (Hendry et al., 1993, p. 9).
Erikson and the psychoanalytical model proposes adolescence as a time of ‘storm and stress’, what Farrelly (1994) termed a ‘traumatic time’ and the individuals going through it as ‘volatile’. Erikson recognized the search for ‘self’ and saw the crisis of adolescence proposed within the storm and stress model as a potential ‘turning point’. Building on Erikson’s model, developmental contextualism was theorised by Urie Bronfenbrenner and Richard Lerner. Developmental contextualism is associated with the life-course perspective which takes into account the ecology or context of human development, timing, continuity of development and reciprocity and agency. Focal theory has close associations with developmental contextualism, and thus has association with the social-ecology model of resilience. Additionally, it further explores the timing of specific issues that ‘come into focus’ for adolescents at different ages and the premise that, by focusing on one such issue at a time, adolescents may cope with the change inherent in adolescence. Focal theory shares much with the work of Erikson and Bronfenbrenner. For example, the notion of stage development is present in Erikson’s as well as Coleman’s model, but Coleman also takes into account the potential when multiple issues are being addressed simultaneously for some young people.
Focal theory holds particular relevance with regard to young people ageing out of care, as they have to undertake dual, highly-stressful processes simultaneously. They must make the transition from childhood to adulthood at the same time as the transition from care to independence in circumstances that are ‘both accelerated and compressed’ (ibid). The need for time and space to process these changes becomes evident when considered from the focal theory perspective and when recognition of the impact of stress is taken into consideration. According to focal theory, young people focus on one issue at a time and, given that there is, potentially, considerable stress present in the life of a care leaver, it is possible that, in these circumstances, the one issue may be the stress associated with the process of leaving care. This may be the anxiety invoked by the impending loss of relationships, familiarity and security (Dixon, 2008; Holt & Kirwan, 2012).
“those people who have to face a number of interpersonal issues at the same time are likely to experience problems of adjustment.” (Coleman & Hendry, cited in Stein, 2012, p. 162)
It is important to bear in mind that children who enter the care system have often experienced trauma in their lives both prior to entry into care and within the entry process itself and these traumas may be re-experienced (Stein & Dumaret, 2011).
“Evidence suggests that many of the children and young people who eventually become looked after already have a high level of mental and physical health problems at their point of entry to care.” (Hannon et al., 2010, p. 11)
This stress can manifest as a re-experiencing of the trauma associated with the process of entering care with the associated experiences of loss, separation, and anxiety (Roger, 2011; Ward, 2011) and the erroneously internalised sense of blame and guilt of having being taken into care due to their own actions. (Cashmore & Paxman, 2006)
Children in Ireland enter care due to a range of issues, with family problems being the single largest reason for admission. (Eurochild, 2010, p. 93). These family problems include: parental separation, death, mental health issues, inability to cope and financial/housing problems. Other problems precipitating entry into care include: neglect, physical, sexual, and emotional abuse. For many of these children, there can be a sense of abandonment attached to entry into care (Yates, 2001). For these children, the later abrupt transition into ‘instant adulthood’ (Antle et al., 2009; Rogers, 2011) can evoke a re-experiencing of these earlier traumas at the same time as they are attempting to deal with a range of other factors associated with leaving care. Unfortunately, a sense of abandonment upon leaving care may not always be a re-experiencing of a prior trauma, but rather an all too real-time experience of a second abandonment, this time by their substitute parents. This was a finding in two prominent recent Irish inquiries: The Commission of Inquiry into Child Abuse (2009) and The Report of the Independent Child Death Review Group (ICDRG), Shannon & Gibbons, (2012). Internationally, Philip Mendes (2008) identified this issue:
“Care leavers are literally abandoned by their substitute parents, and expected to transition directly from childhood dependence into adult self-sufficiency.” (2008, p. 255)
Failure to facilitate the time and space required to process successfully such experiences and the stress which they induce can result in the young person becoming overwhelmed or, within Maslow’s hierarchy of needs context, ‘blocked’ and unable to progress beyond the present level of functioning. Furthermore, times of transition are oftentimes identified for human beings as times of upheaval and vulnerability with the individual’s psychological coping capacities consumed with managing the present stress, thus rendering them vulnerable to being overwhelmed by additional stressors. These additional stressors can occur in the form of new issues with which to cope or the emergence of issues which had remained dormant until this time. Therefore, the level of functioning at which the care leaver is ‘stuck’ may reflect these stress-induced factors and be lower than if they were not present.
Whilst this can add to the burden of coping for young care leavers it also represents an opportunity to focus on an issue which may be of profound significance for the care leaver but has not been within their ‘focus’ for some time. It may have been suppressed but is now brought into focus due to the psychological agitation induced by the transition process and healthy psychological development may be both restored and promoted by seizing the opportunity and addressing this issue.
This strategy is supported by the psychodynamic conception of adolescence, especially that espoused by Anna Freud (1958) and Peter Blos (1962), which, inter alia, posits that adolescence is a second, and sometimes last, opportunity to address unresolved childhood issues. These issues, if not resolved, thereafter become fixed as internalised unhealthy blueprints for adult functioning and deeply-entrenched psychologically, thereby becoming rendered more inaccessible for therapeutic resolution.
Therefore, by alleviating the stress in the life of the care leaver with targeted interventions and by discerning what issue comes into focus within the vacuum created by the removal of the stress, the opportunity may become available to resolve childhood trauma. These issues may be unresolved and formerly suppressed but now become manifest within the opportunity presented by the crisis of transition, where the emotional and psychological crisis-induced tumult creates psychic fissures through which these issues may rise to the surface. It has been my observation over my years in residential care that, both within staff teams and resident groups, vacuums do not last long as people, consciously and unconsciously, jostle for roles within these groups. Similar psychological processes may well be at play within the transition process for individual care leavers.
Thus, the crisis of transition from care may be turned into an opportunity for growth, seizing what many claim the Chinese have identified for centuries as the opportunity present alongside danger when conceptualising crisis. (Ibrahim, 2003)
With this potential in mind, professionals supporting care leavers need to identify the stress present within the young people’s lives and, with targeted support, alleviate this stress. Thereafter, professionals need to continue to support the care leavers to identify what issue comes into focus and then assist them in addressing the issue. This is of major significance for two reasons:
- It allows the care leaver to resolve the current issue and move beyond this to the next issue thereby promoting healthy psychological development.
- This may be a ‘turning point’ for the care leaver (Hannon et al., 2010) as the issue which arises may be one which has been ‘blocking’ their healthy psychological development for some time and by resolving the issue new developmental pathways may become open.
From a similar perspective of disruption to normal psychological development, the potential harm to children in care who are subjected to multiple movements between placements can become manifest when considered from a focal theory perspective.
Focal theory is strengths-based and client-centred and focuses the practitioner’s attention on the here and now of children’s lives. This is important when we consider the propensity for outcomes, risk and other currently dominant paradigms to focus on future events while other approaches and therapies, such as attachment and trauma, look at the past and that this can often be at the expense of the child’s right to quality of life in the here and now. Their daily life is affected by a range of assessments, therapy sessions and programme goals to be met, meaning that their need – and their right – to lead a ‘normal’ daily life may not be met.
The world is changing at an unprecedented pace and this is impacting on young people more than any other age group. Globalisation, unemployment and ruptured pathways to adulthood have all added risk and uncertainty to the lives of today’s young people in a way that I did not have to experience to the same extent at their age (Bryner et al., 2002).
The search for security has become preoccupying yet elusive in an incessantly changing and risk-defined world with ever more porous borders, but for young people, this is magnified (Pinkerton, 2012). The impact on young people’s search for identity, an issue at the core of all young people’s development (Erikson, 1980), but particularly complex for young people in care who may have fractured family and community life histories, is profound within such undefined futures. Here, as Stein (2006) has said, we must remember that care leavers are first and foremost young people and impacted by the same previously mentioned forces that affect all young people. However, care leavers have the additional disadvantage of having been exposed to trauma in their childhoods, having been in care and, on leaving care, being at risk of social exclusion. For care leavers, these forces are both magnified and multiplied when they are also experiencing transitions that are ‘accelerated and compressed’(ibid).
Concurrently, and paradoxically, at the very time of major vulnerability when they most need the stability and security of significant attachment figures, care leavers experience broken relationships and attachments as a result of having to leave care staff behind (Holt & Kirwan, 2012).
If we accept the assertions of eminent theorists such as Anna Freud and Erik Erikson who posit that adolescence is the second, and sometimes last, chance to address the crises of earlier childhood, then aftercare can be seen to represent the second, and last, chance to address the crises of negative in-care and pre-care experiences. Failings of the state to support and protect these children adequately, thereby missing this opportunity, represents the gravest of failures. It is the state’s last opportunity to right many of the wrongs perpetrated upon these young people. Endings and beginnings are intertwined, so eloquently put by T.S. Eliot, and for these young people having a positive ending to their care experiences can facilitate positive beginnings in their adult lives – but unfortunately, the converse is also true.