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Leaving residential placement: A guide to intervention

Varda Mann-Feder and Thom Garfat

Abstract: How we deal with youth who are leaving residential care has a powerful effect on post-placement adjustment. This article reviews relevant literature from a range of helping professions and outlines implications for managing termination with children and youth in care.

Any Child and Youth Care intervention in residential care is, by definition, time limited and temporary. We come into the lives of young people with the goal of helping them to leave us. Ideally, discharge begins at intake.

The purpose of this article is to relate writings that promote an understanding of termination processes to the experiences of young people in residential care and provide guidelines for intervention. While much of the literature reviewed is drawn from other helping professions and addresses the termination of psychotherapy, implications for Child and Youth Care work in residential placement settings will be outlined.

Leaving is difficult

Discharge from residential care is not just an ending, it is a critical, distinct phase of the treatment process (Wolberg, 1997). It begins when young people and the staff working with them begin to anticipate the end of placement. For some, this lasts months or years, while others may only become aware of their impending departure within days or even hours. This phase, which should not be taken for granted, has unique challenges and requirements. Under ideal circumstances, placement ends when the young person, their workers, and the family can acknowledge the progress that has been made and feel ready. Often, however, youth do not leave residential placement under these optimal conditions. While a common tendency on the part of Child and Youth Care Workers is to frame a discharge as a positive graduation, most clients leave residential placement with mixed feelings.

Leaving a residential setting provokes powerful and often unpleasant feelings. This reaction is influenced both by previous experiences with separation and the meaning which they give to the experience of being in care. The end of placement stimulates a rethinking of the reasons for coming into care in the first place and forces a young person to relive the past (Wolberg, 1977). For many young people, this is a painful and angry-making experience. Huge losses typically accompanied the transition into placement: young children tend to idealize parents and blame themselves, while adolescents experience rage at what they perceive as betrayal by family. Shaefer and Swanson (1988) state that the experience of placement is extremely difficult to master psychologically, and that the anticipation of discharge is disorganiz- ing because it revives unresolved issues.

At the same time, young people often fear giving up the protection of a residential setting. They may feel extremely apprehensive about their capacity to function ‘on the outside,’ especially in light of past failures. The longer a young person has been in care, the more severe this anxiety may be (Escoll, 1996). Leaving care also inflicts multiple new losses. Discharge represents the giving up of valued relationships with staff and peers. It may also result in the loss of improved living conditions and access to enriched schooling and activities. Swanson and Schaefer (1988) see these as psychosocial, physical and socio-cultural losses. Not only is this painful in the present, these losses further contribute to the rekindling of “residual feelings that flow from past losses” (Malekoff, 1997, p.166). The result of all this is an uncomfortable mixture of sadness, fear, anger and excitement.

Because of the complex emotions it elicits, discharge frequently stimulates renewed behavioural difficulties in young people in placement, even those who have made remarkable progress. Acting out and difficult behavior that emerge when a young person is leaving residential care are really attempts to cope.

The following are possible motivators for behavioural regression in response to an upcoming discharge:

Trying to reactivate old methods of mastery. If a youth encounters an experience which generates anxiety, then she is likely to try to deal with it in ways that were successful for her in the past. For example, if rejecting others in the past has given her a sense of being-in-control and that felt better than experiencing the loss, then she may turn to that old form of mastery. How much new learning and anticipatory rehearsal a young person has done will obviously affect her response.

Trying to evoke a reassuring (familiar) reaction from care givers. Familiarity in the responses of others, suggests that there is a comfortable familiarity to a situation itself. If I can provoke you into responding in a familiar manner, even if it is a negative response, then I may be able to experience this as familiar, and therefore I know how to handle it.

Trying to do to you what they are afraid you are going to do to them. If youth are afraid of rejection, they may reject you. If they are afraid that you will withdraw from them, they may withdraw first. Replicating the anticipated response of others is a common defence.

Trying to “bring on” the very thing they are afraid is going to happen. If I have an idea (even if it is a fantasy) about how things are going to be in the future, I may try to make those things happen now, so that I feel a greater sense of control and re-assurance that the world is a predictable place. If I am worried about failing after I leave, I may as well push the limits now. We all act in order to meet our own needs. If I am feeling unsafe, I may act to feel more in control.

These reactions can take many forms, including fight and running away, devaluation of staff or even self-destructive actions. Rarely can a young person “terminate smoothly and with finality in one try” (Meeks, 1971). Even when ideal conditions are met, and a young person, the staff and the family all agree to discharge, no young person leaves placement free of difficulties. “If residential placement continues until new behaviors are consolidated and setbacks never occur, it will never end” (Durrant, 1993, p.23). The discharge process exacerbates all difficulties. Most departures from placement are complex and messy, and as such, create specific difficulties that are unique for each young person (Martin, 2003). Sometimes these reactions even lead to premature discharge, because our programs may not tolerate or understand acting out in the context of a discharge process, which may present as regression to earlier problems or new forms of difficult behavior.

Reactions to leaving care vary not only in the form the behavior takes, but also in the intensity of the response. A number of factors can predict how intense a young person’s reaction will be:

The quality of relationships between the youth, the people in the residential care environment, or even the physical or material aspects of the placement environment. Imagine for example that you are leaving a place where you experienced caring in relationship for the first time. Now imagine leaving a place where you thought the people were cruel to you. Your response to the leaving might be quite different.

The meaning or value of the people and the place. Imagine a place that means `home’, now imagine leaving a place that means `prison.’ How you feel about leaving may be different, and so will your reaction to that process.

The number and meaning of previous separations and how they have been processed. If your previous separations have not been processed well, the issues are likely to arise again. If every time you left another place, it meant you experienced pain, then you are going to expect this one to be painful too. This demonstrates the importance of dealing with issues of previous separations while the young person is in care. Related to this is the child or adolescent’s attachment style (Swanson & Schaefer, 1988). Insecurely attached young people are exquisitely sensitive to loss and will react with great anxiety to the inevitable uncertainties of any discharge.

The value or meaning attached to the place, person or thing they are moving towards has a significant impact. The circumstances of the individual discharge bring with it complicating factors that will make reactions more acute. Research suggests that clients who return to their families, while usually thrilled, have fantasized through- out their placement about this return and have particular anxieties about failure (Durrant, 1993). At the same time, the more attractive the future, the easier it is to move towards. Young people who have not had a say in the timing or discharge destination may experience depression and hopelessness as the termination date draws closer (Martin, 2003). Clients who are discharged because of behaviour may perceive that they have been kicked out and may express their grief and anger in their mistrust of the adults in their next placement (Meeks, 1971). Lastly, adolescents who age out of care and go into indepen- dent living mourn anew for the family they have lost in coming into care, which has abandoned them once again at the end of placement (Gordy-Levine, 1990).

The responsiveness of the placement environment in which the separation is occurring. Rigidity or a lack of empathy for these separation reactions may escalate acting out behaviour.

The ability of the young person to understand what is happening. Age, cognitive capacity and maturity level are factors here. Often children and youth have not had a full and appropriate (for them) explanation of the discharge process and what they can expect.

Termination must be processed

Because leaving care provokes a complex array of feelings no matter what the circumstances, adequate preparation is critical (Geldard & Geldard, 1997). “Unskilled management of issues and technical problems raised in the termination phase“ (Meeks, 1971, p.166) can lead to even more dramatic relapses in behavior and the development of new problems. In many senses, discharge from care precipitates a crisis (Swanson & Schaeffer, 1988), which can also be an important opportunity for Child and Youth Care intervention. A skilfully planned discharge can assist a young person to: begin to rework past losses; achieve a degree of closure in relation to placement; and to enter the next phase of life with more realistic expectations and awareness of available supports.

Thus there are three vital aspects of intervention in working with youth who are leaving care:

Helping the young person manage the present separation experience. Being successful with the current task is always a priority.

Helping the young person resolve previously unfinished separation experiences. Current experiences evoke past experiences and given how poorly we have typically managed the separation experiences with youth in care, this becomes a major task.

Helping the young person prepare for future separations. We deal effectively with today and it helps us prepare for being successful tomorrow.

These three major tasks can only be accomplished through a careful sequencing of interventions.

Plan. To begin with, it is vital that discharge from care be planned far enough in advance to allow for some working through of the issues, yet not so far as to cause more anxiety than a young person can tolerate (Malekoff, 1997). The youth’s age and developmental status should be taken into account, because preadolescents may even have difficulty visualizing exactly how long it will be before they really leave. Rose and Fatout (2003) suggest that the element of time should be concretized with all young people as much as possible, to the point of marking days off on a calendar or placing pennies in a jar each day. While optimal timing may vary a little from individual to individual, Swanson and Schaeffer (1988) suggest that termination work should begin three to six months before discharge.

Process feelings about the past.  A common tendency of youth workers is to begin their discussion of discharge with a future focus. An important part of termination work is to anticipate the ending and what comes next, however, the literature stresses that these issues represent a later emphasis, which should only become more explicit with the passage of time (Durrant, 1993). The initial goal is to support a young person to reexamine feelings associated with past losses (Malekoff, 1996). A starting point is to review the conditions of initial placement and to ask about significant separations that preceded placement (Bullock, 1996). The role of the worker is to encourage the ventilation of feelings, to listen, and to provide emotional support. Helping a youth to face difficult feelings by being present and communicating acceptance is an important first step and one that takes time. This can assist a client in learning that loss and letting go are a part of life and can be important developmental experiences (Lanyado & Horne, 1999).

Help youth to review their experience. The next step in termination work is to participate with youth in evaluating their time in placement (Durrant, 1995). This evaluation should focus on feelings towards staff and peers and the identification of gains made by the young person (Swanson & Schaeffer, 1988). In a sense, the theme should be “what do we mean to each other” (Stein, 1995). It is important that the worker remain undefensive in these conversations (Rose & Fatout, 2003) so that the young person has the opportunity to air grievances and express any anger or disappointment in relation to experiences in placement. Once again, the focus is on helping the young person to become aware of feelings and to express them constructively.

Encourage a future orientation. Anticipation and exploration of the future is a third element in a well-managed termination. This means a thorough exploration of the young persons’ expectations, as well as any concerns that they may have. It is vital that they and the youth care worker predict problems and relapses (Wolberg, 1977), especially because many young people idealize conditions after discharge. Youth workers need to remain aware that “the focused, change-oriented tasks of residential placement will give way to the ongoing tasks and ups and downs that will continue in day to day life” (Durrant, 1933, p.171). If they have visited their next placement, the transition from “guest” to “resident” may be sobering, even if they are returning to their family home (Stein, 1995). Helping the youth to accept that there will be problems in the future is an important goal of termination work. It can then lead to a discussion of possible supports (Hummaker & Lager, 2001) so that the young person is aware of where and when to seek out help. Some authors have said that, in fact, the treatment process really begins with discharge, because that is when the young person will really have to exercise learnings from placement (Durrant, 1993). It is extremely helpful if youth in the midst of termination can have an increasingly active role in decision-making in relation to their discharge, even if it is only relative to the details of their departure. Giving adolescents and children a greater sense of control is an important act of empowering them as they move out into the world (Swanson & Schaeffer, 1988).

The last step in a termination is the actual goodbye. For some young people, this is the most anxiety-provoking piece of the process, and their emotionality will escalate until their last day, no matter what the quality of the preparation. It is those youth whose departure is imminent who may test the skills and patience of child and youth care workers the most (Swanson & Schaeffer, 1988). It often happens that, despite much planning, some youth act out so much that they arrange to be ejected so as not to face saying goodbye.

Rituals are important, and a party, gifts and farewell speeches from staff all serve to mark this milestone. It is most important that departing clients hear that we care about them (Shulman, 1999). Mementos or symbolic keepsakes serve an important function in providing a young person with something that they can take with them (Durrant, 1993). These provide concrete evidence of a significant part of their history which has changed their life forever (Rose & Fatout, 2003). Rose and Fatout (2003) remind us that discharge celebrations are both happy and solemn for this reason. Workers need to be aware that participation in a goodbye party also has a profound effect on the residents who are not leaving, and they may experience grief whether or not they were close to the young person who is being discharged (Stein, 1995).

Some intervention strategies are summarized below:

Plan a discharge as far as possible in advance. Start talking about leaving when youth first enter the door, so that it comes as a predicted process, not as a punishment for doing well. And remember what Henry Maier (1994) says, “when you are leaving, it is natural to draw closer together first.”

Provide emotional support of an accepting nature while still offering encouragement. Encourage and support the expression of affect. Begin with a discussion of the initial placement and previous separation experiences.

Offer relevant education about what they might experience while going through the process of separation. Be as concrete as possible about how it will feel and how events around them will unfold. Sometimes it is helpful to prescribe or label the experience you expect them to have.

Help the person to realise what they are grieving about we don’t always know. Sometimes, for example, we think we are grieving the loss of a person when in fact we are grieving the loss of a situation, for example, the security of knowing that meals would always be regular and plentiful. And sometimes the current separation invokes memories of others.

Help youth to talk about self and their own experience. We have a tendency to talk about others during these times. It helps to separate us from our own feelings. Help the young people to focus on the here-and-now and their relationships with staff and other youth in the program.

Explore the feelings about feelings. It is one thing to feel angry, but an important question is often, “how do you feel about being the kind of person who is angry about leaving?” In other words, how do you feel about your feelings?

Give large reinforcements for small steps in expressing themselves appropriately. This helps a person to recognise their own movement.

Help the youth get connected to support structures. It is good to have other supports – friends, clergy, parents, and teachers – someone with whom we feel comfortable to just talk and be.

Create a future orientation. Help them explore the possible positive value of leaving and what they might look forward to in the future. In some ways we help them prepare for the future by helping them situate themselves in that future.

Use separation rituals. This is especially useful in group care situations. When leaving becomes a ritual which others also pass through, it seems more natural and easier to experience. Farewell dinners, memory night, special events, all help to normalize the experience and create a context for containing it. These are good ways of coming closer, before leaving.

Teach them to say goodbye. Many of the youth in our care have never learned to say good-bye. Instead we say things like “see you later.” But goodbye is a natural thing and learning it now, will help them deal with future separations.

Use transitional objects. Maier (1994) talks a lot about the value of transitional objects. Something you can carry from one place to another and that helps you take a little bit of this place, of this experience, with you. They can be very comforting as they help to maintain the connection. They are also helpful in that there is a message here that you don’t have to reject on person, place or experience entirely in order to move on to another.

Show them how you will stay connected. You can practice this, give them examples, and have old residents come back so they can see it happening before they leave.

Our feelings as workers are relevant

Supporting a young person through leaving residential placement can be a draining process. Not only is it painful to share the turmoil; it elicits our own feelings about separation and loss (Malekoff, 1997). All youth workers who participate in discharges from placement need to become aware of their own issues about saying goodbye. An important component is that we “acknowledge and express our (their) own feelings of loss in order to be accepting of similar feelings of the children in our (their) care” (Swanson & Schaeffer, 1988, p.29). Inability of workers to face separation can block the capacity of their clients to express similar feelings. We have a critical role to play in modeling self-expression and ownerships (Meeks, 1971), and we need to acknowledge our own emotions in relation to a young person’s upcoming departure.

Aside from our own history of losses and our readiness to acknowledge their lasting effects, the experience of saying goodbye to a client has a very real and present impact on a child and youth care worker. We, too, are letting go of a valued relationship (Meeks, 1971), sometimes one that met many of our own needs. We may have been dependent on a young person for our sense of accomplishment and professional self-esteem (Geldard & Geldard, 1977). We are often more important to a young person than they will ever let us know (Meeks, 1971) so as we say goodbye, we are often unsure of what our influence has been. A worker may experience relief at the same time, because a challenging young person is no longer demanding their attention. We may have concerns about a client’s capacity to function outside of placement and even wonder if the gains we perceived were real (Malekoff, 1997), leaving us with nagging questions about whether we have done enough (Stein, 1995). At times, workers are not in agreement with a specific discharge plan (Layado & Horne, 1999). At other times, they may experience the termination process as so rocky that they doubt the wisdom of letting the young person go. Because most discharges from placement do not occur under optimal conditions, staff “need to be ready for considerable frustration over unsatisfactory termina- tions” (Martin, 2003, p.70). Like the young people who are leaving placement, we workers need to acknowledge unresolved feelings so that we do not contaminate our functioning in the future. On the other hand, facing and expressing these feelings can free up our energies for the challenges ahead.

References

Bullock, R. (1996). Return home as experienced by children in State Care and their families. In Hudson, J. & Galaway, B. (Eds.) Child Welfare in Canada: Research and Policy Implications. Toronto: Thompson.

Durrant, M. (1993). Residential Treatment: A Cooperative, Competency- based Approach to Therapy and Program Design. New York: W.W. Nelson.

Escoll, L.S. (1996). The termination phase: how it bears on the patient’s view of the therapy and the therapeutic relationship. Dissertation Abstracts International: Section B. Sciences and Engineering. 57(5B), 3407.

Geldard, K. & Geldard, D. (1997). Counselling Children: A Practical Introduction. London: Sage.

Gordy-Levine. T. (1990). Time to mourn again. In Maluccio, A.N., Krieger.R., & Pine, B.A. (Eds.) Preparing Adolescents for Life After Foster Care. Washington, D.C.: Child Welfare League of America.

Hummather, J. & Lager,P.B. (2000). Child Welfare: A Unifying Model of Practice. Belmont, California: Wadsworth.

Lanyado, M. & Horne, A. (1999). The therapeutic relationship and process. In Lanyado, M. & Horne. A. (Eds.) Handbook of Child and Adolescent Psychotherapy. London: Routledge.

Malekoff, A. (1997). Group Work with Adolescents: Principles and Practice. New York: Guilford.

Maier, H. (1994). Attachment theory is “in.” Journal of Child and Youth Care, 9(1), 35-52.

Mann-Feder, V. (2003). Termination issues in residential placement. Irish Journal of Applied Social Studies, 4 (2), 35-40.

Martin, D.G. (2003). Clinical Practice with Adolescents. Pacific Grove, California: Brooks/Cole.

Meeks, J. (1971). The Fragile Alliance: An Orientation to the Outpatient Psychotherapy of the Adolescent. Baltimore: Williams.

Rose, S.R. & Fatout, M.F. (2003). Social Work Practice with Children and Adolescents. Boston: Pearson.

Shulman, S.R. (1999). Termination of short term and long term psychotherapy: patients’ and therapists’ affective reactions and the therapists’ technical management. Dissertation Abstracts International: Section B: Sciences and Engineering. 60(6B), 2961.

Stein, J.A. (1995). Residential Treatment of Children and Adolescents: Issues, Principles, and Techniques. Chicago: Nelson-Hall.

Swanson, A.J. & Schaefer, C.E. (1988). Helping children deal with separation and loss in residential placement. In Schaefer, C.E. & Swanson, A.J. (Eds.) Children in Residential Care: Critical Issues in Treatment. New York: Van Nostrand Reinhold.

Wolberg, L.R. (1977). The Technique of Psychotherapy. New York: Grune & Stratton.

 

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