Listen to thisYoung people leaving the care system face significant challenges when making the transition to adulthood, with limited support from other agencies. Their outcomes are significantly poorer than those of their non-care peers. This review aims to synthesise recent research on informal network support for care leavers making the transition to adulthood.
Keywords
Children in care, transition, social networks
Introduction
The link between leaving care and poor life outcomes is well established. Care leavers are poorly equipped prior to transition and subsequently experience loneliness, isolation, poor mental health, unemployment, poverty, drift and homelessness (Stein, 2005).
Numerous papers and reports have highlighted such shortcomings and offered recommendations aimed at supporting care leavers. For example, the policy document Care Matters (DHSSPS, 2007) highlights the need to strengthen support for young people leaving care as they make the transition to adulthood. Nevertheless, the quality of support for care leavers remains patchy, and the ‘longstanding problem’ of poor outcomes (National Audit Office, 2015, p. 5) continues to present challenges for policymakers and governments, both in the UK and internationally.
Prior to leaving care at eighteen, young people can experience nurturing relationships with carers who provide ongoing emotional and practical support. While a small number in Northern Ireland may stay in foster placement until 21 as part of the Going the Extra Mile (GEM) initiative, the majority of young people will leave their care placement before turning eighteen. The post-care framework significantly decreases the support that young people receive, whether they have been in a foster or residential placement, and most make the journey out of care largely on their own (The Centre for Social Justice, 2013). Literally overnight, some will move from their care placement to independent living in the community with a limited network of people around them. As one care leaver put it, “I never left care, care left me” (The Centre for Social Justice, 2013).
Research on care leavers suggests their transition out of care and into adulthood is ‘compressed and accelerated’, placing unrealistic responsibilities and expectations on them (Stein, 2012). Furthermore, predisposing factors related to early trauma can impact on their ability to trust others, affect emotional development and increase the likelihood of isolation (Smith, 2011).
In 2017/2018, there were 313 care leavers in Northern Ireland (DOH, 2018). The Health and Social Care Services (NI) retains responsibility for supporting young people post-18 into early adulthood. This responsibility was strengthened by the Children (Leaving Care) Act (Northern Ireland) 2002, which placed additional duties on the Trust to improve the life outcomes of young people leaving care through a Pathway Plan prior to leaving care. While the legal framework is clear, the system is not working effectively to deliver good outcomes (National Audit Office, 2015). For example, while the Pathway Plan includes consideration of support, identity, social needs and family relationships, in practice these elements are often missing, with practical aspects of transition, such as housing, training and employment, receiving primary focus (Munro, Lushey, Ward & National Care Advisory Service, 2011).
Recognition is emerging of the important role informal networks and relationships play in determining the quality of life after care (Winter, 2015). Various studies in this review have identified that strong relationships and supportive networks enable young care leavers to meet the significant life challenges they face and help to improve outcomes.
That said, the benefits of informal networks for care leavers have not received sufficient theoretical or policy focus to date (Dima & Pinkerton, 2016). This review therefore has four objectives: (1) identify and evaluate evidence from research on care leavers’ experience of informal networks when making the transition from care; (2) explore how informal networks influence their adjustment to adulthood; (3) present recommendations for further research; and (4) stimulate discussion to influence practice and policy regarding preparation for leaving care.
Limitations
The author is a team leader in a long-term residential home for young people aged twelve to seventeen which is part of the Belfast Health and Social Care Trust, Children's Community Services Directorate. The nature of this role, which involves working with care leavers transitioning out of residential care, with particular focus on their emotional needs, elevates the risk of confirmation bias (Nickerson, 1998) or overcompensation to avoid bias in the selection process.
These factors may have influenced the selection of studies and the focus on areas relevant to the author’s own interests at the expense of others.
Method
A systematic search was undertaken using three bibliographic databases: PsycINFO (Ovid platform), Social Care Online (SCIE) and Social Services Abstracts. Systematic searching identified three concepts: ‘children in care’, ‘transition’ and ‘social networks’. Of the 161 studies retrieved initially, ten articles were identified following expansion and amendment of the search terms as being pertinent to the review topic and meeting the inclusion criteria.
Inclusion criteria
The primary focus of this review, and therefore of the studies selected for inclusion, is on informal networks. A significant challenge in the selection process was the lack of an agreed definition of this term. For the purposes of this review, informal networks include those adults in the community who do not have a paid role in the young person’s care and with whom the young person has a personal significant relationship. These include biological and extended family members, mentors, former carers, foster carers and individuals from community organisations.
To be selected, studies must have been peer reviewed and published in English between April 2018 and January 2000. This time range ensured content was relevant to current policies and practices. The selected studies varied in size, geographical location and age of participants, and include both residential care settings (n=5) and foster care settings (n=5). They also varied methodologically, with data collected through interview, survey and focus groups involving various participants, including care leavers, carers, and caseworkers.
Findings
Emerging themes
Role of informal networks
Across the studies, there was recognition of the important role of informal networks that include various family members, peers, naturally occurring mentors, and community groups (Collins, Spencer & Ward, 2010; Dinisman, 2016; Dima & Pinkerton, 2016; Sala-Roca, Biarnés, García & Sabates, 2012). Across these studies, four main social support figures were mentioned: care system staff (foster parents, caseworkers, and home staff) representing formal networks; and family members (biological parent, siblings, and extended family), mentors, and peers representing informal networks (Sala-Roca et al., 2012).
Frimpong-Manso (2017) found that those involved in formal networks and services, including foster carers and home staff, gradually take on an informal role such as significant adult or mentor after transition. However, this change from a formal to an informal role appeared to be limited, the exception, not the rule.
Both Dima and Pinkerton (2016) in Romania and Frimpong-Manso (2017) in Ghana examined outcomes for care leavers in countries where there is little or no formal support. In this regard, they are unlike the other eight studies, which were located in countries with formal aftercare services. Dima and Pinkerton’s (2016) mixed-method study comprised three stages of data collection. The first phase involved semi-structured interviews with 34 young people who had left residential care two to four years earlier (between 2004 and 2006). This data was analysed qualitatively using Interpretative Phenomenological Analysis (IPA). Two further waves of data collection followed in 2016. The first of these involved interviews with two young people and file data. The second involved a focus group of six other care leavers who were involved in an aftercare programme.
Thematic analysis of both datasets was conducted.
The study provided a unique perspective on informal support that highlighted the important role played by peers in providing emotional and practical support to care leavers and identified the practice of discharging young people in small groups and setting them up in accommodation to live together in the community. Its findings suggest that informal networks, particularly care peer support networks, are very effective in supporting care leavers through challenges such as accommodation, relationships and instability in the absence of formal networks. However, the study also highlighted the disadvantages of peer support. For example, peers can be fluid and perpetuate negative behaviour and a care identity. The authors conclude that special attention should be given to learning from countries where there is an absence of formal support and suggest that informal networks may be the ‘richest resource available to those who have left care’ (Dima & Pinkerton, 2016, p. 424).
Like Romania, Ghana is a country with little formal aftercare support. Frimpong- Manso’s (2017) qualitative study sampled a group of 29 former residents of a care home in Ghana from which the young people experienced a graduated and extended transition to the age of twenty. In examining the sources and types of support as well as the barriers to social support in the absence of formal support the author found that the role of care staff changes from formal, professional SOS carer to informal mentoring. The findings suggest that the graduated transition process was a factor in maintaining these strong relationships well into adulthood.
The importance of family support was evident in a number of studies. Most young people named their biological mother in particular as an important influence, even if they found their foster parents supportive when they were in their care. In contrast, biological fathers were rarely mentioned in these studies (Nesmith & Christophersen, 2014; Collins et al., 2010; Jones, 2013).
Jones’ (2013) qualitative longitudinal study examined the adjustment from foster care and the level of social support. The author conducted structured interviews with 97 young people over a two-year period at six months, one year and two years. Highlighting the important role of biological and extended family in a care leaver’s network, Jones (2013) suggested that the ties with family remained strong even when a young person spends a long period in care. Some contradictory findings regarding family support were reported, however. For example, the study found that while biological family can be a great source of support, young people who return home did more poorly than young people living independently because of previous family problems.
Furthermore, the prominence of family during transition reported by Jones (2013) contrasted with the findings from other studies that suggested family provided limited or no support to care leavers (Sala-Roca et al., 2012; Frimpong-Manso, 2017; Dima & Pinkerton, 2016). These studies suggest various reasons for this, including the family’s belief that the residential home meets most of the young person’s needs post-care or the presence of substantial relationship difficulties that led to the original family breakdown. Nevertheless, Jones’ (2013) main finding was the need for professionals to engage much more proactively to reconnect young people with their family members.
The importance of family in supporting care leavers was highlighted also by Collins et al. (2010), whose mixed-methods study sought to examine care leavers’ social support and outcomes and to identify types and characteristics of supportive relations. Qualitative and quantitative data was collected from 96 young people discharged from foster care, aged nineteen years and above, through in-person interviews using a combination of closed survey and open- ended questions. Descriptive analysis was used to summarise young peoples’ views of their social support.
The relationship between social support and self-reported youth outcomes was examined through bivariate analysis. Most young people (90%) in the study had contact with their birth family and identified the birth mother as the most significant person. The birth father, by contrast, did not feature as a significant person. Both these findings were echoed in other studies. Like Jones (2013), Collins et al. (2010) recommended further assistance for care leavers to facilitate reconnection with their birth family. These studies suggest that little is known about the benefits and problems that may stem from reconnection with family after care and that more attention on family is required in support plans prior to discharge.
The impact of early negative experiences and placement disruption
Daly (2012) used a mixed-method approach of survey and interview to collect data on 65 young people aged seventeen to eighteen currently involved with aftercare services in North Dublin. A survey questionnaire was used to retrieve data from participants’ case files, including care history, education, accommodation and health.
A follow-up survey was distributed eight months later to the same participants. The survey data was complemented by semi-structured interviews with the caseworkers (n=8) who had provided the survey data and eight young people drawn from the original group of 65. These interviews aimed to provide an in- depth view of young people’s experiences of leaving care and aftercare service, as well as practitioners’ views of emerging issues working with the group of 65 care leavers.
The main method of the study was quantitative. Because the question posed by the title of the study, What do Young People Need When They Leave Care?, is very broad, numerous aspects of care leavers’ general needs were addressed rather than a specific topic. Nevertheless, some of the findings were relevant to the topic of informal networks. In addition to highlighting the views of significant adults and identifying relationship characteristics from a care leaver’s perspective, Daly (2012) suggested that instability and placement moves in a young person’s care history increased the likelihood of frequent accommodation moves after care. This finding echoes established theory, which suggests that placement movements can re-traumatise young people and impact negatively on their future ability to develop relationships and make connections (Bowlby, 1980).
Daly’s (2012) findings highlighted the negative impact of repeated network disruption on the wellbeing of young people, which compounds the challenge of creating supportive networks prior to leaving care. The study also recommended assessment and planning around emotional needs. Like those from other studies in this review, this finding is in line with the overwhelming view from young people regarding the importance of having someone they could turn to in times of need and an adult they could trust and rely on.
Educative and activity approaches for young people
A number of studies highlighted a growing recognition of the need to help young people strengthen their internal resources through educational approaches that increase their competence, coping skills, and self-efficacy, thereby promoting social connection and creating supportive networks.
Nesmith and Christophersen (2014) assessed the benefits and effectiveness of an American foster model entitled CORE (Creating Ongoing Relationships Effectively), which was designed to improve care leavers’ transition to adulthood. The model engaged others involved with the young people such as their foster carers.
Nesmith and Christophersen (2014) is a qualitative comparison study with a longitudinal element. The study sample comprised 88 young people who were currently in the care system and connected to one of two foster agencies. Both groups had similar demographic features and care histories. Participants ranged in age from fourteen to nineteen. One foster agency implemented the CORE model (n=58); the comparison group received traditional foster care (n=30).
The primary data source was in-person interviews with the foster youths, who were interviewed twice, nine to eleven months apart. Two assessment tools were developed specifically for this study. The first, relationship competency assessment, was used both pre- and post-interview. The second assessment tool, quality youth relationship assessment, included a scale addressing areas such as trust, encouragement, and willingness to devote time to the young person.
An educational programme targeted at young people leaving foster care, the CORE model was designed to help them learn skills to develop supportive networks. The model focused on three areas: relationship skills to build supportive relationships, empowering young people to be involved in all aspects of the planning, and educating adults such as foster carers about the impact of trauma and its effects on young people. The programme included a twelve-week “Emotional Effectiveness Education”-session, which brought foster carers and young people together. The primary recommendation of CORE is that nurturing relationship programmes should supplement daily living skill programmes.
Nesmith and Christophersen (2014) concluded that the CORE programme yielded positive results in terms of helping older foster youths develop relationship skills and develop relationships with adults post-care. They recommended that programmes to nurture relationships should be promoted and incorporated into the independent living programme for care leavers, which places foster youths at the centre of planning and decision-making processes.
They also recommended education programmes for adults working with young people regarding the impact of past trauma on present behaviour to help foster youths develop relationships. This is in line with other studies that have advocated an increased emphasis on an educative programme aimed at helping care leavers develop connections in the community with naturally occurring mentors or significant adults.
Sala-Roca et al.’s (2012) study involved 21 care leavers aged nineteen to 28 who had left residential homes in Catalonia, Spain. The study had a comparative dimension, as participants were selected based on the success or failure of their transition. Data was collected through qualitative, semi-structured, in-person interviews, conducted by two interviewers to minimise subjectivity, at a venue preferred by the young person. Topics included the young person’s involvement in education, social relationships with peers, current social network, and housing problems. The interview content was analysed by means of an inductive classification process using analysis scales.
One finding from this study was that the group who experienced a successful transition had better social abilities, which was partly due to the socio-educative intervention by the homes. Most participants in this group reported enrolling in leisure activities and in extra-curricular activities which they felt helped them develop relationships. By contrast, the other group had problems with employment and society and appeared to have poorer social and emotional skills. They did not engage in activities and had a small social network. The authors therefore recommended that social and emotional education programmes be implemented to help young people in care develop abilities and create and maintain social relationships (Sala-Roca et al., 2012).
Both Sala-Roca et al. (2012) and Thompson and Greeson (2017) specifically suggested involving young people in extra-curricular activities to promote the acquisition and development of social skills. Furthermore, these studies highlighted the need to design programmes that will increase care leavers’ opportunities in different areas of their lives.
Dinisman (2016) focused on 272 young people leaving care from a residential setting in Israel. Having identified a lack of emotional and tangible support in the participant group, the author recommended greater emphasis on relationship skills and emotional preparation for leaving care alongside practical skills development, designing programmes that strengthen internal resources through educative approaches to relationship skills building and emotional competency, and putting the young person at the centre at the planning process. The study also identified a need for specific leaving care programmes that provide opportunities to participate in pro-social activities to help young people build social networks and promote an interdependent approach.
Types of support
The selected studies reference different types of support in which various people are involved. For example, informative support, which includes advice, guidance, and provision of services to help young people cope with future challenges, is likely to be provided by care system staff (that is formal networks). Jones (2013) suggests that care system staff also provide ‘instrumental support’ relating to material aid, finance, and housing. Although Dima and Pinkerton’s (2016) findings suggest that peers, care peers, and friends were more prominent in providing an ‘instrumental role’, this could be due to there being limited, if any, formal support in Romania (Dima & Pinkerton, 2016). Despite these challenges, the young people quoted in these studies place a high value on trust.
Day-to-day emotional support was found to be provided on a primarily informal basis by peers, siblings, and significant adults in the community or naturally occurring mentors/significant adults (Collins et al., 2010; Dinisman, 2016; Nesmith & Christophersen, 2014). Young people themselves defined emotional support as someone who provides advice and comfort when they have a problem, as feeling valued and loved, and someone who they trust to share a problem and who believes in them (Dinisman, 2014; Frimpong-Manso, 2017; Jones, 2013). Interestingly, these definitions of emotional support seem to mirror the aspects of care young people may not receive in early childhood.
There was broad acknowledgement across the studies that young people recognise the importance of family support and the need for a feeling of closeness whether they are still in care, with family or living independently. Support from family is complex considering many young people enter care due to poor parenting and relationship breakdown at home. As Jones (2013) highlighted, some young people who returned to the family home after discharge did less well than peers who moved to independent living.
Collins et al. (2010) identified a need to think more creatively about how to tap into potential support from adults and to recognise that the composition of these networks and their effectiveness in helping care leavers in particular circumstances is not clear-cut.
Prosocial activities to develop relationships with others
Thompson and Greeson (2017) examined the extent to which involvement in prosocial activities is associated with naturally occurring mentoring, which they defined as ‘supportive non-parent adults such as teachers, coaches, neighbours, and religious leaders’ whom young people self-select. Questionnaires were administered through computer-assisted personal interviews to 720 foster children aged fourteen to seventeen prior to ageing out of care. The study suggests that environmental factors such as prosocial activities, community activities and clubs create opportunities for ‘protective natural mentoring relationships’ among foster youths who will be leaving care. However, the data collection method used in this study is a limitation, however, as computer- assisted interviewing may attract only computer savvy respondents.
Additionally, the data in this study is self-reported and not verified through any other source of data.
Thompson and Greeson (2017) suggest that foster children who participated in prosocial activities (e.g. organisations, hobbies, clubs, church) were less likely to have no natural mentor. Their study attests to the importance of ensuring that this type of (naturally occurring) mentoring is self-selected by the young person and develops gradually without pressure or expectation. The authors suggest that this form of mentoring may be less prone to trust difficulties and more likely to be long term in contrast to formal mentoring, which can be time-limited and not self-selective.
Collins et al. (2010), Daly (2012) and Thompson and Greeson (2017) observed that the settings where relationships and networks can be developed encompass a wide variety of systems and people, including employment settings, schools, and community and religious organisations. Similarly, Sala-Roca et al. (2012) highlighted the importance of leisure and extra-curricular activities as opportunities for young people to learn and develop values, skills, and behaviours that promote relationships. Their data also suggests a link between getting involved in prosocial activities and developing supportive aftercare relationships, such as those with natural mentors.
Dinisman’s (2016) findings suggest that a young person’s readiness to leave care will mediate the effectiveness of network supports post-care. This finding is important, as readiness to leave will be determined by the quality of planning and leaving care programmes. Furthermore, Dinisman (2016) suggests that planning should include assessment of young people’s emotional needs and abilities and extent of social support prior to leaving care so that any concerns can be addressed in a timely manner. Likewise, both Sala-Roca et al. (2012) and Thompson and Greeson (2017) recommend placing more emphasis on care planning for prosocial activities through community organisations/clubs to help the young person develop supportive relationships.
Discussion
Most young people growing up are likely to have well-established supportive networks of family members, peers, and other adults. However, this experience contrasts starkly with that of young people leaving care, who may have been separated from their families, communities, and school peers (Perry, 2006).
Almost a quarter of care leavers in the UK, for example, will have experienced more than eight placements, disrupting relationships and leading to dislocation (Department for Education, 2012) and instability that may be further compounded by staff turnover (Stein, 2005). Various studies in this review suggest placement disruption re-traumatises young people and instils and compounds a deep sense of distrust in others, further limiting their ability to develop the important relationships they need to support and enrich their lives.
Dima and Pinkerton (2016) suggested that care leavers might have difficulty asking for help due to past negative experiences. Fewer than half the interviewees in their study mentioned the need for help to ‘overcome tough times’, and one interviewee explained ‘that even if the majority of care leavers needed emotional support, they would not admit it’ (Dima & Pinkerton, 2016 p. 420). In fact, one of the findings from the focus group in this study was that care leavers are more willing to offer emotional support than to ask for it.
Similarly, various scholars, including Frimpong-Manso (2017), have observed that young people leaving care have difficulty trusting others. Both Sala-Roca et al. (2012) and Collins et al. (2010) suggest that the issue of trust is compounded by lack of stability and staff turnover, which can re-traumatise those who have already experienced loss and who harbour a deep sense of rejection. The vulnerability of this group informs Nesmith and Christophersen’s (2014) contention that foster carers and other professionals need to be educated about the attachment challenges and other factors that hinder the ability of young people to connect with others.
A significant theme across a number of other studies (Sala-Roca et al., 2012; Daly, 2012; Thompson & Greeson, 2017) was that external resources such as relationships with adults, mentors and participation in the community are linked to increasing potential for better outcomes. Likewise, various studies suggested more planning is needed around young people’s social and emotional needs prior to discharge (Dinisman, 2016; Daly, 2012; Sala-Roca et al., 2012). Many studies highlighted the importance of young people developing internal resources through role modelling, shared values, and relationship skills through relationships with other in their community (Thompson & Greeson, 2017; Sala- Roca et al., 2012).
The findings from this narrative review highlight a need for better support for care leavers. While informal networks can play an important role in helping young people transition from care and into adulthood, the studies also highlighted that predisposing factors associated with young people in care amplify the challenges of developing relationships, making connections, and asking others for help. Various studies suggest introducing educational programmes and promoting socialisation opportunities to help young people develop emotional resilience and the ability to connect with others.
Implications for practice
The findings from this review suggest that awareness is growing of the importance of informal network support for care leavers. Traditionally, there has been a focus on independent living skills as opposed to interdependent social connections and skills to help build relationships and promote the value system of a ‘collectivist culture’ (Frimpong-Manso, 2017, p. 195). However, there has been little research on how informal support networks may promote wellbeing (Collins et al., 2010; Dima & Pinkerton, 2016).
The review identifies the need to promote a learning agenda that will help care leavers develop relationships and informal supportive networks and simultaneously educate key adults on the challenges specific to care leavers and how best to support them. This narrative synthesis suggests that a variety of approaches could promote learning among young people regarding how to develop social networks and build relationships with potential mentors/significant adults in their community.
The review has identified a need for education not only of the care leaver, but also of those helping them. Attachment theory is fundamental when considering how people connect with each other and there should be more of a focus on the challenges young people with attachment issues face in developing a network of support. Some research has highlighted the need to ensure that the underpinning principles of the helping and enabling role of professional and significant adults includes an ability to ‘believe in’ (Dinisman, 2016) the young person. Arguably, there could be a tendency to have lower expectations of care leavers than of their non-care peers, which could be detrimental to the young person’s confidence and sense of self-worth.
Approaches that help promote relationship building through education and socialisation are explored in these studies. Practice and policy must incorporate such approaches to ensure a more meaningful focus on the social and emotional needs of young people in care. Towards this end, foster carers, social workers and residential social workers must be educated about the importance of their specific role and undertake training in the skills required to help young people in care develop meaningful links to their community.
The studies all advocate further research to establish the flow of support and analyse network support. For example, Blakeslee (2012) examined the need to understand commonalities through more innovative research around network analysis with the aim of identifying the level of support to help inform policies and practice.
Dima and Pinkerton (2016) found that peer support was especially important in the absence of a formal support system. This approach is not without drawbacks, however. Some of the young people in this study eventually concluded that these same peers were holding them back by perpetuating negative behaviour and therefore decided to separate from them.
Sala-Roca et al. (2012) and Dinisman (2016) advocated more focus on designing a preparation programme to educate young people specifically in the development of relationship skills and to promote socialisation. Dima and Pinkerton (2016) concluded that research is needed on the interface between formal and informal network to complement support for care leavers.
Conclusion
Various studies in this review acknowledged the importance of interdependent as opposed to independent living. Additionally, the traditional focus on attainment and tangible support is giving way to a recognition of the role of relationships in promoting health and wellbeing. Indeed, some emerging research suggests that it is their relationships with others, not the accruing of individual attainment, that determines the quality of young people’s lives after care (Winter, 2015).
Practice needs to develop ways to support an agenda that promotes peer support, peer educators, mentoring, and network group conferencing. The important role of existing formal networks such as organisational services and foster carers cannot be overlooked, as they can provided much needed stability for young people. However, this recognition should be developed alongside a better understanding of informal networks. Learning from other countries where there is an absence of formal support should continue. Informal networks may not be the panacea, but this literature review suggests they represent a rich resource that should be developed.
Relationships and network support should have more prominence in pathway planning. In the assessment and planning process, emotional and social support are to some extent overlooked as professionals tend to focus on the practical needs of care leavers (Munro et al., 2011). Based on my professional experience, I would concur with this view.
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From: the Scottish Journal of Residential Child Care, 20.1
