Elaine Farmer, Sue Moyers and Jo Lipscombe
Centre for Family Policy and Child Welfare
School for Policy Studies
University of Bristol
There is little information about what makes some carers particularly successful in looking after young people or which services make a real difference. This Department of Health-funded research therefore examined how supports for foster carers and their parenting approaches relate to outcomes for adolescents.
In this one year prospective study 68 young people aged 11 to 17 were selected when they entered a new foster placement that was intended to be medium to long term. The reasons for admission had to include concerns about their current behaviour and/or emotional well-being. The sample was drawn from 14 local authorities and 2 independent fostering agencies. The young people’s case files were reviewed to obtain background information about past adversities, previous social services involvement and their care histories. Interviews were conducted with the young people, their foster carers and social workers at the beginning of the placement and again 12 months later or at the point of placement ending if this occurred earlier.
Standardised measures were used with the young people and their carers at both time points. A self completion measure of behaviour was used with the young people (the Strengths and Difficulties Questionnaire or SDQ), together with measures of depression and peer relationships. The foster carers completed the SDQ about the adolescents and the General Health Questionnaire measuring their levels of day to day functioning and stress. The foster carers also completed questionnaires designed for the study about training, support and contact issues.
Two types of outcome were considered. One was placement breakdown and one year after the placements had started just under half (44%) had disrupted. The other related to the quality of the placement. Placements were considered to be of good quality or ‘successful’ when they were continuing well or had had a planned positive ending by the one year follow-up (47%). They were rated as of poor quality when they had disrupted or were continuing but showed evidence of severe difficulty (53%).
FORMAL SUPPORT SERVICES
Placements disrupted more often when social workers had not been open with carers about the extent of the young people’s difficulties and had provided inadequate information about school attendance and plans for their education and long-term care. Foster carers were able to deal with some very difficult behaviour, provided that they knew what they were taking on, that the child’s problems had not been downplayed and that social workers responded to their requests for assistance.
It was not only the foster carers who wanted full and realistic information about the young people. The young people too wanted more information about the foster families before they moved. Most had not felt sufficiently involved in pre-placement decisions and if an introductory visit was not possible telephone contact with the carers and/or information in booklet form about the foster family might have been helpful.
Placements were also more likely to break down if the carers’ gender preference had been overridden. These preferences were generally based on well-founded concerns about the effect, for example, of placing a teenage girl in a household of boys.
An unexpected finding was that placing young people of a similar age to those in the foster family did not produce particular difficulties and could sometimes be helpful. However, when the foster carers had a birth child between two and five years younger than the fostered young person, placements were at increased risk of disruption, probably because these younger children were more vulnerable to being affected by high risk or violent behaviour by the fostered adolescents.
During the Placement
Four elements of the formal support system for foster carers (the family placement worker, foster carer groups, the child’s social worker and the out of hours service) were investigated in depth. The first two specialist services were broadly effective, the other two generic ones much less so. Family placement workers provided consistent high quality support. The foster carer groups were important for half the carers and might have had higher attendance if child-sitting had been provided and the carers allowed ‘to have a moan’. However, foster care was rarely prioritised by busy children’s social workers or general out of hours services and the deficits in these parts of the formal support system often led to carers feeling poorly supported overall. It is important to note that out of hours services run by the family placement service were experienced as much more supportive than emergency duty teams.
Foster carers experienced local authority support rather like a net: it was only as strong as its weakest point. All the four formal support services noted above needed to be in place if foster carers were to feel adequately supported. Moves to strengthen one part of the service (for example the out of hours service) at the expense of another (for example family placement workers) are likely to lead to considerable carer dissatisfaction.
The weakest point in the local authority support ‘net’ was the service offered by the young people’s social workers. The considerable difficulties in contacting them (experienced by 70% of carers) and low levels of visiting by some (21% saw the child and 37% the carers less often than monthly) were significantly related to carers feeling under strain and poorly supported. Inability to contact social workers left a range of pressing issues related to the young people and their families unresolved. Foster carers were particularly upset when they thought that the child needed specialist help and it was not forthcoming. A number of findings in the study showed that lack of support from the young people’s social workers was related to poorer placement outcomes. The opposite was also true: there were significantly more successful placements when social work support was good.
The provision of appropriate counselling for the fostered teenagers proved to be very important. Over a third of the young people were seeing a specialist for counselling and carers felt better supported when this was the case. Over and above this, there were more successful placements when young people reported that they were receiving such assistance. Foster carers’ requests for such help should always be taken seriously.
Local authority support did not always match the needs of carers – for example, young people’s social workers visited the foster carers with good social and local professional support more often than those with poorer support networks. If services are to match individual needs better, family placement workers and social workers may need to find out more about foster carers’ overall support systems (support from friends, relatives and local professionals) to identify those who lack adequate support and consider how to reach those who do not readily request or use help.
Real partnership with foster carers has not proved easy for professionals to achieve. Just under half (44%) of the foster carers felt that their views were seldom or never taken seriously within social services and fewer than half (46%) felt that they were an important member of the team which had responsibility for the young person.
THE FOSTER CARERS’ INFORMAL SUPPORTS
Carers who received a lot of support from their own children had fewer disruptions. This included adult children who lived in the family or nearby. These children wanted their views to be listened to and their difficulties acknowledged, including the stresses of bedroom sharing, feelings of jealousy and lack of attention. More recognition is needed of the important role played by the carers’ children in supporting placements.
In addition, there were significantly more successful placements when the carers were receiving substantial support from family members or from their social networks and local professionals, such as doctors and teachers.
Low confidence in schoolwork was significantly related to disruption and low confidence in social relationships at school were linked to low success rates in placements. In addition, young people with particular skills and interests (which may have been developed at school or at home) had an increased chance of having a successful placement. Action to assist young people with their education and relationships with other children is important not only to enhance their life chances but may also help to maintain placements.
YOUNG PEOPLE’S BEHAVIOUR AND CHARACTERISTICS
Young people with histories of aggressive behaviour or with no attachment to an adult before the placement (for example because of failed adoption or long-term care) experienced increased levels of disruption. Hyperactivity and conduct problems in the placement also predicted poor outcomes. Local authorities need to consider organising more extensive packages of support for such placements if they are to survive. Such approaches might include for example, shared care between two foster families, dedicated respite care, buying in the services of specialist helpers for these young people or purchasing therapeutic counselling.
THE YOUNG PEOPLE’S RELATIONSHIPS WITH OTHER CHILDREN
Young people who by follow-up had had a negative impact on the other children in the placement had poorer outcomes on both of our outcome measures. Carers were willing to deal with much difficult behaviour unless it had a detrimental effect on the other children in the family (including other fostered young people), at which point they would seek to end the placement. These effects were not apparent at the start of the placement but emerged as the placements went on. It is therefore very important for professionals to monitor the impact of fostered adolescents on other children in the family over the course of the placement.
Many of the foster carers faced the arrival of a newly placed young person when they were already under significant pressure from stressful life events such as bereavements, relationship difficulties, accidents, illness, financial worries and people joining and leaving the family, including recent foster placement breakdowns. Two fifths (41%) had experienced 4 or more of these stresses in the 6 months prior to the adolescent’s placement. The presence of the fostered adolescent not surprisingly was often itself very stressful. The extent of strain on carers, not only during but also before the placement began, had a statistically significant effect on outcomes: the more strain on the carers, the more often placements disrupted. Strain had a major impact on carers’ capacity to parent well. In particular, strained carers responded less sensitively to the young people, disliked them more often and showed them less warmth.
These findings suggest that family placement workers should review the stresses on carers before each placement is made, as well as during its course, in order to match those who are under a great deal of strain with less demanding adolescents and/or to offer them enhanced levels of support or a paid break.
At the time of the first interviews four parenting approaches were found to predict placement outcomes.
There were fewer disruptions when:
The foster carers had been able to respond to the young person’s ‘emotional age’ when it was considerably younger than their chronological age. Such responsiveness indicates sensitivity and understanding that many looked after young people function emotionally at an immature level well below their chronological age and need regular opportunities for play and nurture appropriate to a much younger child to meet these earlier unmet needs.
The young people had been able to talk about their past histories with their carers. Such sharing of sensitive information implies time made for the teenagers to share difficult issues and probably the capacity on the part of carers to bear to hear painful past events. We also found that disruption occurred less frequently when young people had access to other people in whom they could confide.
There were more successful placements when:
The foster carers had given a moderate level of encouragement to young people to learn life skills that would prepare them for leaving care and later life, such as budgeting, helping with cooking meals and completing forms.
The carers monitored the activities of the young people when they were outside the house. This required skill and an extended view of the foster carer role and was important for those young people who were unable to keep themselves safe or out of trouble when away from the foster family.
THE PARTICULAR DIFFICULTIES OF SINGLE CARERS
One third of the foster carers were looking after the adolescents alone and they were more disadvantaged than couple carers in a variety of ways. These single carers received less training, lower levels of local authority services and less support from local professionals than the foster carer couples even though they had weaker social support networks. For single carers support from their friends was therefore particularly important. In addition, significantly fewer of the single carers took active steps to facilitate the young people’s education or attended the foster carer groups - principally because of the lack of child minding, pressure on their time if they worked and a feeling that the groups were not serving their needs. Increased understanding of the needs of single carers and some supplementary services might well benefit lone foster carers and the young people they look after.
Almost two thirds of the young people had contact with someone in their network that was detrimental to them and difficulties with contact were significantly related to higher disruption rates. Sometimes contact was directly related to placement breakdown and, in other cases, contact problems and attendant difficulties in the relationships between young people and their parents were one of a number of factors that influenced disruption. The main problems with contact were repeated rejection from parents, unreliability in visiting and exposure to high risk situations. As a result, the young people often returned from contact extremely upset and acted out their distress in regressive, disturbed or violent behaviour. Over the one year follow-up there was little change in the quality of the young people’s contact. For most (57%) poor quality contact was still poor one year after placement. In a few cases proactive social workers had taken action to improve contact, usually by arranging for less frequent contact but of a higher quality or by involving another family member in contact, like a grandparent or aunt, who could provide attention and nurture. This had been very beneficial for the young people and their placements.
The young people who had contact with their maternal grandparents had more successful placements partly because grandparents often ensured that contact with other family members occurred and because they themselves provided enriching relationships for the young people.
A third of the young people whilst having some contact had none that was rated as beneficial to them. In addition, a small number (13%) had no contact with any family member, generally because of an adoption breakdown, because their parents had died or in the aftermath of an allegation of sexual abuse. In such cases the appointment of an Independent Visitor under the Children Act needs to be considered, but this had occurred in only one case.
The widespread idea that adolescents can manage their own contact was not borne out in the study. More work with parents might be useful to help them to negotiate meaningful contact with their children whilst the involvement of other family members such as grandparents, who can offer a positive relationship is to be encouraged. There is also a real need for work with young people to help them to integrate the reality of their parents’ actions in ways which allow them to move on and make use of other more sustaining relationships.
Placement outcomes are likely to be improved if training includes:
Helping foster carers to respond to young people’s emotional and developmental age
Dealing with contact issues
Talking to young people about the past and about difficulties in their relationships with their families
Monitoring adolescents’ activities outside the home.
In addition, training gaps identified by the carers included: working with withdrawn, depressed and suicidal young people, the management of deliberate self-harm, dealing with young people who sexually abuse others and managing violent behaviour.
CLARIFICATION OF RESPONSIBILITY FOR KEY TASKS
There were gaps in the practice of this sample of experienced foster carers that were likely to have an impact on the young people’s future life chances. Training and greater clarification of who is responsible for these tasks is important:
Two fifths of the carers did not discuss sexual health or sexuality with the young people even though many looked after young people are poorly informed about normal sexual development, sexual health and contraception.
Half of the foster carers had little involvement with schools, including twenty who reported having no contact with the young people’s school teachers.
Two fifths of the carers showed little encouragement for the young people to develop age-appropriate life skills that would prepare them for leaving care and later life, such as budgeting, helping with cooking meals and completing forms.
Foster carers were significantly less sensitive to the needs and anxieties of girls than boys. The interviews revealed a small number of girls whose worries and real unhappiness about their placements were not apparent to their foster carers.
Training, recruitment and support for foster carers should include a focus on the key parenting skills identified in the study. Clarification of responsibility and accountability for key tasks such as sex education, educational involvement and life skills are also needed.
Much greater emphasis is needed on giving foster carers full and honest information about young people before placement, even when placements are made at short notice. Failure to do so is associated with poorer outcomes. Young people too want more prior information about the foster families.
Good support services reduce the strains on foster carers and in this way are linked to better outcomes for fostered adolescents. In particular:
Foster carer strain is reduced by regular and reliable availability of the young person’s social worker, continuity of social work help and taking carers’ views seriously. Given the high pressures on children’s social workers, improvements to the service they provide will require organisational change that allows specialisation or major task reallocation or both.
Out of hours services run by the family placement service are much more useful than those by emergency duty teams.
Substantial packages of support are needed for carers who take young people who are hyperactive or have serious conduct problems.
Foster carers who are already under a great deal of strain before placement require less challenging adolescents, much increased support or a break between placements.
Foster carers’ own children are an important part of their support network but when the impact of a fostered young person on the other children is very adverse placements disrupt. This issue therefore needs careful monitoring and review.
Counselling and other specialist help for fostered teenagers is important in its own right and in the maintenance of placements. Foster carers’ requests for such help should always be taken seriously.
More proactive work is required in relation to contact with family members, in particular in helping young people to cope with continuing parental rejection, ambivalence or unreliability and in encouraging the involvement of relatives who can offer them more positive relationships.
Prof. Elaine Farmer 0117 954 6755
Sue Moyers: 0117 954 6732 e.mail: firstname.lastname@example.org
Centre for Family Policy and Child Welfare, School for Policy Studies, University of Bristol,
8 Priory Road, Bristol BS8 1TZ
Elaine Farmer, Sue Moyers and Jo Lipscombe (2001) The Fostering Task with Adolescents, Report to the Department of Health, School for Policy Studies, University of Bristol.
Jo Lipscombe, Elaine Farmer and Sue Moyers (forthcoming) ‘Parenting Fostered Adolescents: Skills and Strategies’ Child and Family Social Work Issue 8.4.
Elaine Farmer, Jo Lipscombe and Sue Moyers (forthcoming) ‘Foster Carer Strain and its Impact on Parenting and Placement Outcomes for Adolescents’, British Journal of Social Work.