Young People S Perspectives of Foster Placement Instability: a Grounded Theory Approach

Young people’s perspectives of foster placement instability: A grounded theory approach

Ruth Hunter

Submitted for the Degree of

Doctor of Psychology

(Clinical Psychology)

School of Psychology

Faculty of Arts and Human Sciences

University of Surrey

Guildford, Surrey

United Kingdom

July 2015

Abstract

This qualitative grounded theory study aimed to explore experiences of placement moves for young people in foster care, an area neglected in previous studies. For young people these moves were distressing experiences of loss and uncertainty that they frequently lacked support to manage. Consequently the young people felt the need to be self-sufficient for their emotional needs. However this self-sufficiency often increased instability and distress as they struggled to influence others or withdrew in self-protection. Despite this, the young people displayed resilience and were hopeful for a better life after care.

Acknowledgements

To all those who have played a role in my path up to this point, thank you. This achievement is partly yours. Unsurprisingly this encompasses a large number of people in my personal and professional life. But I would particularly like to thank God, my parents, my family and those closest to me. Thank you sounds so simple but I hope you realise just how grateful I am.

Contents

MRP Empirical Paper 5

MRP Empirical Paper Appendices64

MRP Proposal 104

MRP Literature Review124

Brief Overview of Clinical Experience192

Table of all Academic Assessments195

MRP Empirical Paper

Young people’s perspectives of foster placement instability: A grounded theory approach

Ruth Joanne Hunter

Submitted in partial fulfilment of the degree of Doctor of Psychology (Clinical Psychology)

School of Psychology

Faculty of Arts and Human Sciences

University of Surrey

May 2015

Abstract

Introduction

Globally, young people in care are one of the most at-risk groups for a range of negative outcomes both in childhood and later life (Minty, 1999; Barber & Delfabbro, 2003; Tapsfield & Collier, 2005; Ford, Vostanis, Meltzer & Goodman, 2007) as a consequence of early-life experiences (Newton, Litrownik, & Landsverk, 2000; Rubin, O’Reilly, Luan, & Localio, 2007).

Placement instability, including unplanned changes, is a major predictor of negative outcomes from care (Rostill-Brookes, Larkin, Toms, & Churchman, 2011). The literature refers to such changes using terms such as ‘breakdowns’, ‘moves’ and ‘disruptions’ (Unrau, 2007).Research indicates that multiple placements are associated with an increased risk of emotional, behavioural and mental health problems and also future placement breakdowns (Rubin, Alessandrini, Feudtner, Mandell, Localio, & Hadley, 2007; Strijker, Knorth, & Knot-Dickscheit, 2008; Stott, 2011). An understanding of what influences placement stability is key in developing effective interventions to address this and minimise negative outcomes.

Understanding of Placement Stability

The views of all stakeholders need to be included in a comprehensive understanding of placement breakdowns and efforts to reduce these (Wilson, Sinclair & Gibbs, 2000). There is an acknowledged lack of sufficient perspectives of young people, foster carers and social workers, as well as birth families and other professionals (Rostill-Brookes et al., 2011; KhooSkoog, 2013). The majority of research into placement instability has used quantitative methods (Unrau, 2007; Rock, Michelson, Thomson & Day, 2013), highlighting risk factors such as child problem behaviours, longer time in care; older age of child; multiple social workers; and separation from siblings (Koh, Rollock, Cross & Emblen-Manning, 2014; Rock et al., 2013). These quantitative approaches have frequently relied on psychometric or standardised measures, often failing to reliably represent the viewpoints of children or professionals (Unrau, 2007) and the broader systemic inter-relationships and interactions that may impact stability. Consequently the complexity of the psychological wellbeing of the young person has also been overlooked.

Perspectives of those involved in foster care

When perspectives of key stakeholders have been considered, the use of labels for behaviour such as 'difficult' or 'problematic' highlights a dominant adult perspective. This perspective has likely been influenced by the need to retain foster carers through understanding and supporting them (Sellick, 2006). This focus is reinforced by research showing that the distress and sense of failure from placement breakdowns reported by foster carers can lead to reluctance to offer future placements (Nutt, 2006). Unfortunately, this focus on foster carers has resulted in a lack of appreciation of the child's voice and child and foster carers' interpersonal dynamics.

Some attempts to obtain the perspectives of young people have occurred, but the success of these has been limited by the approaches used. Some researchers have attempted an indirect approach through seeking foster carers’ and social workers’ perspectives on the young people’s feelings and experiences (Unrau, 2007). Sommer, Pramling and Hundeide (2010) highlighted that gaining valid insight into the experiences of young people relies on going beyond a 'child perspective' to also include a 'child's perspective'. A ‘child perspective’ is the adult’s perception on children’s actions and experiences and perceptions. In contrast a ‘child’s perspective’ relates to the child’s view on their actions, experiences and perceptions based on what they view as important.

Obtaining ‘a child’s perspective’

Despite acknowledged difficulties in obtaining young people's perspectives on care and more specifically placement stability (Gilbertson & Barber, 2002), an increasing number of studies have attempted to address this gap of knowledge from the 'child's perspective'. However, these have often focussed on young people's perspectives of what leads to placement breakdowns and the impact of the breakdown, neglecting the process. For example, Hyde and Kammerer (2009) found that adolescents in care reported mis-matches between themselves and foster carers, leading to placement breakdowns. An earlier study by Butler and Charles (1999) found young people reported difficulties forming relationships with new carers following placement changes.This gap in understanding the process has begun to be acknowledged and explored; Unrau, Seita and Putney (2008) found that foster alumni remembered breakdowns as significant losses that continued to impact upon relationship success. However, this study included alumni who had left care up to 5 decades previously, whose experiences likely differ from those going through care services today. It is also likely that their perceptions will have changed over time. Another study into the process of moves highlighted that young people (9-15 years) wished for the placement process to be more inclusive and transparent in order to help them prepare for transitions, both emotionally and practically (Rostill-Brookes et al., 2011).

Despite this progress, these studies remain at the individual descriptive level, failing to develop a theoretical understanding of the process and impact of placement moves for young people. Research needs to go beyond simply obtaining the ‘child’s perspective’ to responding meaningfully to this: Building a coherent understanding of the experiences and perspectives of young people, grounded in theory to inform a more comprehensive understanding of placement instability. This can then inform more effective evidence-based practises to reduce the negative impact of placement instability and improve the well-being of fostered young people. This study therefore set out to address this gap and ascertain what are young people’s perspectives of the process and impact of foster placement moves?

Approach

Glaser and Strauss’s (1967) Grounded Theory approach was adopted due to the suitability of this approach for the broad research question as Grounded Theory is designed to explore phenomena of which little is known. Furthermore, the inductive approach of Grounded Theory facilitates the 'discovery' of processes that unfold and give meaning to social interaction, going beyond merely descriptive accounts of phenomena (Charmaz, 2006).

Stance of the researcher

Given the approach adopted, an avoidance of a priori assumptions was supported through a non-theoretical stance adopted at the outset of the research. The gap in the area of research was identified but an exploration of potential applicable theories through a detailed exploration of the literature was avoided. The aim was to avoid the development of assumptions and preconceived theories that could increase bias in the exploration of the data and evolution of the consequent theory. Consequently, the research question was broad. [1]

Aim

This study aimed to explore the process and impact of placement moves from the perspective of young people in foster care to develop a preliminary foundation of understanding regarding the psychological processes and behaviour related to these perspectives. This work will also aim to provide an early platform for other researchers to further develop a coherent and theoretically-based account of these phenomena.

Method

The limited knowledge around young people’s perspectives of placement moves determined a qualitative methodology for the research. It was considered that young people would recount their experiences in relation to the social meaning they had attributed to the events, influenced by their social context. This social constructionist ontological position adopts a perspective that reality is influenced by social narratives rather than being fixed, with one 'truth'. This approach enables consideration of how different perspectives may be located in wider frameworks such as social, familial, cultural and political contexts. Greig, Taylor and MacKay (2007) described this as particularly valuable for research involving children, to enable ethical and useful research that is completed 'with' young people rather than being 'about' them. Historically, the voices of young people in foster care have been overlooked or moderated by adults and legal frameworks. Therefore the value of an approach that enables young people's voices to retain their own narratives in research is clear.

Data Analysis: Abbreviated Grounded Theory

Grounded Theory does not only aim to collect these experiences but to develop a framework of understanding. Indeed Glaser and Strauss (1967) designed the methodology to enable new theories to 'emerge' whilst retaining grounding in the context of the data. Further development to this approach has acknowledged the impact of the researcher’s role in the process (Willig, 2008) resulting in Charmaz's (2006) Social Constructionist version of Grounded Theory. This version acknowledges that the actions and influence of the researcher led to an interpretation of reality rather than a positivist 'true theory'. Furthermore, this study aimed to take an inductive approach. It was acknowledged that prior to this study, an appreciation of the wider topic area was gained from scoping the research. It was understood that such exploration of the literature could influence the researcher's analysis of the data, alongside the researcher's previous experience and values. Reflections were used to help identify and minimise this influence.

Previously highlighted difficulties with recruiting young people successfully for studies about foster care led to an anticipation that recruitment was likely to be difficult in this study (Gilbertson & Barber, 2000), which would have potential consequences for being able to saturate the data. Therefore Willig's (2008) Abbreviated Grounded Theory approach was adopted to enable development of a preliminary framework despite these anticipated limitations. It ensures analysis goes beyond descriptive accounts, though is more limited in its ability to broaden and refine the analysis through obtaining further data than a full Grounded Theory approach[2]. It was hoped that this project would work as a 'foot-in-the-door' study (Burger, 1999) developing understanding upon which to develop and direct further research.

Ethics

The University of Surrey Faculty of Arts and Human Sciences Ethics Committee gave a favourable ethical opinion for the study (See Appendix A). The research was also undertaken in line with British Psychological Society (BPS) and Health and Care Professions Council (HCPC) guidelines (BPS, 2010; HCPC, 2012).

Inclusion & Exclusion Criteria

Inclusion criteria were broad, as an appropriate starting point for collection of data in a Grounded Theory study. Some criteria aimed to contain the parameters of exploration, given the small scale of the study. The exclusion criteria mainly focussed on ethical considerations, to prevent inappropriate participation in the study from causing distress or harm.

Inclusion Criteria:

Young people who experienced a placement breakdown in foster care after the age of 11 years, to avoid confounding placement transition issues with school transition issues.
Young people 12-21 years of age. This ensured placement breakdowns had been experienced after age 11 but also gave recent care leavers an opportunity to share their views.
Young people who were in mainstream schooling. Interviewing individuals with additional needs would have increased the likelihood of engagement difficulties and the risk of emotional distress that could arise.

Exclusion criteria:

Young people who experienced a placement breakdown only in kinship foster care, due to the different arrangements associated with this form of foster care.
Young people currently receiving mental health support. This was to avoid risking causing further distress to individuals potentially already distressed.
Young people who had experienced a placement breakdown within the last six months or were at imminent risk of breakdown, due to the increased distress or difficulties that could result from discussion of placements.

Sampling strategy and recruitment

Given the historical difficulties in recruiting to studies regarding care experiences, theoretical sampling of participants was anticipated to be difficult. Due to time and resource constraints, selective sampling was used, based on the inclusion and exclusion criteria.

A number of strategies were used to recruit participants used. This included: using a social networking site, Twitter, to advertise to young people directly and to charities and organisations working with young people; emailing agencies and social service teams working with young people in and just after leaving care.

In total 48 organisations were emailed. 108 followers on Twitter were obtained, including organisational and personal accounts. On Twitter, one young person was recruited from seven expressions of interest. Six further participants were recruited, from a charity and two social care organisations.

As only seven participants were obtained it was not possible to be selective in choosing which individuals to interview, limiting opportunities to discover further concepts, variations among concepts and gain further detail in relation to categories. Therefore the findings of this study remain preliminary and tentative.

The process of recruitment ensured that participants had time to consider their involvement. Professionals passed the study information to young people, who then contacted the researcher directly to discuss the study and consider participation. Young people on Twitter contacted the researcher directly.

Recruitment methods aimed to reduce perceived pressure to participate and facilitate young people to express their views freely. Consequently, young people were only contacted directly if they initiated contact or initial agreement to participate had been gained through associated adults. Accessible information to obtain informed consent; time to decide whether to participate; explicit opportunities to withdraw and to ask questions were all elements which supported the non-pressurising agenda.

Careful consideration was given to issues of confidentiality, informed consent and maintaining participant wellbeing. Participants could withdraw from the study at any time. To manage wellbeing, the exclusion criteria excluded individuals currently experiencing distress and after the interview, written and verbal debriefs were given (Appendices B & C). Follow-up contacts to monitor wellbeing were provided, with six choosing to access this from the support worker or social worker, and one from a direct follow-up contact with the researcher.

Participant characteristics

Seven participants aged 16-21 were included in the study: three females and four males. Six were White British and one was Romany-Gypsy. Six had left care in the last three years and one was just about to leave foster care. Demographic details are in Appendix D. One potential participant felt too nervous about participating and seven young people did not meet the criteria.

Procedure

Pilot interview and subsequent development of the interview schedule.

To ensure the interview questions appropriately supported the collection of the young people’s perspectives on the research topic a consultation with a care leaver was undertaken. This provided confidence that the questions were clear and open and did not reinforce issues of power[3] (See Appendix E for the initial interview questions). Feedback resulted in the re-phrasing of the questions: The term ‘placement breakdown’ was replaced with ‘unplanned placement moves’,[4] understood as placements ending earlier than agreed in the child’s care plan (Rostill-Brookes et al., 2011).

The initial interview questions were broad to ensure participants were able to raise the issues they perceived to be relevant. Additional interviews had more specific questions that arose from analysis of the data after each interview. (See Data Analysis section for further detail). (See Appendix F for later interview schedule). For example, some of the early interviews highlighted a reactive element to the experience of placement moves but later interviews explored what determined or influenced this reaction. (See Appendix G for example of how analysis contributed to interview schedule). The broad questions were retained in the schedule to ensure opportunities for further areas of relevance to arise in the interviews. Although all seven participants had multiple experiences to report on, analysis suggested that data saturation was not fully achieved. Some areas of data appeared saturated. These tended to be those that had arisen from the start and were discussed in each consequent interview, for example the impact of support on the experience and appraisal of the moves. However areas such as hopefulness (factors that influenced this) and impact on biological family relationships appeared lacking in richness and depth at the end of the process. Questions remained about these areas and exceptions and disconfirmations were continuing to arise in the last interviews.