Informal supports can also be found in the youth's foster family, their peer relationships, and through mentor relationships. For many youth in out-of-homecare, the term family is used broadly to represent individuals in their lives with whom they have a bond, not necessarily biological. Experts who work with transitioning youth have begun to appropriately recognize the important role that foster parents play in preparing youth for independent living (Mech, 2003). In several studies of independent living, youth report that they learn life skills mainly from their foster parents (Courtney et al., 2001; Lemon, Hines, & Merdinger, 2005). A critical implication for practice is the need to properly train foster parents to care for adolescent youth in out-of-homecare, and for ILPs to formally collaborate with foster parents to prepare youth for self-sufficiency (Lemon et al., 2005). Nixon and Jones (2000) found that young adults felt strongly the need to continue connections with other former foster youth. As an additional resource for youngpeople, aftercare services can encourage young adults in transition to develop support groups and networks with each other. Participation in support groups can also facilitate the development of important communication skills including problem solving and anger management. By communicating with adolescents still in care, foster care alumni share their experiences and offer suggestions for how to improve the transition to adulthood. The young adult benefits by the empowerment of helping others, and the adolescents in care benefit from the knowledge and experiences of those who have gone before them. An alternative formal support system that can benefit transitioning youth is mentorship (Barrera & Prelow, 2000; Mech, 2003). Benefits of the mentoring relationship are enhanced self- esteem, development of coping skills, and a more positive outlook about the future (Barrera & Prelow, 2000). These are all factors that are also considered significant in fostering resilience (Luthar, 1999; Murray, 2003; Rutter, 1987).
Youngpeople leaving care can have histories of abuse, neglect or exploitation that can greatly affect their ability to live independently and programmes have been developed to address this. An example is a transitional living programme for homeless care-leavers in the United States, which assessed the outcomes of care-leavers using a transitional living programme, ‘Avenues to Independence (ATI)’ in Northern California (Rashid, 2004). Independent Living Skills (ILS) training is an integral component of the ATI programme and includes money management, home management, apartment search, personal health and hygiene, conflict management, and decision making. The residents also meet regularly with their case managers, who assist them with planning their future goals and refer them to other resources such as mental health support and medical services if needed. The goal is to provide care-leavers with a safe place to live and with the skills needed for successful adult living. ATI follows an asset-based model of youth development, building on and acknowledging strengths and
eaving care is formally defined as the cessation of legal responsibility by the state for youngpeople in out-of-homecare (Cashmore & Mendes 2008). But, in practice, leaving care is a major life event and process that involves transitioningfrom dependence in out-of-homecare to independence. Youngpeople leaving out-of-homecare are arguably one of the most vulnerable and disadvantaged groups in society. Compared to most youngpeople, they face particular difficulties in accessing age-appropriate developmental and transitional opportuni- ties. Care leavers have been found to experience significant health, social and educational deficits including homelessness, involvement in juvenile crime and prostitution, mental and physical health problems, poor educational outcomes and inadequate social support systems (Maunders et al. 1999; Community Affairs References Committee (CARC) 2005; Bromfield & Osborn 2007; Cashmore & Paxman 2007).
The match rate changes are being phased in so localities have time to change their practice. Estimates based on local spending patterns in recent years indicate that when the match rate changes are fully phased in, the over- all local share of CSA expenditures will be similar to what it would have been under the old rules (i.e., in aggre- gate, the fiscal effects of the incentives and disincentives will be roughly equal). However, the financial incentives that localities face are substantially different; it will be strongly in their interest to seek community-based alter- natives rather than residential placement. Early indications are that localities are already beginning to respond. In the early months of fiscal 2009, the share of noneducation CSA spending that went to community-based serv- ices was about 15 percent, up from about 11 percent in the previous two years; the share going to residential placements is about 49 percent, down from about 55 percent in fiscal 2007. These trends suggest that the new legislation seems to be incentivizing localities to reduce their reliance on congregate care and increase commu- nity-based services, while avoiding a significant overall cost shift to localities. The expectation is that more youngpeople will be served in their home or in the community, increasing permanency for Virginia youth.
Aim: Older people and parents of young children are the most frequent users of out of hours care. However, their needs and expectations of care may be different. The aim of this study was to explore and compare the experiences and views of these two groups following the transfer of responsibility for out of hours services from General Practi- tioners (GPs) to a Primary Care Trust (PCT). Methods: Qualitative research using semi-structured interviews with 19 informants living in a geographically large, semi- rural PCT area in England served by 15 GP practices. Interviews were taped, tran- scribed and analysed using a thematic framework. Findings: Older people presented with more complex health problems than young children, and expressed more reluctance at calling the service. Both groups experienced similar access problems for using the primary care centre (PCC). Older people reported fewer difficulties obtaining a home visit, though experienced continuity problems when illness episodes lasted longer than one shift. Both groups questioned the ability of a doctor to diagnose accurately using only telephone assessment. Conclusion: Despite differences in presenting symptoms and attitudes to service use, older people and parents with young children experienced similar problems in accessing care at the PCC. Older people more frequently received home visits than parents with young children, and it may be that social context is not sufficiently taken into account when assessing need for a home visit. Practitioners should be aware that older people tend to minimise symptoms and should be cautious of relying on lay interpretations of illness when carrying out telephone assessments with this group.
people’s early housing careers and to their overall sense of well-being. How youngpeople fared in housing was not greatly associated with past events in their lives, such as the contours of their care careers, and was more closely linked to life events after leaving care. For example, housing outcomes at follow-up were not associated with length of time looked after, placement movement, age at leaving care or with troubles youngpeople may have experienced while they were looked after (offending, substance misuse, running away or school non-attendance). Nor were they greatly associated with young people’s circumstances soon after leaving care at the baseline interview. Even where youngpeople had experienced brief periods of homelessness after leaving care (and many did so), this was not directly associated with a poorer outcome (unless that pattern of instability continued). Previous research has found that leaving care services have tended to concentrate resources on youngpeople with relatively unstable early housing careers (Biehal et al. 1995), and the lack of association between homelessness and outcome at follow-up is likely to reflect the availability of support systems to help youngpeople back on to the housing ladder in these local authorities.
Specific groups of care leavers face additional disadvantages because of their status or characteristics, compounding their exclusion. Black and minority ethnic youngpeople, including those of mixed heritage, face similar challenges to other youngpeople leaving care. However, they may also experience identity problems derived from a lack of knowledge, or contact with family and community, as well as the impact of racism and discrimination (Barn et al. 2005). Research carried out during 2002–3 in England found that unaccompanied refugee and asylum-seeking youngpeople were excluded from services under the Children (Leaving Care) Act 2000 where local authorities decided not to ‘look after’ them but support them under Section 17 of the Children Act 1989 (Wade et al. 2005). They were also likely to receive poorer services than looked after youngpeople, especially in respect of support from leaving care teams (Hai & Williams 2004).
At Anglicare Victoria our focus is on transforming the futures of children and youngpeople, families and adults. Our work is based on three guiding pillars, Prevent, Protect, Empower. We offer a comprehensive network of services and seek to ensure the provision of high quality services that will bring about significant improvements in the life experience of the youngpeople, children and families/caregivers with whom we work.
The interviews in particular give insight into the extent to which many older people physically and emotionally depend on domiciliary care. Effective communication and continuity of care are central to ensuring that this experience is a positive one. It was clear from the interviews that many older people can find it difficult to come to terms with the domiciliary care service, especially coping with people coming into their home on a daily basis – a transition that is all the more difficult for those who have little continuity as regards care staff. This lack of continuity can prevent older peoplefrom building relationships with care workers who are often undertaking quite intimate tasks, as well as making it more difficult for care workers to identity poor health in the person receiving care. Familiar care workers who communicate effectively are crucial in helping older people feel like they are being treated with dignity and respect in their own homes.
We need to have a much better understanding of what services cost so that we can provide services that meet children’s needs. Children should be having fewer placement moves. There should be restrictions on the number of foster places in a foster carer’s home to three to bring it in line with the recommendations of the Fostering Network. However, committing to quality care has implications for the funding and availability of placements. Although independent foster care services are providing essential placements for children, the costs of purchasing services are having a significant impact on local authority budgets. In the absence of the right kind of services, some youngpeople are placed inappro- priately in high cost services such as secure care units or residential schools. This is an unnecessary expense in these circumstances and not in the best interests of children.
Our study examined national trends in child welfare from 2000 through 2010. We found that although the number of investigated referrals for suspected child maltreatment increased over 11 years, there was a surprising decrease in substantiated maltreatment and an even greater decline in the total number of children in OOH care, because fewer children entered foster care, and the use of alternative permanency options (adoption and guardianship) increased. Also, there was an increase in the numbers of children with multiple forms of maltreatment before placement and those diagnosed as having emotional disturbance. Our data indicate, there- fore, that the child welfare system is now caring for fewer children but for larger numbers with complex trauma histories and emotional and mental health needs.
James is a young man of 18 who has been released fromcare for nine months and has spent half of that time in prison for breaking and entering and car theft. He ran away fromhome and was placed in care at 14 as a result of violence from his stepfather. His school informed “welfare” and he was made a ward of State. He is immature and virtually illiterate. He had three foster placements before being discharged at 17. He worked briefly as a kitchen hand but has since been unemployed for three years. He is living with the family of a mate who has also recently been released from jail. Most of his mates are just going into or coming out of prison. He sometimes drinks too much and smokes “ganja”. His criminal record excludes him from the cricket competition he previously played in, which offered a more positive network. James found independence more lonely than being in care: “It was all right in care. It is just when you get out, really, be(ing) on your own”. When asked where might he be in five years time, he replied: “Could be in prison for all I know. Could have got into some stupid things, some trouble and that”.
Maintaining connections to family, community and country will help Aboriginal and Torres Strait Islander children and youngpeople to develop their identity, feel connected to their culture and develop their spirituality. Strategies underpinning responses to the National Framework for Protecting Australia’s Children are partnerships between Indigenous families and communities, and between Indigenous agencies, mainstream service providers and governments, in order to provide culturally appropriate responses. Aboriginal and Torres Strait Islander communities’ participation in decisions could be through Aboriginal and Torres Strait Islander controlled organisations that participate in decision making with child protection agencies and non-government organisations.
Why some youngpeople cope better than others is complex and there may well be innate and linked personal attributes we do not understand. In the UK, the resilience of youngpeoplefrom very disadvantaged family backgrounds has been found to be associated with: a redeeming and warm relationship with at least one person in the family – or secure attachment to at least one unconditionally supportive parent or parent substitute; positive school experiences; feeling able to plan and be in control; being given the chance of a ‘turning point’, such as a new opportunity or break from a high-risk area; higher childhood IQ scores and lower rates of temperamental risk; and having positive peer influences (Rutter et al. , 1998).
The older people in Fishponds are not a single homogenous group with a common set of out-of-home mobility demands. There are differences as a result of factors such as age, gender and health, and the ability to address their needs is greatly impacted by the level of access to a car – which in the earlier stages of later life provides a simple continuation of existing travel behaviours. However, as people age and become more likely to encounter health constraints then the focus of travel might change (more need for access to healthcare for example), and mobility choices can become more constrained. In general, it would seem that ‘older old’ females without access to a car are likely to be the sub-group with potentially the greatest number of unmet needs. This might suggest that the Frome Vale ward is the part of Gt Fishponds that may be experiencing potentially more issues in respect of this particular study – identified as having a greater number of older old women. In respect of the journey purpose and function, it also appears to be the case that in broad terms it is the ‘discretionary’ travel that is more likely to be unmet as older people age, or where circumstances limit access to mobility choices.
medication, or input from therapy services. ‘Discharge’ from hospital is, therefore, more likely to be a stage in a process involving the transfer of care, rather than being an end-point of care. The movement and transfer of carefrom hospital to home – sometimes referred to as the ‘transition period’ – is likely to involve input from multiple agencies to meet patients’ ongoing care needs. It is a highly variable and complex process that is contingent upon several factors, for example service provision, resource capacity, and knowledge transfer within and between secondary care teams, GPs and corollary services, community therapy teams, and adult social care services; alongside the social support networks and resources that patients themselves have access to (or not). Consequently, the transition of carefrom hospital into community settings can be a risky one. Additionally, older people may experience more than one ‘transition’ in a single hospital admission episode, for example, moving between wards or via intermediate care at a different location. Likewise, some older people may experience readmissions within a short period of time. The
of targeting the intervention to understand whether this is because patients are unwilling to be involved (low moti- vation), they just do not feel they have the knowledge or skills (low capability) or that the formal carers dismiss attempts by patients to be involved (low opportunity). The COM-B complements our broader conceptualisa- tion of transitions within a resilience framework because it focuses on understanding what patients actually do (work as done), rather than assuming that they do what is imagined (eg, by those caring for them). Interviews will be cogenerated by both participant and researcher; to ensure that discussions are relevant to the research, the researcher will use the interview schedule as a ‘map’ to guide the conversation, while remaining flexible enough to follow participants as they express their experiences about being in hospital and transitioningfrom hospital to home. Interviews will be recorded digitally. Individual interviews are likely to take place in the hospital and in the patient’s own home; if an interview does take place in a setting that is not the patient’s home, we will ensure that these occur in a space that is sufficiently private. We may also conduct telephone interviews to speak with partici- pants about an episode of care that has been delivered but not observed by the researchers (eg, visiting their GP).
Phase 2 methods: in‑depth review of prioritised risks Phase 2 centred on the search, appraisal and synthe- sis of English-language citations relating to the risks to youngpeople in these prioritised areas. The final search strategy used was highly sensitive and comprised three core concepts: (1) youngpeople; (2) mental health; and (3) inpatient. Searches were made using the following 17 databases, with time limits from 1995 to September 2013: EconLit (American Economic Association’s elec- tronic bibliography); Applied Social Sciences Index and Abstracts; British Nursing Index; Cochrane Library; Cumulative Index to Nursing and Allied Health Litera- ture; Education Resources Information Center; EMBASE; Health Management Information Consortium; MED- LINE; PsycINFO; Scopus; Social Care Online; Social Services Abstracts; Sociological Abstracts; OpenGrey; Turning Research into Practice Plus; and Web of Sci- ence. The project team reviewed all citations retrieved and manually identified those addressing the risks of dislocation and contagion, and extracted data using an abstraction document designed for the study. Care was also taken at this stage to include any citations address- ing costs and cost-effectiveness. UK government and other organisational websites were searched, in order to include contextual information (e.g., policy drivers) and as a route to the identification of additional evidence. A call for evidence was circulated, and references of included citations were reviewed.
If parents want it, their involvement in social group settings can have advantages. It can provide social contact, an opportunity to share anxieties, help with parenting skills and managing partner relationships. For their children, it offers a chance to socialise and play together (Rickford, 1994). As we have just seen, some individual workers were attempting to link mothers into playgroups and parent groups in the community. At another level, leaving care services may also have an important role to play through the informal groups and social activities they sometimes provide. At least one mother felt there was a need for more specialist provision, since she considered her needs were now different to those of other care leavers. Only one of our participating authorities was operating a group for young parents during the course of the study. However, two other leaving care schemes had provided groups for young mothers in the past and another two were planning them for the future. In addition, some links were being made with local teenage pregnancy initiatives to provide drop in services and support. Although there is a debate to be had about the relative merits of specialist as opposed to community based provision, it is likely that social support of this kind will be helpful to a proportion of young parents, especially given the social stigma that can still be experienced by teenage lone parents in the community.
In total, 787 Year 12 students from 56 schools across New Zealand participated in the survey. In terms of gender mix, 64.2% were female and 34.8% male. The schools were evenly spread across deciles (typically five or six schools from each decile ranking), with slightly more decile 10 schools (n=9), and slightly fewer decile 8 schools (n=3). A school’s decile rating is an indication of the degree to which it draws students from low socio- economic communities, with decile 1 schools having the highest number of students from such backgrounds (New Zealand Ministry of Education, 2014). Comparison with Ministry of Education figures for 2011 indicated that the participating schools were representative of all the New Zealand schools with enrolled Year 12 students in 2011. Purposeful sampling was then used to identify 28 students (18 females and 10 males) from schools across a range of deciles who were subsequently interviewed late 2012/early 2013 (9 from decile 1-3 schools, 11 from decile 4-7 schools and 8 from decile 8-10 schools). At the time of the interviews, participants were in their last formal year of schooling or, in some cases, had left school. Therefore, in some cases, participants were reflecting back on their experiences of technology use in schools. In the context of this study, decile is used as a proxy for socio-economic status.