Extracts II: Nancy Hazel
Introduction
This is the second paper by Nancy Hazel from the booklet “Free to be Myself: the development of teenage fostering” edited by Nancy Hazel and Andrew Fenyo.
John Whitwell.
Theoretical background and the evaluation of teenage fostering (1993)
Nancy Hazel
Theoretical background
The theory underpinning the Kent Family Placement Service, Parent Counsellors in Alberta, and the Minnesota placement agencies such as PATH and Human Service Associates has always been similar.
The objective of these programmes was, by treating the young people as normal and capable of running their own lives, to maximise their strengths and deal with their weaknesses, whilst at the same time their environment was changed to facilitate this process. This way of working comes very close to Maluccio’s ecological model (Maluccio, Fein and Olmstead, 1986). From the start, the Kent Project explicitly based its model on Reid and Epstein’s task-related methods (Reid and Epstein, 1977).* This meant a rejection of the casework style which involved an endless process and emphasised the importance of retrieving and dealing with the past – concepts derived from psychoanalysis. These new programmes did not ignore the past, and foster carers were expected to be good listeners, but the message to the adolescent was, “We accept that bad things have happened to you in the past, but that is over and we are offering to help you to be a success in the future, if you are willing to work with us.” The natural parents were given the same message. Obviously, these relatively short placements, generally ranging from a few months to, at the longest, two consecutive periods of two years, could not aim to reconstruct a personality and were, to a considerable extent, concerned with acquiring life-skills. However, the central issue at adolescence is identity-formation in Erikson’s sense (Erikson, 1968). Who am I? What sort of person do I want to become? In conjunction with new sexual feelings and an increased ability for abstract thought and idealism as described by Piaget (see Flavell, 1963), every adolescent is re-making himself as an incipient adult. A delinquent peer group can affect this process disastrously and most adrift adolescents are very short of other friends.
A foster family represents the way ordinary people live. It is inevitably different from the natural family and, in practice, this difference has advantages. The adolescent can see that people make their lives in different ways and can begin to think out how he/she wants to live. The foster carers’ roles as listening friend is central. For the adolescent, the whole process is very hard work. He has to move into a new family, attach himself to them and trust them, and then move on, hopefully better equipped and retaining the foster carers as friends to turn to in case of need.
The other theoretical pillar of the programmes relates to groups. The importance of self-help groups has been steadily increasing since the 1970s, and, with the change in function and status of the social worker (who has become more like a case manager than a powerful expert), mutually support by the foster carers became more appropriate and likely to be more effective than heavy reliance on professionals. For this reason, attendance at group meetings was seen as an integral part of the task. As well as educative and mutual support functions, the groups also provided a wider network in which it was not difficult to transfer adolescents as the members already knew and trusted each other (Roberts, 1988). In many societies, the family is more than the nuclear group, being part of the much larger system of the extended family, clan or lineage. The foster carers thus formed a sort of artificial tribe. Furthermore, if the groups joined together to speak with a united voice, they were in a much better position to achieve changes of policy than isolated families.
From the start, the teenagers’ families were included as full and (theoretically at least) equal partners. In practice, this partnership has greatly extended over the years. The old idea that the parents were very often the cause of placement breakdown seems to be untrue (Fisher, Marsh and Phillips, 1986; Maluccio, Krieger and Pine, 1990, Ch. 7).
Although to some extent it is true to say that the original theoretical position which was set out in the 1970s (Hazel, 1981) is still valid, Downes (1992) has now considerably widened and deepened the original rather simplistic formulation. From her research on a small sample of adolescents in foster care, she provides both a theoretical analysis and a guide for practice. Her emphasis is on process and relationships. Taking Bowlby’s theme (Bowlby, 1973) of the child’s need for a secure base from which to venture out into the world, she applies this to the relationship between the foster carers and the adolescent. The image of the coffer dam is used to show how the placement can protect the adolescent until he/she is ready to proceed alone. (A coffer dam is a temporary structure built to hold back the water while a new building is being constructed.) Starting with the dyadic relationships, she extends the analysis to the family system and outwards to the care network. The book also suggests that it is possible to misuse a useful concept. Time limits were introduced to make placements more manageable for foster carers and adolescents, and to focus on purposeful activity, but policies of “out as soon as you are 18” or “professional placements for 4 weeks only” obviously subvert these intentions.
Maluccio, Krieger and Pine (1990), like Downes, extend the theoretical base of adolescent fostering. In chapter 4, Levine describes how adolescents must work over and come to terms with the trauma of the past – ‘re-mourning’ – before they can move towards autonomy and feel at peace with their own identity; as one boy expressed it: “free to be myself”. Maluccio and other contributors also analyse the tasks facing the adolescent moving towards selfsufficiency. These tasks encompass both tangible and intangible skills. Tangible or ‘hard’ skills refer to skills that are known or done, such as finding and maintaining employment and housing, obtaining food, clothing, health care and other services and managing money. In contrast, the intangible skills are those that are felt, and are related to communication, decision-making and problem-solving, as well as the personal attributes of self-esteem and the ability to confront anger, manage past losses and develop relationships. Both categories of skills are necessary for a satisfying life. For both categories, the teenager’s own family and the foster family each have a part to play. Links with their own family enable the adolescent to come to terms with his/her history and origins and may (or may not) pave the way for a return home. In any case, the tasks of the foster carers include preparing the adolescent for self-sufficiency – not in the sense of living alone, but in the sense of being able to manage interdependent living within a network of satisfying relationships. Of these relationships, it is that with the foster parents which should usually remain as a reliable and stable backup whenever the young person does not return to a stable and happy parental home.
To some extent, a parallel development in specialist fostering took place in the Federal Republic of Germany, but there were differences of theory and practice. Their foster carers were expected to have a qualification in a relevant discipline: psychology, teaching, residential child care, social work, etc. The placement was seen as the transfer of therapeutic treatment as practised in residential establishments into a family home. This is more or less a medical model, with the therapist in charge and the foster carers carrying out the prescribed treatment. The basis of the work at Kent, PATH, Human Service Associates and Parent Counsellors was different. They deliberately recruited a wide selection of families and expected them to use their imagination and skills to find solutions to the defined problems. Another difference is the far greater German emphasis on education, sometimes at the cost of not tackling the underlying emotional problems. The educational side has always been weak for English children in care (Jackson, 1987; Heath, Colton and Aldgate, 1989). All programmes should be able to buy-in additional educational or psychiatric help where needed. This has been common practice in North America, but much less in the UK.
In what was formerly East Germany (DDR), there was no developed foster care. The Marxist regime laid its primary emphasis on the population as workers, so that child care provision was planned to free the mothers for work, rather than, as in West Germany, to support the parents in their essentially private task of bringing up their children (Colberg-Schrader, 1991). Behavioural difficulties were perceived as faulty development for which retraining, rather than social work, was required. Although the benefits of family life for children might be recognised, it was taken for granted that it would be impossible to find families for children in care, so that the policy was to try to improve the standard of residential provision (Kelm,1989). Since the reunification of Germany and the coming into force of the new Children and Youth Welfare Act on 1 January 1991 (Kinder und Jugendhilfegesetz), child welfare policy for the whole of the Federal Republic now has a new legal basis. The emphasis in this new law is on helping parents to bring up their children in their own home. However, it also provides a new legal framework for foster care, focusing less on the rather repressive elements of supervision and more on positive duties. The inclusion of the natural family is emphasized. The policy for the former East German provinces will be to run down the large residential establishments in favour of care in the community.
In North America, specialist foster care has developed rapidly since the mid70s, but there is now a theoretical division. One model sees the placement as therapy, where the foster carers carry out the plan devised for them by the mental health experts. The other model seeks to use all the resources of the foster carers and their environment to enable the young person to progress. In Germany, there is a further division between those who follow psychoanalytic theory, with its emphasis on the family network (Bl_ml et al, 1989). In the UK all these divisions are less apparent.
Evaluation
Specialist foster care for adolescents has always been relatively well researched. The first evaluations were carried out by Hessen and Parent Counsellors in the mid-70s, and the Kent Family Placement Service always emphasised the importance of publishing the evaluations which were carried out. This programme was formally evaluated four times:
- An independent evaluation of 25 consecutive cases carried out in 1977 (Yelloly, 1979).
- An evaluation of 156 cases carried out by the project social work team in 1979 (Hazel, 1981).
- An evaluation of 92 placements carried out in 1985 by the specialist and nonspecialist social workers and the foster carers, which tried to include the adolescent and his/her family (Smith, 1986). The results of these three evaluations were very close. It appears that 64% of the placements were completed as planned (the rate for traditional foster care was about 50%) and over 70% of the young people improved during the placement. (Although the results of the three evaluations were very close the methods were not comparable). However, with just over 600 teenagers placed over a period of 12 years, it seems possible to say that the method works given competent professional social workers and foster carers, and high morale. Unfortunately, funds were not available for any follow-up study.
- Subsequently Fenyo, Knapp and Baines (1989) at the Personal Social Services Research Unit at the University of Kent used the same data as the third evaluation to study all the 149 placements completed over an 18-month period. Using the same criteria for breakdown, they found that 38% broke down – almost the same figure as before. However, the main thrust of this paper was the importance of using research methodology which takes account of each causal factor simultaneously; that is, multivariate rather than a bivariate comparison. The equation which was developed predicted 79% of the placements correctly, with nine factors ‘explaining’ the incidence of break-down. The weakness of this study is that the available data did not include information on the teenagers’ own families or of the social work input before or during the placement – which suggests the need for further research within an objective rather wider than breakdown.
Finally, it is important to recognise the difficulty of assessing success and failure. Measures such as ‘breakdown’ or ‘improved in placement’ are both incomplete and short-term. There has so far never been any money available for follow-up studies of teenage fostering. Even a young person who has done very well in placement may fail afterwards and vice versa. A television programme (Jan. 93, Independent Television) followed up children from Aycliffe school (a residential school with a good record of modifying the behaviour of disturbed and violent children), showed that, as young adults, all but one of the sample of seven had failed tragically, although behaviour had improved while at the school. A foster carer with 17 years experience of difficult teenagers – and still in touch with 12 or her 14 ex-placements – feels that most of them experience a period of acute depression after leaving care, but by their mid-twenties, seem to find their way to an acceptable lifestyle which suits them, although it may not be quite in line with conventional expectations. The lifeline for these young adults was the former foster carers, who were contacted mainly when the young people were in difficulty. No young person should leave care without a relationship with a caring adult which can last. This may be with their own parents or foster carers or someone else, but cannot be a social worker unless the latter guarantees not to move.
Colton (1988) compared two groups of older children, one in children’s homes and the other in specialist foster care over a period of 12 months. He considered four dimensions of care:
- the management of social events
- children’s community contacts
- the physical environment
- controls and sanctions
On all these dimensions, the foster homes scored better than the children’s homes, the gap being particularly wide in respect of community contacts. The caretaker roles and behaviour towards children and the children’s perceptions and behaviours were also studied and he concludes:
‘Paradoxically, therefore, it might be said that because the meeting of children’s needs is only one of the functions performed by the family, and because the needs of foster children are accorded secondary import to the needs of the pre-existing family or household members, the foster homes were able to provide child-oriented care. Whereas the foster children had to adjust to a social environment conditioned by the fact that their caretakers were seeking to meet their own needs and those of any natural children living with then, and from which bureaucratisation was virtually absent, the residential children were obliged to adapt to the requirements of bureaucratic management. The needs of the youngsters in the children’s homes were able to meet the basic needs of the children which they accommodated (eg, the need for food and shelter), it is uncertain whether they satisfactorily met the higher order needs of the children concerned.’
Finally, Fry (1992) has surveyed the contribution currently offered by foster carers to young people preparing to leave care and afterwards when their care authority ceased to be officially responsible. Sixty-one per cent of her responses were from carers on specialist teenage fostering programmes and showed extensive support being offered – practical, financial and emotional. Almost all of the foster carers identified the main form of help given as providing a ‘listening ear’. Agency response to carers offering after-care support was one of unofficial/limited official encouragement, or indifference. The foster carers believed that financial support would make their contribution more effective, but above all, they wanted their efforts to be formally recognised and valued.
Summary
As time has passed since the original programme of teenage foster care started in the 1970s, the theoretical base has developed and diversified, although the changes are less than might have been expected. There are now significant differences between the proponents of the transfer of techniques used in residential care (often based on learning theory) to family placements, those who expect the foster carers to act as independent professionals using their skills and imagination to tackle defined problems – which may include the need to re-mourn the past.
From the start, teenage fostering has been relatively closely evaluated – with encouraging results – so that the actual placements seem to be rather successful. On the other hand, there is an almost complete dearth of follow-up studies so that it is impossible to tell whether any lasting improvement was achieved. Given the lack of after-care provision, it is possible that the original gains may have been lost subsequently. However, the assessment of family placements should be seen against a background of the research on residential care, where the lack of after-care has probably been even greater.
The survey of EC countries being undertaken by Nicola Madge at the European Children’s Centre (publication due in 1993) shows that residential care is in retreat throughout Western Europe. New legislation and social policies now lay primary emphasis on promoting services which will help parents to bring up their children in their own homes. For those who must leave home and can never return, all these countries provide adoption services, although not always for older or handicapped children. The UK is one of the leaders in providing for these children, but scores poorly on day care. In all these countries, fostering is generally to be preferred to residential care, but some countries still consider that ‘difficult’ children and adolescents need to be cared for by ‘experts’ in residential units. In Spain, for example, rapid progress has been made in closing the large, old institutions, and professional fostering for adolescents has just begun. The UK fostering services for younger children are probably as good as anywhere else, but there appears to be a lack of ability to develop individualised programmes on a fairly large scale for emotionally disturbed and delinquent adolescents. This book tries to demonstrate that this is not impossible.
Footnote
* Doel and March (1992) describe how social workers ought to use this task-centred method in England in the 90s. However, they only consider working with individuals and families in their own homes and do not extend the discussion to cover people in the care of either residential establishments or foster families – a far more complex situation.
References
Blüml H. et al (1989) Changing Concepts of Social Work in Foster Family Care, Community Alternatives: International Journal of Family Care, Vol. 1, No. 1, pp. 23 – 24. -Bowlby J. (1973) Attachment and Loss, Vol. 2: Separation: Anxiety and Anger, The Hogarth Press and the Institute of Psycho-analysis, London. -Colberg-Schrader H. (1991) Ein Land zwei Traditionen [One Country with Two Traditions], Deutsches Jugendinstitut Bulletin, Heft 17. -Downes C. (1992) Separation Revisited, Ashgate, Aldershot. -Erikson E. H. (1968) Identity, Youth and Crisis, Norton, New York. -Fenyo A., Knapp M., and Baines B. (1989) Foster Care Breakdown: a Study of a Special Teenage Fostering Scheme, in Hudson J. and Galaway B. (Eds), The State as Parent, Kluwer Academic Publishers, Dordrecht. -Fisher M., Marsh P., and Phillips D. (1986) In and Out of Care, Batsford, London. -Flavel J. H. (1963) The Developmental Psychology of Jean Piaget, Van Nostrand, New York. -Fry E. (1992) After Care: Making the Most of Foster Care, National Foster Care Association, London. -Hazel N. (1981) A Bridge to Independence, Blackwell, Oxford. -Heath A., Colton M. and Aldgate J. (1989) Educational Progress of Children in and out of Care, British Journal of Social Work, Vol. 19, No. 6. -Jackson S. (1987) The Education of Children in Care, School of Applied Social Studies, University of Bristol. -Kelm A. (1989) Mõglichkeiten und Grenzen der Heimerziehung bei der Korrektur psychosozialer Fehlentwicklungen [Possibilities and Boundaries in Residential Care for the Correction of Faulty Psycho-social Development], pp 64-71, in Korrektur der psychosozialen Fehlentwicklung, Friedrich-Schiller Universitat, Jena. -Maluccio A. N., Fein E. and Olmstead K. A. (1986) Permanency Planning for Children: Concepts and Methods, Routledge, Chapman and Hall, London & New York. -Maluccio A. N., Krieger R., Pine B. (1990) Parenting Adolescents for Life after Foster Care, Child Welfare League of America, Washington. -Reid, W. J. and Epstein L. (1977) Task-centred Practice, Columbia University Press, New York. -Roberts J. (1988) From A to B to C to D to E: A Multiple Bridge to Family Placement, Adoption and Fostering, Vol. 12, No. 3. -Smith P. M. (1986) Evaluation of Kent Placements, Adoption and Fostering, Vol. 10, No. 1. -Yelloy M. (1979) Independent Evaluation of 25 Placements, Kent County Council Social Services Department, Maidstone.