Extracts I: Nancy Hazel

Introduction

Nancy Hazel was a pioneering figure in the development of professional fostering in the 1970s and 80s in the UK. She wrote three papers in a booklet, “Free to be Myself: the development of teenage fostering” edited by Nancy Hazel and Andrew Fenyo (1993). This is the first of the three.

John Whitwell.

The original phase: the Kent model and developments up to the mid- 80s.

Nancy Hazel

In the early 70s, the reputation of foster care in the UK was low and the breakdown rate high. The Department of Health and Social Security (latterly the Department of Health) was calling for an expansion of residential care, and the existing homes and residential schools were full of adolescents. Everyone knew that these adolescents could not be placed in foster homes! At the same time, research was appearing which showed that the residential provision for adolescents was both expensive and counter productive.

A study by the Council of Europe of all the member countries (Council of Europe, 1973) had shown an enormous variation in the use of residential care. At that time the Swedish state system placed almost all separated children and young persons in families, whereas Belgium, with a network of largely denominational voluntary organisations, relied mainly on residential care. The UK was roughly half-and-half. Every country had a different balance resulting from its history, religion, political persuasion and geography. Sweden’s progressive thinking was encapsulated in the finding of the 1974 Swedish Royal Commission for the Placement of Children which proposed four basic principles:

  • Normalisation: living in a family in the community as opposed to an institution.
  • Localisation: being near own home and social network.
  • Voluntariness: as opposed to constraint.
  • Participation: all parties sharing decision-making.

Today these principles seem obvious. Two new, and more difficult, placement principles are openness and egalitarianism. In 1975, the Kent Family Placement Project started as a reaction against the English preoccupation with residential care and the unsuccessful foster care system in the UK. It seemed an obvious fallacy to believe that putting badly behaved adolescents together (the specialist option) would be likely to make them behave better: generally in such a group status is accorded to bad behaviour. Conversely, one delinquent adolescent in a normal family does not gain status by lying or stealing – although they may attract attention. By this time, the penal establishments for youth in Massachusetts, USA, had been closed, and the new fostering programmes of the Parent Counsellors in Canada and the PATH agency (run by foster parents) in Minnesota, USA, had successfully placed difficult teenagers in normal families. They were closely followed by Human Service Associates and other agencies. If it was to be proved that even the most delinquent or emotionally disturbed adolescents could be maintained successfully in ordinary families, it had to be a quite different brand of fostering. This meant developing a method which anyone could use. It also seemed important to make these placements as expensive as residential care so that a fair comparison could be made. It has since become clear that although high quality foster care is certainly expensive, it is unlikely to be quite as expensive as the equivalent residential placement. The Kent Project placed “the most difficult” adolescents aged 15 to 17 with “severe problems”. The problems were not specified, but if the social workers could not justify their severity, the referral was not accepted.

This was the first point of difference. Up till then, social workers had tried to persuade families paid a very low boarding-out rate to accept difficult children by minimalising the problems – or even concealing them. This still happens. The Kent Project presented bad behaviour as a challenge and emphasised the problems to be solved. The families which proved themselves able to deal with the worst behaviour achieved high status in the group. (‘Family’ meant any person or persons living a stable lifestyle in their own home. In practice, the majority were married couples, but a substantial minority were not.) The foster carers saw themselves as high achievers, so that morale remained high. The foster families were considered to be working and were paid on this basis. This also increased their status and brought a whole new population into foster care as there were many women who enjoyed the challenge and social contacts of work, but did not wish to be away from home for long periods each day. A ‘caring career at home’ had been created. As a result, the foster carers became colleagues of the social workers instead of clients: a situation which is not yet fully accepted, as it involves a considerable redistribution of power.

The Kent Project started as a five-year experimental project. At the end of this period, it was taken over by the Social Services Department of the country, decentralised and renamed the Kent Family Placement Service. 

The Method

The basic method is simple and can be replicated and tested. It rests on:

  • written agreements
  • enhanced status of foster carers
  • payment of fees
  • groups
  • foster carers’ direct work with parents
  • support worker for foster carers

All the work conformed to the Swedish principles of normalisation, localisation, participation and voluntariness, with the addition of the principle of egalitarianism, which includes openness. Information is power and the exclusion of others is a means of hanging on to power. All information and all decision-making should be shared. All those concerned in a placement are considered to be equal in esteem and status, although the legal powers and responsibilities of the social worker remain intact. So the concept of the social worker ‘in charge’ no longer fits, although he or she remains as a kind of central pivot as organiser, enabler and sometimes as expert. Although the social worker – holds the power of veto, the basis of the work is partnership. 

Agreements

Each placement starts with a written agreement of which all parties have a copy. The parties to the agreement (the placement ream) are usually:

  • the adolescent
  • the foster family
  • the adolescent’s own family
  • the social worker responsible for the adolescent and his/her family
  • the specialist social worker responsible for the foster family

The agreement will contain:

  • a statement of the overall aim and estimated duration of the placement
  • the specific objectives or tasks to be undertaken
  • the contribution of the adolescent’s own family or other important people
  • the contribution of social workers
  • the schedule for review and arrangements for termination, including aftercare.

The agreement should be as short and simple as possible, as everyone must understand it. Detailed instructions can turn it into mere form-filling instead of a kind of therapeutic collaboration. It is always possible to have another paper setting out agreed arrangements of various sorts, but the initial agreement must get to the heart of the matter and be absolutely clear. It is not easy to write such an agreement. (Since the 1970s, various models of agreement forms have been published.)

The agreement can be shortened, lengthened or amended, but only by agreement with the placement team. Decisions should never be made unilaterally. It is also crucial that the agreement should be reciprocal, and not just a set of instructions which the young person agrees to follow. Usually a clause is inserted stipulating four weeks notice if anyone wants to end the placement prematurely. This provides a valuable cooling off period and safety valve, especially for the adolescent, who is also expected to produce an alternative plan. The way this gives back power and responsibility for his own life to the adolescent has been well described in an article written by P Brentnall (1992). Throughout the process of reaching an agreement, it is important to help the adolescent to gain confidence and skills in negotiating with powerful adults, so that he/she is not afraid to stand his ground and express his point of view clearly and calmly.

Lastly, the “If not, why not?” rule. The rules of contracting should be followed rigorously – unless there is a reason to break them. If this is so, the reason should be recorded. The importance of planning the outcome at the very start should be emphasised, so that the adolescent is never cast adrift at the end of the placement. Foster carers show enormous ingenuity in finding suitable accommodation for young people and supporting them there. If the work with the parents has been successful, many of the young people will return home, retaining the foster carers as a refuge in times of stress. From the start the adolescents and foster carers liked the agreements, but many social workers have resisted this way of working as they are unused to defining their social work input and sharing decisions. 

Status and payment

The increased status of foster carers, who were recognised as undertaking tasks as difficult as those of professionals and being experts in their own right, has already been mentioned. Payment was originally calculated at half the rate of a basic grade professional for one placement – and there were difficulties as traditional foster parents were paid much less. It was open to anyone to apply to work with difficult adolescents, but hardly any of the traditional foster parents wanted to make this change. Before the Kent Project started, one other programme had employed foster parents as staff members (salaried), but although this would have been financially more secure, it had a number of disadvantages and the Kent families did not want to be part of a large bureaucracy. (A recent study shows that this is still the case – Sellick, 1992.) The families therefore became freelance fee earners – which meant a lot of disentangling of tax, insurance and so on. A fee is now the norm in specialist fostering, although there are a few salaried posts. 

Groups

The next important innovation was a new kind of group to provide mutual support and development for the foster carers. The basic principle underlying groups is that no one should work alone. The groups were compulsory and met fortnightly at first, but later the meetings could be spaced out at slightly longer intervals. Many people resist joining a group but like it when they are there. Foster carers get to know each other and help newcomers to understand the work. They collaborate as a team, offering each other help and support. Again this reduces the importance of the social worker, whose role in the group is fairly restricted – enabler, referee and so on – rather than leader. The foster carers are the experts as educators, therapists and advocates for the young person. Groups are used for training and for sharing experiences, but, since the early days of the Project, training has greatly improved and foster carers are now able to attend courses together with social workers and residential staff and to act as trainers themselves. Finally the group’s awareness of the progress and problems of all the placements is a valuable safeguard for the teenagers and responsible social workers. The principle that no-one works alone is extremely important.

Groups also have the great advantage that, as the foster carers know each other’s skills and capabilities, it is fairly easy to move adolescents within the group – which was conceived as a sort of ‘tribe’ or artificial kin network. In this scheme it is possible for an adolescent to outgrow one placement and make a constructive transfer to another family. Finally, the group increases the power of the foster carers by giving them voice, especially if they combine to make a statement. A recent development is for the group, rather than one family, to take responsibility for a particularly difficult teenager. 

The foster families

From the beginning of the Project specialist social workers were responsible for recruiting and training the foster families, organising the groups, for suggesting the match, and for supporting the foster families. Referring social workers continue their contact with the adolescent and his/her family. The foster families feel that it is essential to divide the work in this way and the practice is now widespread.

The families who are attracted to this kind of programme have always been diverse in age and social class. Generally they could be described as openminded and outspoken. Their lifestyle tended to be a kind of ‘open house’ and they were not bound by convention. However, there were exceptions and a wide range of families are needed to match a wide range of children. Very few of the original applicants had had experience of traditional fostering and there are still many direct entrants. Counselling-out of unsuitable applicants has always been important and a regular evaluation of the foster families is undertaken.

Families must consider carefully the impact of a difficult teenager on their own children. Sometimes this means that the idea of fostering must be abandoned or postponed but, more usually, families feel that their own children benefit in a number of ways. In particular, seeing how unhappy other young people can be, they learn to value their own family which they had previously taken for granted. They also acquire a new awareness of social problems – and anti-social behaviour is generally perceived as unattractive.

In the past, the recruitment of foster carers has been hampered by the social workers’ search for perfect families. It is essential to abandon these preconceptions. If the attitude today is that every child or adolescent should be able to live in a family, unusual children are likely to need unusual families. Rather than seeking families with certain characteristics, almost any family should be considered initially, unless they are debarred by ill-health or a criminal record. As they meet the other foster carers and get to know the social workers, most will either drop out or become enthusiastic and eager to learn. If the family could only manage children of a very specific type, they must be warned about the difficulty of making a match, and must decide for themselves whether it is worth waiting. It is important for all families to clarify preferences and dislikes. Some families will welcome the challenge of aggression or delinquency, others will prefer withdrawn or slow-learning children. All must accept the need for training and evaluation and must be willing to cooperate in the group.

The parents

Much recent research has shown how parents are excluded or edged out, even though their inclusion tends to be linked with success (Department of Health, 1991a). The structure of the Kent agreement included them, but in the early days it was quite difficult to maximise their contribution, although the rather business-like nature of the transaction virtually eliminated the jealousy so often complained of in traditional foster care. Over time, the situation has greatly improved and many parents now work together with the foster carers and social workers towards the resolution of defined problems. This is not always the case, but even difficult relationships can generally be improved. Contact with siblings is not usually particularly difficult as adolescents can generally manage it themselves. ‘Access’ or ‘contact’ are both unfortunate terms, implying the parents’ right to see their children, but little more. The Kent method expects form the start that the foster carers should enter into a planned, active partnership with the natural parents, except where this is clearly impossible or forbidden by the court. 

General points

One of the keys to the success of the programme was that it provided individualised treatment in a situation where status is not achieved by bad behaviour. Generally only one adolescent at a time was placed, but sometimes two (which did not affect the success rate). It was considered that four placements constituted a group, where the newcomers might outnumber the family. Once the scheme was established there were usually between 75 and 84 placements in 55 to 65 families at any one time. There were usually as many families applying as the workers could cope with, generally without advertising. The programme always adopted a high profile with the media both to recruit and to publicise what was being done, but once the scheme had started, word of mouth was the best way of finding families.

The following example of an early successful case illustrates a number of the preceding points.

Linda’s mother described herself as ‘unable to get close to the children’. Her father had a history of mental instability and abused Linda sexually – lying on her and making her sit naked on the floor while he jeered at her. As a result of all this he was sent to prison. Linda was aged 15 at referral. She had one more year of compulsory schooling to complete. Her behaviour was terrible – she stole and lied and bullied the other children at school or truanted. There were allegations of sexual promiscuity and drugs. Linda was terrified of her father’s imminent release from prison and determined to leave home and be taken into care. This was agreed. She said she wanted a family where she was the only child. This was agreed, but she hated it – it was boring and lonely. She said she wanted to be with a group of children and a transfer was arranged. She hated it – there was too much competition. Another transfer was arranged (all this within a few weeks) as Linda had made friends with the daughter of another of the Project’s foster families and wanted to go there. This was a great success – although hard work for all concerned. Linda remained in touch with her mother and, by the date of her father’s release, had learned not to be afraid but to feel sorry for him. She met him on her terms and was kind to him. Since then Linda has become a secretary and has led an interesting life, including a spell in the USA. The foster family remained a refuge and reference point. 

Expansion and differentiation

The Kent Project provided the model for a substantial number of programmes in the UK, and its methods were paralleled elsewhere, with certain differences. The North American and British programmes did not require the foster carers to hold any specific qualifications, although they emphasised the importance of training and preparation for the task. Although the German programmes insisted on relevant qualifications, such as social work or residential child care, teaching, psychology, etc, there is no evidence to show that qualified people are more successful.

At first, not all schemes provided a support worker for the foster carers and not all programmes required the foster carers to work together as a team by means of the group.

There were, and still are, differences of attitude towards the status of the foster carers (Hazel, 1981). The Kent Project explicitly required ‘equality of esteem and status’ between all participants, although the social worker retains extensive legal powers. Tunstill (1989, p. 19) and Maluccio (1989, p. 48) both emphasise the inequality of the participants. This is an important point as ‘equality’ is not a unitary concept. Legal powers are clearly unequal. Although parents are usually poor and poorly educated, they may be more wealthy and better educated than the social workers. Foster carers are generally intelligent people and may be highly qualified.

The period from approximately the late 70s to the mid-80s was one of some expansion and differentiation. In the UK, there was quite a rapid increase in the number of programmes, generally based, more or less loosely, on the published Kent model (Shaw and Hipgrave, 1983). In Germany, there was not much expansion. However, two distinctive features emerged: the requirement for qualifications and the transfer of therapeutic methods used in residential establishments to foster care. In North America, there was a steady expansion of the number of programmes, mainly small-scale, private schemes. In Minneapolis, one substantial programme, Professional Association of Treatment Homes (PATH), was entirely run by the foster carers, who acted as directors and hired their own social workers and other staff. This has been a successful programme, has continued to expand, and has been a model for developments in the UK. The last few years have seen a tremendous expansion in North America and very significant changes in the UK which will be described later, after a discussion of the theoretical basis for the work and the research findings.

References

Bretnall P. (1992) Teenagers Take Control, Foster Care, September, London -Department of Health (1991a) Patterns and Outcomes in Child Placement, HMSO, London -Hazel N. (1981) A Bridge to Independence, Blackwell, Oxford -Maluccio A. N. (1989) Writing an Agreement: An Exploration of the Process, in Aldgate J. (Ed), Using Written Agreements with Children and Families, Family Rights Group, London -Shaw M. and Hipgrave T. (1983) Specialist Fostering, Batsford, London -Sellick C. (1992) Supporting Short-term Foster Carers, Avebury, Aldershot -Tunstill J. (1989) Written Agreements: An Overview, in Aldgate J. (Ed), Using Written Agreements with Children and Families, Family Rights Group, London.