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CHAPTER FOUR: KEY POINTS FROM THE REVIEW
Legal and Policy context
Section 17 of the Children (Scotland) Act 1995 states that local authorities should ensure that all children and young people in the care of the local authority are prepared for the time that they will no longer be looked after. This preparatory and ongoing care is often referred to as 'throughcare' in comparison to 'aftercare', support on leaving care. If a young person is looked after beyond school leaving age, then under section 29 of this Act there is a duty to provide aftercare support up to their 19th birthday. Aftercare may be provided up to the young person's 21st birthday, under the powers of section 29, as long as their welfare requires this aftercare support and section 30 of the Act also makes provision for supporting young people near their place of education, training or employment. This support may continue until such a course has been completed, so may possibly extend to 22 or 23 years old. As the subsequent sections make clear, however, few children leaving care have continued in higher education and many have left care and education at 16 or 17 (Dixon and Stein, 2005).
There have been major developments in law, policy and practice affecting young people who have been looked after and leave care since the origin of this act with many changes being put in place since April 2004. The first significant change was the implementation of the Children (Leaving Care) Act 2000 which provided for the transfer of financial support for young people aged 16 and 17 from the UK government's Department for Work and Pensions to individual local authorities including those in Scotland. Section 6 of this act relating to the transfer of financial support to local authorities was not implemented in Scotland until April 2004. In addition, the Regulations of Care (Scotland) Act 2001 was implemented at the same time with part of the act strengthening previous provisions in the Children (Scotland) Act 1995 around assessment and complaints.
Alongside these two pieces of legislation, the Scottish Executive also introduced the regulations and guidance on young people leaving care in April 2004 (Scottish Executive, 2004b). These provided detail on how young people were to be supported as well as the duties of local authorities, assessment and planning for young people leaving care known as pathway planning, support to young people, financial arrangements and accommodation provision.
Materials were developed by specialist agencies, Barnardo's Scotland and the Scottish Throughcare and Aftercare Forum (Scottish Executive, 2004a) to support local authorities in their duties and to be used in conjunction with the guidance and regulations on leaving care.
Housing arrangements for young people leaving care were included in the Homeless (Scotland) Act 2003 which extended 'priority need' to young people who were looked after and were assessed as homeless. In addition the Supporting People Initiative which was introduced in April 2003 in Scotland, England and Wales to provide housing support for vulnerable people included young people leaving care.
The Scottish Executive has also taken forward a range of policy and practice initiatives which have focused on children and young people who are looked after, both at home and away from home. These include, for example, Learning with Care (Scottish Executive, 2001), which focused on improving the educational opportunities of children and young people who are looked after, the publication of several reports arising from the Social Work Inspection Agency ( SWIA) looked after children review ( SWIA, 2006) and the more recent report Looked after Children and Young People:We Can and Must Do Better (Scottish Executive, 2007).
Gaps in research
There has been no major research on young people leaving care since the Dixon and Stein research which was commissioned by the Scottish Executive, published in 2002 and again in an extended form in 2005 (Dixon and Stein, 2002; Dixon and Stein, 2005). There is therefore no study which considers the impact of the guidance and regulations on leaving care since they were implemented in 2004. There is also no study which evaluates current practice across Scotland since 2004 including accommodation provision to care leavers or the decision making processes of housing providers.
There are not any long term studies in Scotland on outcomes for young people leaving care. There are, therefore, no studies which attempt to disaggregate the impact of individual factors and interventions on young people. Similarly, there is not a body of research which disaggregates the experiences of young people who have been looked after in different care settings including that of being looked after at home. Happer, McCreadie and Aldgate (2006) point out that there is not extensive research on what contributes to good outcomes for children and young people who have been looked after.
Organisations who contributed information to this review commented that there was a great deal of unrecorded professional 'practice wisdom' on young people's transitions which was under-researched as well as a lack of longitudinal studies. There is a wider body of research which has been undertaken in England on young people leaving care, linked to similar changes in regulations and guidance which were implemented earlier than in Scotland.
This review focuses specifically on Scotland and therefore does not claim to be a detailed review of all the research recently undertaken in England or the rest of the UK although some studies are referenced here. A recommendation, arising from the review, is that a more comprehensive review of research in England, Wales and Northern Ireland would be worthwhile and would provide further detail about research in the rest of the UK on transitions, moving on from care to living independently and accommodation provision. This could also be further extended to include a review of research internationally.
The Scottish Commissioner for Children and Young People ( SCCYP) is, at the time of this review, undertaking a project exploring the situation of young people leaving care at 16. This has involved contacting local authorities on their policies and guidelines on the age of leaving care as well as gathering the views of young people and front line workers. A report will be produced during 2007 and will be laid before the Scottish Parliament.
Stein, in his review of international literature, also states there is a need for more research on outcomes for young people and indicates that the links between empirical and theoretical literature are under researched with the majority of research detached from theory (Stein, 2005).
Organisations who were contacted as part of this review to identify studies for inclusion indicated that there was little research on the housing needs of young people who have been looked after, particularly as the regulations and guidance on leaving care have been in place only since April 2004.
The remit of this research review has meant that the current policy and practice of major housing and leaving care support services across Scotland could not be analysed in the absence of significant research in this area. A Scottish wide review of homelessness and housing strategies, children's service plans and leaving care plans might provide a fuller picture of current practice and policy. A number of reports on work in Glasgow are referred to including the work of the big step organisation which is targeted on the needs of young people between 15 and 25 who are in or have previously been in care.
Young people leaving care
Young people who have been looked after and move to independent living between the ages of 16 and 18 are known to be affected by a number of factors ( SWIA, 2006). Although this group of young people have diverse experiences, studies show that they have experience of disrupted childhoods and have previous poor life experiences (Dixon and Stein, 2005; Glasgow Homelessness Network, 2005; Stein, 2006). They are affected by trauma and abuse during childhood and have often experienced a number of care settings as a result.
Most young people move on from care at 16 or 17 years (Dixon and Stein, 2005). This transition is often abrupt and impacts on other aspects of their lives such as education and relationships. During their previous care journey, young people will have had a variety of professional interventions. Studies draw attention to the swiftness of the move from childhood to adulthood for this group of young people (Stein, 2006). Stein calls this an 'accelerated and compressed' transition to adulthood which is different to the experience of other young people who generally stay at home longer and still have access to support from family and friends (Stein, 2006). Young people who have been in care may return to the family home but this can be a transient situation and often disrupts leaving care arrangements, particularly accommodation provision.
Studies and statistical data on young people leaving care and their move to independent living indicate that this group of young people are more likely to have poor educational outcomes including fewer opportunities to access further and higher education than other young people (Dixon and Stein, 2005;Scottish Executive, 2006). They are more likely to experience low paid employment or unemployment than other young people. Thirty seven per cent of young people receiving aftercare in 2005-6, in touch with a local authority and with known economic activity were in education, training or employment (Scottish Executive, 2006). Problems with health, particularly mental health and misuse of alcohol and drugs are more prevalent. Young people are likely to have difficulties with relationships with family and friends and there is a higher proportion of this group of young people who are young parents. Young people say that they are likely to be affected by stigma and prejudice if they have been in care (Paterson et al, 2003; Stein, 2006).
The resilience of young people who have been looked after depends on a number of factors including previous experiences at home or in care and personal attributes. Stability and continuity of care, including being able to maintain an attached relationship, are known to be protective factors as well as leading to poorer outcomes for young people where they are not adequately present (Dixon and Stein, 2002; Happer et al, 2006; Stein, 2005). Recent research by Wade and Dixon (2006) indicates that previous experiences are relevant to how young people cope when they leave care. However, what happens after young people leave care also has a significant impact on their outcomes and can be helped by the availability of services and support.
Support for young people moving on from care
Research shows that preparation for leaving care and the transition to independent living needs to start well in advance of a move (Ann Rosengard Associates and Jackson, 2005; Glasgow Homelessness Network, 2005; Scottish Throughcare and Aftercare Forum, 2006). The appropriate age for young people leaving care is dependent on their needs and individual circumstances. Young people need to have support in developing independent living skills in caring for themselves including cooking, cleaning and budgeting (Dixon and Stein, 2005). Those young people who have lived away from home often have an institutional experience of care and have not had the opportunity to develop skills in these areas.
There appears to be a significant variation in the level of care that young people experience on leaving care from a high level of support to very little (Dixon and Stein, 2002). Scottish Executive statistics for 2005-06 show that half of all young people leaving care had a pathway plan with 60 per cent having a nominated pathway co-ordinator (Scottish Executive, 2006). Young people whose behaviour is anti social or who find it difficult to keep to the rules of accommodation provision can be excluded from having access to the services they need although they might be among the most vulnerable of those leaving care ( The big step, 2006).
Certain kinds of services such as supported accommodation appear to be more effective than accommodation with less access to onsite support (Wade and Dixon, 2006). Several factors impact on young people sustaining tenancies including high costs and expenses, too little support, loneliness and a lack of independent living skills ( The big step, 2006; Dixon and Stein, 2002; Pawson et al, 2006; Scottish Council for Single Homeless, 2004). Factors which help to support tenancies include informal and formal support, choice in accommodation options, practical assistance with rents, bills and furnishing property and addressing young people's complex needs ( The big step, 2006; Glasgow Homelessness Network, 2005; Wade and Stein, 2005). Young people themselves emphasise the importance of being involved in decisions that affect them with advocacy services available for support (Paterson et al, 2003; Pawson et al, 2006; Scottish Council for Single Homeless, 2004; Scottish Throughcare and Aftercare Forum, 2006).
Some young people who leave care have more difficulties in accessing the right level of resources, particularly accommodation, than others. These include young people who have disabilities, young women and young parents, young people who arrive in the UK unaccompanied and those who have behaviour difficulties, young people who offend, have mental health problems or misuse alcohol or drugs ( The big step, 2006; Hopkins and Hill, 2006; Glasgow Homelessness Network, 2005; Glasgow Housing Association, 2006; Stein, 2006).
There is a view that changes in legislation and regulations have meant an increasing focus on the provision of specialised accommodation and support services. This, does not, according to some commentators, address a more fundamental issue about whether young people are leaving care too young (Baillie, 2005;Stein, 2005). Consideration should be given to securing high quality care for young people so that they do not move to independent living so young with the resulting difficulties and problems (Baillie, 2005; Wade and Dixon, 2006). Their transition to adulthood could then take place in line with the experience of other young people who deal with the complexities of becoming young adults during a more extended timescale.
The research strongly supports the advice given by the Scottish Throughcare and Aftercare Forum:
'There is no set age on when throughcare preparation and planning should begin. It should be well in advance of any move, and should take into account the young person's views and their readiness to move from care. .. Some local authorities ensure that throughcare preparation and planning begins after it has been agreed at a child care review, often some time around age 15 years. It is important for young people not to feel that they are being 'pushed' to leave too soon, for example if a young person is in long-term foster care. It could be said that the development of 'life skills' and preparation for adult living should take place at a suitable pace, throughout a young person's time in care. The provision and continuation of aftercare support should be based on an assessment of needs and pathway plans which are regularly reviewed.'( http://www.scottishthroughcare.org.uk accessed December 2006)
Research on young people leaving care and health issues
This section summarises conclusions relevant to 'transitions challenges' and independent living from research on the health, health views and experiences of looked after and accommodated young people leaving care.
It is clear from the wider literature, and echoed in the background research presented in these health studies, that young people leaving care are often multiply disadvantaged when they face the transition into the adult world. They may be lacking some of the taken-for-granted skills and knowledge which other young people may have absorbed simply through having a 'family'- based upbringing. Jones (2002) has referred to this as 'social inheritance'. Supporting this is evidence that young people who have had relatively stable looked after experience also tend to fare better in terms of their health than those who have experienced several placements (Allen 2003). As Scott and Hill report:
'a survey by Meltzer and colleagues (2004) of children looked after in Scotland asked carers and parents to rate the health of the children they care for. Children living with foster carers were more likely to be rated as having very good health (70%) compared to children living in other types of placement, particularly residential care (38%)'. (Scott and Hill, 2006, p 19)
Again, health also seems to improve with experiences of security. Added to this, the gap appears to be widening between those who gain good educational achievements and those who do not; this is further disadvantaging young people leaving care whose educational qualifications are already known to be extremely poor. The 'poverty penalty' of their childhoods which many young people leaving care carry with them into adulthood has increased over time (Bynner et al, 2002).
The background to health issues of looked after or accommodated young people leaving care is, therefore, also one of health inequalities, compared with their peers, and the reasons for this, and their subsequent life trajectories, are multi-faceted. As Scott and Hill have recently concluded:
'Research in several countries has shown how poorly equipped many young people leaving care are to cope with life after care - practically, emotionally and educationally- and has made connections with their subsequent experiences of loneliness, isolation, poor mental health, unemployment, poverty, drift and homelessness'. (Scott and Hill, 2006, p6)
Such statements must, of course, be qualified by acknowledging that looked after and accommodated children tend to come from socio-economically deprived backgrounds and many have had previous experiences which heighten the risk of poorer than average current and future health and wellbeing. Nevertheless, Scott and Hill concluded that, the health of looked after young people is quite good, but many have lifestyles that may damage future health and well-being. There is a particularly high level of mental health problems, particularly conduct disorders. Indeed, statistics from ONS in 2004 (Meltzer et al, 2004) suggest that 45% of looked after children have a mental disorder, compared with 8 - 9% of those of similar age in the general population; rates of conduct disorder are similarly high ( 44% of 5- 11 year olds in care compared with 4% of children in the general population). Meltzer and colleagues (2004) also found that looked after and accommodated children in Scotland aged 11 to 17 were twice as likely to smoke, drink or take drugs as their English counterparts. Such health relevant statistics have implications for everyday behaviours, for instance, McCarthy and colleagues (2003) found that 40% of a sample of children looked after by one English authority were experiencing significant difficulties in three of four key areas: home life, friendships, learning and leisure activities and concluded that: ' children and young people with multiple adjustment problems are at high risk of developing a range of very significant psychosocial outcomes in later adolescence and early adulthood'(p17 ). All of these issues would seem to have potential consequences for entry into, and ability to cope with, transitions to adulthood, not the least of which is independent living.
Young people themselves have been critical of the timing and inadequate preparation for leaving care. The majority of young people leaving care are still in their teens and research finds that, for them, 'the pressures of growing up, deciding whether to finish or continue education, and finding work are challenges in themselves without also finding a home and living independently' (Scott and Hill, 2006). Once again young people leaving care are disadvantaged relative to their peers, as most other young people in the community may be in education and retaining some dependency on their families until early or mid twenties (Jones, 2002). Small scale studies regularly find that young people leaving care want to be taught practical skills and feel that they can be supported in accessing health care and generally finding their way around adult concerns. Such support has, for example, been identified and provided in Edinburgh by the Underground, a lottery funded Healthy Living Centre targeting socially disadvantaged and homeless young people. Workers not only invited primary health care and other professionals into the Centre but also accompanied their users on visits for example to dentists. Over time they also began to support young people's health relevant needs around providing healthy food and basic washing facilities (Platt et al 2005).
When socially disadvantaged, looked after and homeless young people are asked about their own health care needs and services they tend to make fairly consistent responses. The young homeless population contains a significant proportion of young people leaving care and it is therefore useful to examine what this group has said about their health and health needs. A recent report for NHS Health Scotland (Watt et al, 2006) found that this group tended to see health in very functional terms, emphasising getting a good nights sleep and taking exercise. Although they recognised the importance of aspects of emotional health, such as feeling in control of their lives and being happy, they expressed greater concerns about their physical health. Similarly the big step report on young people in Glasgow living in foster care settings found that:
'There was a demand for more information/ advice on all health related topics in the future but especially for information and help with cooking on a budget, losing weight, getting fit and exercise, being a parent, self confidence and self esteem and relationships' . (Scottish Health Feedback, 2003, p25)
Many of these points echo earlier findings and recommendations from similar big step research about health with young people in care and leaving care in Glasgow (Scottish Health Feedback, 2001)
Looked after children and young people's views of their service needs again emphasise similar points. The big step report of 2001 stated that the most significant barriers young people identified to using services (echoing concerns of young people generally) were: boring waiting areas; lack of choice of staff; feeling that the service might not be confidential. However, they also wanted friendly staff who understood young people's problems, someone they felt they could discuss health concerns with and those in young people's units said they would be more likely to see health staff if they came to them. The DOH report on 'Promoting the health of looked after children' states that the messages from young people again emphasise confidentiality of their health information and their need for privacy. They too wanted advice on fitness, depression, stress, drugs, skin and hair care, sexual health, contraception and how to use a GP practice.
Throughout this health literature there is a clearly identified need for more information and dedicated support for young people leaving care in this area of their lives. It is also suggested that they start off more disadvantaged and less prepared than their peers, yet have greater challenges to face and at younger ages. The needs that recur, from the accounts of young people, professionals and carers are 'information' , 'emotional support', 'befriending', 'stability' and 'mentoring'; all of these are set in the context of the particular levels of understanding needed by young people leaving care because of their childhood experiences to date. As Scott and Hill (2006) comment: 'Discord within their own families, moves of home, changes in school or interrupted school careers, and lack of access to the support and advice of trusted adults can load additional pressures on young and vulnerable shoulders' (p30). It seems reasonable to suppose that these needs are also relevant to their transitions generally and to particular issues they may face, such as housing.
In the areas of housing as well as health, experts and young people themselves would seem to be advocating the need for continuing personalised support for young people leaving care, plus greater preparation for the transition itself. Mentoring would seem to be one way forward but the message from recent research (Philip et al, 2004) and evaluation (Kendrick et al, 2005) is that this must be carried out in a realistic fashion with young people leaving care, not by following mentoring guidelines to the letter. For instance, many young people leaving care find it difficult clearly to articulate ends and goals and mentoring relationships can be fragile and easily undermined. Moreover, there can be many shifts and changes in the young care leaver's life and circumstances and this means that support needs to be non-judgemental, friendly and often not from professionals!
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