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Black young people’s perspectives on friendships with Looked after children: A Thematic Analysis

Stephanie Akinyi Makalwala Sewell

Submitted for the Degree of

Doctor of Psychology(Clinical Psychology)

School of PsychologyFaculty of Health and Medical Sciences

University of SurreyGuildford, SurreyUnited KingdomSeptember 2018

Abstract

Background: A growing concern within the looked after community is that there is an over-

representation of Black, Asian and minority ethnic young people in the care system; the

largest group being children from Black and mixed heritage backgrounds. Aim: The purpose

of this research is to contribute to our understanding of the processes involved in peer support

development for Looked After Children (LAC) from minority communities

Method: The study gathered information through face-to-face multi-method, interviews

informed by a topic guide. The sample comprised of eight young people, both male and

female, with their ages ranged from 11- 16 (mean age = 12.88). Results: The three main

themes emerged from the data were: learning about each other, levels of closeness, and a

sense of belonging. It also found young people from back and dual heritage background hold

fairly realist views of LAC by believing they feel sad, experience stigma, struggle with

building trusting relationships but should be treated no differently to others. Discussion: This

research has also highlighted the potential process used to inform their inclusive nature

towards LAC and how this may be related to prosocial qualities and past experiences that are

unique to black and dual heritage young people. Conclusion: This research has extended our

knowledge on what the views and perceptions black and dual heritage young people have of

LAC and can serve as a preliminary base for future studies.

Acknowledgements

Completing this training has given me immense joy and would not have been possible

without the support of those around me. I would like to express my sincere gratitude to my

supervisor. Additionally, I would like to acknowledge and give a heartfelt thank-you to my

parents, sister-in-law, best-friend, mentor, fellow trainee clinical psychologist colleagues and

my church community for the support and prayers I have received over the years and

throughout this process. I would like to say a special thank you to my husband who selfless

emotional and spiritual support has proved invaluable. Lastly, I would like to acknowledge

that none of this would have been possible if it were not for God and I give thanks to him for

this. Collectively they have given me the strength to keep going through the difficult

moments and for which I am eternally grateful.

Contents Page

Contents

MRP Empirical Paper 5

MRP Empirical Paper Appendices 66

MRP Literature Review 96

Brief Overview of Clinical Experience 145

Table of all Academic Assessments 148

MRP: Black young people’s perspectives on friendships with

Looked after children: A Thematic Analysis

By

Stephanie Akinyi Makalwala Sewell

For confidentiality reasons pseudo names was used to protect the identity of participants and

all identifiable information were anonymized in this report.

Abstract

Background: A growing concern within the looked after community is that there is an over-

representation of Black, Asian and minority ethnic young people in the care system; the

largest group being children from Black and mixed heritage backgrounds. Aim: The purpose

of this research is to contribute to our understanding of the processes involved in peer support

development for Looked After Children (LAC) from minority communities

Method: The study gathered information through face-to-face multi-method, interviews

informed by a topic guide. The sample comprised of eight young people, both male and

female, with their ages ranged from 11- 16 (mean age = 12.88). Results: The three main

themes emerged from the data were: learning about each other, levels of closeness, and a

sense of belonging. It also found young people from back and dual heritage background hold

fairly realist views of LAC by believing they feel sad, experience stigma, struggle with

building trusting relationships but should be treated no differently to others. Discussion: This

research has also highlighted the potential process used to inform their inclusive nature

towards LAC and how this may be related to prosocial qualities and past experiences that are

unique to black and dual heritage young people. Conclusion: This research has extended our

knowledge on what the views and perceptions black and dual heritage young people have of

LAC and can serve as a preliminary base for future studies.

INTRODUCTION

Recent developments in individualising support for looked after children (Brewin &

Statham, 2011) have heightened the necessity for identifying the needs of looked after

children (LAC) subgroups such as ethnic minorities, as there is an over-representation of

young people from black, Asian, and minority ethnicities in the care system. The phrase

looked after children (LAC) is used to refer to children or young people under the care of a

local authority, including foster care children, accommodated children, and children in

kinship foster care. According to the Department of Education (DOE), there is an estimated

72,670 children under the care of the local authorities in England (Department of Education,

2017).

Within this figure, approximately 17,400 (approx. 24%) young people defined as

belonging to black, Asian, and minority ethnicities (BAME) are in care in the UK (DOE,

2017). This is a higher percentage than the percentage of BAME children in the general

population (DoE, 2017; Coward, 2015). Black and mixed heritage children are mainly the

overrepresented minority (11,600 of the 17,400; 16%), whereas young people from Asian

communities are slightly under represented (5%; DoE, 2017). Additionally, LAC from

BAME backgrounds are more likely to have longer stays in foster care (Kools, 1997);

however, research exploring this phenomenon is sparse. These statistics and research indicate

LAC from black and dual heritage are entering care at a higher rate with protracted stays.

Furthermore, there is a disparity between the over representation of black and dual

heritage children in the care system and their voices not being well reflected in the looked

after literature. Boushel (2000) highlights how research in this field is dominated by studies

from majority white culture samples undertaken primarily by white researchers. For example,

Ridge and Millar (2000), who researched LAC views on friendships, acknowledge their

sample included no LAC from black (or BAME) backgrounds. When reviewing the literature,

overall, the views, and experiences of black and dual heritage young people are

underrepresented in the LAC research field, with studies having little to no young people

from this demographic (Coward, 2015). The studies predominately had no non-white LAC,

but a few studies included up to 11% of the sample from BAME backgrounds (McMahon &

Curtin, 2013; Sudgen, 2013; Tausig, 2002). Considering this evidence, it seems studies use

homogenous samples of young people almost entirely from white heritage and generalise to

non-white LAC, and the appropriateness of this is somewhat questionable.

In actuality, the LAC population is not a homogenous group, as acknowledged by

national guidelines. Black and dual heritage children in care have distinctive needs additional

to that of the wider LAC population. The Social Care Institute for Excellence (SCIE, 2008;

Community Care, 2008) recognises this group has specific emotional and behavioural needs

that differ from other LAC. The National Institute for Health and Care Excellence Guidelines

(NICE, 2010) has also stressed the importance of addressing the specific difficulties of

BAME LAC and identified that looked after children and young people from black and

minority ethnic backgrounds have unique needs that differ from the larger LAC population.

This is further supported by research that recommends adaptations be made to interventions

because experiences and presentations vary across cultures and ethnicities (Ho, Rasheed, &

Rasheed, 2003). Though these guidelines recommend providing support for these differences,

Clough (2006) reported there is a limited understanding of the needs of this LAC population

by staff working with black and dual heritage LAC.

The overall service structures and policy initiatives in place for LAC are not informed

adequately by the voices and experiences of dual heritage and black LAC (Clough, 2006).

Therefore, the system struggles to meet their needs. Boushel (2000) stated, “social welfare

research is failing adequately to reflect the multi-racial and multi-cultural nature of society”

(2000 p. 71). This sentiment is echoed by Ince (1998) and Ahmad (1992), who caution this

lack of research on black looked after children is resulting in unmet needs. The evidence

reviewed here seems to suggest a pertinent role for the research, specifically reporting from

the perspective of black and dual heritage young people in the field of LAC.

Recent attempts have been undertaken by researchers to rectify this disparity by

capturing the views and experiences of black and mixed heritage young people within the

LAC literature and raising important issues that are distinctive to the larger LAC population.

The broader research field has established that the general LAC population has a poor

prognosis of mental and physical health, educational achievement, and interpersonal

relationships (Beck, 2006; Rees, 2013; Honey, Rees & Griffey, 2011; Zima et al., 2000; &

Francis, 2000).

Similar to the broader research field, Coward (2015) conducted a study exploring the

needs of LAC from black and dual heritage backgrounds using Interpretative

Phenomenological Analysis (IPA) and found they struggle with placement moves,

interpersonal relationships difficulties around feeling emotional unavailability from the adults

around them, and feeling low at times: “Once in care you feel isolated from friends”

(Coward, 2015, p. 64). However, interestingly he found a theme, unique to black and mixed

heritage young people not making friends with people from the same background (BAME)

but was not sufficiently addressed by the authors’ policy implications. Coward (2015)

reported that young people often struggled with their identity as black and dual heritage

children, which was reflected in their friendships choices. See table 1 for some examples of

the quotes reported:

Table 1.

Table of Young people’s quotes from Coward, 2015

Quotes

Example 1 “My main friends were white. For a while I wanted to be white. I didn’t

know where I belonged – no identity”

Example 2 “I have a good balance [now]. I was more towards the white side when in care and

I had only white friends. My foster carer, who is Jamaican made me realise both

sides are important”

Example 3 “My friends call me bounty bar, black on outside white inside and I am not

insulted by this. Generally, my friends are all white. I have a black couple of friends

who class themselves as bounty, and this is not a problem at all for me.”

Overall, the findings from this study suggest that the young LAC were seeking a

connection with their peers of black or dual heritage to support their sense of ethnic identity

seems to be evidence. Research exploring peer relations with LAC is limited; however, over

the years, wider research has found peers can play a vital role in the lives of looked after

children (Bulleri, 2004; Emond, 2003; Singer Berzin & Hokanson, 2013). The role of peer

support and friendships is identified as a resilience factor that helps LAC navigate adversity

(Mac Mahon & Curtin, 2013; Sudgen 2013 & Taussig, 2002). When looking at LAC positive

outcomes, emotional support from positive (pro-social) peers (Sudgen, 2013) and their

friends (McMahon & Curtin, 2013) is an influential factor. This support can have lasting

effects into the adult life of LAC (Jacobs & Freundlich, 2006). Children who leave foster care

without permanent connections with peers and their relatives are often at a greater risk of not

achieving positive outcomes. Collectively, these studies outline a critical role for peer

relations for LAC.

Moreover, LAC have self-reported the need for peer support but often struggle to

attain and sustain friendships (Ridge & Millar, 2000). Other studies also state LAC’s access

to peer support is an area of difficulty (Mac Mahon & Curtin 2013) and experiencing barriers

to relations with LAC peers can have a negative impact on their resilience (Mac Mahon &

Curtain, 2013). One such barrier is the stigma associated with LAC status (Peters, 2005),

which is possibly influenced by non-LAC views of LAC (Kools, 1997).

LAC have reported feeling there is stigma attached to being looked after by the local

authority (Hedin, Höjer, & Brunnberg, 2011) and the view of others hinder the development

of peer friendships. Over the years, the concept of stigma has been criticised for being

somewhat ambiguous (Link & Phelan, 2001). In response to this critique, a proposed

conception of stigma put forward by Link and Phelan (2001) is the co-occurrence of

labelling, stereotyping, separation, status loss, and discrimination. This suggests it is a

process in which an aspect of one’s identity deviates from the norms of the social normative

group, resulting in those from the social normative group feeling uncomfortable (Link &

Phelan, 2001). This results in a devaluing of ‘the difference’ in the individual’s social

identity, thereby increasing the stigma (Dovidio, Major, & Crocker, 2000).

LAC are identified as different by peers due to their status, possible behavioural

difficulties, problems arising from their biological parents (e.g., abuse, ill health), and

emotional difficulties they may experience (Kools, 1997). This arguably increases when other

differences are added, such as coming from a BAME group (National Institute for Clinical

Excellence, 2010) and mental health difficulties (Meltzer, 2003). Research identifies that

differences between children contributes to the formation of stigmatising beliefs, attitudes,

and behaviours and similarities between the young person and peer groups increases the

likelihood of peer acceptance (Link & Phelan, 2001). Because of these factors, young people

in care are likely to feel marginalised and different from their non-LAC peers, making it

difficult to form and sustain friendships. BAME LAC may feel additional marginalisation

because they belong to more than one stigma-associated group.

Rogers (2017) explored how young people in care in the United Kingdom coped and

managed the stigma associated with being looked after. After interviewing 20 young people

in care (including two dual heritage young people), they found they experienced stigma

because of the LAC status and therefore found it difficult to access social support from non-

LAC peers. Rogers (2017) concluded that young people adapted by selecting to disclose their

status to peers. They suggested LAC would benefit from meeting other looked after children

to develop a sense of belonging and in-group experience. However, this would be limited to

specific settings. Further exploration on how to support LAC to access social support from

peers in school or other youth group settings may help to strengthen their social network and

support network. Given the evidence outlined, one may suppose positive peer relations for

black and dual heritage LAC could play a role in the development of their identity,

particularly in relation to their ethnicity and in overcoming stigma.

To reduce isolation and reinforce a stronger sense of identity of BAME-LAC, NICE

guidelines recommend creating links with community groups to increase access to support

and provide continuity of cultural experiences (NICE, 2010). To provide continuity in

cultural experiences, it can be argued that the links should be made with communities similar

to the LAC’s culture/ ethnicity. SCIE (2008) have also recommended that a LAC from a

minority background should have exposure to environments where they can understand their

culture and gain emotional support to deal with any racism or discrimination they may face.

Researchers have found that groups that report having pro-social attributes/behaviours

are more likely to be accepting of marginalised individuals (Boivin, Hymel, & Hodges,

2001). With the increased attention looking at the ‘‘fit’’ between the child’s characteristics

and that of the larger group’s norms and expectations, the importance of exploring how group

level processes influence peer inclusion and peer involvement have been highlighted

(Gifford-Smitha & Brownell, 2002). Research has identified the importance of peer support

from pro-social peer groups but little is known about the processes that help young people

become friends with LAC.

It is of high importance to explore friendship formation for this particular group of

young people as research has found that, specifically, black adolescents have different

portraits of peer relationship (e.g., appearing more tolerant of behavioural differences)

compared to their non-BAME counterparts (Giordano, Cernkovich, & DeMaris, 1993; Clark,

1989). Young black people scored lower than their counterparts on needing

mutuality/similarity as a prerequisite for forming friendships, potentially resulting in them

being accepting of friendships with individuals from uncommon circumstances/backgrounds.

Giordano et al. (1993) also recommend further research into the processes involved for this

population to help understand the group level differences.

Given the likelihood of protracted stays in foster care, understanding the meaning of

friendship to LAC and the possibility of these peers offering support is important in terms of

how black non-LAC peers understand and relate to them and how they understand their

needs. This could provide helpful insights into how these needs could be met. This study is

interested in the interpersonal relationships of black non-LAC and their perceptions about

LAC.

Aim

The study aims to contribute to knowledge of the underlying mechanisms and

processes of how black young people who are not in care might form and sustain supportive

friendships with LAC. Understanding the processes involved in building and sustaining peer

friendships could give rise to future work in developing target interventions for positive life

trajectories. Understanding how to increase peer support for LAC can be a step to reducing

stigma, increasing resilience through access to external supportive experiences, and

identifying and promoting individual strengths of young people.

Research question

1) What is the understanding of young people from black and black Mixed heritage

backgrounds on how to form and sustain friendships with LAC?

METHOD

Ethical consideration, such as the confidentiality of participants when presenting data,

was given to this project, and anonymity was preserved by removing identifiable information.

Subsequently, a proposal was submitted for review and approved by the University Faculty of

Health and Medical sciences ethics committee only (see Appendix 4).

Participants

The study gathered information through face-to-face interviews that were based on a

topic guide. The study’s sample consisted of eight young people, ages 11-16 (mean age =

12.88 SD =1.81) with the ratio of 1:1 for gender participants who attend a youth group based

in inner urban city in England. Due to the exploratory nature of this area, a qualitative

approach was best positioned to address the research question (Birkinshaw, Brannen, &

Tung, 2011). The researcher interviewed black and black-mixed heritage non-LAC

concerning their views of LAC and how to create relationships with them.

Recruitment

The study was advertised in youth groups based in the urban inner-city area.

Permission was sought, to undertake this study within the youth club setting or setting

associated with the youth club’s regular activities (e.g., youth club building). A leaflet was

given to young people outlining the project in an information sheet with an invitation to

participate in the study. An opportunity to discuss the project informally prior to agreeing to

participate was offered. Participants were self-selecting and met the inclusion criteria.

Written consent was sought from both the parent/guardian and young person. After gaining

consent from the young person and their parent/guardian, arrangements for a convenient

interview date were made at a youth club affiliated community building. The interviews were

recorded on a digital recorder and then transferred to a password protected encrypted USB

drive until it was transcribed. The transcription was completed verbatim by a transcription

services and the names or identifiable information remained anonymous by either changing

the details or removing it.

Table 2.

Table of Participants age range and demographics.

Name (Pseudo-

names)

Demographics

Age Gender Ethnicity

1 Peter 11 Male Black British African

2 Paul 13 Male Black British African

3 Andre 13 Male Black British Caribbean

4 Simeon 14 Male Black British African

5 Esther 14 Female Black British Afro-Caribbean

6 Sarah 11 Female Black British Afro-Caribbean

7 Crystal 16 Female Black British African

8 Annie 11 Female Black Mixed Heritage Caribbean

Interview Structure

The interview process consisted of one meeting. It was anticipated that the young

people recruited in this study would have varying experiences/contact with LAC and

therefore differing levels of understanding of what it means to be a LAC child. To ascertain

the level of understanding about the terms associated with LAC and foster care, participants

were invited to participate in an icebreaker activity, where there were opportunities to

introduce the young person to these terms. These were presented with unfinished sentences

and definitions (adapted from NSPCC, 2018). Participants were asked to finish the sentence

and encouraged to discuss each sentence further. Then the interview progressed to talking

about the questions framed in the topic guide to gather information on the research question

(see appendix 11). The topic guide was devised in order to enhance replicability and was

developed with the researcher supervisor, experts in the field and a care leaver. The interview

lasted between 30 to 60 minutes.

Treatment and Analysis of Data

The qualitative data derived from participants’ responses in their respective interviews

were analysed using Braun and Clarke’s (2006) Inductive Thematic Analysis. A semantic,

critical realist approach was taken when analysing this data, as it was understood the

participants could express and articulate meaning, with the assumption there is a

unidirectional relationship between meaning and experience (Widdicombe & Wooffitt, 1995)

whilst acknowledging the social and historical influence on knowledge. The procedure for

conducting thematic analysis of data, as described by Braun and Clarke (2006), was followed.

The analysis commenced with a familiarisation of the data before transcription. Then, each

transcript was inspected line by line to develop initial codes and micro themes (see appendix

15 for an excerpt of coded transcript).

These themes were grouped based on identified links and similarities observed,

resulting in broader themes/subthemes emerging. Additional review of each interview

enabled further exploration of themes, validating that the themes were reflective and

grounded in the data, providing comprehensive understanding of the concepts, whilst being

embedded in the data. Lastly, summaries of these themes and subthemes were produced and

reported (please see credibility section for details on checks undertaken). Overall, this

analytical strategy allowed for an iterative process from the moment of transcription until the

writing stage was complete.

Reflexivity and Researcher position

In relation to the study, the researcher took a realist position, as it was aligned with

the stance of a person, researcher, and a trainee clinical psychologist. One of the main

reflections of the researcher/interviewer was the impact of their black ethnicity on broaching

this topic with young people of black and dual heritage backgrounds. The researcher

acknowledges that their own past experiences of being a young black person could have

influenced the interviews in some way. This may not have been in a negative way, as

experiences and understanding of black identity due to shared heritage may have been

initially useful for guidance, identification, exploration of salient points and building rapport.

For example, the researcher could relate to some of the experiences shared in the interview

(e.g. making friends with individuals of the same or different background) and may have

explored particular areas even further to capture nuances. It was also acknowledged that the

time the researcher was a young person is different to the present day and not all experience

would relate to the participant experiences.

However, it also left the content of the interviews susceptible to assumptions and

possible bias. Additionally, the interviewer would have had the aims of the project in mind,

so it is likely that during data collection and analysis, the interviewer may have been

vulnerable to emphasizing the aspects considered to be most important. However, safeguards

were put in place to minimise these and the interviewer believed the data collected can

provide useful feedback. For example, a senior researcher reviewed interviews as well as

questioning style and provide feedback (see credibility section for additional details).

Another reflection, concerned potential uneasiness of discussing race related issues

observed at the beginning with young people. During the interview, whenever the topic

relating to a black experience arose, initially there were noticeable pauses and tentativeness in

the phrasing of the young people’s responses, but as the interview progressed, this reaction

was reduced, and the young people were more at ease and spoke more freely. They

potentially reflected a sense of discomfort in discussing this topic so freely. Articles and

papers have documented this experience of discomfort when speaking about a race related

topic (Sue, Lin, Torino, Capodilupo, & Rivera, 2009). As a result of the study one thing that

has changed for the researcher is that I have become more aware of how important it is to

engage in race related topics. Further details of the researcher’s reflections on their

epistemological position and for the reflexivity during the analysis stage can be found in

Appendix 13 and 17.

Credibility

Analytical credibility was maintained and ensured throughout the process. Data was

reviewed and reconsidered until there was confidence in the analytical process. This was

done by engaging with an experienced researcher (supervisor), record keeping of the process

and reflection at each stage Nobel' (2015). For example, the researcher sought verification of

the meaning of the themes as they emerged against the quotes with a supervisor. This assisted

in the development of the findings around rejection. Initially, the findings centred around

views that LAC experience rejection. But through discussion and reflection in supervision it

expanded to include the nuanced findings of rejection experienced by the participants. This

was further developed through critical realist position to understand this finding in the socio

historical context into the of racial rejection.

Yardley’s (2000) four characteristics of qualitative research that was deemed credible

of sensitivity to context; commitment and rigour; transparency and coherence; and impact

and importance were integrated whilst conducting this research (see appendix 12 for an

example of how this was done and a thematic map to aid transparency).

Results

Thematic Analysis

Three broad themes and their subthemes emerged through the thematic analysis.

These were ‘Learning about each other’, ‘Levels of Closeness’, and ‘A sense of Belonging'.

Their subthemes are detailed below (see appendix 16 for emerging themes map). The main

themes were related; with the subthemes being only unique to their meta theme.

Theme 1: Learning about One Another

This theme related to how interviewees’ friendships were initiated, constructed, and

maintained. The young people’s responses for this theme appeared to be organised around

three subthemes. This included the processes involved in the initial meeting, the importance

of doing activities together regularly, and the need for finding common ground and

exchanging experiences around differences.

Table 3.

Table of Themes and Subthemes.

Themes Subthemes1. Learning about each

othera) Initial Meetingb) Being around each other

c) Finding “common grounds” and “exchanging differences”

2. Levels of Closeness a) Growing Trust b) Holding back c) Rupturing Closeness

3. A sense of Belonging a) Fitting in (Acceptance)b) Rejection and frustrationc) Protectiveness

Initial Meeting

Within this subtheme, the views and ideas shared by the young people about how they

engaged and were engaged in forming a friendship were foregrounded. Overall young

people’s appraisal of making friends in the youth club setting was mainly positive and

“easy.” Most felt that either knowing individuals that attended the youth club or being

approached and invited to join an activity contributed to making it easy.

Table 3.1

Examples of quotes from young people evidencing the above

Quotes

Example 1 “It [making friends] was easy” (Andre).

Example 2 “Even when you meet people you don’t know, they are just randomly nice”

(Simeon).

Example 3 “It’s easier if somebody like somebody realizes you're by yourself […] breaks

the circle, that they can allow you to come” (Paul).

Example 4 “It was quite easy because all of us when we first came” (Sarah)

In relation to children in care, two young people felt that Looked after children were

more likely to be nervous and intimidated coming in to the youth club setting and meeting

new people. This belief seemed informed by perceived ideas that LAC have experienced

difficulties in making friendships (rejected because of being LAC) and are apprehensive

about how it would progress.

Table 3.2

Examples of quotes from young people evidencing the ideas above

Quotes

Example 1 “They might feel nervous and a bit scared at first. But then I’m sure they would

like get used to it and be a bit happy” (Andre).

Example 2 “A bit shaky, a bit nervous” (Sarah).

The ideas of invitation and initiating contact were reoccurring concepts in the young

people’s responses. When the young people reflected on what it was like for new people to

start attending the youth club, two recalled being approached and invited to join a class or

game. This was important to them, as it helped reduce nervousness and made it easy to make

friends with young people at the youth club.

Table 3.3

Examples of quotes from young people evidencing subtheme above

Quotes

Example 1 “So it’s easy to join in…. you try to make friends for that one week […] we'll

just invite them” (Paul).

Example 2 “Maybe ask them if they wanted to come and play or talk or just do

something fun, ‘Would you like to join?’” (Esther).

This was further supported when an interviewee described his experiences being new at the

youth club and joining an established group. He expressed feeling nervous, initially, but soon

began to enjoy himself.

Table 3.4


Quotes

Example 1 “I was a bit nervous but then it felt a bit fun” (Andre).

Similarly, the interviewees frequently shared that, when they see new people attend

youth club, it was important to initiate conversation with the young person. One young

person expounded on this when he said, from the outside, the group may seem like a ‘clique’

(in-group) but making initial contact can help the new person enter the circle of friends. This

potentially highlights an in-group/ outgroup dynamic, but a member of the in-group can help

support the new young person’s entry. It also highlights the fact that this young person was

potentially proactive in considering the needs of the other and facilitating their involvement.

Table 3.5


Quotes

Example 1 It’s easier if somebody like somebody realizes you're by yourself […]

breaks the circle, that they can allow you to come” (Andre).

In relation to LAC, the young people felt their behaviours and intentions would not

change. They felt they would still approach and introduce themselves to LAC because they

were not likely to know they were LAC. Two young people felt LAC would “need more

effort to understand them” (Sarah). A few felt they would need to persevere to engage LAC

because they would need more persistence and more invitations, but they did not feel being a

LAC would mean they would decline their invitations. The reason as to why they thought

they would need to persevere was due to LAC having bad past experiences and being more

hesitant and untrusting.

Table 3.6


Quotes

Example 1 “It’s if I keep on trying to speak with them and try to form a better

relationship” (Andre).

Thoughts concerning their desire to get to know new individuals were not unique to

LAC, but applied to young people in general. For example, there was a strong sense of

intentionality and interest from two young people wanting to get to know new people, and

three other interviewees shared they did not like seeing others being by themselves.

Table 3.7


Quotes

Example 1 “Not nice to see somebody just by themselves” (Paul).

Conversely, Crystal and Esther’s accounts were distinctive from the other children’s

narratives. Crystal shared she did not have friends at first, whereas Esther explained she

struggled to make long-lasting friends at the youth club and at school. Esther shared that a lot

of the initial friends she made (that were her age) stopped coming to the youth group, and she

had no other way of contacting them, resulting in the friendships not being sustained. She

spoke of making friends after this difficult time by seeking friends that were easy talk to, who

enjoy being around her and would accept her for her and not need her to try and be different

to fit in. Esther’s appraisals appeared to be informed by two unsuccessful attempts to make

friends in different settings, which have made her more apprehensive. Interestingly, making

one friend, who introduced her to other friends at school, helping her to develop a friendship

circle facilitated the successful attempt.

Table 3.8


Quotes

Example 1 “We are all friends and […] we really enjoy each other's company” (Esther).

After her initial struggle to make friends, Crystal talked about the usefulness of humour that

helped her join group conversations. She recounted a trip where an established youth club

attender was making “jokes that were funny” in a larger group. Crystal responded and

socially reciprocated by laughing at the joke, and she would comment on the jokes, initiating

conversation.

Table 3.9


Quotes

Example 1 “She was the funny character and she kept cracking jokes and then we kept

commenting on it, but not in a good way” (Crystal).

A reoccurring belief by the young people was that LAC experiencing difficulties

making new friends was due to “not wanting to be noticed” and “keeping to themselves.”

These ideas were informed by experiences the young people had with LAC. One young

person shared they met a looked after child at school, but they were infrequent attenders and

could not talk to them often, making it harder to make friends with them. Other young people

felt LAC may be apprehensive about becoming friends, due to not knowing how long they

would be around or bad past experiences, or they believed LAC could be shy.

Table 3.10


Quotes

Example 1 “They are shy […] ‘cause you are not gonna be open about anything […]

maybe they’re shy or whatever and I’ve tried to make small talk when

coming and see what they are interested in […] cause to us I didn’t know

anything it’s just gonna be like there is a shy person, he doesn’t really

wanna talk to people, so let’s try make friends with them” (Paul)

Many perspectives were expressed regarding impact of ethnicity on the initial

meeting. Generally, the young people shared that their process for making friends was the

same, regardless of the ethnicity they were engaging, and it was possible to make friends with

people of different backgrounds.

Table 3.11


Quotes

Example 1 “[it is] the same” (Peter).

Example 2 “Can make friends across ethnicity if you are being nice (Andre).

“Doesn’t really matter in friendships” (Crystal).

However, the young people felt it was easier to make friends with a young person from a

similar background, compared to those of a different ethnicity.

Table 3.12


Quotes

Example 1 “It's a little bit harder but it’s doable.” (Andre).

Example 2 “Try and make friends and not try to make everyone come to them and

make friends but they would want them to go to them. Two girls are a

different colour to me they wasn’t really friendly to me but after they

realize that it wasn’t about the colour of your skin but it is about your

personality they were able to get to know me and become friends” (Sarah)

Example 3 “Easier bond if same background – can talk about the similar things”

(Andre).

Two young people expressed concerns about ethnicity being an initial “barrier”, but

once overcome, friendships can be formed. These views surfaced mainly in relation to young

people feeling that others would not engage with them because of their ethnicity. In one case,

a participant thought this was because “some people can’t accept their difference and so make

fun of other people’s difference.” (Esther).

Table 3.13


Quotes

Example 1 “You may be a nicest person in the world but because green people,

who are not like you, a section of green people are not nice about red

people […] you gonna have that […]” (Paul).

Example 2 “[It is a] barrier, but once they get to know you better, then you

can make friendship, don’t judge a book by a cover” (Sarah).

Example 3 "Once ethnicity barrier is gone, it’s easy to make friends” (Paul).

Whilst a minority mentioned it would be easier for LAC of black or mixed heritage

background to make friends with young people from similar background (non-LAC), all

agreed it was important for them to have friends of similar background.

Table 3.14


Quotes

Example 1 “It would be like they’re not the only ones so it could be more happy for

them. […] so it would be a better bond” (Andre).

Example 2 “Very good to make friends from a similar background – they understand

more” (Simeon).

Example 3 “Extra difficult for LAC [to make friends with different background] harder

for them” (Esther)

Being Around Each Other

Young people repeatedly referenced factors in their environment that helped foster a

friendly environment and enabled the formation and maintenance of their relationships with

friends. Some features of youth club environment provided was regularly being in the same

vicinity as other young people, doing group activities together, and going on trips. In both

youth club settings, these factors helped enable the development of friendships. The young

people cited being in the same location regularly or for a long time or doing one of these

activities, when describing an event where a successful friendship developed.

Table 3.15


Quotes

Example 1 “Well it sort of helps you bond with them and you kind of get closer to them”

(Paul).

Example 2 “We are at the same place […] helps us to interact with one another” (Peter).

Example 3 “We would, like, go camping with ****** and spend more time with your

friend” (Andre)

When exploring this topic, the young people often referred to and compared other settings,

such as school. They felt school provided a similar opportunity to be in the same place

regularly, but it was harder due to the larger number of children there and possible peer

pressure.

Table 3.16


Quotes

Example 1 “First week really [at new school] I was outsider and that didn’t feel

nice to me, made me feel sad. Obviously after that people realised I’m a nice

person and well not soon they invited me [to join them]” (Paul).

Example 2 “School friends would probably tell you what to do, but if it’s friends [at

youth group] they can tell you what they know” (Andre).

Another somewhat reoccurring theme was the role of adults in these settings. Young

people found it helpful to have adults present in the youth group. This appraisal was informed

by the roles they provided for them. This included helping to facilitate interaction between

young people and improves their character.

Table 3.17


Quotes

Example 1 “An adult could get a child to interact with them” (Peter).

Example 2 “We are at the same place […] helps us to interact with one another” (Peter).

Example 3 “They [adults] boost your character” (Simeon).

Two young people mentioned how these adults would not tolerate anti-social

behaviours (such as bullying or fighting) and would respond to any sign of it. There was a

difference in the accounts on how it was handled in each youth club setting (parents being

involved vs. being sent home).

Table 3.18


Quotes

Example 1 “I know here they don’t like no trouble, they like us to be nice, like if

you misbehaved they would to send you home” (Simeon).

Simeon also shared how one adult facilitator (coach) running a basketball group

helped engender a family-like environment to the children. He shared how helpful it was to

have a safe space, “uncompetitive environment”, where he can learn skills and is not judged

but is encouraged by peers and older youth which “It made me feel special” (Simeon).

Finding common ground and exchanging differences

Overall, the informants reported having common interests aided in building

friendships. One participant explained it helps by giving them things to talk about to help

them get to know each other. Another young person, Andre, said it helps them understand the

other young person and know there is someone they can do the things they like together.

Participants explained this gives rise to engaging in activities with each other, such as playing

football, playing with toys, and so forth.

Table 3.19


Quotes

Example 1 “We could play games that we both like” (Annie).

Also within this theme, difference was frequently mentioned. Three young people

shared that other children’s varying characteristics help facilitate the reduction of another

young person’s negative feeling about their difference. One participant gave an analogy

depicting this.

Table 3.20


Quotes

Example 1 “For example if you get a church that everyone has a has a big head and

you are the only one with small head, you know you're going to feel like

it's weird because you're the only one different, because you are the only

one standing out, […] but when you go to a different church, someone

has a big head, some people has medium head, some people has small

head […] you feel like that everybody is

different […] no one likes to be the only person.” (Paul)

Generally, participants felt they would find it easier being friends with individuals

(not just LAC) similar to them (age and ethnicity). These views surfaced mainly in relation to

believing the similarity would result in having more things in common.

Table 3.21


Quotes

Example 1 “Same background means more similar – more to talk about” (Paul).

Example 2 “Will have things in common (common interests) share experiences”

(Andre).

However, amongst the interviewees, there was a strong sense of finding common

grounds with LAC and with young people from different ethnic backgrounds, as ultimately,

they were “normal” and “humans” just like them.

Table 3.22


Quotes

Example 1 “Not hard to find things in common” (Peter).

Example 2 “Talk to LAC about things they have in common e.g. football” (Andre).

Example 3 “Try make conversation. Favourite stuff” (Sarah).

A common view amongst interviewees was that looked after children deserved to be

treated the same, not differently. Equally, participants expressed that looked after children

deserved to be loved and cared for. They also felt they should have someone they could talk

to and that would encourage them and they also deserved to have someone stand up for them.

Participants felt LAC were not getting these needs met. They gave varying examples of

insensitive language used at school, bullying they had witnessed LAC and non-LAC endure,

and how they have tried to help.

Young people spoke about how they would try to be someone they could talk to and

support them with their sad feelings. One participant explained they would, “understand them

more and not always just thinking about yourself.” (Sarah)

Table 3.23


Quotes

Example 1 “If a looked after child comes to my club I would make sure that everybody

wouldn’t make fun of them. I would play with them, make them feel

welcome” (Andre).

Example 2 “Come and just talk to you and just say are you ok and then just if they could

just take you to the teacher and let them know what’s happening. LAC can do

well, normal” (Simeon).

Example 3 “Young people often made referenced to difference, and felt that

young people in care would feel different and that other young people would

treatment differently. “If I were a looked after child I would feel different

because […] people treat me different” (Annie).

Interestingly, one young person expressed they can share their experiences: “share

ideas if different background” (Simeon). This was echoed by another participant, who coined

it as “exchanging differences” (Crystal). This ties into what was mentioned about learning

about each other. When asking the young people to think of friendships in the context of

other ethnic groups the young peopled reported that having the same culture had benefits.

Table 3.24


Quotes

Example 1 “You are more likely to be closer to that person compared to a white person.

[…] The way you are raised up is differently […] I have this friend, she’s

white. And I told her that I washed my plates and she’s like, ‘You washed

your plates?!’ So that kind of thing. I’m like, ‘You don’t wash your plates?’

[she says] No! This and that. ‘Why would I wash my plates?’ I’m like, ‘Oh,

ok.’ So we have this kind of major differences kind of thing. So even[…]

well we’re still friends but it’s like we share different […] what’s it called

[…] different things that we’ve experienced being from a certain ethnic

group. […] So we exchange differences.” (Crystal)

Theme Two: Levels of Closeness

Subtheme One - Growing Trust

This theme level of closeness refers to the quality of affection, intimacy and strength

of a relationship between young people. During each interview, the young people appeared to

use different terms to describe the quality of their friendships, which seemed linked to

varying levels of closeness. For example, being “friends, friends”, “friends for a long time”,

“close friends”, “strong friendship” or “close-knit” referred to closer friendships, whereas the

opposite indicated a more distant friendship.

Table 3.25


Quotes

Example 1 “It’s a close-knit friendship circle and I think I like it because we all

know each other, we are all close.” (Esther).

Example 2 “It’s then we would get to know each other more” (Annie)

Example 3 “It [trust] brings the friendship closer together” (Sasha)

Two young people shared that building long-lasting friendships is a slow process that

involves getting to know one other by spending time with each other. The word slowly was

frequently used when describing the process of building a friendship.

Table 3.26


Quotes

Example 1 “It was a slow process but I think it paid off” (Esther).

Example 2 “We would slowly become friends” (Annie).

When explored further, one young person explained that it helped them get to know

each other more.

Table 3.27


Quotes

Example 1 “It’s then we would get to know each other more […] I get to know what

they like and what they don’t like and from there make me to tolerate

their differences […] That if you like making jokes and they don't, then I

know that we can probably not make jokes”. (Annie).

A frequently mentioned ingredient in ‘close’ friendships was trust. Most individuals reported

trust was an important and necessary aspect of friendships. Young people said trust starts

small at the beginning of a friendship but getting to know each other and spending time

together strengthens their bond and increases their trust in their friend. One young person

said having trust meant knowing a friend would be there for you “to comfort you” (Esther).

The interviewer asked. “What does trust do in a friendship?”, and Sasha stated: “It brings the

friendship closer together” (Sasha). “Little trust when first meeting because little is known”

(Peter).

A recurrent idea in the interviews related to this subtheme was a sense amongst

interviewees that being friends with young people from a similar background was likely to

become a close friendship. This appraisal seemed mainly informed by the belief that having

similar experiences growing up resulted in that person understanding them more and building

more trust.

Table 3.28


Quotes

Example 1 “You are more likely to be closer to that person compared to a White

person. Because I think for White people they have like their own

different way of doing things” (Crystal)

Example 2 “So like if you’re from the same background you could talk about things

you know that has happened in your background” (Andre).

Of those who mentioned the importance of trust, two young people connected this with

being able to tell their friend personal information. Young people felt it was important to

have someone to share this with and one of the young people’s worries was that LAC did not

have someone because they did not have family or moved around a lot. The only participants

who did not mention this were Peter and Simeon. Young people also spoke about breaking

trust, where individuals do not keep their promise. They acknowledged this would make it

harder to trust in future.

There was consensus that LAC struggle to trust other individuals, and some expressed

they thought LAC were distrustful of others. One young person gave an example of when a

looked after child watched people when they were not aware to check that their reaction was

genuine.

Table 3.29


Quotes

Example 1 “Don't know if I can trust and tell that person” (Sarah)

Example 2 “His teacher taught him to be one of the best student in the classroom where

he used to be the worst. He wrapped up the gift and he give it to her, its the

little actions, like she unwrapped it and she said thank you but he sat down

and watched what she did with it, to make sure.” (Paul)

Subtheme Two -: Holding Back

The young people’s accounts of making friendships also incorporated the recurrent

theme of factors that make them or other children hold back, which poses an obstacle to

friendship development. There were many perspectives expressed, relating to this theme. The

most reported reasons for being apprehensive was a perceived lack of motivation of the new

young person wanting to be their friend and that the young person was not interested. This

was negatively appraised by the interviewees.

Table 3.30


Quotes

Example 1 “But some people just don’t wanna relate” (Paul).

Upon further exploration, participants offered explanations on why they thought a

young person might appear reluctant to be their friend. Mostly in relation to LAC, they felt

they may be shy or may have had bad experiences and were worried it would happen again.

Some young people expressed empathy and shared they would keep trying to engage them.

This also suggested they may not try to engage the young person if they thought this was not

the case.

Table 3.31


Quotes

Example 1 “[…] keep on trying to speak with them and try to form a better

relationship” (Simeon).

Two young people felt that because of this, LAC would hold back information and

not want to talk about their experiences. Peter stated, “Not sure if they would tell me they are

LAC, not sure if friendship would extend past youth club setting,” While Sarah also stated it

was “uncomfortable to talk about LAC status”

Issues related to “shame” were prominent in the interview data when exploring

reasons for LAC holding back. Most of participants alluded that being a looked after child

was laden with “shame” (stigma). Young people felt having LAC status can come with

negative responses (such as gossiping) from others but felt this was not fair to LAC. They felt

looked after children may feel ashamed or embarrassed of their identity (being a LAC).

Table 3.32


Quotes

Example 1 “may feel shame” (Sarah)

Example 2 “Like people might laugh at you or make fun at you, yeah” (Sarah).

Another view that fell within this theme was the need to hold information back and not share

it too freely, many of these views were organised around sharing of the LAC status too freely

or too quickly with peers, and they would urge LAC to be cautious and not share it because

they believed that young people would not be able to know their LAC status just from

looking at them.

Table 3.33


Quotes

Example 1 “It's not a thing that people openly speak about” (Simon)

The young people generally expressed a view that LAC share their status too quickly by

“blurting it out” in way that might make them feel embarrassed. One participant felt sharing

the positives about being LAC could help it to be seen in a more balanced way.

Table 3.34


Quotes

Example 1 “They don’t really have a guide, […] understanding how much loss they

have […] they're losing a bit of their family” (Esther)

Example 2 “Some people find it embarrassing or don’t want to speak about it

because it may be emotional to them to actually speak about it” (Esther)

Example 3 “If you put it in a bad way than you give them loads of things to gossip

about even if you blurt it out and you put it in a really positive way for

people to understand then people won’t treat you differently” (Esther)

Furthermore, two young people felt LAC are sensitive and they would be concerned about

upsetting them and would therefore hold back from asking questions and saying or doing the

wrong thing.

Table 3.35


Quotes

Example 1 “Like something little could probably hurt their feelings a lot…..Like try

your best not to do anything that will make them feel upset” (Andre).

This appraisal appeared to be informed by their beliefs about LAC and the

experiences they have encountered. Of the eight young people, four knew or had known a

looked after child. A variety of beliefs about Looked after children were shared in the

interviews. Television programmes, plays, and past experiences with LAC informed these

appraisals. The belief shared by all the young people was that they felt LAC had difficult

lives and believed LAC generally felt sad, as they are not living with their parent, and

participants believed LAC moved around a lot. The young people generally felt more

fortunate than LAC.

Table 3.36


Quotes

Example 1 “Well he’s not looked after by his mum. And every time the

teacher said his mum it is going to have an effect on” (Peter).

A few young people tried to imagine what it would be like to be in their position.

Some likened not living with their parents to experiencing a loss. A couple shared the reason

a child may become a LAC was because they experienced loss as a result of their parents

dying. This circumstance was related to knowing LAC personally.

Table 3.37


Quotes

Example 1 “How difficult their [LAC] life is” (Sarah).

Generally, the young people admired LAC for coping with their life circumstances,

and two young people described them as strong and still being able to smile. A few felt the

smile would be to cover up how they were feeling and to stop others from enquiring. Three

young people held hope for LAC and felt that, if they were in a good home, they could still

do well and have a life that seems normal. One young person shared a positive story about a

young person doing well in care. He also shared how the youth club setting had been useful

for her.

Subtheme Three - Rupturing Closeness.

Another recurrent theme the young people reported was around closeness when it

ruptures. This mainly centred on the ability to sustain friendships and the factors that

interrupt and sever closeness. When it came to general friendships, two young people (Esther

& Crystal) in different youth clubs reported that, after the initial friends they made, stopped

attending the youth club, there was no way to keep in contact. Crystal gave the example, the

following year when they returned for the summer programme, the friendship was gone, and

it was like she had to start again. In relation to young people in care, a couple of young

peoples believed that LAC would have similar difficulties in staying in touch because of the

frequent moves they endure and thus experiences ruptures in relationships.

Table 3.38


Quotes

Example 1 “Like you know when you lose contact with someone and you can’t

really speak to them anymore? It was like that” (Esther).

Two young people shared that staying in contact to sustain friendships was

particularly problematic when being friends with LAC. This was explained as being due to

LAC frequently moving.

Table 3.39


Quotes

Example 1 “They could stay there and it would last their friendships would

last longer and they’d feel like they belong somewhere and they're not

just being moved around constantly” (Simeon).

Others talked of having difficulty maintaining friendships due to “fall outs.” Young

people appear to view this as a threat to the relationships, with only one feeling confident it

could be overcome. This young person felt adult facilitators at the youth group had helped her

repair these friendships. Positive support in repairing friendships was less commonly reported

in the community based youth club setting. No specific comments were made about LAC as

the belief that adult facilitators helped children attending the youth group repair ruptures did

not make distinctions.

Table 3.40


Quotes

Example 1 “Breaks it apart and brings you back together which makes you kind of

learn from your mistakes […]” (Sarah).

Two young people mentioned being negatively influenced by the new young person

they met and how this would hinder the relationship progressing to being “friend friends” /

closer (Paul). He also shared that, though the young person would want to help them and

influence in a positive way, they were wary of being persuaded to engage in activities they do

not agree with and become guarded. Paul gave an example of how a young person can

negatively influence others: “So that boy was basically the leader of that group. He wasn’t

nice to me so everyone else isn’t nice to me, the day he was sick, and he wasn’t in, everyone

was nice to me” (Paul).

Lastly, three young people described themselves as shy or not outspoken and felt it

made it harder to make friends. They believed, because they find it difficult to go up to an

established youth group member to initiate a conversation, it reduced their opportunity for

friendship formation. However, this shyness did not appear to extend to newcomers to the

youth group, as these young people expressed they would feel comfortable to initiate

conversation.

Table 3.41


Quotes

Example 1 “I think maybe because we are just shy and all of that” (Crystal).

Example 2 “I don't just randomly just to go up to someone and talk to them. It has to be

like some sort […] we have to be doing something together before I start

talking” (Annie).

Theme 3: A Sense of Belonging

The last meta theme that arose from the data contained ideas concerning

belongingness. The thoughts and responses were organised around the concept of being a part

of something featuring ideas of acceptance, rejection, and being protective against rejection

and bullying.

Table 3.42


Quotes

Example 1 “You're supposed to because I think everybody wants to sense of

belonging and not everybody gets it” (Simeon).

Subtheme 1: Acceptance

Generally, individuals felt for a child. Being accepted for who they were and what

they were interested in was important. This was based on them having a strong sense of belief

that LAC are normal and should be treated as so. A few young people felt family often

provide this acceptance, but a couple of young people felt that if a LAC had “friend friends”

they would feel accepted. One young person shared how the youth group felt like family to

him and felt that a LAC could experience the same. One young person went on to explain that

for LAC being accepted would help reduce their feeling of isolation.

Table 3.43


Quotes

Example 1 “Respect them for who they are, treat everyone the same. So they can

feel like they are actually a part of it” (Simeon).

Example 2 “They [LAC] should be treated normal” (All)

The consensus for conceptualisation of being accepted meant being who you are

without being made to feel bad or being judged.

Table 3.44


Quotes

Example 1 “Not to judge a book by a cover” (Sarah).

Example 2 “Like not everyone had money and no one was judging them.

Instead we'd help them, like we're buying food for them that kind of

stuff” (Crystal)

Subtheme Two - Rejection and Frustration

Parallel to the responses around acceptance, rejection was a recurring topic where

young people shared that LAC or new young people in the youth club may feel alone or

worried that past negative friendships will happen again. One young person expounded,

saying LAC status may make them vulnerable to being rejected, gossiped about, and bullied.

Table 3.45


Quotes

Example 1 “being made fun of not having parents” (Peter)

Example 2 “may feel shame cause of Gossip” (Sarah) - check

Example 3 “gossiped about, they would be questioned more they would use their

LAC status” (Crystal)

An interesting idea that arose out of this was that the young people’s attempts to

understand LAC children’s experience of feeling different and rejected were informed by the

young person’s own experiences of peer rejection. This appeared to be a strong motivator for

their inclusiveness. All the young people that participated in the research were black or of

black mixed heritage. Their experience of friendship informed their appraisals of future

rejection for themselves and others. Four young people shared past experiences of when they

were made to feel different and not accepted due to ethnicity or cultural difference. These

experiences were considered rare and a unique event (not the usual experience), but this fed

their appraisal of what rejection feels like, engendering empathy for LAC who might feel

rejected.

Table 3.46


Quotes

Example 1 “Two girls were a different colour to me. They wasn’t really friendly to

me but after they realised that it wasn’t about the colour of your skin but

it is about your personality, they were able to get to know me and [we]

became friends” (Sarah)

Example 2 “First week really [at new school] I was outsider and that didn’t feel nice

to me, made me feel sad. Obviously after that people realised I’m a nice

person and well not soon they invited me [to join them]” (Paul).

Two young people felt LAC who are black would have an especially difficult time but could

not expound on this. Esther stated, “They (black LAC) may find it difficult because they are

already going through changes so to have something that's different to what they are used to

could be hard for them”

Conversely, there were circumstances where inclusiveness may be limited. Two

young people shared sympathy with LAC but said they would find it difficult to become

close friends with a young person that may influence them to do things they were not

comfortable with. There was frustration around LAC rejecting resources, support and

friendships, which can lead to rejecting behaviour from young people. They tolerate

difficulties if they are trying, but if not, empathy towards them reduces. Collectively, this

could lead to distancing and feeling of rejection toward LAC that display anti-social

behaviours.

Table 3.47


Quotes

Example 1 “If I know somebody is not going to make me a better person. I’m not

gonna make friends” (Simeon).

Example 2 “I wouldn’t disagree with LAC” (Andre).

They reported LAC sometimes waste opportunities and can engage in negative

behaviours that can negatively influence other young people. One young person felt those

looked after children were unlikely to attend the youth club and would struggle with sticking

to the rules, potentially resulting in them being sent home. This could possibly be seen as

over compensation. On the other hand, it could be an alternative a perspective of a strong

willed and independent LAC who was able to look after themselves.

Table 3.48


Quotes

Example 1 “But some foster kids, they would just come here, act like the big boss,

be rude, disrespectful. But some people, some foster children take

advantage of you and stuff like that […] they take advantage of this

country because back at home [country in Africa] we don’t have

opportunities so it's hard to be what you and get what want”. (Simeon)

Example 2 “If I know somebody is not going to make me a better person I’m not

gonna make friends with you. I might say ‘hello to you’ or ‘have a nice

day’ and I’m gonna associate with you but you’re not my friend”.

(Paul)

Example 3 “It depends how they are, cos’ they are because the girl I was talking

about she comes here in but like not regularly but she really calm she

is always happy. But some foster kids, they would just come here, act

like the big boss, be rude, disrespectful” (Simeon).

Subtheme Three: Protective

Building upon the previous subtheme, another theme emerged surrounding

protectiveness. When talking about what they would do when they met a LAC or what they

thought LAC should do, most young people spoke with a sense of protectiveness during the

interviews, appearing to be motivated by caring. They felt LAC should know a young person

before trusting them with their personal stories, as there appeared to be a high chance of

betrayal of confidence.

Table 3.49


Quotes

Example 1 “Not point out that they are in foster carer […] they feel hurt but they

cover it up” (Esther).

Example 2 “No one need to know you are in care […] make it positive” (Crystal).

The young people who shared this perspective seemed confident they would keep

their confidence and would try to block others enquiring about the LAC status to prevent

gossiping or negative comments. Others echoed similar views surrounding being selective in

who they trust. Again, quite a few young people could recount a time when their trust had

been betrayed, which motivated their need for self-preservation and that of others who may

be vulnerable to it.

Table 3.50


Quotes

Example 1 “I go to the person that was being emotionally hurt, I’d go to them and

tell them, I’m like, ‘Don't listen to this person’” (Esther).

Example 2 “Act like they don’t care but you can see it, think about what it

would be like in their shoes” (Paul).

Summary of Results

In summary, the results indicate that, though the young people were strong on the

principle of treating LAC in the same way as others, the process of friendships with LAC

appears to be multifaceted and complex. On the surface, these results suggest the strategies

that young people employed for initiating and developing friendships with LAC would not

differ from how they form friendships with non-LAC in a youth club setting. However, the

complexity surrounding this became apparent as the young people shared their views,

revealing other elements such as apprehension, shame around the LAC status, and feelings of

hurt and frustration, further compounding this process. The young people who shared

additional efforts and perseverance are required to engage LAC. The desire to persevere was

motivated by empathy informed by their previous encounters with LAC and the perceived

appraisal of what it would be like to go through the circumstance and experiences of LAC.

The interviewees reflected upon their experiences of friendship, rejection as black young

people, and were reported to help them relate to the experience of rejection for LAC. Lastly,

there appeared to be conflicting narratives around genuineness, being authentic to one’s self,

and not pretending to be someone they are not to engage LAC or as a response to engaging

with other individuals of a different ethnicity. However, this belief was not extended to the

situation of LAC in believing their status resulted in them not being who they are. These

results provide important insights into the complexity and changing positions dependent of

the context of the friendship.

Discussion

This study aimed to explore the process of how young black people, who are not in

care, might form and sustain supportive friendships with LAC. This work is intended to

provide insights that would contribute to understanding the processes involved in building

and sustaining peer friendships between young people from black, mixed-black heritage, and

LAC, potentially giving rise to future work in developing target interventions for positive life

trajectories.

The emergent themes highlight the young people’s openness and willingness to build

supportive friendships with LAC against a backdrop of obstacles and barriers that need to be

overcome to achieve this. The discussions captured anecdotes of their experiences with LAC

and predominantly unsuccessful attempts to sustain friendships with LAC in a landscape of

emotional and social values. The themes of ‘learning about each other’, ‘closeness’, and ‘a

sense of belonging’ captured their experiences of friendship, rejection, and apprehension as a

black or dual heritage young person. Their reflections demonstrated their ability to navigate

the complex and multi-layered processes involved in friendships; not only as a black/dual

heritage young person, but also as a LAC.

This section will discuss findings and results and how they fit with theories and prior

research, as well as highlighting areas that require further exploration or indicating areas for

intervention to help LAC integrate with other young people in community settings. The

theoretical models will include the profile of friendship in black young people, stigma, and

group processes. The young people did not identify areas such as education difficulties or

health difficulties. Generally, they had a good level of understanding of what it meant to be

looked after but were more familiar with the phrase “children in foster care.”

Perceptions of LAC

During the interviews, the young people shared views about LAC, including what

they perceived to be struggles. They identified several issues pertaining to what looked after

children experience, which has also been reported in existing literature. For example, the

participants commented on how children in care may be isolated, struggle to trust their foster

carers, have to endure placement moves, and struggle to form and maintain friendships

(Coward, 2015). Rogers (2017) found that LAC had difficulty accessing social support from

non-LAC peers. Some of their beliefs about LAC has been supported by existing literature,

suggestive of some of their assumptions they have about LAC are not incorrect.

The young people also identified LAC are likely to be upset and nervous. Though the

young people did not say LAC are likely to have mental health difficulties, they identified

key emotions they would be feeling such as sad, upset, and nervous. This can be somewhat

linked to what literature reports about emotional wellbeing. Numerous studies have found a

high incidence of mental health difficulties, such as depression or anxiety in the LAC

population (Beck, 2006; Zima et al., 2000). Furthermore, the identification of the mental

health difficulties in these studies were from foster carers, social workers, and mental health

professionals. It is interesting that the young people were able to identify the sign of distress.

Stigma

The young people spoke of issues that alluded to children in care experiencing a

stigma around holding LAC status and feeling different because of this. Studies have

established that LAC perceive a difference between themselves and other children and feel

stigmatized and marginalized for being in care (Harker, Dobel-Ober, Akhurst, Berridge, &

Sinclair, 2014; Sugden, 2013). Hedin, Höjer, and Brunnberg, (2011) established that stigma

hinders the development of peer friendships. The findings of this study support this notion, as

the young people often recommended LAC do not disclose their care status in order to make

friends easily and to avoid being bullied. Again, this fits Roger’s (2017) study that young

people in care adapted to coping with stigma by being selective on when to disclose their

status to peers.

The young people’s conceptualisation of stigma included being identified as different,

feelings of shame, a sense of not belonging, and being made fun of because of their LAC

status. Although the definitions of stigma have been critiqued for being ambiguous (Link &

Phelan, 2001), the young people’s narratives of stigma appear to be in line with Link and

Phelan’s (2001) proposed definition. In this instance a person may be identified (labelled) as

different, experience separation linking back to LAC’s feeling of not belonging, experience

status loss resulting in feelings of shame, and discrimination in the form of ‘being made fun

of’. This provides some support of this definition and understanding of stigma (Dovidio,

Major & Crocker, 2000). They reported that stigma occurs when there is a devaluing of ‘the

difference’ in the individual’s social identity. Overall, the findings suggest this group of

young people believe that LAC experience stigma due to their status when interacting with

wider populations of non-LAC. It can be inferred with the knowledge of existing research

this could be due to the somewhat accurate view they have of LAC, preventing negative

labelling, the subsequent ‘othering,’ and discriminative behaviours.

It is plausible that educating the general population of children about what it means to

have LAC status could result in children having a more accurate understanding of the LAC

experience and potentially preventing labeling. Link & Phelan (2001) believed it takes a

multifaceted approach to tackle stigma. Step one includes changing attitudes and beliefs, and

the second includes limiting the power of the dominant group acting on their misconceptions

of the stigmatized group. Therefore, corrective education may tackle stigma on the attitudes

and beliefs level. Advocating for education of the general child population to reduce stigma is

not a new idea.

Many initiatives and studies report the usefulness of using education in school to

reduce stigma around a stigmatised group. For example, Pinfold et al. (2003) evaluated the

intervention to challenge negation beliefs and stereotype surrounding having a mental health

difficulty in primary schools. They reported the programme increased their positivity which

was sustained past the six-month follow-up and resulted in some disclosing they had friends

with mental health difficulties. This was supported by a meta-analysis conducted by

Corrigan, Morris, Michaels, Rafacz, and Rüsch, (2012), who not only reported that education

reduces stigma around mental health but that for adolescents, this is the most effectual

strategy compared to individuals having contact with the stigmatised population.

Pro-social characteristics and Peer Acceptance

Furthering the comments of the last section, the young people seemed to locate

responsibility for acceptance of LAC with the group they are joining (e.g., classmate peers,

youth club peers). This seemed consistent with research that has shifted away from seeing the

child as the primary contributor to their status and acceptance in the group. Studies

examining heterogeneity within socioeconomic status have contributed to the understanding

of group acceptance and pulled more attention to how the characteristics of the young person

interact with the features of the peer group they are joining (Wright, Giammarino, & Parad

1986; Boivin, Dodge, & Coie,1995). These studies have demonstrated there is an association

between child characteristics and peer group features and group acceptance. This was true

whether or not the characteristics/features were deemed prosocial behaviours.

This is referred to as individual-group similarity hypothesis (Stormshak et al., 1999).

Stormshak et al.’s (1999) study examined 2,895 children’s relationships and found

individuals deemed as socially undesirable were more likely to be accepted in the prosocial

environment of the classroom than a classroom that was considered to have more behavioural

difficulties. Boivin, Hymel, and Hodges, (2001) found that prosocial behaviour was

associated with higher levels of peer acceptance and that groups that report pro-social

attributes/behaviour are more likely to be accepting of marginalised individuals. In this study,

the young people who took part who are considered to be pro-social group setting believed

they would have commonalities with LAC they meet; which is in line with Boivin et al’s

(2001) findings.

Friendships in Black Young People

The young people seemed to be of the same opinion of NICE guidelines and felt it

was important for black and dual heritage LAC to have access to peers reflecting their

ethnicity. NICE guidelines advocated this would reduce isolation and reinforce a stronger

sense of identity of BAME-LAC. Again, the young people who participated in the study had

similar beliefs drew on their experiences of friendships and what it meant for them. They

echoed thoughts of belonging, not feeling alone, and having someone that understands that

part of them.

Within the study, the interviewees’ experiences of friendship were captured from the

perspective of black and dual heritage young people. As mentioned in a literature review,

Giordano et al. (1993) and Clark (1989) found that black adolescents have different portraits

of peer relationship. Specifically, black young people scored lower than their counterparts on

needing mutuality and similarity as a prerequisite for forming friendships, potentially

resulting in them being accepting of friendships with individuals from differing background

and status. Additionally, the study suggested that mutuality was also important to sustain

friendships. Additionally, they scored higher than their white counterparts in terms of

importance of intimacy (closeness) in relationships (family or friends). The study also points

to the fact that the young people will hold out a hand of friendship but want it to be returned

and have various narratives around the semantics of friendship. The narratives in this study

highlighted the young people were willing to accept LAC and balance the intimacy in

relationships. For example, the young people alluded to growing closeness and having

friendships that varied in the level of closeness.

This level of inclusivity has been reflected by other research. McAddo (1988)

reported that black young people appeared to have a tolerant friendship style and acceptance

of differences compared to their non-BAME counterparts (Giordano, Cernkovich, and

DeMaris, 1993; Clark, 1989). Though these findings corroborate the ideas of Giordano et al.

(1989) and McAdoo (1989), there is little support for the explanation of why this is the case.

McAdoo (1989) offered an explanation, but this study could not directly demonstrate

it. He suggested black young people must possess social flexibility to navigate and adapt their

environments when faced with social and economic challenges unique (or more common) to

their communities. This social flexibility enables them to be more tolerant of difference. One

unanticipated finding that potentially explains this data was that the young people from black

or dual heritage backgrounds had experienced rejection. Though McAdoo provided no

examples of socio-economic challenges, it is plausible that the experience of past peer

rejection due to their ethnicity as well as the historical context of slavery and migration of

this race could constitute some of these challenges. Hence, it could be hypothesized that this

enabled the young people to relate and connect to that specific aspect of a looked after child’s

experience, resulting in their being an individual vs group similarity occurring ((Link &

Phelan, 2001).

Areas for intervention

Although the findings of the research are tentative, linking the results with existing

literature provides educative interventions to address the misconceptions and lack of

understanding peers have about LAC to help change attitudes and beliefs within this

community as well as the broader community. At present, there appears to be little to no

research on this topic. Future research for reducing LAC stigma would be needed before

exploring broader implementation.

Another potential area of intervention could be around having discussion and training

on disclosure of their LAC status to aid them in identifying who and when might be the most

helpful and unhelpful time to share their status. Lastly there may be a need for some

intervention with social workers and residential staff to help LAC sustain friendships, form

new ones and support the repair relationships with peers.

Limitations

This study aimed to capture the views and experiences of black and dual heritage

young people in relation to looked after children. The small sample size did not allow the

findings to be necessarily applicability to mixed- heritage young people; as one young person

was represented in this data set. Though their experiences may be considered similar, it

remains unclear whether the collective responses would have differed meaningfully, if there

was a greater number of mixed heritage young people were represented in this research. This

is plausible, as Rogers (2016) reported that the young people from dual heritage had the

additional struggle of coping with their dual identity.

It is notable that there are a few limitations associated with the sample. Firstly, the

study’s sample recruitment strategy of self-selection, though pragmatic and likely to enlist

participants more committed/engaged to the process, is it also likely to be vulnerable to a

degree of self-selection bias. A participant’s decision to take part may reflect some inherent

bias in the characteristics/traits of the participants (e.g. obliging).

Secondly, the scope of the study’s findings was limited in terms of the participants

demographics and experiences with LAC. For example, the study included participants from

both black British African and black British Caribbean heritage. Though they have

commonalities in their experiences as Black British young people, it is unlikely that they are

completely homogenous group. Also, the broad range of participant ages participants as well

as 50% of the young people in the study have previously met a LAC and 50% had not, may

have limited the study’s finding. It could have possibly resulted in varying levels of richness

and understanding possibly limiting some of the potential depth of findings. This might have

been better achieved in narrowing the age range and adding LAC experience to the criteria.

Notwithstanding these limitations, this study still provides valuable insights.

An issue not addressed in this study, as mentioned in the researcher’s reflection, was

whenever the topic of ‘being black’ arose during the interviews; there were noticeable pauses

and tentativeness in the phrasing of the young people’s responses. However, as the interviews

progressed, this response was reduced, and the young people spoke more freely. In hindsight,

it may have been helpful to conduct an icebreaker activity, like the activity used to socialize

the young people to LAC concepts to help the young people socialize to talking about their

experiences as black young people. Additionally, a possible alternative may have been to

have two-part interviews.

Lastly, how the findings of this study would compare views of young people of a

White British background could not be addressed in the current study. However, as there is a

study in progress looking at this a future direction of tis could be to compare these finding to

that study.

Conclusion

This research has extended our knowledge on the views and perceptions black young

people have of LAC and can serve as a preliminary base for future studies. This has identified

that young people from black and dual heritage backgrounds hold fairly realistic views of

LAC and believe they feel sad, experience stigma, struggle with building trusting

relationships, but should not be treated differently from others.

This research has also given some rise to the potential factors that involved

inclusiveness of LAC. This included prosocial qualities and past experiences that are unique

to black young people. The second finding was that the young people’s appropriate

perceptions of LAC may be a factor in the occurrence of unstigmatised labeling. Potentially

education around LAC experience could be helpful in impacting attitudes and beliefs around

this population.

An implication of this is the possibility that educative interventions for schools and

youth clubs could start to address stigma, as there is a lack record of success in this area

(Mannay, Evans, Staples, Hallett, Roberts, Rees & Andrews; 2017). Additionally, it would be

interesting to compare the views of individuals with this cultural heritage with those form

other ethnic and cultural backgrounds.

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**Appendices**

Appendix 1 - Research Decision Letter

PSYCHD CLINICAL PSYCHOLOGYRESEARCH GOVERNANCE COMMITTEE

RGC Decision for MRP Proposal

URN number and Trainee Name:

6338174 Stephanie Sewell

University Supervisor:Decision of RGC Proceed with considerations Project Title:

Black Young People’s Understanding of Looked After Chil-dren

Overall comment

This is an interesting topic with clear clinical relevance. The rationale for the age range and specific target sample is no yet clear. Your interview questions appear to focus on both LAC and friendships in the church context which is not reflected in the rationale. The proposal is basically sound but there are some considerations that you will need to discuss and clarify in supervision, the key one being clarifying the rationale for the project.

Considerations to be addressed.

There is one or more consideration to be addressed before you proceed with the project that must be discussed with your course team supervisor and resolved before you proceed.

1. You appear to assume that your participants will understand and have thoughts on LAC, do you have evidence to support this? It may be necessary to address the possibility that they don’t in your design. You might consider using a vignette or a news item to allow participants to understand and engage with the concept of LAC.

2. You are including a wide age range, and it is not clear that this is strictly necessary. This may make your analysis complex as conversational language, richness and understanding may vary considerably between age groups.

3. The use of a church community that you presumably have access to will certainly help to make the project more feasible in terms of recruitment. However, will it be difficult to show the relevance of the findings to other groups? Is it appropriate to characterise your research as representing the views of BAME young people when your participants are members of a small minority of BAME young people.

4. If the project goes ahead with this target population, it will be very important for you to strengthen the rationale for the sample.

5. The two parts of the title contradict. The first suggests your informants will be looked after children, the second that they will be young people rather than looked after young people. You may need to change the title to fit the new project.

Chair of RGC signature: Date: 16.2.17

Appendix 2 – Research Project Poster

Appendix 3 – Information Sheet for Young people

Appendix 7 – Information Sheet for Parents/Guardians and Gate Keepers

Appendix 4 – Information Letter for Parents and gatekeepers

Participant Information Sheet (Parents Letter)

Making Connections: Black Young People’s Understanding of Looked After Children

IntroductionMy name is Stephanie Sewell and I am a Trainee Clinical Psychologist at the University of Surrey. As part of my training to become a Clinical Psychologist, I am carrying out research into looked-after children (or children in care) and how young people view them. I would like to invite your child to take part in this research project to share the views and experiences. To help you and your child decide if they would like to take part, please read this information sheet carefully, so that you know what your child will be asked to do and why the research is important.

The researchI am interested in school aged children’s views of looked-after children in the youth group setting. Not enough is known about how young people’s views of Looked After Children impact children’s behaviour towards them. It is hoped that this research will help us understand what young people think about looked-after children and that this could inform education and social care policies. Who has reviewed this project?This study has received a favourable opinion from the Ethics Committee of the University of Surrey’s Faculty of Health and Medical Sciences. Why has my child been invited to take part in the study?I am hoping to talk with up to twelve young people who are aged between nine and seventeen years of age. As children that are looked-after know much more about what it means to be in Local Authority Care, it will not be appropriate for them to take part in this study. Does my child have to take part?No, it is completely up to you and your child whether they take part in the research or not and your decision will have no effect your child ability to access the youth group. Your child will also be asked to consent to taking part in the project.

What will my child be asked to do?I will ask your child to spend 40-60 minutes talking with myself. The conversation will be recorded to ensure we have an accurate record of what is said. If your child would like to take part in the study and you agree to their participation, I will ask both you and your child to read and sign a consent form, which you will be given a copy of. I will also keep a copy of the consent form. What happens after my child takes part?When the interview has finished I will type out everything your young person has said and the audio recording will be destroyed. I will use made up names in the typed version so that no one will be able to tell who took part in the study. All information that is gathered as part of this project will remain anonymous, unless your child tells me something which causes me concern about their own safety or the safety of someone else. If this should happen I will follow the School’s safeguarding policy. Quotes s from the interviews maybe used when the project is written up, but these will be made anonymous, so that no one will be able to identify your child from anything they say. This anonymous data will be kept for at least 10 years in line with the University of Surrey policies. Consent forms will be kept separate to data collected during the interview, so that the information collected during the interviews cannot be traced back to your child. These will be kept for at least 6 years in line with the University of Surrey policies. The research will take around five months to complete in total, although your child will only be asked to attend the one interview during this time. Once completed the youth group will be given the project report, which you may request a copy of. Your rightsIf you and your child decide you would like to take part in this research, you can still change your mind at a later date. You will not need to say why you or your child has changed their mind. You can also choose to have the information your child gave during the study removed for up to two weeks. After this time, I will have started to include their thoughts with other young people. What if there is a problem?This study has been approved by the University of Surrey’s Faculty of Health and Medical Sciences Ethics Committee. It is their job to make sure that studies are safe for people to take part in. If you are not happy about anything to do with this research, please contact the

Research supervisors: Dr Mary John ([email protected]). Additionally, you can contact the Heads of School: Derek Moore ([email protected]) What do I do next?If you are happy for your child to participate in these interviews, then please sign and return the attached consent form. Feel free to contact me using the telephone number or email address below if you have any questions. You are welcome to talk to others about the study if you wish and I encourage you to talk through this information with your child. If you have any questions about your child taking part in this research please contact me XXXXX XXXXXX (this number will be monitored from Monday to Friday, 9-5) or via email, [email protected] If I am not able to answer the phone straight away then please leave a message with your contact details and I will get back to you as soon as possible. Thank you for taking the time to read this Information Sheet,

Stephanie SewellTrainee Clinical PsychologistSupervised by Mary John (Email: [email protected] Tel: 01483 689267) and Kate Gleeson (Email: [email protected] Tel: 01483 689815)

Gatekeepers Letter / Information Sheet(Youth Group Letter)

Making Connections: Black Young People’s Understanding of Looked After Children

Dear …… [ Insert Name of Youth Group],My name is Stephanie Sewell and I am a Trainee Clinical Psychologist at the University of Surrey. As part of my training to become a Clinical Psychologist, I am carrying out research into looked-after children (or children in care) and how young people view them. We would like to invite young people in your youth group to participate in a research project which aims to find out their view young people of young people who are in foster care.Not enough is known about how young people’s views of Looked After Children impact children’s behaviour towards them. Our study aims to learn from both the perspectives and

insights of young people from Black Asian and Ethnic Minorities (BAME) about Looked After Children. It is hoped that this research will help us understand what young people think about looked-after children and that this could inform education and social care policies as well as developing interventions to support these young people. This study has received a favourable opinion from the Ethics Committee of the University of Surrey’s Faculty of Health and Medical Sciences. We are seeking to recruit young people who are currently aged between eleven and sixteen. We will interview the young person on one occasion lasting from 40 to 60 minutes. For their participation, they will receive a £7 Amazon voucher. Interviews can be held on sight at your youth club in a room or a public building that suits them. I am writing to ask if you can help with the process of recruiting young people for this project.We are looking for young people who are:

- Aged between 11 and 16

- Black or Black mixed heritage

- Attends a youth club

The flyer and information sheet for young people provide more information for potential participants. We would appreciate your help in either giving these directly to young people who meet the above criteria or using them to promote the project during youth groups activities. I am very happy to tell you more about the study, or to answer any questions you may have. In order to do this, we would like to arrange a time to meet with you or speak to you over the telephone.With thanks, Stephanie SewellTrainee Clinical PsychologistPsychD Clinical PsychologyDepartment Faculty of Health and Medical SciencesDuke of Kent Building, University of Surrey, Guildford, Surrey GU2 7XH

Appendix 5 - Consent Form for Young people

Appendix 6- Consent form For Parent/ Guardians and Gatekeepers

Appendix 7 – Emotional Support Information

Appendix 8 – Topic guide

TOPIC GUIDE – YOUNG PEOPLE in Youth group

Title project: Making Connections: Black Young People’s Understanding of Looked After

Children

The key questions below will not be asked sequentially within a interview format. They will be used to guide the questioning during the discussions generated using multi-method participatory techniques as detailed fully in the Research Protocol. Structure of Interview 1

Introductions and consents Interview based on topic guide Unfinished sentences activity (ice breaker) Continue with interview based on topic guide

Introduction

At the outset of the interview the research will be introduced as follows: "I am interested in

finding out about your friendships what they are like in youth group as well as outside the

youth group. I am also interested your views of LAC, what it is like to make friends with

them and what supports LAC best. You may want to consider sharing with me about a range

of experiences some good and other less so. I will start off by asking about the youth group

generally, your general view of LAC before moving on to talk more specifically about what

your feel helps or hinder building friendships with LAC as well as any experiences you have

had in the past with LAC. You may have other ideas you want to share with me at this time

which will be helpful. I am really interested in what you think and there are no right or wrong

answer”.

Topic guide:

Experience of Youth Group- When did you first start coming to this youth group?- How was it when you first joined?- What is it like now?

Forming friendships

- What was it like for you making friends here? (is it different to making friends at school?)

- How does your youth group support the development of friendships?- What words would you use to describe your friends here?- As wells as seeing your friends here where else do you see them- What kinds of activities do you enjoy doing with them?

LAC – Baseline understanding of LAC

- What is your understanding of the name Looked After Children (may also use un finished sentences and vignettes to facilitate part of this dis-cussion if it seems appropriate for the young person)?

Experience of Relationships with LAC

- Have you known anyone who was looked after?- Did you become friends? If yes, how easy was it to become their friend?

If no, what contributed to not becoming friends? What interest if any did you share?

- If you were to meet a look after child what would help you want to be their friend

- What type of support do you think Looked After Children want /need?

Views of LAC

- What do you think about children who are looked after?

What would it be like for then to join this youth group and make friends

- How do you think Looked after children can get involved I the youth group

- What do you think it is like for young people in care who are new to the youth group?

- What might they experience when making new friendships in the youth group

What might be some of the barrier

- What do you think are the things that helped or hindered them making

friendship?

- What do you think would be most helpful for them?

Friendships in Black and Black Mixed Heritage Communities- Do you think ethnicity influence how friendships are formed? - What is It like to make friends from the same or similar ethnicity group?- What is It like to make friends from the same or similar different ethnic-

ity group?- Do you think ethnicity impacts friendships for LAC who are Black or

Black Mixed Heritage?

General Prompts - What were the positive aspects to this?

What were the negative aspects to this?

Can you tell us a bit more about this?

If your best friend was here what would they say?

What is something you might not say when answering this question

What do you think might be unhelpful to say about…?

What has made you come up with this idea

Have you talked to your friends about this at all?

At the end

How can I ask these questions differently?

Is there any way of introducing it that’s more helpful

Appendix 9 – Yardley’s Credibility Principle’s

Table of Yardley’s principles of credibility (Yardley, 200 p 219).

Principle Description

Sensitivity to context. Theoretical; relevant literature; empirical data; sociocultural setting;

participants’ perspectives; ethical issues.

Commitment and rigour In-depth engagement with topic; methodological competence/skill;

thorough data collection; depth/breadth of analysis

Transparency and

coherence

Clarity and power of description/argument; transparent methods and data

presentation; fit between theory and method: reflexivity

Impact and importance

Theoretical

(enriching understanding); socio-cultural; practical (for community,

policy makers, health workers).

Below is a description of how the researcher was informed by Yardley’s four principles of

credibility in the planning, executing and analysing of the present study.

Sensitivity to context

The present study explored black young people’s view of Looked after children. Prior to

commencing the research, the researcher immersed themselves in the relevant research in

order to have an in depth understanding of the research field into resiliency in LAC, peers

support for LAC and the general resiliency field were drawn upon. Exploring the context

enabled the current research project to be informed by wider research and theory, which was

much needed, However, given the inductive nature of the analytical approach employed,

remaining sensitive to the data was necessary as to allow the themes to emerge. This was

ensured through the use of supervision.

Commitment and rigor

Over the course of a few months, the researcher read and re-read the data and was referred

back to frequently during the analysis and the development of theme stages. The competence

of the researcher in the selected analytical method of thematic analysis was developed

through doctoral teaching, supervision, and further reading.

Transparency and coherence

The researcher endeavoured to be transparent about the research process and this was done

through open discussion in supervision and amongst researchers as well as sharing on

transcripts and audio clips with supervisor. Additionally, the researcher has provided

diagrams showing the process of the themes development. Also, to aid transparency,

examples of each theme and subtheme were presented within the results. In relation to the fit

between the chosen analytical method and the wide research field are congruent as it provides

richer data that captures the themes around participants perspectives and experiences.

Impact and importance

The impact and importance of the current study discussed in the introduction and discussion.

Appendix 13- Reflexivity and Researcher position

Reflection on Epistemological position

In relation to the study, the researcher took a critical realist position, as it was aligned with

the stance of the person, the researcher, and a as a trainee clinical psychologist. The critical

realist position aims to maintain the original ontological position of realist approach to

research where it is understood that the participants could express and articulate meaning

with the assumption there is a unidirectional relationship between meaning and experience

(Widdicombe & Wooffitt, 1995). However, it also accepts the knowledge can conditioned

socially and historically therefore can be relative. When entering in to the doctoral training

program the researcher’s position had not been fully defined but over the course of the

training as well as various conversations in supervision and with peers, their perspective of

the different epistemological positions widened, resulting in their position solidified.

Initially, the researcher began as realist but with further research and reflection on personal

beliefs (e.g. faith) this began to shift. For the researcher, the ‘blind men and the elephant’

poem (Saxe, 2016) it provided an analogy that encompassed idea of what critical realism

meant for them as it acknowledged that there is a single reality with multiple experiences

(interpretation of it (truth) as well as differing experiences and perspectives of this truth. This

position also allowed for me to accommodate my

Appendix 10 - Outline of key changes during in thematic map

Initial thematic map

At the beginning every code/ micro-theme that appeared was extracted from the transcripts

and grouped with similar codes/ micro themes. This was done to ensure that potential themes

were not disregarded to soon. This resulted in the initial thematic map being produced and

names were generated that seemed to best describe each group of codes. It is of note that

some codes were synonyms and were synergised to reduce volumes of codes. Also, some

codes appeared to be closely related however these were left independent until further

support for them emerged from the data and themes would be reworked if necessary.

Developed thematic map

After the development of the initial map the researcher returned to the data and re-read

it, matching each code to theme and subtheme. Where there was not much evidence of codes

for a subtheme/ theme it was removed. It was at this point more appropriate group labels

emerged as the terms of themes were also examined in the context of the data and more

appropriate, inclusive labels better described the data in the words of the young people, for

example, quality of relationship becoming closeness. Also, subthemes that appeared to be

related but were initially mapped as independent were substantiated with quite a bit of codes

but did not fit well in the original grouping. These were regrouped in to the theme of

belonging.

Final thematic map

In order to arrive at the final version of the thematic map, the researcher explored

distinctiveness between themes and compared definitions. Some subthemes were merged and

integrated into one if they were considered to similar (for example being in the same place

and infrequently seeing each other) .

Appendix 11 - Transcript Excerpt and examples of coding

Appendix 12 – Thematic Map

Appendix 13 – Quotes s Table

Theme Examples

Learning about each other

Initial Meeting Being around each other Finding “common grounds”

and “exchanging differences”

Annie: “It’s then we would get to know each other more….It helps build friendships”

Sarah: I still have common grounds…. sometimes it may be difficult because naturally you are more drawn to people

that looks like you so it can be easy for some but other people find it difficult

Peter: “We are at the same place…. Helps us to interact with one another”

P8 We would slowly become friends. It’s then we would get to know each other more

Even when you meet people you don’t know, they are just randomly nice

Paul: “Not nice to see somebody just by themselves”

Annie: “We could play games that we both like”

Peter: “not hard to find things in common.”

Andre: “talk to LAC about things they have in common e.g. football”

Sarah: “Try make conversation. Favourite stuff”

Esther: “We are all friends and……we really enjoy each other's company”

we have different music tastes for example but then we show each other and then you can see that we are starting to

like… and then I don’t just think Black people start to sing White people’s songs as well. So it’s that kind of thing. So we exchange differences.

Andre: “We would, like, go camping with ****** and spend more time with your friend”

Andre: “can make friends across ethnicity if you are being nice

Levels of Closeness

Growing Trust Holding back Rupturing Closeness

Sarah: you are more likely to be closer to that person compared to a White person. Because I think for White people they have like their own different way of doing things.

Andre: “It’s if I keep on trying to speak with them and try to form a better relationship”

Annie: “We would slowly become friends.”

Sasha: “It [Trust] brings the friendship closer together” (Sasha, )

Esther “ you have to find friends that you can become close with and I think that's what happened…

It caused us to be closer school and to show that we knew each other from out…not just at school but outside as well”

It’s a close knit friendship circle and I think I like it because we all know each other, we are all close

And the thing… me and one girl we got really close there because it was just mainly us

Esther: “like you know when you lose contact with someone and you can’t really speak to them anymore? It was like

that”

Simeon: “They {LAC] could stay there and it would last their friendships would last longer and they’d feel like they

belong somewhere and they're not just being moved around constantly”

Sarah: “Breaks it apart and brings you back together which” makes you kind of learn from your mistakes…”

Peter: “Not sure if they would tell me they are LAC, not sure if friendship would extend past youth club setting”

Sarah: “uncomfortable to talk about LAC status”

Andre: “I wouldn’t disagree with LAC”

A sense of Belonging

Fitting in (Acceptance) Rejection and frustration Protectiveness

Esther: “It’s a close-knit friendship circle and I think I like it because we all know each other, we are all close.”

Peter: “being made fun of not having parents,

Paul: “can get verbal abuse at school”

Crystal: “Gossiped about, they would be questioned more they would use their Lac status”

Simeon: “because I think everybody wants to sense of belonging and not everybody gets it”

Esther: Well it could be depending on where you're moving around. The school...schools, friends in an area or you feel like you don't belong anywhere because you don't have a stable place to be

They could stay there and it would last… their friendships would last longer and they’d feel like they belong somewhere and they're not just being moved around constantly

“respect them for who they are, treat everyone the same

Simeon: “So they can feel like they are actually a part of it”

All: “they [LAC] should be treated normal” (by everyone in some form)

Literature Review

Assignment Title: Resilience in Looked After Children: What helps

children in Care attain positive outcomes in spite of adversity? A

Systematic Review and Narrative Synthesis of Quantitative and

Qualitative Evidence

Stephanie A. M. Sewell

ClinPsychD

Abstract

Background. In recent years, there has been a heightened focus on the factors that have

helped LAC successfully enter and progress out of the fostering system and achieve positive

academic and socio-emotional outcomes (Leve et al, 2012).

Aim To systematically review factors which contribute to resilience in LAC outcomes.

Method: A systematic search utilizing eight databases including ‘PsychInfo', ‘Medline'

and ‘Science Direct' databases. In addition to this, hand searches of relevant articles were

carried out (August, 2016).

Results: These searches yielded 24 relevant articles that explored factors contributing

to resilience. The studies varied in the measures used and methods employed to investigate

resilience in LAC. The main findings suggest key resiliency factors include good self-

perception, peer support and interested/ supportive other. The review suggested that female

LAC were more resilient and some of the processes utilised also varied by gender with LAC

males having more internal locus of control and females were more able to regulate their

emotions. Additionally, some understanding surrounding the processes involved in the

development of resilience emerged from this review. Some factors may mediate/facilitate the

building of other resiliency factors.

Conclusion: This review identified a number of factors related to resiliency, self-

perception, peer support and interested/ supportive other. Some papers adopted a trait whilst

others saw it as a dynamic process and was dependent on the environment. However, overall

the evidence reviewed is suggestive of resilience as a dynamic process. It also identified areas

of further research and application for practice.

Keywords: Looked After Children, LAC, Resilience, Protective Factors, Children in

care, Foster Care

INTRODUCTION

Background. The total number of Looked-After children (LAC) in the United Kingdom is

growing annually, an increase requiring more from a system struggling to meet the needs of

this population (Leve, Harold, Chamberlain, Landsverk, Fisher & Vostanis 2012). The term

Looked-After Children (LAC) refers to children that are provided with care, via a court order,

with the local authority holding full or shared responsibility. This shared responsibility is

usually with one or both biological parents (Fernandez & Barth, 2011). Children under the

care of a local authority can be placed with relatives (kinship care) or unrelated foster parents

(foster care) by the local council if the birth parents are unfit or unwilling to care for the

children. In the UK, there are an estimated 71,440 children in the care of local authorities at

any time (not including those in short-term respite placements), of whom 80% live with

foster caregivers. There has been a significant growth in numbers of LAC from 2016, with

the number estimated at 69,000 LAC, and in 2014, it was estimated at 62,000 (British

Association of Adoptions Foster Care, 2017). For a group with recognised needs, this steady

yearly increase suggests more resources are needed to support these vulnerable young people.

LAC are one of the most ‘holistically at risk’ populations in society (Hodges, 2006).

Research has found that LAC are at risk of poor emotional wellbeing, physical health,

educational outcomes, and interpersonal relationships (Zima, Bussing, Freeman, Yang, Belin,

& Forness, 2000). For the purposes of brevity and economy of expression, a summary of each

outcome will be outlined below.

Emotional wellbeing disparities: Numerous studies have found a high incidence of mental

health difficulties, such as depression or anxiety, in the LAC population (Beck, 2006; Zima,

Bussing, Freeman, Yang, Belin, & Forness, 2000). The DoE reported the gap between LAC

and non-LAC mental health needs is as high as approximately 25% (DoE, 2017), with LAC

having poor mental health. Furthermore, LAC are less likely to access support from services

and have caregivers who are less likely to detect a need for such support (Meltzer, Gatward,

Goodman & Ford, 2000). Hodges (2006) surveyed a group of LAC and found most of them

met the threshold for a diagnosis of a mental health difficulty that had previously gone un-

treated.

Physical health disparities: Studies have established a variety of physical health issues for

LAC. While an initial assessment of LAC entering care usually reveals the need for medical

interventions, they receive a lower level of care, due to accessibility, as the current systems

are less accessible to the instability that LAC experience (Anderson et al., 2004). Also, LAC

typically receive fewer immunizations than other young people from the general population,

a cause for great concern (Ahrens, Garrison, & Courtney, 2014; Anderson et al., 2004).

Educational disparities: There is a disparity in educational achievements between LAC and

their non-LAC counterparts, with LAC having difficulties in maths, reading below their ap-

propriate reading age level, and generally being behind their non-LAC counterparts, resulting

in lower exam scores (Zima et al., 2000; Zorc, O'Reilly, Matone, Long, Watts, & Rubin,

2013).

These vulnerabilities are not only because of the adversity the LAC experience prior

to entering care but also due to the numerous challenges they face whilst in care. Harden

(2004) argues some LAC enter care as a result of abuse and trauma and are vulnerable to

emotional difficulties that have arisen from these traumatic and challenging experiences they

suffered before entering care. Research has shown they are more likely to be insecurely

attached and develop attachment disorders (Bowlby, 1988; Solomon and George, 1999),

which may hinder friendships and relationship formation. Alternatively, others purport the

experience of care is responsible for these difficulties. Anderson, Vostanis and Spencer

(2004) demonstrated that being in care disrupts LAC’s social networks, as children lose

contact with other individuals in their life (friends and extended relatives). Irrespective of the

cause, LAC can present with a myriad of challenges, highlighting the need to improve their

circumstances and alter the trajectory of their future outcomes.

Despite minor improvements in educational attainment and mental health support, the

outcomes (bio-psychosocial) gap between LAC and non-LAC young people has remained

largely unchanged over the last decade, suggesting additional resources and further research

may be required to address this disparity (Department of Education, 2017). For example, a

recent literature review from the Oxford Rees Centre (Luke, Sinclair, Woolgar, & Sebba,

2014) reported LAC still have many emotional, educational, physical, and interpersonal

needs that support services and local authorities could better address. They also stated there

was a disproportionate focus on LAC poor outcomes and recommended this research bias be

addressed by focusing on the positive attributes and outcomes of this population. With the

holistic needs of LAC still outstanding, a shift towards resiliency and successes of LAC

needs to be explored, revealing potential pathways for intervention for the entire LAC

population.

In recent years, there has been heightened focus on the factors that have helped LAC

successfully enter and progress out of the fostering system and achieve positive academic and

socio-emotional outcomes (Leve et al, 2012). Resilience can be defined as “qualities which

cushion a vulnerable child from the worst effects of adversity” (Gillian, 1997 page 12).

Research has identified a list of factors that are important in developing resilience within the

general population, namely having a secure base, high self-esteem, support from foster

caregivers, other social relationships, access to educational systems, and good problem-

solving skills, being socially competent and autonomous, and having a sense of purpose to

life, as being important (Golding, 2003 & Van Breda, 2001; Ungar, 2013).

Literature reviews looking at resilience in the general population of children have

highlighted the difficulty in conceptualising resilience (Van Breda, 2001; Fleming &

Ledogar, 2008). There is an ongoing debate as to whether resilience in children is an innate

trait or the result of interactions between the child and their environment (Condly, 2006).

Alternatively, others have suggested adversity can contribute to the development and

strengthening of a person’s resilience (Van Breda, 2001). Antonovsky and Bernstein argued

“a stressor may be a challenge, giving rise to successful coping precisely because it makes

unanticipated demands” on a person or a system (Antonovsky & Bernstein, 1986, p. 64).

These arguments are not necessarily incongruent, but they highlight the multifaceted nature

of developing resilience. This is nicely depicted by Wolff and Wolff’s (1995) theory. They

posited the ‘constitutional traits’ of a child appeal to and attract others, who provide positive

responses that contribute to the child’s inner self-worth and self-esteem.

Leve et al. (2012) conducted a systematic review of eight papers that implemented

strengths-based interventions that aimed at reducing risk factors of poor outcomes. They

found these interventions were promising, but more research looking into resiliency in LAC

was required. More specifically, they recommended research into “resilience-promoting

factors among foster children” is needed to contribute to the underlying mechanisms

involved in “resilience-based processes”. Stein (2005) completed a literature review looking

into resiliency and LAC but did not present a clear methodology of how papers were

included. To date, there have been no systematically executed reviews addressing this

research area of exploring resiliency factors in LAC. Furthermore, there remains a lack of

clarity about the nature of resiliency, such as would be helpful or are accessible to influence,

which should be addressed. Understanding what resiliency is and what helps some young

people thrive, despite the adverse circumstances surrounding them, can help improve ways to

help support LAC.

Aim. This paper seeks to review how research has progressed in this field in the

past two decades. The primary aim of this systematic review is to examine what can be learnt

about resiliency in relation to LAC in the existing literature, with a secondary aim focused on

exploring the role resiliency may play in the positive outcomes of LAC. The key research

questions are:

1. What is currently known about resilience and LAC who attain positive outcomes and

who do not?

2. How is resilience theoretically understood in LAC?

METHOD

Search Strategy. Many disciplines have contributed to this research area but use

different terminologies. Consequently, the databases utilised for this search included

‘Medline’, ’Psych Info’, ‘Psych Articles’, ‘Psychology and behavioural Sciences’, ‘Science

Direct', ‘Web of Science’, ‘ProQuest and ‘Criminal Justice’. A list of terms was generated to

increase the probability of sourcing papers from the various professions.

Table 1.1

Table of Search terms

Search Terms Variation

Resilience (OR ‘Protective Factors’ OR ‘Overcoming Adversity’)

AND

‘Looked After

Child*

(OR ‘Child* in social care’ ‘Child* Protection’ OR ‘Child* in Foster

Care’ OR ‘Young People in Care’ OR ‘Public Care Child* OR

‘Accommodated Child*’).

Eligibility Criteria. Searches were restricted to English free text searches in ‘Titles’,

Abstracts and ‘Keywords’ from the year 1998 to the present (2016 at the time). This time

period was selected because in 1998 the ‘Qualities Protect Programme for Transforming

Children Services’ by the secretary of state was released and initiated (Department of Health,

1998). They called for equality; and an improvement of outcomes for looked after children in

relation to physical health, mental health, education and reduced antisocial

behaviours/criminality. Therefore, a review of what makes LAC attain positive outcomes

from this year onwards is needed as there was a shift in services to focus on this.

Furthermore, there has been an increasing recognition of resiliency in LAC during this time

(Leve et al, 2012). In the first stage of the literature search, identified articles’ titles and

abstracts were scanned to establish if they met the criteria (see figure 1 for consort diagram).

For this review, a number of inclusion and exclusion criteria were applied. The papers

included in this study met the following criteria:

Table 1.2

Inclusion and Exclusion criteria

Inclusion

criteria

1) Studies of LAC in kinship or foster care between the ages of 0-18 or

retrospective studies for care leavers.

2) Studies that gathered information from the adults supporting LAC in

kinship or foster care between the ages of 0-18 (e.g. foster caregivers).

3) Papers had to explore resiliency/resilience factors.

4) Peer-reviewed empirical paper.

Exclusio

n criteria:

1. Papers were excluded if resilience was not directly explored or was

concluded from an exploration of risk factors alone.

2. Papers that were in the form of book chapters, unpublished disserta-

tions, editorials, and commentaries were not included in the study.

Data Extraction. The included papers were appraised using the Mixed Method Appraisal

Tool v2011 (MMAT; Pluye, Robert, Cargo, Bartlett, O’Cathain, Griffiths et al., 2011). The

MMAT was used as a guide to assess the quality and rigor of the studies and their findings.

This checklist was selected, as it was designed for systematic reviews including mixed

methodologies. The MMAT has a reliability estimate of 0.8 (Pluye & Hong, 2014) and

allows for an appraisal and comparison of qualitative, quantitative, and mixed methods

studies using the same tool. It produces percentage scores, and the criteria for which one

deems a study low, good, or high quality is then set by the reviewers (user of the tool). For

this paper, percentages at 63 and above were considered good quality. Studies that do not

meet the screening criteria or have a percentage below 50 were not included in this review.

Figure 1: Consort diagram of Literature Search

Records Identified through Initial Database Searches

(n = 5791)

Additional record found through other sources [related or cited papers from papers read]

(n = 9)

Total Records after duplicates removed

(n=4630)

Records Screened

(n = 4630)

(n = 2521)

Full Texts assessed for eligibility

(n = 159)

Records Excluded:(n = 4471)

Excluded because they were:Not about LAC (n = 4249)About care leavers (n = 193)Books = (n = 29)

Full Text Articles Excluded:(n = 135)

Excluded because they were:about risk factors (n = 29)about education disparities (n = 53)about mental health difficulties (n = 29)about placement difficulties (n = 16)not exploring resilience directly (n= 6)

About criminality (n= 2)

Included

Eligibility

Screening

Identification

RESULTS

Characteristics of Studies. Altogether, 24 studies were identified and retained in this review.

The studies were dated between 1998 and 2016 and conducted across several countries, including

Canada, Spain, Romania, Israel, the United Kingdom, and the United States of America (see table 1.1

and 1.2).

Participants (LAC, non-LAC and the key adults around LAC). Twenty-one of the included

studies had a sample of LAC and non-LAC children between the ages of 0-18 years old, with a total

of 1,839 young people (LAC and non-LAC) who took part, with an additional 281 participants (ex-

LAC and non-ex-LAC) between 18-35 years of age. Some studies included other participants, such as

social workers, teachers, and foster caregivers. Of the studies that reported the numbers of adult

participants (N=4), the total was 387. The main recruitment strategy reported by the studies included

in this review was self-selecting or convenience sampling (n = 11). Other recruitment strategies

included purposeful participant selection (n = 1) or recruitment of an entire sample through a school

class or local authority (n = 3). Nine of 24 studies did not explicitly report the sampling strategy.

Ethnicity. Of the 24 papers, seven studies did not report demographic information (represented

by the ‘unknown’ category). Of the 18 studies that included demographic signifiers (2,120

participants), the majority of participants were Whites British/European/American (34%), young

people from Israeli background (21%), or Black British/African Americans (15%), followed by Latin

American/Hispanics (7%), multiracial individuals (1%), and others. The seven papers that did not

Studies included in quantitative synthesis/ mixed

synthesis review(n = 14)

Studies included in qualitative and /review

(n = 10)

include, did not know, or did not provide demographic information represented 21% of total young

people in this review.

Methodology/Analysis. Of the 24 papers, a total of 10 papers were qualitative in design, 11

were quantitative, and three were ‘mixed design’ (please see table 1.2). All the qualitative papers used

face-to-face interviews, while 14 of the quantitative and mixed design papers relied on self-report

questionnaires. Three of the quantitative and mixed design studies used standard tests. Twenty of the

studies were cross-sectional, three were longitudinal, and two were reviews (see tables 2.1-2.2).

The MMAT (Pluye et al, 2011) was used as a guide to inform the appraisal of the 25 papers.

Each paper is evaluated on four main areas: 1) the premise behind the research question, 2) the

method selected to address the research question and analyse data, 3) sample size (including response

rate and attrition), and 4) whether consideration was given to study limitations. Subsequently, each

paper’s quality was quantified into a percentage (Pluye et al, 2011; see appendix 2). I t was decided

that a percentage of 63% and above is likely to indicate a good quality methodology where the

findings can be trusted.

Of the 25 papers, 24 had appropriately selected methods and analysis to address their research

questions, resulting in one paper being excluded. Of those who reported participant numbers, 13

quantitative studies were sufficiently powered, as did nine qualitative studies that had an appropriate

sample size. Two studies had less than desirable sample sizes (see table 1.1 and 1.2). The paper was

included in this review, since it is the only review evaluating resilience and LAC leaving care. Three

of the 24 studies reported collecting data from a randomised sample that made up a foster care

treatment program efficacy trial (Pears, Kim, Buchanan, and Fisher, 2015; Pears et al., 2013; &

Jackson, et al., 2010). The 22 studies that did not use a randomised sample had lower MMAT

percentage scores as a result; the justification for non-randomisation in these studies was the inability

to randomise each experimental setting.

Measures used. The papers that met the inclusion criteria for this review each implemented a

variety of outcome measures. A total of 52 measures were implemented across the 14 quantitative and

mixed method studies, with little consistency or continuity in the measures implemented. The only

measures that appeared in more than one study were the Children's Behavioural Checklist, which was

used on three occasions (Pears, Kim, Buchanan and Fisher, 2015; Pears et al., 2012; & Taussig,

2002), and the Strengths and Difficulties questionnaire, which only appeared twice (Rees, 2013; &

Schofield, Biggart, Ward, & Larsson, 2015). A 2013 study by Rees used six questions previously used

by Honey, Rees, & Griffey (2011). The Wechsler Intelligence Ability Test and the British Ability

Scales (Jackson Whitehead, & Wigford, 2010 & Rees, 2013) were used to investigate intelligence, as

this could be a resilience factor for LAC as it is for non-LAC (Block & Kremen, 1996). Six of the 14

quantitative and mixed methods studies did not report reliability estimates for the measures used, but

of the eight studies that did report Cronbach’s alpha, most of the estimates fell between 0.71-0.98,

indicating appropriate reliability.

However, a few limitations remain for many of the studies in this review. For example,

Davidson-Arad’s 2015 study reported a reliability estimate of 0.91 that may not be applicable due to

an unorthodox manipulation of the study’s survey instrument and had not calculated one for the

changed version. Specifically, the study utilized a ‘back translated’, shortened version of the Healthy

Kids Survey to administer the survey in Hebrew; such a manipulation may have equivocated the

validity of the reliability estimate for this measure. Regarding the caveats of other studies, the semi-

structured interviews found in 11 qualitative studies and two mixed methods studies were poorly

outlined, suggesting there is no guarantee these studies can be replicated. The implications of these

caveats on data synthesis will be discussed later in this review.

No Reference Aims Measures Used Cronbach Alpha

No. of Children/ YPᵃ & Other Psᵇ

Age Range

Ethnicity Type of Care Summation of Main Significant Findings Effect sizes Critical

Appraisal %

1

Davidson – Arad et al 2015

Looked at the factors contributing to Resilience in LAC in different care settings e.g. foster, residential.

Resilience and Youth Department module (From California Healthy Kids Survey)

Was back translated into Hebrew and shortened 0.65 - 0.91

286 (FC= 63, RC= 71, Com=152)

13-17 Israeli (further details NR)

Foster, Residential, Community (home)

LAC reported relatively high internal, external and general resilience. They also found that parental acceptance played a key role, especially paternal acceptance, Internal resilience correlated with father’s acceptance. Girls showed greater resilience (general Fj (2.276) = 5832, pk<,05; internal F2.276)=5.832, p<0.05) and external F2.276, p<0.01

0.26

0.14

0.23

75%

2

Daining and DePanfilis 2007

To identify personal and interpersonal factor that contribute to resilience in LAC leaving care

Social Support Behaviours Scale (SSB) (Vaux, Riedel,& Stewart, 1987)

Spiritual Support

subscale of the Revised Spiritual Experience Index (RSEI) (Genia, 1997)

Perceived Stress Scale-selected items

(Cohen, Kamarck, & Mermelstein, 1983)

Resilience composite score (six outcome domains: education participation, employment history, and avoidance

of early parenthood, homelessness, drug use, and criminal activity)

0.90 -African American,

0.86 -White American

-

100 (original 125) 18-21

White Am 9% African Am

91%Foster Care

Foster youth had higher resilience scores when they were either female, older or youth with lower perceived life stress.

NR. Can’t calculate due to only one group’s Means and SD scores reported

100%

3 Harkess -Murphy et al, 2013

Explore Self-harm rates & psychological characteristics in sample of LAC and LAAC

Reasons for Living adolescents

Beck Hopelessness Scale

Forms of Self-Criticising/ Attacking & Self-reassuring scale

-

-

0.81

102 11-17yrs

Measured but NR

NR LAC who did not have thoughts about self-harming had more reasons for a living than LAC who thought about self-harming t L (46) =-5.787,

p <0.001. Higher self-acceptance in non-self-harmer and non-self-harmers was significantly

different t (40) = -5.234. p<0.001

NR & cant calculate due to no

SD’s reported

75%

Table 2.1 Characteristics and findings of quantitative and mixed design studies retained in this survey

Functions Self-Criticising/Attacking Scale

Bachmans School Ability Self-concept

0.92

-

4

Honey et al., 2011

To elicit educational perceptions for LAC

Risk and Protective Factors Rees, 2006

Not reported

51 + 99 and their Ts

7-10yrs NR NR

No difference between genders and protective factors x2 = 2.65, p < 0.1 (self-esteem and homework support at home) 0.31

0.05

73%

5

Jackson & Martin, 1998

To explore contributors to the group of successful people who had grown up in care.

Mixed Methods: Questionnaires administered (with follow-up semi-structured interview. No details of questionnaire give

Not reported

38 Under 35 NR Foster

LAC in the successful group had similar past experiences (emotional/ physical/sexual abuse

and neglect) when to compare to the less successful LAC group. No difference in self-

esteem score between groups. Internal locus of control was higher in LAC who were more

successful p<0.018)


SD’s reported

54%

6

Jackson et al. 2010

Explore if LAC would differ in attainment, resilience, and self-perceptions to Non-LAC

Mixed Methods: All about me (provides qualitative data)

WIAT (Wechsler, 2005)

Resiliency Scale (Prince-Embury, 2007)

None reported

16 (LAC= 4, Non-LAC =12)

Yr 7 & Yr 9

NR (English first language) Unclear

LAC increasingly perceived themselves as positive when thinking about their relations to

others, more than their personal qualities. Lower levels of resilience in LAC were found when

compared to Non – LAC. Learnt to read early (no stats) Access to books compared comparison group x2 13.88, p<0.0002 Parent or carers more

likely to attend school event, show interest in educational progress F (1,56) =0.57, p<0.029

More internal locus of control F (1,56) =5.92, p<0.018


SD’s reported

100%

7 Legault et al. 2006

To build an exploratory predictive model of psychological adjustment, defined regarding anxiety and physical aggression.

NLYSCY – Cycle 3:

Anxiety. Physical Aggression

Accumulative risk index

Natural Parenting Scale

Self-esteem scale

Coping Scale

0.86. 0.84

-

0.87

0.83

0.73

220 14-17 Canadian (Ontario) (other

details NR)

Foster Homes, Group Homes,

Placements

a significant association between lower levels of anxiety and higher-quality relationships with the

female caregiver, a greater number of close friendships, and higher self-esteem. rm = -.17

p<0.01 0.53

0.16

100%

8

Melkman

,2015

They explored the role protective and risk factors play or adolescents in residential care f in the uptake of behaviours that are sexually risky and, criminal as well as substance abuse,

Risk Involvement and perception scale

National Youth Survey

Impulsive Sensation Seeking Scale

Future Orientation

0.88

0.72

0.72

0.95

147 (Original was 227) 14-19 Israeli (other

details NR)Residential Care

“Of the protective factors, only future orientation was found to be significantly negatively associated with problem behaviors (r =0.52, p<0.01). Even more so for older children (b = -0.29, p = 0.027): i.e., a more positive future orientation correlated with lower engagement in problem behaviors, an association that increased in strength with age. Peer acceptance was associated with increased risk behaviours”

NR. Can’t calculate due to only one group’s Means and SD scores reported

75%

9

Pears et al. 2015

To explore the impact of school moves on foster care children in comparison to non-foster care children in community schools.

Sample from randomise efficacy trial

Conduct Problems subscales from Seattle Personality Questionnaire (Greenberg and Lengua,1995)

Aggression Subscale

Disruptiveness Subscale

(from Loneliness and Social Dissatisfaction Questionnaire, Cassidy, and Asher,1992)

Emotional Regulation Checklist (Shields and Cicchetti, 1992)

School Competence (from Child Behaviour Checklist, Achenbach, 1991a)

0.72

0.83

0.86

0.82

0.79

141 (FC=86, CC=55) 3-6

White Am (fc= 86% cc= 78%);

African. Am (fc= 1% cc= 6%); Native. Am (fc = 6%

cc=7%); Mixed Race (fc= 3%

cc= 2%); Pacific Islander

cc= 2%

Other/Unknown (fc = 4% cc=5%)

Foster Care, Community Comparison

Unconstrained model (TRdn=7.17,p<0.05) showed that Early school skills serve as a resilience factor against school moves. When early skill falls above the mean, then school moved is not associated with later socioemotional competence.

NR. Can’t calculate

due to Means and SD scores were not reported

for factors of

resilience

(school moves between FC and Com group = 0.51

75%

10 Pears et al. 2012

To identify risk and promotive factors that associated with school adjustment after the transition to middle school.

Teacher Report Form (Achenbach and Rescorla’s. 2001)

Overt Aggression from peers Subscale

Relational Aggression from peers (both from Revised social experience questionnaire, Paquette & Underwood,1999)

"high test-retest."

0.76 -0.80

0.80-0.89

75 girls and their FCRs

M= 11.59, SD=0.46

Caucasian 66%; African.

Am 9%, Native. A 4%; Multi-racial 12%

Foster Care Identified that higher academic performance was associated with higher care give support (Statistics for this not reported)

100%

Attachment to Parent subscale

Attentional problems subscale (From CBC) 0.82 – 0.88

0.83

11

Rees, 2013

Exploring if LAC has more mental health difficulties and underachieve in other domains.

Strengths and difficulties questionnaire

Emotional Literacy: Assessment & interaction inventory

Cognitive: British Ability Scales

Literacy: British Ability Scales

0.72

-

-

0.94 - 0.96

0.91 – 0.98

193 7-15yrs

99% White British Foster

LAC who met the exception positive criteria. There was an association between contact with

parents. Parental contact x2 (1, N=193) = 11.57, p < 0.001



for factors of

resilience

75%

12

Roca 2009

Analyses characteristics associated with LAC progress post care (after leaving care)

Mixed methods

Semi- Structured interviews and content analysis

NR 143 20-23

Spain (Catalonia)

(other details NR)

Foster/Post Care

The LAC who were in the ‘successful’ group score better in a number of area including

education, level of autonomy rule acceptance ability to preserver, negotiate and be assertive as

well as regulate their emotions.


SD’s reported

63.3%

13

Schofield et al. 2015

Evaluate which risk and resilience factors predict membership of the three groups of young people

(British Picture Vocabulary Scale, Dunn

et al., 2009)

The Adolescent Stories (Conduct Problems Prevention Research

Group, 1999)

Strengths and Difficulties Questionnaire Goodman,

Meltzer, & Bailey, 1998), behavioral screening questionnaire,

and the DANVA 2 (Diagnostic Analysis of Non-Verbal Accuracy, Nowicki

& Duke, 1994

Not reported

100 (LAC offenders=33,

Non-Lac offenders=35,

Lac non-offenders = 32

14-19yrs

Average across the three

groups 64% White British

and 36% Black and Minority

Ethnics

Found individual (self-perception), family and education and activity resilience factors

(especially benign attribution)

Also, highlights the role and significance of relationships and constructive activity in

resilience

0.68 (benign attribution)

72%

14 South et al 2016

To explore what professionals

Mixed Methods: a Delphi survey and interviews

Not Reported

106 UK Foster They found that Ts, FCs, and SWs defined resilience as survival, coping and self-worth.


91%

around LAC view resilience to be and see how similar different hey are.

due to process of

survey creation

(34 Ts, 36 FCs 36 SWs) No

LAC

After this there was not much more consensus on what it was. Participants also felt resilience has

its limitations because it was argued that it expects the LAC to survive everything that life

presents them with. Also there. Significant between FCs and SWs view of resilience.

Ts views were more in line with FCs views.


for factors of

resilience

15

Taussig, 2002

The longitudinal study looked at how protective and vulnerability factors play a role in the lives of long-term foster care young people

Child Behaviour Checklist,

Peabody Picture

Vocabulary Test - Revised

Vineland Adaptive Behaviour Scales

Harter Social Support Scale

Harter Self-Perception Profile for Children

Delinquency Scale

Self-destructive scale

Sexual behaviors Scale

-

-

-

-

-

-

0.77

0.70

0.82

214 7-12yrs

White Am 43.6%, African

Am 36.4% Hispanic 20.0%

Foster

Positive social acceptance from ‘wrong’ groups was associated was correlated with substance

use and sexual behaviours. [(r = - 0.19, p≤0.05, r = - 0.20, p≤0.05 & r = - 0.20, p≤0.05)



for factors of

resilience

100%

a YP= Young Persons, b NR= Not Reported c Am= American d Br= British e FCRs= Foster Carers f Ts= Teachers g SWs= Social Workers h EP = Educational Psychologists i HCP= Health Care Professionals jF= kp = p value Lt= mr= regression

No Reference Aims Method used No. of Children/

YPᵃ & Other Ps

Age Range

Ethnicity Type of Care Summation of Main Findings and Themes Quality Appraisal Score

16

Bell & Romano 2015

To gain welfare workers perspectives on resilience and explore factors that may influence it.

Semi- Structured interviews Unclear No

of LAC. SWs

(N=11)

Yp =0-18yrs

SWs=Unkno

wn

NR Unclear

identified some factors associated with resilience (e.g., child intelligence, worker communication skills); however, the critical importance of a child's

relationships and social support from others underpinned all factors discussed. The findings highlight the importance of including the perspectives of all those involved in the child welfare system in assessing the well-being of

children in out-of-home care.

100%

17

Birneanu, 2014

To investigate the role attachment and resilience in foster care children.

Semi- Structured interviews (Adapted from attachment interview, George et al., 1996; & Family and Friends interview, Steel, 2005)

92 6-18yrs

Romanian (other details

NR)Foster LAC -girls have more protective factors that LAC- boys. Higher rate of

protective factors was associated with positive self-perception in LAC

75%

18 Brewin & Stratham, 2011

Find out the key factors that support Looked

Semi- Structured interviews

6 + 7 and their

FCRs, Ts, SWs, Eph

10-12yrs NR Foster

Highlighted the importance of communication between agencies around the child to communicate. Also highlighted that one single support package to promote resilience that it has to be holistic and tailored to the individuals.

100%

19

Daniel et al 1999

Operationalised resilience and trained social workers to completed resilience based assessments on Looked after children. Explored impact of such assessment on children


8 and their SWs

5-11yrs NR

Foster Care (6), Kinship care, Home

Training in resilience factors enhanced SWs understanding of the construct which improved their ability to identify it in resilience strength in LAC they

are working with

50%

20Drapeau et al. 2007

To better understand processes contributing to resilience in foster care youth


12 boys 14-17yrs

Canadian - Quebec (other

details NR)

Residential, Foster (1)

That resilience factor facilitates turning points in LAC (turning point - where they decide to change the direction of their life) the Main factor identified

perceived self-efficacy, distancing from risks and new opportunities. Also, the identified that there is a snowballing effect of benefits following the initial

decision reinforces the changes.

75%

21

Driscroll, 2011

Pilot study exploring young people accounts of their educational attainment


7 LAC 16-20

Living in England – reported as

unrepresentative sample

Foster care – Leaving care

Attainment of qualifications, strong motivator when approaching leaving care. The protective factor of self-reliance can prove challenging for schools to

provide support

75%

22 Mc Mahon & Curtin 2013

To explore social networks of a group of young people in Ireland who have experienced long-term foster care


38

13-17yrs

18-21yr

Ireland (other details NR) Foster

Highlights the importance social network but the impact foster care has on it. It can result in losing contact extended family, make it hard to sustain

friendship, access activities and impact education

64%

23Quarmby, 2014

To provide an insight into a new area of research in the field of sport and physical activity

Semi- Structured interviews 5 12-

17yrs White British Residential

Highlight that there is a secondary gain from going to activities for male LAC. The young people used sport as a means to an end; to spend time with

friends and develop stocks of social capital

100%

24

Samuels 2008

Explored the experiences of 44 young people/adults as they were transitioning out of care.


Wave 1 = 90 surveys incl , Wave

2= 44 interviewed

(Total surveyed =

17-21

Africa Am. 61.4%, White Am 13.6%, Multi-racial

2%, Native Am. 2/%

Kinship Care, Foster Care

Self-reliance (belief in one's ability and relying on it) can be a useful resilience a factor but also hinders the building of relationships with supportive others.

91%

Effect size estimates. None of the quantitative and mix methods studies reported

standardised effect sizes, and in only five studies could Cohens D be calculated from the statistics

reported. This meant the effect sizes of only nine studies could be calculated. Of these, three fell

within the small effect range, three in the medium effect range, none in the large effect range, and

three were <0.2.

Synthesis of findings: This review has primarily sought to bring together existing knowledge to

enhance our understanding of resiliency in LAC. It also identifies strengths and gaps within the field,

highlights the limitations of this review’s integrative approach, and outlines future directions for the

field. There is an ongoing debate regarding how best to synthesize epistemologically different data

sets. Quantitative meta-analysis, as defined by Walsh and Downe (2005), traditionally seeks to

strengthen certainty in the causal relationship found, whereas qualitative meta-synthesis seeks to bring

together existing knowledge and explain a phenomenon in greater detail. Noblit and Hare (1988)

described quantitative review as a process that seeks to integrate data, while qualitative review seeks

to induct and interpret. They argue, "Interpretive reviews achieve synthesis through subsuming the

concepts identified in the primary studies into a higher-order theoretical structure."

Yet, to construct a more holistic conceptualization of resiliency in LAC, these studies need to be

aggregated and evaluated. Ultimately, a narrative synthesis approach was utilised to describe,

amalgamate, and compare the qualitative and quantitative findings using text, tables, and figures

(Popay, Roberts, Sowden, Petticrew, Arai, Rodgers, et al, 2006). In line with Popay et al.’s (2006)

guidance, the themes that emerged from the studies included in this review were identified in an

inductive manner by reading and re-reading the studies.

Reference Resilience factors Within LAC Resilience factors around LAC

Hope and Future

aspirations

Self -esteem/

perception

Attachment style

Locus of control

Self-efficacy/

competence

Intelligence / skills, academic

ability

Friendships/ Social

Acceptance

Interested/ Supportive

Adult

Extra-Curricular activities

Communication between systems

Faith / Community Connection

Placement

/School Stability

Contact with birth

family

Davidson – Arad et al. 2015 X X

Daining & DePanfilis 2007

X X X X

Harkess- Murphy et al X X X

Honey et al., 2011 X X X X

Jackson & Martin, 1998

No diff found X X X X

Jackson et al. X X X

Legault et al 2006 X X X X

Melkman X

Pears et al. 2012 X X X X

Pears et al. 2015 X X

Rees, 2013 X X

Roca 2009

Schofield et al. 2015 X X X X

South et al 2016 X X X

Taussig, 2002 X

Table 2.1 Resilience factors identified in Quantitative papers and mix methods

Table 2.2 Resilience factors identified in Qualitative papers

Reference Resilience factors Within LAC Resilience factors around LAC

Hope and Future

aspirations

Self -esteem/

perception

Attachment style

Locus of

control

Self-efficacy/

competence

Intelligence / skills, academic

ability

Friendships/ Social

Acceptance

Interested/ Supportive

Adult

Extra-Curricular activities

Communication between systems

Faith / Community Connection

Placement

/School Stability

Contact with birth

family

Bell and Romano 2015 X X X X X X X

Birneua X X X

Brewin & St.... 2011 X X X

Daniel et al 1999 X X X X X X

Mc Mahon & Curtin 2013 X X

Samuels 2008 X

Drapeau et al 2007 X X X X X X X X X

Driscroll, 2011 X X

Quarmby, 2014 X X X

Findings

Narrative Synthesis/Themes

The themes and subthemes were compiled from the results’ general groupings of research of factors

relating to resilience (Masten & Coastworth, 1998). Four themes relating to resilience emerged from

the systematic review process: 1) LAC who experience positive outcomes possess specific qualities,

2) The environment’s contribution to the positive outcomes of LAC, 3) The construct of resiliency as

a complex interplay between internal and external factors, and 4) The processes involved in the

development of resiliency.

Overview

Overall, the 24 studies identified 13 resilience factors related to positive outcomes (see table

2.1and 2.2). Some examples of positive outcomes explored in these papers include education, mental

health, physical health, social and interpersonal connections. Of these 13 factors, an

interested/supportive other, self-esteem/self-perception, and friendship/ social acceptance were

frequently reported (see table 2.1and 2.2), highlighting their important role in the resilience of LAC.

Across both the qualitative and quantitative studies, interested supported friendships and self-

esteem/ self-perception were identified as important, whereas friendship/social acceptance and

stability tended to be located only within the qualitative studies. Of these 13 factors, Spirituality, the

quality of the communication between services supporting LAC, and the locus of control of a LAC

were less represented in the findings of the studies (see table 2.1and 2.2).

Five studies compared the LAC who attained positive outcomes with LAC with poor

outcomes. These studies predominantly reported female LAC had more protective factors than male

LAC or had greater positive achievements (Daining & DePanfilis, 2007; Honey et al., 2011; &

Drapeau, Saint-Jacques, Lepine, Bégin & Bernard, 2007).

In relation to how looked after children performed in comparison to peers who were not in care,

three studies compared LAC with positive outcomes with non-LAC (either community samples or

non-LAC classroom peers); one study found LAC have a lower level of resiliency compared to non-

LAC (Jackson et al, 2010). Specifically, it was reported that LAC had higher vulnerability and lower

resources compared to non-LAC (p=0.03). Whereas, Schofield et al. (2015) found both LAC and non-

LAC benefit from having a benign perception of negative events for increasing resiliency.

LAC who experience positive outcomes possess specific qualities

Fifteen studies evaluated the role that LAC’s perceptions of themselves and their circumstances

had on positive outcomes. The existing literature on this subject can be broadly grouped into three

categories: 1) the beliefs LAC hold about themselves, 2) conceptions LAC have about adversity, and

3) LAC’s beliefs about the future.

The beliefs LAC hold about themselves

Fifteen studies elucidate how LAC’s beliefs (e.g., view of themselves, their abilities, and sense of

self-worth) are implicated in the positive outcomes they achieve. For example, a quantitative study by

Legault Anawati and Flynn (2006) on emotional wellbeing found higher self-esteem was associated

with lower anxiety and lower physical aggression. Harkess-Murphy (2012) also found that having

positive self-perceptions was negatively correlated with self-harm among LAC. Furthermore, LAC

who did not self-harm had significantly higher self-acceptance than LAC self-harmers. With regard to

education, positive self-competence (the belief in one’s own ability and competence) was associated

with positive academic outcomes (Pears et al., 2012). A study by Daniel, Wassell, and Gilligan (2001)

reported self-esteem in LAC was positively associated with fitting in at school and in youth clubs.

Furthermore, South Jones, Creith, and Simond (2015) reported there was a general consensus in LAC,

where they believed resilience was connected to a sense of self-worth. A major limitation of these

findings is that, except for the study by Pears et al., (2012), these studies predominantly recruited

white participants, minimizing the generalizability of these results.

Conceptions LAC have about adversity

Four studies reported variations in LAC’s beliefs about adversity but generally found that

conceptions of adversity were important in overcoming adverse circumstances and attaining positive

outcomes. In a robust study by Daining and DePanfilis (2007), there was a significant difference in

perceived stress between LAC with and without positive outcomes, with lower perceived stress

associated with greater resilience (high score on resilience measure composite score).

Jackson and Martin (1998) also found that, during adversity, LAC who perceived themselves as

having internal locus of control was associated with LAC achieving positive outcomes. The authors

found internal locus of control was higher in LAC who were more successful compared to LAC in the

unsuccessful group. The authors suggested LAC with greater internal locus of control were more

likely to feel in control over their direction in life and be more successful. In addition, they said male

LAC had more internal locus of control than females, a finding supported by Roca, García, Biarnés,

Rodríguez, (2009). In contrast, females high levels of control were orientated over their ability to

regulate emotions; those with higher levels of emotional regulation were found to have positive

outcomes However, irrespective of gender, the LAC with more positive outcomes were statistically

significantly more autonomous than LAC without positive outcomes (M=3.81 vs. M=3.31;

F2,93=4.29; Pb0.05). These results suggest each gender benefits from certain resiliency factors more

than others.

Hope and aspirations for the future

Six studies indicated hope and aspirations for the future played a role in the positive outcomes of

LAC. Melkman (2015) found future-directed thinking and behavioural difficulties were negatively

associated, suggesting LAC who have aspirations may present with fewer behavioural difficulties.

Future optimism was also implicated in LAC not engaging in self-harming behaviours (Harkess-

Murphy, 2012). However, there is a difference in the type of aspirations LAC have across genders, as

well as differences in aspirations between LAC and non-LAC. Honey et al. (2011) found female LAC

aspired to go into caring, teaching, health, or beauty professions, while male LAC aspired toward

skilled manual jobs. In comparison, non – LAC chose professional jobs; ten percent (5 out of 50) of

the LAC that took part in the study chose professional jobs in comparison to 44% (44 out of 99) of

non-LAC.

LAC Skills and Ability

Three quantitative studies and three qualitative studies investigated traits and abilities LAC

have that are associated with resiliency. Jackson (2006) found reading ability and IQ enhance

resiliency, and building reading ability earlier put LAC on track for better future outcomes. Another

study reported child intelligence was related to resiliency in LAC (Bell and Romano, 2015). Also,

those with better outcomes displayed more secure attachments (Birneau, 2014 & Driscroll, 2011).

LAC with positive outcomes also tend to possess the ability to accept rules (M=2.33; F2,93=4.8;

p=0.05), the ability to persevere through required tasks (M=3.45 vs. M=2.60 vs. M=1.57;

F2,92=13.18; Pb0.001), and the ability to regulate their emotions (M=2.94 vs. M=2.15; F2,93=12.46;

Pb0.01). Additionally, they are noted to have a good level of social skills but, more specifically, an

aptitude to negotiate (M=3.28 vs. M=2.52; F (2,93) = 8.69; Pb0.01), as well as have assertiveness

skills (M=3.02 vs. M=2.44; F(2,90) = 5.12; Pb0.05). Using discriminant analysis, Roca et al. (2009)

found, of all these attributes, perseverance most accounted for the differences between the successful

and unsuccessful groups of LAC. However, when separating the genders, ‘perseverance’ accounted

for the difference between successful and unsuccessful LAC males (Wilks' Lambda = 0.818; p=0.01)

but not females. Emotional regulation became the most significant factor to distinguish between the

female LAC groups on whether they became successful (Wilks' Lambda = 0.868; p=0.05).

The environment’s contribution to the positive outcomes of LAC

Eighteen studies’ findings provided information about the role of the environment in the positive

outcome of LAC. The ways in which the literature explored the environmental factors could be

broadly grouped into: ‘Quality of the relationships LAC possess’, ‘Support provided by systems in

LAC’s environment’, and ‘Opportunities LAC are afforded to have’.

Quality of the relationships LAC possess

The most commonly reported factor in the environment of LAC attaining positive outcomes

was their relationships with others – namely their perceived supportive relationships with others.

Daining and DePanfilis (2007) reported the greater the social support a LAC had, the more resilient a

young person was (F(5,94) = 10.48, p = 0.0005). Importantly, this was the case if the supportive

person was a peer or an adult (Harkess- Murphy et al.; Jackson et al.; Legault et al. 2006; Pears et al.

2012 & Schofield et al. 2015). However, Taussig (2002) found this was the case with only some types

of peers. Classmate support served as a significant negative predictor of risk behaviours. In other

words, the more classmate acceptance and support a LAC received, the less likely they were to be

engaged in risk behaviours (e.g., criminality). Interestingly, this was limited to this setting, as they

also found greater social acceptance from non-classmate peers was a positive predictor of greater

engagement in risk behaviours. The authors suggested non-classmate peers could potentially be more

deviant peers (Taussig, 2002). Additionally, sustaining contact with friendships and extended family

prior to entry into care was important (Quarmby, 2014; Drapeau et al., 2007).

Daniel et al. (1999) found LAC, who achieved positive outcomes (e.g., educational

performance), had more positive relationships or contact with parents than LAC, who had these

relationships but did not have positive outcomes (87% and 53% respectively). This was supported by

Jackson (2006), who found that, when compared to a LAC control group, high achieving LAC had a

significant adult or parent encouraging their education, attending school events/meetings, and

remaining interested in the progress of the LAC after childhood (F (1,54) = 5.07, p = 0.029).

However, these studies also highlight there are some LAC who may have such support but still

underperform and do not attain positive outcomes, giving rise to the question what else is involved to

bring about these outcomes.

Other studies have highlighted that, sometimes, significant adult beliefs and skills hinder the

‘supportive other’ factor that is helpful for LAC, affecting the aforementioned resiliency factors.

Honey et al. (2011) found designated teachers had lower career predictions for LAC than non-LAC,

so LAC felt “given up on”. Bell and Ramono (2015) found that resiliency was associated with social

worker communication skills, with those with poorer skills associated with LAC evidencing

poorer/weaker resiliency. Helpful communication skills were reported to include advocacy for the

young person, ability to build strong encouraging relationships with them, and be supporting foster

carers. Daniel et al. (1999) suggested an individual that provides continuity and encouragement in

school and extra-curricular activities (e.g., attending school and youth clubs) is needed for resiliency.

The authors also stated increasing resiliency is not the preserve of the social worker alone.

In relation to paternal and maternal parents, high quality relationships with female caregivers

was associated with less aggressive behaviours, close friendships, higher self-esteem, use of coping

strategies, and less avoidant strategies (Legault, 2006). However, Davidson-Arad’s study (2015) with

Israeli children found a positive association between acceptance of the father and internal resilience

(p<0.01).

Support provided by systems in LAC’s environment

Fewer studies have looked at the role that support systems for LAC play in their positive

outcomes. Brewin and Stratham (2013) reported holistic and individualised support was a factor in

promoting positive outcomes (Brewin and Stratham, 2013). Another study found that less placement

moves and more stability (Pears, Kim et al., 2015) were associated with better outcomes for LAC.

Interestingly, three studies reported LAC children found it helpful to be treated the same as

non-LAC. In Driscroll’s qualitative study, it emerged that normalisation played an important role in

the resiliency of LAC (Driscroll, 2011). LAC felt it was important for them not to be singled out; they

were generally reluctant to be treated differently: ‘It makes you feel really different. I absolutely hate

it’ (Anabel’s quotation in Driscroll, 2011). Qualitative analyses by Brewin and Stratham (2013) and

Drapeau et al. (2007) also suggested minimising the difference between LAC and non-LAC was

beneficial.

‘Opportunities LAC are afforded to have’.

Another factor associated with positive outcomes for LAC was the opportunities in which

LAC can engage, e.g., extra-curricular activities. Schofield et al (2015) looked at resiliency in relation

to extra-curricular activities and found a strong relationship between predicted group a LAC would

belong to and the actual group they fell in (χ2 = 58.61, (5, n = 84), p b .001). The Wald criterion

demonstrated taking part in positive activities significantly predicted LAC non-offenders’ group

membership, where LAC were less likely to engage in offending behaviours if they were engaged in

positive extra circular activities. In other words, no association with positive peers and activities

predicted membership of offending LAC (95% of offenders correctly predicted), and the reverse

predicted the membership of the LAC non-offending group (80%).

It is interesting that Schofield’s study found the strongest predictors of group membership were

associations with positive peers and positive activities, as Quarmby’s (2014) qualitative findings

indicate a potential mediatory effect between these two. He found LAC reported that sports (extra-

curricular activities) were a vehicle to attain additional resilience factors, such as integrating into a

community and developing social support and networks. Daniel et al. (1999) also reported that

attending youth clubs was beneficial.

The processes involved in the development of resiliency

There were two main conceptualisations of resiliency across the existing literature: resilience

as: 1) a stable set of traits or 2) a dynamic process. Most studies included in this review did not

explicitly outline their position, but the factors explored gave some indication of their potential

position. For example, two studies in the current review solely explored factors related to the

attributes possessed by LAC (Birneua and South et al.). In relation to LAC’s conceptualisation of

resiliency, South et al. (2015) reported that, for them, resilience was related to “survival, carrying on,

and not falling apart in the face of adversity.” However, the LAC also noted “children should not be

expected to survive everything they are faced with” (South et al, 2015), which could be seen to fall

into personal attributes category, whereas others appeared to look at a dynamic process between

attributes within and resources around the LAC. For example, Davidson-Arad et al. (2015) took the

position of resilience as an innate trait that motivates young people to seek fulfilment of their needs

through interactions with their environment. Overall, most of the studies that took a position (n = 8)

aligned with the dynamic process. For example, Daining and DePanfilis (2007) viewed resilience as a

developmental course. This is supported by the two broad categories identified in this review,

‘internal personal attributes vs external psychosocial factors’, for LAC positive outcomes (six internal

factors and seven that can be considered externally located). Furthermore, a couple of studies that

could fall in the dynamic process category provided differing perspective potential process involved.

Honey et al. (2011) explained resilience as having both risk and protective factors, where the

protective factors ameliorate and reduce the risk (Legault, 2005, Taussig, 2002). Similarly, Jackson

(2006) explored resilience in terms of vulnerability and resources compared, suggesting some aspects

of resilience are personal attributes but all indicating a cumulative and complex interaction between

static and non-static constitutional qualities of the LAC with their environment. Overall, of the factors

that emerged from this review relating to positive outcomes for LAC, the majority seemed to align

with the dynamic conceptualisation of resilience, not the static trait framework (Davidson-Arad et al.

2015).

The construct of resiliency as a complex interplay between internal and external factors

Few studies examined the processes involved in developing resilience in LAC. One study

implemented a qualitative method that allowed researchers to explore the processes by which

perceptions of adversity contribute to the positive outcomes attained by LAC. For example, Drapeau

et al. (2007) interviewed 12 boys who lived in a residential care setting in Canada and found

resilience typically involved ‘turning points’ that altered their perception of a forthcoming adverse

circumstance. These ‘turning points’ fell in one of three categories: 1) the result of an achievement

obtained through hard work and an increased belief in one’s abilities (self-competence), 2) the

development of relationships with significant adults during a time of adversity (building trust and

security), and 3) the acknowledgement that one has reached an impasse and must try an alternative

method to bypass the barrier. All three turning points supported the idea of resilience being a dynamic

process.

DISCUSSION

Summary of Reviewed Articles

This review has taken a systematic approach and examined a range of literature looking at

resilience factors associated with LAC to derive meaningful evidence to inform practice. While most

papers explored factors associated with resilience in the LAC population, few studies looked at how

resiliency can be promoted, and even fewer studies explored what processes are involved in building

resiliency. The review identified a number of factors that appear to be related to resilience in LAC.

The strongest evidence points to the following factors: self-perception, self-esteem,

supportive/interest other, peer support, intelligence/academic skill, hope/future aspirations, and locus

of control. Some of the less evidenced factors included communication between systems, faith,

community connection, and placement/school stability.

In relation to the wider research field of resilience in the general population of children, the

current review found resilience factors similar to those associated with the general population or care

leavers. For example, Stein’s literature review (2005) also found similar themes to those presented in

this review, although the paper was assessed to be low quality due to a lack of procedure and clear

inclusion criteria. Additionally, the thirteen factors found in this review (e.g. self-perception, self-

esteem, supportive/interest other, peer support, intelligence/academic skill, hope/future aspirations,

and locus of control) have also been reported by Golding (2003) and Van Breda (2001) as factors

associated with resilience. According to Ungar (2013), children in the general population who were

deemed as resilient were noted to have good problem-solving skills, to be socially competent and

autonomous, are insightful, and have a sense of purpose to life. The findings of that review are in line

with this paper.

It also emerged that there is a recurrent pattern of gender differences across a variety of resiliency

factors. Female LAC were more likely to be found as more resilient than boys, and girls have

different processes that support the development of resilience. Research in resiliency has found that

females are more likely to be resilient than male children in the general population, but the latter

findings of gender difference in the type of resiliency factors being utilised are not well-supported by

wider research (Van Breda, 2001).

The current systematic review revealed research was not consistent about how self-

perception and social network contribute to resilience. There is considerable evidence suggesting the

most important element of the social network is a supportive or interested other. Noteworthy was the

finding that research suggests adults (social workers and foster carers), without genuine interest, who

are around the child, could become a hindrance to LAC outcomes (Harker, Dobel‐Ober, Lawrence,

Berridge, & Sinclair 2003; Coward, 2015; Harker, Dobel-Ober, Akhurst, Berridge, D., & Sinclair,

2004).

There were a few recurring methodological limitations across the papers reviewed in this

paper. For example, the use of convenience and non-representative samples, self-reported and

retrospective data resulted in restricted opportunity for external validity of results. Drapeau et al.

(2007) acknowledge having ungeneralisable findings and limited diversity of participants who

experience foster care. This is also the case for some of the more unique, interesting findings, such as

Quarmby (2014).

One positive aspect in this field is that, as evidenced by Quarmby (2014), the field has done well to

capture the voices of LAC, which is a difficult population to recruit.

With respect to the nature of resiliency, the review found a wide range of measures used with

varying reliability estimates, along with a variety of methods utilized and differing conceptualisations

of resilience. Overall, there was a lack of consistent definitions, as each study looked at different

resilience factors, resulting in some factors being more researched than others. These issues are not

unique to research into LAC but is true of the wider body of research on resilience (Kaplan, 1999).

This challenge is not just the limited of LAC, as it is evident within the general population of children

(Van Breda, 2001; Fleming & Ledogar, 2008).

This difficulty in conceptualisation is not limited to the theoretical field of research. From the

perspective of LAC, South et al. (2015) reported their understanding of resilience differed somewhat

from the understanding provided by existing literature. For example, young people felt resilience was

related to “survival, carrying on, and not falling apart in the face of adversity,” a finding similar to

other published reports (South et al, 2015). Aside from these statements, the views of LAC differed

greatly regarding resiliency, further highlighting the lack of consensus on the concept even among the

study participants. Ultimately, these findings suggest LAC have views on resiliency that may not be

reflective of others’ beliefs.

There is an ongoing debate as to whether resilience in children is an innate trait or an interaction

between the child and their environment (Condly, 2006). The trait view of resilience is believed to

have originated from the term ego-resiliency, which describes the personal attributes an individual

possessed to help them overcome adversity (Jeanne & Jack Block, 1980; Luthar, Cicchetti & Becker,

2000). No paper set out to clarify this question, but most of the studies that discussed their position

and their results often viewed them as a ‘dynamic process’.

In Ungar’s (2011) social ecology model of resilience, he stresses the importance of ‘interactional

processes’ and suggests moving away from the search for ‘traits’. He suggested resilience should be

understood as the result of enabling environments that facilitate children to thrive (their social

ecology). Rutter (2012) looked at resiliency in the general population and agreed resilience is

“dynamic rather than fixed or inherent to the young person.” In a 2013 systematic review of resilience

for at-risk children who lived in areas of armed conflict, Tol and colleagues concluded resilience was

a “complex dynamic process driven by time- and context-dependent variables,” as opposed to a

balance of risk- and protective factors (Tol et al., 2013), differing from Honey et al., Legault, 2005,

Taussig, 2002, and Jackson (2006) understanding of this interplay of factors.

The current review findings revealed studies in this field support the position that LAC

possess internal qualities, giving some support for ‘trait’ perspective; however, there was a strong

support for environmental factors as well, which is suggestive of an interplay between the two. This

dynamic tension suggests some synergy with Ungar’s ideas of the interactive dynamic process and is

in line with Sarkar and Fletcher’s (2014) postulation of the interplay between factors reflecting the

multifaceted nature of resilience.

Wolff and Wolff’s (1995) theory suggests children have constitutional resiliency traits, which

allow a child to appeal to others and draw them into social and emotional interactions. This results in

positive responses that contribute to the child’s inner self-worth, self-esteem, and self-efficacy; the

current review found support for the implicated factors. Wolff and Wolff (1995) also postulates the

notion that some resiliency factors complement others, indicating there is some interdependence

between some factors. It is plausible that, in some instances, there is an implicit hierarchy of factors,

meaning it is helpful for some factors to be present to facilitate the development of others . This may

account for some of the findings that emerged from this review. For example, self- efficacy was

highlighted as being a protective factor within LAC who progress well socioemotionally. This review

also found past academic success or early academic skills also served as protective factors. These past

achievements fuelled LAC self-efficacy throughout their time in care. This is in line with research

into self-efficacy, as it highlights that self-belief in one's efficacy is contributed to by past

achievements (Schuck, 1982). A young person who has a sense of achievement is likely to have

greater confidence in planning for their future (Rutter, 1999). The wider field of resiliency research

suggests raising self-esteem and self-efficacy encourages individuals that they can overcome life's

difficulties as opposed to feeling powerless to them (Rutter, 1999).

However, self-efficacy and reliance can become an obstacle. If LAC focus upon their

independence and self-reliance exclusively, it can be unhelpful, but if self-efficacy is focussed on

enabling social engagement, it becomes a positive force. A couple of studies revealed self-reliance

could hinder the LAC’s ability to form supportive relationships, blocking them from strengthening

their resilience through broadening their social networks (Samuels & Pryce, 2008). This is supported

by Howe (1995), who found that, for individuals in the general population to be resilient, good quality

social relationships are usually important. In other words, it is plausible that a culmination of LAC’s

self-reliance, their tendency to have difficulty forming relationships, coupled with ‘generic and

impersonal’ care from surrounding networks (social workers, designated teachers, peer groups), may

impact the development of the resilience factors.

Similarly, friendships and social acceptance were implicated as protective factors but only

when it is from a positive social group (e.g., classroom acceptance). The review found that, when

social acceptance was gained from what might be called the "wrong crowd" (a negative social group),

this type of social acceptance can lead to an increased likelihood to engage in substance abuse,

criminality, and unsafe sexual behaviours. Furthermore, Rutter (2012) argued that, for resilience to

transpire in the general population, there needs to be a discontinuation of negative past associations

and exposure to new opportunities, supporting the distinction between the influence of negative and

positive peer associations. This is supported by Melkman, (2015), who reported that a LAC who does

not receive school/class acceptance is more likely to seek approval/ acceptance from a more 'deviant'

social group. Research, in general, has established that this population is likely to feel marginalised

and stigmatised because of their Looked After Children status (Peters, 2005), as well as their potential

need of mental health support (Beck, 2006). It is plausible that difficulties, coupled with their desire to

be accepted, leave them vulnerable to seek it from peers that expose them to risky behaviours.

Together, this highlights the need to help LAC integrate with peers positively.

Positive peer influence was not limited to the school setting. Quarmby, (2014) revealed that

young people in the study engaging in extracurricular activities also can provide this. This study

highlighted how crucially important extra-curricular activity was, as it provides a forum for young

people to meet others and to develop self-efficacy. For the young people, it was considered a means to

an end; they enjoyed the activity, and it provided more meaningful gains. This process can be

considered as a possible example of processes/ factors facilitating the emergence of others, which was

referred to earlier. However, as this study had a small sample, the findings need to be treated with

caution.

This result can contribute to the development of new or existing interventions. In the wider research

field, there is research attempting to look into the effectiveness of interventions that promote positive

outcomes. Liabo, Gray and Mulcahy’s (2013) systematic review appears to be saying that, whilst

there is a will to look at the development of interventions within the school context, the scale of the

research is limited, so no conclusions can be drawn, leaving the field open to develop larger scale

interventions. Addressing social engagement and self-efficacy for all young people with low self-

esteem, this form of intervention would include LAC, whilst not making them a special case, as a

significant number of young people experience low self -esteem and the consequent low self-efficacy

for a variety of reasons. Therefore, the studies were unable to provide evidence of effectiveness,

possibly because it was unitary, where LAC require a more holistic and all-encompassing approach to

their resilience building (Brewin & Statham, 2011).

In this review, there was a recognition of turning points being important in the development of

resilience. The turning points within the wider literature have been identified as stressors by

Antonovsky and Bernstein (1986) or periods of adversity by Van Breda, (2001), with the latter author.

This is suggesting adversity can have a contributory effect to the development and strengthening of a

person’s resilience. This idea of ‘turning points’ is not new to the field of resiliency, as this has been

previously reported on by Howe (1995). He also offered examples, stating a new relationship or

family may lead to a change in trajectory for the LAC.

Limitations

The majority of papers included in the review came from western societies, and as previously

highlighted, they were predominantly unrepresentative of minority ethnicities, with the exception of

Daining and DePanfills (2007). Also, the primary studies that utilised heterogeneous measures and

methods reduced the weight of the conclusions that can be drawn from this review. This heterogeneity

in methodology also made synthesising results and findings challenging. Employing a narrative

synthesis for quantitative data (instead of an integration of data) limits the conclusions drawn from the

quantitative studies. However, as argued by Sarkar & Fletcher (2014), qualitative, quantitative, and

mixed methodologies are best positioned to explore the interplay of factors in resilience.

Future Directions

There is a need for a consensus on how to operationalise resilience and better define the

parameters of the construct. There are several research questions that warrant further exploration,

such as a need to develop a greater understanding of the factors that lead to resilience and how they

blend in a framework. Some authors have suggested a hierarchy, but it is possible that the scaffolding

supporting resilience may have a different shape, depending on the discrete factors in question. The

relationship between trait and process factors would also benefit from further exploration, with lesser

studied resilience factors, such as faith, aspirations, and interactions with birth parents. Additionally,

further exploration is needed into the processes involved in developing and sustaining resiliency in

LAC.

Adult stakeholders have been identified as being able to identify what resilience factors are held by

LAC. This expertise could be utilised to facilitate strength-focused interventions for LAC to build on,

such as relationships between LAC and supportive adults. The research has identified gender differ-

ences across numerous resilience factors; these differences need to be incorporated into assessments

and to help inform direction of the support offered.

This review also highlights the importance of support networks and encouraging LAC to engage in

extra-curricular activities to expand their networks and expose them to positive peers. The implication

for practice is that the benefits of extra-curricular activities and support networks need to be more

broadly recognised, with policies and procedures associated with LACs care. There is a need to make

it easier for friends/families to be risk assessed to facilitate these networks to avoid marginalisation

and facilitate engagement through peer-focussed activities.

Conclusion

In conclusion, the extant literature has demonstrated the numerous ways resilience is being

operationalised. This process is impacting the researcher’s ability to examine this construct within the

general population, as well as specific sectors, such as LAC. The available literature suggests there is

complex interplay between internal and external qualities. Gender appears to interact with some of

these factors, whilst others appear to facilitate the development of critical aspects of resilience

development. Further research needs to be undertaken to look at the possible linear and hierarchical

relationships between these factors.

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Overview of Clinical Experience

Adult Mental Health

I have been afforded the opportunity to develop my clinical experience in adult mental health

through the placement based in an Adult Community Mental Health Recovery Team. In this

placement, I predominately utilised Cognitive-Behavioural Therapy model (CBT), with some

Schema therapy and Narrative therapy. During this placement, I was able to work with

individuals with a range of enduring mental health difficulties such as Paranoid

Schizophrenia, Bipolar Disorder, Borderline Personality Disorder, Depression, Panic

Disorder, Phobias, Obsessive Compulsive Disorder (OCD), anger, assertiveness difficulties,

Post Traumatic Stress Disorder (PTSD) and Generalised Anxiety Disorder. For each of these

presentations, I formulated and delivered intervention but at times I developed a care

packages in conjunction with other professionals (e.g. occupational therapists and nurses)

which at times lead to joint working. I also had the opportunity to co-facilitate a CBT based

skills group for clients with enduring mental health difficulties as well as the course

‘STEPPS’. I also evaluated this to inform service developments. I also conducted

neuropsychological and extended assessments that queried memory difficulties and explored

possible Korskoff Syndrome.

Older People's Mental Health

Working within an Older Adults inpatient setting and Community Mental Health Team

provided me with valuable experience with this population and enabled me to be able to work

intergratively. For this setting, I drew upon systemic and Cognitive Behavioural Models.

Additionally, I was able to widen my knowledge and understanding of the needs of this

population as well as the psychosocial changes associated with ageing. As a part of this

placement I conducted assessments for dementia, to provide a neuropsychological profile to

inform the diagnosis. Alongside this I provided pre-assessment counselling and post

diagnosis support. This enabled me to deepen my understanding of differing

neuropsychological profiles of various types of dementia. I also visited various care homes to

complete observations and worked with families caring for elderly relatives. I also provided

therapeutic input for individuals with anxiety and depression and provided training for ward

staff for managing behaviours that challenge and self-care.

Child and Adolescent Mental Health and Advanced competencies

For this area, I gained experience of child and adolescents mental health through a few

settings. This included a child and adolescent mental health setting, a child and adolescent

learning disability mental health service and a paediatric psychology hospital department.

For all of these settings I predominantly adopted an integrative approach drawing upon CBT,

systemic, narrative and psychodynamic techniques. During my time at CAHMS I worked

with children with anxiety, low mood, as well as with young people with youth offending

behaviours, histories of sexual assault and Foetal Alcohol syndrome. I co-facillitated an

anxiety management group for young people age 12-17 and their parents. I also worked with

a range of young people and families from a range of ethnicities and taken in to account

cultural differences and it impact of therapeutic work. For this placement, I completed

cognitive assessment to inform learning disability diagnoses.

In the child and adolescent learn disability placement, I was fortunate to gain experience

in adapting therapeutic interventions for children and young people with learning disabilities

for presentations of OCD, behaviour difficulties, autism (ASD), and trauma related. I have

attend observations of young people lasting the duration of a class room lesson, to half a day

for an individual who was in a care home attending a day service. These to placements

expanded my knowledge and enhanced my skillset in social care procedures, risk assessment/

management as well as complete assessments around capacity and sexual understanding.

I completed my elective Placement in a Paediatric Psychology team. During this time, I

worked with a range of children and young people (5-16) who have a diagnosis of physical

health difficulties such as Pectus Excavatum, Chron’s Disease and Spina Bifida; and were

struggling with a mental health difficulty related to their condition or impacting their

conditions (appearance anxiety, low mood, general anxiety disorder or sleep difficulties,

trauma related to hospital stays).

Learning Disabilities

This experience was gained in a Community Adult Learning Disability Team. In this

placement I worked with a variety of presentations such as anxiety, PTSD, low mood, anger

difficulties and behaviours that challenge. For this placement I drew on CBT and systemic

principles and adapted the techniques to make it accessible to people with learning

disabilities. The therapeutic input mainly surrounded individual work around anxiety,

emotion regulation, adapted CBT for PTSD, behaviour activation and anger difficulties.

Other work I completed took the form of family work, consultations with colleagues and staff

teams. I conducted a number of observations in care homes, homes and days services as apart

of extended assessments for dementia and for behaviours that challenge. For the latter, I also

employed the technique of functional analysis to help develop a better understanding of

presentations and inform behaviour plans. As a result of this work, I also gained further

experience in safeguarding issues for this population, specifically around risk assessing the

behaviours that challenge as well as assessing capacity. Lastly, I completed a number of

neuropsychological assessments to assess for learning disabilities, contribute to diagnoses as

well as identify strengths and weaknesses.

PSYCHD CLINICAL PROGAMME

TABLE OF ASSESSMENTS COMPLETED DURING TRAINING

Year I Assessments

ASSESSMENT TITLE

WAIS WAIS Interpretation (online assessment)

Practice Report of Clinical Activity

Case Formulation of Female, in her late 30’s with a diagnosis of Borderline Personality Disorder.

ASSESSMENT TITLE

Audio Recording of Clinical Activity with `Critical Appraisal

Critical Appraisal of therapy session with a young man with symptoms of depression.

Report of Clinical Activity N=1

A case report of an intervention with a young man with symptoms of Depression and Post Traumatic Stress Disorder.

Major Research Project Literature Survey

Survey of Research exploring the needs of Looked after Children during period when they Transition from Primary to Secondary School

Major Research Project Proposal

Understanding BAME Looked after children experience of peer support: An Exploration of BAME Young People’s View of Looked after Children and What helps them Sustain Relationships.

Service-Related Project Feedback from individuals who completed the Systems Training for Emotional Predictability and Problem Solving Skills training Program.

Year II Assessments

ASSESSMENT TITLE

Report of Clinical Activity/Report of Clinical Activity – Formal Assessment

A case report of an extended formal neuropsychological assessment of an older adult in her mid -seventies

PPLD Process Account The Process: A reflective account of the development of the Practitioner using the Personal and Professional Learning Discussion Group

Year III Assessments

ASSESSMENT TITLE

Presentation of Clinical Activity

intervention for a lady in her late 30s with Down Syndrome

Major Research Project Literature Review

Resilience in Looked After Children: What helps children in Care attain positive outcomes in spite of adversity? A Systematic Review and Narrative Synthesis of Quantitative and Qualitative Evidence

Major Research Project Empirical Paper

Black young people’s perspectives on friendships with Looked after children: A Thematic Analysis

Report of Clinical Activity/Report of Clinical Activity – Formal Assessment

A CBT piece of work within a system of a young man with Autism Spectrum Disorder, Obsessive and Compulsive Disorder and a Learning Disability.

Final Reflective Account On becoming a clinical psychologist: A retrospective, developmental, reflective account of the experience of training

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