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Children and Youth Services Review 35 (2013) 14551462

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Children and Youth Services Review

journal homepage: www.elsevier.com/locate/childyouth

Anti-social youth? Disruptions in care and the role of behavioral problems

Turf Bcker Jakobsen
SFI The Danish National Centre of Social Research, Herluf Trolles Gade 11, DK-1052 Copenhagen K, Denmark

a r t i c l e

i n f o

a b s t r a c t
This paper explores the mechanisms behind the disturbingly high occurrence of placement disruption among young people in out-of-home care. Discussions have usually been framed in a vocabulary of risk and protection, with the bulk of research designed for singling out factors that correlate with stability and discontinuity in care arrangements. From this research tradition, we have learned that behavioral problems are by far the strongest predictor for disruptions in care. By exploring the quality of care as experienced by young people themselves, this study suggests an alternative strategy. Findings suggest that disruptions occur as a result of complex social relations, as when young people struggle to t in among other troubled youth in demanding residential settings. The paper concludes that labels such as behavioral problems may have a reifying effect that individualizes the problem of care disruption while not being particularly helpful in explaining the phenomenon. 2013 Elsevier Ltd. All rights reserved.

Article history: Received 6 December 2012 Received in revised form 21 May 2013 Accepted 22 May 2013 Available online 2 June 2013 Keywords: Placement Disruption Instability Behavioral problems Anti-sociality Social context

1. Introduction

Without a measure of quality, any meaning given to high versus low numbers of placement moves is open to question. [Unrau (2007: 129).] For more than 50 years, researchers have struggled to explain the high occurrence of unplanned moves or placement disruptions for children and young people in out-of-home care (Oosterman, Schuengel, Slot, Bullens, & Doreleijers, 2007). Young people in particular are likely to experience considerable care discontinuity, and studies from the past twenty years conclude that between one third and more than half of all teenagers going into care will experience unplanned placement moves (Jnsson, 1995; Vinnerljung, Sallns, & Kyhle-Westermark, 2001). Looking at foster care placements alone, an international review nds disruption rates between 20 and 40% when all age groups are considered (Egelund, 2006). To some extent, variations in disruption rates reect differences in research designs and the groups of children under study. For example, substantial research consensus exists on the potential of kinship care for warding off unplanned moves (Berridge & Cleaver, 1987; Millham, Bullock, Hosie, & Haak, 1986; Vinnerljung et al., 2001). Nonetheless, the consistently high level of instability in care arrangements is disturbing, as most researchers point out the detrimental effects of

Tel.: +45 3348 0855, +45 2342 3016(Mobile). E-mail address: tbj@s.dk. 0190-7409/$ see front matter 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.childyouth.2013.05.012

disruptions for cared-for children (e.g. Baxter, 1988; Berridge, 1997; Festinger, 1983; Newton, Litrownik, & Landsverk, 2000; Rushton & Dance, 2004; Ryan & Testa, 2005). That providing stable living conditions for troubled children and young people constitutes a primary objective of the placement intervention only exacerbates this problem. Thus the massive occurrence of unplanned disruptions also poses a threat to the legitimacy of child protection services, pointing to the inability of public authorities to carry out placement decisions that are typically taken not long before the care arrangement falls apart (Egelund & Vitus, 2009). Thus far, discussions of disruption in out-of-home care have been framed in a vocabulary of risk and protection. Within this research tradition, predominantly quantitative studies involving a longitudinal perspective have been designed for investigating and singling out factors that may inuence or correlate statistically with placement disruption or, correspondingly, with placement stability and continuity. Generally, studies on care disruption have focused on four types of explanations, associating risk and protective factors with characteristics of the child or young person, the biological parents, the care environment, or the casework process (Sallns, Vinnerljung, & Westermark, 2004). Comparing ndings from this long research tradition tends to be complicated. As Egelund (2006) notes, studies on disruption in care have taken place over many decades, from the rst wave of studies in the 1960s and early 1970s (George, 1970; Parker, 1966; Trasler, 1965) to the more recent research development beginning in the late 1980s. During this period, the nature of the care landscape has changed along with dominant views of the generic problems of the children in need of care. However, one nding emerges with remarkable regularity over time, irrespective of national context: the key role of behavioral problems. Thus, in trying to locate vital risk and protective factors in


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terms of care disruption, almost every study that considers the individual characteristics of the child or young person establishes a correlation between the frequency of placement disruption and the occurrence of behavioral problems (Barber, Delfabbro, & Cooper, 2001, 2002; Berridge & Cleaver, 1987; Delfabbro, Barber, & Cooper, 2000, 2001; Farmer, Lipscombe, & Moyers, 2005; Fenyo, Knapp, & Baines, 1989; Fratter, Rowe, Sapsford, & Thoburn, 1991; George, 1970; Jnsson, 1995; Kelly, 1995; Kendrick, 2000; Millham et al., 1986; Newton et al., 2000; Pardeck, 1984; Rushton & Dance, 2004; Sallns et al., 2004; Sinclair & Wilson, 2003; Skuse, Macdonald, & Ward, 2001; Strijker, Zandberg, & van der Meulen, 2005). Indeed, Egelund's (2006) review nds only one study (Cautley, 1980) that does not produce a correlation between care disruption and the socially inexpedient conduct of children or young people themselves. In other words, an astounding research agreement appears to prevail that children and young people described as having behavioral problems are more likely to experience unstable placements than cared-for children with other kinds of difculties. At rst glance, the correlation between care disruption and behavioral problems rings true; it makes sense that this kind of difculty constitutes a crucial risk factor in terms of placement instability. However, children and young people are often placed in care as a result of difculties related to their conduct, e.g. in the wake of extensive school truancy and conicts with adult authorities. Later on, the placement appears to break down as an implication of these same behavioral patterns, e.g. when young people are being expelled from placement settings. This element of recurrence has led some observers to conclude that problem behavior represents both a cause and a consequence of placement disruption (Newton et al., 2000). But if so, we need to ask precisely how useful the notion of problem behavior is in trying to explain unplanned placement moves. This paper suggests a different analytical framework for understanding disruptions in care. Instead of looking at isolated elements of risk and protection, I investigate care arrangements that are dispersed in unplanned ways by looking into the quality of care and the social contexts integral to out-of-home care. The paper argues that behavioral problems do not explain much in their own right. That a great number of young people in care display some kind of troublesome behavior is clearly true, else many would not be candidates for public care in the rst place. However, arguing for the decisive role of those problems in terms of unplanned placement moves is another matter. To come closer to an understanding of disruptions in care, I suggest that we need more detailed knowledge on care quality as experienced by children and young people themselves. 2. Key terms and concepts Denitions of unplanned placement moves differ among studies, and the vocabulary for describing the very phenomenon itself has been subject to controversy (Minty, 1999). Whereas the term breakdown or disruption in care is used most frequently, alternatives such as care failure or care termination are also found (Rowe, 1987). In this paper, I mainly employ the formulation care disruption. The reason for so doing is that most other concepts tend to carry unhelpful connotations, especially among social work practitioners. For example, care breakdown is often viewed as the immediate result of a shattered relationship between cared-for children and their primary caregivers. As I will demonstrate, this is not necessarily the case. The strand of research concerned with care disruption is clearly related to the discussion about the pursuit of permanence in out-of-home care (Sinclair, Baker, Lee, & Gibbs, 2007). However, studies of care disruption constitute only a subset of the much wider literature on permanence. Placements may be ended for a number of reasons, some altogether sensible, as when children are placed and assessed in special institutions before moving into more long-term care arrangements. Such types of instability are not under study in

this paper. In line with Vinnerljung et al. (2001), the key word here is unplanned. In short, when looking at care disruptions I refer to placements that are terminated prematurely in an unplanned manner either by the child or young person, the parents, the care providers (foster parents or residential staff) or the responsible social authorities. The notion of behavioral problems is a correspondingly intricate matter and, as Berridge (1997) emphasizes, such problems may be dened in a number of ways. This conceptual uncertainty is noticeable from the literature, which has referred to behavior-related issues as, for example, anti-social behavior (Sallns et al., 2004), conduct disorder (Osborn, Delfabbro, & Barber, 2008) and emotional and behavioral difculties (Ward, 2009). Sometimes denitions are based on clinical screening tools such as the Strengths and Difculties Questionnaire (SDQ) or the Child Behaviour Check List (CBCL); in other cases denitions are less precise. However, even though the wording differs, behavioral problems and their implications for care stability are discussed in a like manner across a wide range of publications. Thus studies have reached more or less similar conclusions over at least three decades, demonstrating that troublesome externalizing behavior among cared-for children and (especially) young people links closely with an increased risk of care disruption. 3. Methods and analytical approach The ndings in this paper come from the rst major study of disruptions in out-of-home care for young people in Denmark (Egelund, Jakobsen, Hammen, Olsson, & Hst, 2010; Egelund & Vitus, 2009; Olsson, Egelund, & Hst, 2012). The study comprises a qualitative part, based on in-depth interviews with 12 young people in care and adults relevant to their placement process (n = 45), and a longitudinal, quantitative part, building on survey data from 225 young people placed in care by the Danish Child Protective Services in 2004. The qualitative study constitutes the main data source for this discussion. The twelve young people, aged 1621 at the time of the interview, were selected randomly from the sample of 225 teenagers. However, as disruption in care was the main analytical theme, a majority of interviews were conducted with young people who had experienced at least one unplanned placement termination. The number of disruptions ranged from 1 to 11 throughout each care career. Most of the interviewees had been placed in care for the rst time as teenagers, while a few had been in care for large parts of their lives. To allow for comparison between successful and failing care arrangements (an initial but somewhat misguided conception of ours), the study included four young people with continuous, non-disrupted placement stories. While the qualitative study comprises 45 interviews in total, the narratives of the young people themselves constitute the cornerstone of the study. These interviews focused on the experience of being placed in care, key events before and during the placement, social relations within and outside the family, and the importance and meanings attached to disruptions in care (if such events had taken place). In general, these young people were profoundly outspoken and detailed in their descriptions, and they demonstrated admirable patience with the interviewers. Some of the interviews clearly exceeded the format of accounting for the care career, turning instead into interviews closer to the life story genre. Methodologically, a crucial feature of the qualitative study was to follow the conict (Marcus, 1995). The intention was to look at the disruptions in care not as isolated events but as contextualized processes with a diversity of potential meanings. In each case, the point of departure was the individual story of the young person. Gaining further insight into the dynamics of the specic care process then involved talking to those people who, in the eyes of the young person, were in some way vital actors in the placement process, including parents, caregivers (staff at residential units and foster parents), caseworkers, and so-called personal contacts (street-level social workers appointed by the local authorities providing everyday support and

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guidance). Sometimes the relevant interviewees were difcult to locate. On more rare occasions, such persons were found but not willing to give interviews, as with a foster family with the record of a particularly difcult care arrangement. The latter case was a reminder that disruptions can also be traumatizing for care providers. Biological parents turned out to be difcult to include, either because the young person did not want them interviewed or because the parents themselves refused to participate. We managed, however, to record the perspective and insights of parents in a handful of cases. The analytical approach in this paper is inspired by the work of Unrau (2007). In her article on Seeking the perspective of foster children, Unrau calls attention to standpoint theory and its relevance to the study of children in care. Building on Swigonski (1994), Unrau highlights a prominent feature of standpoint theory, noting that: any one phenomenon or event such as a placement move has attached to it several standpoints, or points of view, and that (u) nderstanding comes from concrete experience that is tied to an objective location, or the place from which people view or interpret their worlds (Unrau, 2007: 123). Given that some groups will typically hold power over other (marginalized) groups in terms of voicing their own standpoints and experiences (ibid.: 125), Unrau reviews the ways in which the perspective of foster care children is represented (or not) in research on placement moves. Following Unrau's thinking this study is based on the assumption that giving voice to the different actors involved in the care process is essential to understanding the underlying dynamics of placement disruptions. As their own stories provide the point of departure for this type of research, the voicing of young people's perspective is pivotal to such contextualized understandings. I will return to some of Unrau's points in the discussion section, as they are highly relevant to the issues at hand. A few details of Danish out-of-home care services are necessary here, particularly that residential care holds a much more dominant position in Denmark than in most other Western countries. Nearly half of all children in care and the majority of young people entering care are placed in some kind of institutional setting. Institution, however, is not a xed category: it covers a wide range of residential services, from traditional children's homes and specialized therapeutic residential units to secure accommodation and socio-pedagogical homes. This last category, widely used for young people, is characterized by a relatively low degree of institutionalization, for example taking the shape of small-scale units with staff-members living in or nearby the care facilities. Particularly if they have entered care as teenagers, young people in Denmark will be acquainted primarily with institutional placements. 4. Findings As previously mentioned, the backdrop of the qualitative study was a longitudinal study of 225 young people entering care across a number of Danish municipalities in 2004 (Egelund & Vitus, 2009). By the time of the nal data collection in 2009, 44% of the young people had experienced at least one unplanned care movement. The majority of these disruptions (62%) took place within the rst year of the placement (Egelund et al., 2010; Olsson et al., 2012). While it may appear dramatic that almost every second young person in the study would experience one or more collapse of the care arrangement, these results are in line with research ndings across the Western world. Nonetheless, the fact that ndings are internationally recognizable does not make them any more intelligible, or any less in need of explanation. Importantly, no correlation was found in the Danish material between disruption rates and any behavior related issues. Indeed, none of the characteristics of the young people themselves could be effectively linked to the risk of care disruption. The only factors that held any statistical explanatory power were associated with the

care environment. Thus caring for more than one young person in the setting increased the risk of disruption, while placement in open residential care decreased the risk (Olsson et al., 2012). The generally poor level of statistical correlation found in the quantitative dataset urged us to consult the qualitative interview data, to look for other kinds of connections and explanations. At this stage, the complexity of the matter became evident. Even if the qualitative study dealt only with a limited number of cases, the stories of the 12 young people (and the views of the 45 key stakeholders) unveiled intricate webs of relations and connections between actors and events. Only on rare occasions would a care disruption appear as an easily explicable single-factor phenomenon. Much more often, that a care arrangement had to come to an untimely end was comprehensible only when viewed as a combination of multiple factors working together in unfortunate ways. Moreover, from a care quality perspective the presence or absence of disruptions clearly constituted a too limited explanatory framework. All 12 cases represented detailed stories of young people struggling to nd their way through adolescence with vulnerable parents, complicated peer relations and demanding placements. In these processes, care disruptions often constituted important personal turning points as heralds of changing times, different places and new people to face. But whether such changes were for better or worse could not always be determined unequivocally. In presenting the ndings from the qualitative study, I take into account this level of complexity. The aim is not to offer an exhaustive account of the comprehensive data set, but rather to present and analyze in detail three individual cases of young girls going in and out of various placements. My purpose is to explore the complex links between concrete events during the care process and the outcomes of the placement with a particular view to care disruption. The social authorities considered all three girls as having some sort of behavioral problems (as were most of the young people interviewed). Two were placed in care as teenagers, partly as a result of their difcult social conduct in relation to adult authorities at home, school or elsewhere. The last case concerns a young woman who was placed in care for the rst time as a pre-school child and who, over 15 years and 11 placements, has been viewed by basically everyone around her as a strongly anti-social person. Nevertheless, the three cases raise the question of whether the notion of behavioral problems is really the most helpful conceptual frame for understanding the extensive occurrence of care disruptions. The three cases do not differ signicantly from the larger qualitative sample. Although all three stories concern young women, gender is not an important feature for their relevance in this context. While the cases represent individual care career stories, my argument is that the processes involved, leading towards disruption in care, are indeed more general. 4.1. Julie: I didn't need a family anymore When we meet Julie, aged 18, she is still in care but living in a at of her own, closely supervised by a personal contact (as part of the after care services provided by the municipality). From age 13, Julie has lived alternately with her mother and at different residential institutions. Initially, Julie is placed in care due to escalating conicts with her mother and after a period of massive school truancy. She moves into the Farmhouse, a local children's home, situated close to the mother's place and the local public school that she still attends. Although Julie stays at the Farmhouse for almost one and a half years, she never really appears to settle in. She is often home with her mother, and the troubles in school only intensify. Julie explains: It was all right at rst. I had a brand new duvet, bed-linen, clothes, everything. It was really cool. But then the staff began to set up all kind of rules. And they didn't even know me! I wasn't used to


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coming home every night. I was used to doing whatever I wanted. When they told me to come home at 6:00 p.m. and stay in after 9.30 p.m., I said: What are you talking about? I didn't give a damn. On weekends, me and the other girls sneaked out the window and went clubbing. So, yes, I guess it didn't go so well (). I skipped school altogether. My teacher had told the class that my mother was ill from cancer, and that was why I had been acting a bit weird lately. Alright, I reckoned, in that case I don't want to go there anymore. Also, the other kids were giving me funny looks, because I was living in a children's home and all (.). I dropped out of school and spent my days in the woods instead, making bonres with a friend from the institution. The staff called my mom. They said: Julie isn't going to school again. She told them: I bloody know that, why do you think I sent her off to you lot? Try and do something about it, I don't know what to do! The care arrangement eventually breaks down, and Julie returns to her mother's house. But the domestic conicts continue and after a while another placement is found. Wiser from experience, Julie's caseworker suggests something very different from the children's home: a socio-pedagogical home with just a few other residents and a family-based structure. This placement, however, is no more successful than the rst, even though Julie's difculties take a slightly different course in the new setting. She recalls: The staff was annoyingly cute. The female pedagogue was a real old hen, I tell you she could cry if you didn't show up for supper. The other pedagogue, he tried to be funny. When I moved in, I had put on a lot of weight because of that disease of mine. I gained 80 pounds in six months. On the day of my arrival, he's wearing a T-shirt that says: Fat people are harder to kidnap. He thinks it's hilarious, and he says: Look! I don't think it's funny at all. What kind of place is this, I remember thinking. I went straight to my room. He felt bad about it and brought me a DVD and a lot of grapes. The staff was all right, but it was not what I needed at the time. I didn't need a family anymore. I needed to learn to take care of myself. I was 15, almost 16. Julie repeatedly gets into conicts with the staff. When they realize she has been smoking hash on the premises with a younger resident, she is expelled. After the disruption, Julie moves back with her mother but stays mostly with friends. For a short while, she moves in with her stepfather, who no longer lives with the mother. Like the mother, however, the stepfather struggles with substance abuse issues, and the housing is only temporary. Julie is persuaded by her caseworker to contact her biological father with whom she has only had sporadic relations since early childhood. The father offers Julie a bit of money but otherwise rejects her. The caseworker acknowledges Julie's difculties and offers to look for a third placement. The caseworker clearly remembers the considerations at this stage: Once again, we begin looking for a placement that ts Julie, and we are really giving it some thought. We ponder deeply on the insights we've gathered over the years, concerning Julie's personality, and we think about the institutions where she's been placed. Foster care, we agree, is not the answer. She's too old for that, and she already has a family. Also, we're not going to put her in a large institutional setting like the Farmhouse again. Finally, and somewhat by chance a new placement is found. The caseworker describes the place as a socio-pedagogical home without the home, involving Julie living in a at of her own with close professional supervision. After some initial doubts, Julie begins to feel at home. She points to the personal contact, Martin, as the real protagonist of the changes taking place in her life: Martin is perfect! He never tells you what to do. He offers advice. He can be downright infuriating, because he's so right. At one

point, I was banging on about my girlfriend who cannot take advice from anyone, because she never listens to any of it. You spend your time explaining things to her, and she goes out and does the exact opposite. Then he said: Excuse me, what are you doing? I can only agree. It's so provoking, and when it's provoking, it's like you have to do something about it. He never cuts you down or tells you what to do. He helps you when you need it. When I've been messed up in things like that lawsuit, he actually thinks about it and engages personally (). I'm important to him too. I know he was worried when I had that car accident. He called me, but I couldn't ask him to come around to the hospital, it was 8 o'clock on a Sunday morning. But he just came straight away. No discussion whatsoever. After a long period of turbulence and two complicated care disruptions, Julie feels relatively at ease with her life situation. She is also beginning to think about the future in terms of education, working possibilities and romantic relationships. Julie's case complicates the common picture of the inevitable value of stability in care. First, contrary to the care process of most of the other young people in this study, the casework conducted in relation to Julie and her mother is characterized by a profound level of continuity and thoroughness. Indeed, nding families who have had the same personal entry point with the local authorities for more than a decade is highly unusual in social work today. In Julie's case, the municipal caseworker is knowledgeable not only about the girl's situation but also about that of her mother and the family. This knowledge clearly leaves the child protective services with a much better foundation for making qualied and professionally informed decisions than in most cases. Nonetheless, the two rst placement decisions turn out to be sheer failures. The point here is not that the casework should have been even better informed. Rather, the case indicates that the needs of young people on the verge of critical placement decisions cannot always be easily predicted. Indeed, what appears to everyone involved to be the best solution may sometimes turn out for the worst. Moreover, Julie's story shows that just as young people change over time, so do their care needs. Julie obviously had different expectations of an out-of-home placement at age 13 than what she saw as meaningful when turning 17. High disruption rates may therefore somewhat reect children and young people growing out of care, even if neither care settings nor local authorities recognize this change. Finally, Julie's bumpy placement at the Farmhouse demonstrates how disruptions always take place in a social context. Even if Julie plays an individual role in the wreck, she is also a passenger on a ship bound for the rocks. The Farmhouse is a municipal residential setting, the rst choice of the local authorities and expected to deal with young people arriving with a great variety of difculties. After a relatively short while, the understaffed institution appears to give up on Julie, leaving her to her own devices. The importance of the context of care and its signicance in terms of the risk of disruption is explored further in the next case. 4.2. Sarah: They don't have a clue what it's like to be young Sarah is 9 years old when her mother ees a violent husband, bringing her three small daughters with her to a crisis center. Later, the family moves in with the mother's new boyfriend. Sarah has a hard time living with the new stepfather, and conicts abound. At age 13, Sarah is placed in residential care for the rst time. A few months later, she runs away from the institution and refuses to return. She badly misses her smaller sisters and her mother, so she moves back with them. The family is evicted from their at several times, and for a period Sarah stays with various friends and acquaintances. Sarah has a personal contact, Thomas, who increasingly worries about her situation. Thomas succeeds in putting pressure on

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the caseworker to allow for another placement. This time Sarah is placed in a small residential unit for young people. But again, after little less than three months, the care arrangement is disrupted. According to the residential unit, the disruption stems from conicts between Sarah and the other residents, and they label the episode an overreaction on her side. Sarah has a different view of the events leading up to her decision to leave: One Sunday evening, I'm coming home to the unit. I'm having a chat with one of the other girls. Suddenly all the boys are coming over. They have been smoking hash, and they act really weird. Maybe they have been doing other drugs too, I can't say. Later on, I speak to my personal contact about it, and I ask him if he thinks I should tell the staff (about the drugs). He believes it's the right thing to do, and I go and tell them. But they already knew. One of the other girls had already told them. She'd been part of the smoking, and she was sorry about it. She wanted to quit the drugs. I didn't turn anybody in. I had planned to, but I didn't. Still, I'm blamed for turning everybody in. The three boys from the unit blamed me for everything. One of them was going to the same school as me, and he told everybody. Bloody hell, I was thinking, this is it. I called my mom and told her how I felt and that I didn't want to go back. Subsequently, a meeting is held at the residential unit with the participation of the staff, Sarah, her mother, Sarah's personal contact and her caseworker. The caseworker explains: At the beginning of the meeting, I was thinking that we were going to nd some solution. But somehow things were already out of control. Sarah had decided that she didn't want to stay there anymore. We are all talking at the meeting, and I believe she feels a lot of pressure. She thinks we're a bit annoying and unable to appreciate her situation, since we all agree it's a silly thing to move out so quickly (). We try to explain that it was right of her to tell the staff, and that the other kids need help to stop smoking hash. She denitely considers us to be ignorant adults, just sitting there with all our little pieces of advice. She gets frustrated and angry. The caseworker's analysis of the situation is quite accurate. Sarah recalls the meeting and the disturbing occurrences around the disruption in the following way: Yes, we had a meeting. The staff believed that it was foolish of me to move out, that I should rather stay and give it a chance. People like that don't have a clue what it's like to be young. They're not even close. I tried to explain. They didn't think I'd turned anybody in. I didn't think so either, but other people did. I know how you're treated when you've done something like that. I'm young, I just know. And I didn't want that to happen. I didn't want to be the black sheep down there. No one protected me, and they were all taking it out on me. I couldn't take it. I've been bullied all my life, and then suddenly I'm told that I'm an informer. A recurrent theme in the interviews with the young people is that patterns of marginalization and social exclusion experienced before the placement are reproduced in the care setting. This paradox is related specically to institutional group care: serious conicts with peers and adult authorities often play an important part in the decision to place a young person in care, but rather than dampening it, the group home in many cases supports or even intensies the level of conict the bullying, in Sarah's words. The social mechanism is a general one, allowing most newcomers to occupy only a low position in the powerful informal hierarchy of residential care. While such social processes are well described, they have rarely been linked to the risk of care disruption. In Sarah's case, however, the connection is clear: while she is the one to terminate the placement,

holding her individually responsible for the outcome of the conict hardly makes sense. Rather, the chain of events leading to Sarah's exit tells the story of young peoples' need to nd a place and to t in among their peers. Moreover, a look at Sarah's rst institutional placement shows that the disruption is better analyzed at the social, not the individual level. While Sarah terminates the placement by running away from the institution, her main motivation is her feeling the loss of her family and needing to be near her sisters. If one were to look at her case le, Sarah would likely be among the statistics of placements disrupting due to behavioral problems. Indeed, the adults around her appear to agree that she is the one acting inexpediently, even irresponsibly, to what they deem a minor episode. Sarah views the situation the other way round: the disruption is unfortunate but the alternative is unbearable. As a long-term victim of bullying, she knows her own limits and the need for allies. No one protected me I couldn't take it, she concludes. This existential loneliness and how it links with placement disruption is further explored in the last case below. 4.3. Katie: You're at a deadlock, wondering if you dare to move beyond the threshold When interviewed, Katie is 21 years old, living on her own in a small at. Although she has never completed her schooling, she holds an unskilled fulltime job that pays for her needs and provides everyday continuity. The quiet life of the present contrasts sharply with the problems and challenges of the past. From the age of 5, Katie begins to move back and forth between the home of her single-parent mother and a local emergency residential institution. At 9, she is placed in full-time out-of-home care for the rst time. Any expectations that the placement would provide Katie with more safety and stability are rapidly dashed. Katie remembers walking through at least 11 placements, including foster care, kinship care, emergency units, therapeutic institutions, psychiatric departments and secure accommodation. Katie looks back on only one of those placements with any positive association: a two-year stay at a socio-pedagogical home called Amber House: Looking back on all the different places I stayed, it's funny to think about who I was, and what I could have done differently in those situations. I couldn't see it back then, but I see it now. In fact, the only place I didn't feel that I was one hundred per cent on my own would be Amber House. All the other places, it was always on the verge. Sometimes you would get help, at other times you would have to stand completely still, and be independent (). We're talking about public places, children's homes and institutions. You can't tell if you have to act independently, or if you have the guts to take that step forward that you really need to take. In some sense, you're at a deadlock, wondering if you dare to move your foot beyond the threshold, to see if you dare move further in. Often you're kicked right back out again. Katie eloquently describes the difcult situation that children and young people face when going into care: the experience that everything is different from what one knows, with all familiar faces and features dispersed, and a feeling that getting any real help or support involves making the rst move oneself. That rst step is hugely demanding. At Amber House, however, after some turbulent beginnings, things slowly begin to fall into place for Katie. The head of Amber House explains: Katie has never been as close to an adult in a positive relationship as she was here. Every time she was in conict, we had to physically restrain her. It was always me who was holding her. It would be quite erce at rst, and you had to hold her really tightly. Then slowly, you could feel that she was beginning to calm down, certain that someone else was taking responsibility. We had a lot of


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these conicts, several times a day for some time. When she nally would calm down I never forget those eyes. I don't think I ever saw eyes with such tremendous grief in them. However, I believe that when you demonstrate that kind of condence in a child, when you show them that you still care for them, even if they have acted violently or destructively, something begins to happen. The natural human reaction is rejection, conrming these children's perception of themselves as evil. We never do that here, and that, I believe, is the foundation of a relationship (). It has been said for years about these children that they're unable to connect emotionally with other people. This is not true, I'm deeply convinced. They just need the opportunity. The majority of the placements that Katie undergoes through her childhood are disrupted in often dramatic and traumatizing ways. At Amber House, all parties agree for the rst time that the placement is successful and that some positive developments are taking place. Yet despite this success, Katie's stay is disrupted prematurely. After two years, the municipality concludes that the arrangement is too costly, demanding almost the effort of one full-time employee. Although the staff at Amber House objects, the municipality chooses to move Katie to a large residential setting for children with very diverse difculties. Two months later, the new placement is disrupted when Katie is hospitalized with a broken arm from falling as she tries to escape from a group of children at the institution. For the rest of her childhood, Katie continues the uneven pattern of entering and leaving a variety of care settings. Katie's case begs the question of what we really mean when we say that behavioral problems constitute the strongest predictor of disruptions in care. What does the pinpointing of this correlation actually imply? Clearly, Katie struggles with various behavior-related issues, and she is the rst to acknowledge that her actions have had consequences, not least in the shape of numerous care disruptions. But acknowledging the connection is not the same thing as explaining the phenomenon. If we are looking for the meaning behind placements falling apart, we need to look elsewhere. First, contemplating Katie's turbulent care career nearly turns on its head the common research astonishment about the level of care disruptions among young people. From Katie's case, one might wonder how a relatively large share of teenage placements can possibly stay intact and be concluded in accordance with the original plans. We should recognize the courage and willpower a young person needs to go into care and look upon the placement as a new, potentially valuable chapter of life. It is a tremendous personal investment they have to be ready to make and ready to lose. Often, as Katie notes, you're kicked right back out again. Moving from one abortive care experience to the next, she has developed a sound suspicion of any attempt by the many faces of the child care system to pave the way for genuine change. The one clear lesson that she has learned is that she stands alone. Second, the case demonstrates the way in which different factors relating to care disruption are intertwined. By any standard, Katie belongs to the group of young people often referred to as anti-social. As the head of Amber House quietly remarks during our interview, not a single piece of furniture was intact by the termination of Katie's two year stay. Nonetheless, that her anti-social conduct constitutes the only reason for her placements going awry is unlikely. As for the placement at Amber House, the unrivaled success of the arrangement is paradoxically connected to its failure in as much as the treatment is deemed too costly. Finally, Katie's story more fundamentally questions the link between care disruption and behavioral problems. Again, no one would deny that Katie's socially inexpedient behavior is part of her personal complex of difculties. But these problems are clearly neither a constant, nor an inherent personality trait. The course of events at Amber House depicts the ways in which interpersonal relations

and social contexts can affect and alter human conduct, even in cases where difcult and destructive patterns of conduct are highly predominant. Indeed, the residential staff succeeds where others have failed, supporting Katie to a degree that brings her on a markedly different developmental trajectory. The real misery of this case is that an extraordinary socio-pedagogical effort is terminated by the very authorities who organized the care arrangement in the rst place. 5. Discussion and conclusion Thus far I have argued that to reach a better understanding of care disruptions a phenomenon recognized as a major dilemma for child protection services everywhere we need to turn our attention from single factors of risk and protection towards the interpersonal relations and social contexts that children and young people are part of when moving in and out of care. If we want to know more about the complex reasons for the massive level of care disruptions, we need to face the question of what basically constitutes quality in care and tap into the experience of children and young people. Until now, decades of research have focused almost exclusively on establishing correlations between the occurrence of care disruption and single factors related to the children and young people themselves, the biological parents, the care environment, and the casework process. Yet examining in detail the care careers of just a few adolescents shows the critical need for focusing on contexts rather than isolated factors, and for discussing social relations rather than only statistical correlations. The rst-hand accounts of young people in and out of care thus pave the way for developing an alternative explanatory framework for understanding the disproportionate occurrence of placement disruption. This change of research perspective is in line with Unrau's (2007) cogent suggestions from her review study on placement moves. Investigating the various data sources used for accounting for children moving in and out of foster care, Unrau uncovers the level at which research has represented the perspective of foster children and other key stakeholders: she nds that of the 43 studies she examines, more than half are based on case record data, while one-third include foster parents, and only one-fth include foster children as a data source (ibid.: 127). Further, her review reveals that these studies give little information about placement moves as experienced by foster children and parents: Although some studies included parents and foster children as data source, placement data were not often gathered from them. Instead, parents and children provided data for other key study variables, such as well-being measures or additional service history variables. A few studies had caseworkers or foster parents verify the accuracy of placement move data documented in the case records. In no instance was any other data source asked to comment upon the value or meaning of placement move data gathered from case records. (Unrau, 2007: 127, emphasis added). Arguing that our current knowledge base of placement moves is fundamentally detached from or stripped bare of any context (ibid.: 129), Unrau concludes that we have only a faint picture of the nature of the move experience, its quality and its consequences. This paper is an attempt to embrace Unrau's perspective and to address the research gap she has pointed out. The question remains what we can learn about the meaning of care disruptions by qualitatively consulting the perspective of young people in care and other key actors. To begin with, thinking of stability and continuity as indisputable qualities of care may be too narrow an approach for adequately capturing the complexities of such processes. Even if unplanned care moves are rarely cheerful occasions, they may in certain circumstances stand out as positive pathways to better living conditions for the individuals

T.B. Jakobsen / Children and Youth Services Review 35 (2013) 14551462


involved (see also Barber & Delfabbro, 2004; Sinclair et al., 2007). Indeed, care disruptions can become necessary in some cases, simply because children and young people grow and develop during placement along with their changing needs, wants and aspirations. This factor is rarely considered in discussions about care disruption, since such discussions are often built on the assumption that stability in itself is a benchmark of successful placement. Nevertheless, the massive disruption rates demonstrated by numerous studies (and conrmed by the present one), are clearly not satisfactory, either to the young people and their families or to the social authorities providing the services. The key question here is the explanatory power of behavioral problems: does the strong correlation between disruptive placements and the anti-social conduct of young people provides an adequate framework for understanding this pronounced lack of care stability? As the ndings from this study suggest otherwise, we need to look squarely at some of the more disadvantageous aspects of the concept. First, behavioral problems constitutes a rather poorly dened concept (cf. Berridge, 1997). The common roots of the concepts are vague a certain kind of young people demonstrating a certain kind of improper conduct and in practice it may refer to a wide range of problems. This very lack of clarity makes it a very unhelpful tool for analysis. As Vinnerljung notes, behavioral problems constitutes a weak concept with tremendous explanatory power (Vinnerljung, 2010, personal communication). While the explanatory power of the concept is well demonstrated by the existing research literature, the present study makes its weaknesses clearly apparent. All 12 young interviewees exhibit behavioral problems ranging from occasional school truancy over recurrent conicts with adult authorities and to patterns of psychiatric attacks and severe criminal acts. These problems are often, and quite obviously, related to care arrangements falling apart. However, the very diversity of the behavior-related issues complicates the picture, making it difcult to argue for the crucial role of behavioral problems as fully explaining the care disruptions. As Unrau (2007) demonstrates, most studies on placement moves look only at case records or include only case worker perspectives and the risk attendant to limiting studies in this way is that of collapsing behavioral problems into one generic phenomenon. Second, the ndings from this study encourage us to take a step forward to argue for the role of behavioral problems as representing more a symptom than an explanation of care disruption. A look at young people's unstable care careers reveals how the quality of interactions and relations in specic social contexts are crucial to the paths they take and the choices they make. Interestingly, the professionals in this study (caseworkers and staff in residential settings particularly) tend to point out how young people typically are the ones who bring the placements to an end. However, if we listen carefully to the voices of these young people a different but surprisingly familiar picture emerges. What they describe are the well-documented informal hierarchies of residential care and the ongoing struggle of trying to t in among peers in often harsh and competitive social settings. A considerable number of studies have demonstrated the dilemmas of young people in care, dilemmas relating to tacit institutional value systems, e.g. when nding a place of one's own involves participating in or at least condoning the use of drugs or other illegal activities (Barter, Renold, Berridge, & Cawson, 2004; Bengtsson, 2012; Berridge & Cleaver, 1987; Emond, 2004; Stokholm, 2006). Thus far, however, such insights into the social dynamics of young people in restricted settings have not been applied to the problematic of care disruption. This absence is curious, given the social mechanisms at work. Indeed, the young people in this study respond very similarly to the pronounced hardship of nding a legitimate position within their peer group: they ee, once again convinced that the problem of not tting in rests on their own shoulders. Paradoxically, while these young people are often viewed as anti-social, one might argue that they demonstrate a keen awareness of the realities of youth life and an exquisite sensitivity to the consequences of belonging (or not) in complex social settings.

A nal critical remark about the analytical value of behavioral problems concerns the reifying tendencies of the concept. The ndings from this study illustrate that the behavior-related issues of young people in care are not static but dependent on social contexts. Managing young people's socially inexpedient conduct constitutes a massive task for residential care services everywhere, and sometimes the challenges are met in very promising ways. Notions of anti-sociality or behavior problems, however, carry the risk of turning such challenges into xed personality traits of a particularly troubled group of young people. As the results of this study demonstrate, behavioral problems are never exclusively an individual matter. For out-of-home care services across the Western world, handling young people's socially and culturally unacceptable behavior has always been a crucial task (Egelund & Vitus, 2009; Levin, 1998). If we want to move beyond the ascertainment that most current interventions are largely unsuccessful in this respect a conclusion that involves the risk of blaming the victim we need to start analyzing and discussing the circumstances that produce such poor results in terms of care stability. There are good reasons for the high level of care disruption among young people, with no easy solutions at hand. Understanding the social worlds that young people occupy as they move in and out of care is a crucial step towards interventions of not only higher continuity but also better quality. Acknowledgments This paper is based on a study of care disruption among Danish teenagers which was conducted in association with professor Tine Egelund and Ph.D. fellow Ida Hammen. I thank them both for a highly inspiring and closely cooperated research project. I would like to pay a special tribute to the late Tine Egelund whose high professional standards, clever insights and personal friendship has been invaluable to me. I would also like to thank Natalie Reid for her expert assistance with language issues. The study was funded by The Danish Ministry of Social Affairs, while the development of this paper was supported nancially by SFI The Danish National Centre for Social Research. References
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