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Leaving residential Care

Sharon Bacher

This article looks at the processes involved when young adults leave medium-term residential care. The importance of continuity as a principle in the child's experiences, in treatment, planning and provision, and in enabling the transition between community and children's home and back into community is emphasised. The necessity for preparation is discussed including recognition of termination as a critical event in the life of the child and family.

Leaving residential care should be viewed as an intrinsic stage in the treatment process of the child and his family, which were initiated when they first came to the attention of the helping services. Leaving care cannot be looked at as an isolated event – it should always have been seen as an essential link in the chain.
For practical purposes we can divide leaving care into the following phases:

• preparing to leave care;
• terminating living in the residential children's home;
• providing for the continued welfare of the child in the community.

Children leave care for many reasons, at different ages and after differing periods in care. Some will have experienced multiple placements in a variety of settings. They leave for different destinations: some to return to their parents, others to foster families or alternative institutions, while others will be setting out on their own in the community. This means that our preparation of them and of their families, has to be individually tailored.

Nevertheless those who leave care do have some needs and feelings in common: they all need to be deliberately prepared for leaving, they all have to endure the emotional upheaval of termination, and for all of them after-care provision will have to be considered and planned. In helping children/families leave, we may be guided by the following principles:

The experience of continuity and meaning in their lives

Removals, separations and placements disrupt continuity. In addition, life in a children's home, with its high turnover of people means that children must endure the stress of constantly making new relationships and then losing them. This discontinuity can hamper the child's stable sense of knowing who he is and what his life is about. Loss of people who have shared in his growing-up means loss of confirmation of his identity as known, predictable, and accepted.

Anyone who has relocated to a new town or suburb will be able to empathise with the disconcerting feeling of not having an acknowledged identity, and with the stress of having to prove who one is with little time and opportunity. The child who has a succession of caregivers loses access to the memories and perceptions of who he is – especially difficult during adolescence when his sense of self-certainty is at its most vulnerable.
Because we are dealing with children who have an insecure sense of identity, we have to make conscious efforts to help them integrate their life experience in a coherent way. The worker can do this by bridging the different social systems in which the child finds himself. For instance, placements should not result in the child's losing contact with his parents. Parents' involvement in treatment and in the life of the home provides for continuity in important (even if difficult) relationships, and keeps him connected to the wider community. Similarly of course, the home should be integrated into the neighbourhood and not stand as an island, apart.

The worker who places the child plays a key role, through interpreting to him the reasons for and purposes of his placement, as well as what is expected of him and what he can expect. We can help him make sense of the changes and the ups and downs of his life. In the same way, the eventual experience of leaving care also needs to be anticipated, discussed and planned. Purposeful efforts are essential to enable the child to experience his life as a coherent progression rather than as a collection of haphazard circumstances which cannot be foreseen or controlled.

The child's involvement in problem-solving and planning his future

When we help a youngster look forward and confront his future, we create opportunities for him to take stock. He is helped to look backwards at the situation before his placement and to assess how he has grown and to what extent his circumstances have changed subsequently. From such stock-taking the child's energies can be released into new growth towards competence and realistic self-confidence. Helping him see the knowledge, skills and resources he will need to cope on his own can have other helpful effects: it can break down tendencies towards denial of the challenges of the future, and bring the child face to face with his anxieties. At the same time problem-solving with a caring person can support him to plan creatively. Involving the child in planning activates him and lessens his feelings of powerlessness. On the contrary, he is enabled to experience himself as an energetic force and he can learn to take responsibility for creating a good life for himself. This could be a much needed antidote to the passivity and apathy we see in so many institutionalised children.

Bearing these principles in mind, here is an outline that could be followed in preparing a young adult to leave the children's home.

Acquiring Knowledge and Skills for Independent Coping

Long-term preparations bring together all our efforts to enable the child to grow towards secure, actualising and responsible adulthood. Included here too are all the efforts we make to maintain the child's bonds with his family, and to supporting and treating them so that they can eventually take over responsibility for their children once again. However, our older teenagers also need more focussed preparation and training. The institution experience has removed from them the chance to learn many fundamental life skills. For instance they need to learn about:

• Food – The basic ingredients of a healthy diet, where to shop, how to buy, and how to prepare food that is nutritious yet inexpensive.
• Budgeting – They need to learn how to handle money, how to budget for their needs, how to get loans or bursaries, how to invest money. They need to discover how much things cost.
• Vocational Preparation – What are their interests, skills, and aptitudes? What work is open to them?What training will they need? Where can they get money for studying? What can they do if they drop out of school? How much can one earn with a technical diploma? How does one go about getting a job, handling interviews, writing letters, preparing a curriculum vitae? They need guidance about the responsibilities of work, the expectations of employers, appropriate ways of relating to other staff or to employees, etc.
• Basics of Health Care – includingessential first aid, basic hygiene and cleanliness, the morality of sex, contraception and family planning.
• How Things Work -How to do elementary household repairs, how electricity works, how to regulate the temperature on the geyser, how to change a globe, how to go about getting a telephone installed, how to care for clothes including basic sewing and repairs. How cars work.
• How to Cope with Emergencies – who to call and where to find the number.
• How to find and use community resources.

These are basic "how to's" of life – yet we have to make a systematic effort to teach them to children and youth who have spent a time in care. It has been my experience that children learn best about these things when the necessity for doing so becomes part of their daily lives. There should be be gradual modifications in the living arrangements of teenagers as they grow, which allow them to take on increasing responsibility for their own lives.

We also need to help our older children to learn interpersonal coping skills, e.g. communication skills, how to handle problems, how to negotiate using the democratic process, etc. They also need to grow towards social assertiveness: they need to learn how to initiate, build and maintain relationships. Again, in the hubbub of the home it is easy for the child to become socially passive. If he is not going to suffer from loneliness and isolation on the outside he is going to have to learn the realities of having to work at achieving and sustaining a social network. In our home we try to connect our older children to a counsellor – usually a member of our committee or another adult in the community, who is prepared to take a special interest in the child. The counsellor may act as a mentor, advisor, helper and friend. Where the system works well, this helps the child to orientate himself in the community and provides an informal extension of care.

The Emotional Demands of Termination

The prospect of leaving the home is likely to reactivate feelings and anxieties experienced in previous circumstances of separation and loss. He is likely to experience a confusion of emotions and probably some ambivalence about leaving. On the one hand there may be fear of the future and the unknown, doubt at the prospect of losing his familiar world and the friendships, the predictability of the home routine.
On the other hand, moving out also denotes moving on – and most children will look forward to the rewards of their future situation. Our task is so to equip them to fend for themselves, that they can realistically feel optimistic about the future.

Termination is fraught with danger for the child – yet simultaneously it presents opportunities. It is a major event in his life: it can be the catalyst for stimulation and personal growth, or it can be experienced negatively as yet another abandonment, reinforcing helplessness and poor self-regard. How the child copes depends partly on how he has always coped with crises, particularly those involving separation and loss.
Many children in care have learned to survive psychologically through the defence ofdenial: denial of their own sadness and pain, denial of their needs, denial of the impact and significance of other people in their lives, denial of problems. This denial may be expressed through detachment or as a false independence. The child may have learned not to trust in others and so to avoid the possibility of being let down. This defence may even have been functional and protected him from hurt in the past. Nevertheless it would seem important to facilitate in the child a positive response to leaving to encourage continuing growth as a person.

Our Help Should Focus On:

• Consciousness-raising with the care workers and other significant adults to the fact that the child is experiencing a potential crisis and enabling them to understand his often upsetting behaviour.
• Creating possibilities for the child to express his feelings of fear, sadness, anger and ambivalence. As children near termination, it is common for them to revert to their old immature ways. Many need to make the institution and its people "bad" in order to make their leaving easier.
• Encouraging the child to resolve old grudges – old baggage of this nature should be left behind when he goes.
• Helping positively with the process of reminiscence and consolidating old memories. This builds continuity across the change of place and people. This includes going through the good and bad times, collecting together memorabilia, photographs, things which may have sentimental value for him.
• Initiating the arrangement of parties or other "rites of passage", to mark the event of his leaving as significant for everyone and to give permission to the group to express emotion, affirmation and to say their goodbyes.

The aim of this termination work should be to enable the child to leave the home with appropriate sadness, probably with some ambivalence, but armed with the certainty of support and his own preparedness for the future. In addition the child should be assured that the door to the home remains open to him and that his longtime friends and allies will always be available to encourage and befriend him.

The Child in the Community

What are the needs of young adults who leave children's homes?

Occupational Help – Many of our young adults are at risk in the job market, have limited social skills and are not able to present themselves well at formal job interviews. They often lack the confidence for self promotion and the energy to find good jobs. In addition many of them have personality difficulties, are unreliable, do not handle authority well and are impulsive. Having found a job they may be unable to keep it. They need help in handling the responsibilities of work. Clearly they will need mentoring here.

Accommodation – This is a serious problem for the young adult especially for those who leave the children's home with minimal education and unproved work skills. Many of these youngsters cannot return to their own homes, and often have no family or people in the community to help them. Where are these youngsters to live and how are they to support themselves? We need to develop creative resources for those who still need some supervision and support until they become at least economically stable.

Social Integration – Despite our efforts, many youngsters leave children's homes lacking social skills and assertiveness and suffer from feelings of inadequacy. It may well be that we must create some way (a place, a program) whereby they could meet and talk to other young people in the same situation. Peer groups at this level could create the climate for honest problem solving and sharing of ideas and resources about the real difficulties of life on their own. Finally the home itself can be supportive and will retain informal ties – inviting them to meals from time to time, remembering birthdays and inviting them to join in other communal events.

Reference

Brearley. P., Black. J., Gutridge. P., Roberts. G. and Tarran. E.Leaving Residential CareTavistock Publications, London and New York, 1982.