Forging brighter futures with young care leavers

What are the conditions under which young people are enabled to grow, flourish and reach their full potential? And what might these conditions look like for young people in the care system, many of whom have encountered significant relational adversity and trauma through disruptions to their care experiences?

Typical life outcomes for people who have been in the care system during childhood can be distressing to read about. Research over the past quarter of a century suggests that young people who have been in care typically fare far worse than other young people across a wide range of areas such as mental health and wellbeing; educational achievement; physical health; prevalence of teenaged pregnancies; socio-economic status; and involvement in crime, including substance misuse (Burch et al., 2018).  

It may seem, then, that for these young people, we have not yet figured out how to create environments that enable them to flourish.  However, as the famous American writer, William Gibson, once said, 'The future is already here, it's just not very evenly distributed.'

The Reboot West Project

In 2018, a charity sector organisation called 1625 Independent People (1625IP), which operates in the West of England, applied for a Department for Education (DfE) funded Strategic Impact Bond (SIB). The funds attached to the SIB were allocated with the overarching intention that they should provide the resources for charity and public sector organisations to improve overall life outcomes for young care leavers, including improving access to education, employment and training (EET) and improving overall social and emotional wellbeing.

A unique feature of the application by the charity, submitted in partnership with four Local Authorities and a Social Investor (Bridges Fund Management), was that it outlined a single, driving psychological model at the centre of the proposed project. This was a developmentally informed version of the Acceptance and Commitment Therapy model (developed by Steven Hayes, Kirk Strosahl and Kelly Wilson) [find interviews with founders of ACT] called DNA-v (L. Hayes & Ciarrochi, 2015).

Following their initial application and a prolonged and nail-biting short-listing process, 1625IP and their partners were successful in their application. What followed was the recruitment of 10 Education, Employment and Training Coaches and a Project Manager, and the commissioning of a series of training and monthly team supervision sessions [see box below] delivered by the authors and a small team of ACT and DNA-v trained psychologists.  

BOX: The supervision process

Supervision in DNA-v work needs to have an experiential component. Practitioners are best placed to help shape psychological flexibility in others when they have initially focused on and engaged in psychological flexibility work personally. Within the Reboot West Team, the supervision process was built around the SHAPE supervision framework (Morris & Bilich-Eric, 2017). 

SHAPE is a multi-component framework that can manifest in a variety of ways, but is primarily designed to target a combination of both didactic and personal experiential learning processes in practitioners. SHAPE is an acronym for:

• Supervision values;
• Hold stories lightly;
• Analysis of function;
• Perspective taking; and
• Experiential methods.

For Reboot, this manifests in a combination of:

1. Casework formation spotlights, which involve group-based problem-solving around individual young people's situations, with regular reference to the DNA-v model to enable psychological formulation of the presenting context, and reflection on coaches own experience of the coaching process with the in-focus young person.
2. Real-play activities, wherein the wider team divides into groups of three for direct experiential skills-practice. The roles within this part of the supervision process are:

                          i.         Coach: this team member assumes their professional role as coach, with the intention of using the space to shape their own DNA-v coaching practice within a relatively safe and contained environment.

                        ii.         Client (themselves): this team member brings a personal issue or problem that they themselves are working through, and struggling with, in their own lives at present. The idea here is that the coach uses, and shapes, their DNA-v skills to help the client work through this particular struggle in their lives.

                       iii.         Helper: this team member is on hand to support the coach when they get stuck. At any point, if the coach gets stuck, or is struggling to connect their practice to the model, they can call timeout and defer to their helper for some brief reflection and guidance.

The discoverer, noticer, advisor and more

Acceptance and Commitment Therapy (ACT) is part of what has been broadly referred to as the third wave of cognitive behavioural therapies (Hayes, 2004). According to Hayes and Hoffman (2017), this third wave focuses 'more on the person's relationship to thought and emotion rather than on their content. Third wave methods emphasise such issues as mindfulness, emotions, acceptance, the relationship, values, goals, and metacognition.'  

ACT in particular articulates a narrative of human wellbeing in terms of Psychological Flexibility (PF), which can be defined as contacting the present moment as a conscious human being and, based on what the situation affords, acting in accordance with one's chosen values (Hayes et al., 2004).

Importantly, the ACT model is considered to be transdiagnostic. That is to say, rather than being informed by an account of a particular deficit or pathology within the human condition, it is driven by a theoretical account of the general human psychological condition, known as Relational Frame Theory (RFT; Hayes et al., 2001). The empirical trail blazed by ACT thus far extends to a wide range of issues, including: depression, anxiety, work-related stress, chronic pain management, smoking cessation, palliative care, sports performance, parenting and mental wellbeing in young people (see Gloster et al., 2020, for a full discussion).

According to Gloster et al. (2020), the empirical journey of ACT so far includes 325 published Randomised Controlled Trials (RCTs) and a recent meta-analysis identifies 14 of these as reporting on interventions for young people (Fang & Ding, 2020). As encouraging as this is, the ACT model was never designed with explicit regard to child-development matters. In light of this, along with her colleague Joseph Ciarrochi, one of the authors of this article (Louise) embarked upon a journey to develop a more developmentally sensitive version of the ACT model, which they called DNA-v (L. Hayes & Ciarrochi, 2015). 

The strength in DNA-v is its solid and clear scientific foundation plus its readily accessible style. In application it can be visualised using the disk image at the top of this page (the DNA-v contextual model of development, L. Hayes & J. Ciarrochi. 2015), where young people learn experientially to move their lives in valued directions using four 'skills' which are behavioural groupings with real practical utility. DNA-v also includes two contextual perspectives that are targeted to 'see' ourselves and others. These segments of the model are designed to help young people practice using perspective taking skills flexibly, to promote personal growth and to reduce rigidity and excessive experiential avoidance.

1. The Discoverer. Learning through trial and error, attempting new things, developing new skills, and paying attention to what works. Low skills in this area would be indicated by repetition of unworkable behaviour.
2. The Noticer. Listening to the wisdom of our body and using the messages as a guide for responding, or pausing, with awareness. Low skills in this area would be indicated by being reactive and excessively avoidant of unwanted inner sensations and feelings.
3. The Advisor. Using our thoughts, rules, beliefs and judgements in a practical way, learning how to hold unhelpful language and cognitive processes like worry and excessive resentment at a distance. Low skills in this area would be indicated by rigid thinking and taking thoughts literally.
4. Values. Learning to being open to listen to the journey of our hearts and practicing choosing actions that build wellbeing.
5. Flexible self-view. Learning to take a flexible perspective on oneself in the past, the present and the future and learning to see your potential rather than your limitations. When working in the flexible-self-view space, the aim is to see our stories about ourselves as just that; as a story that we tell about our lives (thus far and future-projected), rather than as literally true.
6. Flexible social view. Learning to take a flexible perspective on others; on our social world and our relationship to it. Working in this space within the model involves targeting the expansion of one's social networks, creating lasting, positive and meaningful relationships.

Using DNA-v in community-based coaching contexts

Like ACT, DNA-v is a model that can be used to inform clinical work, including one-to-one therapeutic interventions. But its value for informing the work undertaken by Reboot is in part owed to the flexibility of its application. So many of the young people with whom they work are highly disaffected; unsurprisingly given that they may have met scores of professionals over the years, due to their care and familial circumstances. So, coaches need a way of bringing effective practice to young people – to where they are right now – not just psychologically, but physically.

'She fits around when I can do, meets me later in the day which I need and takes me to cafes to get a hot chocolate.'

Reboot coaches apply their therapeutic model flexibly, across a whole range of community-based contexts, from the coffee shop, to the gym, to walking in nature – wherever the young person wants to, and is able to, meet.

And there is real power in this. For many years Behavioural Therapists and Cognitive Behavioural Therapists have written about the challenge of transferring their work from the primary sphere of influence (face-to-face work in the therapy room) to the secondary sphere of influence (clients' daily, lived experiences) (Villatte et al., 2016). Working therapeutically in the community bridges the gap between direct therapeutic input, on one side of the river, and the daily lives it is intended to affect, on the other.

Critically, this is not work that coaches do to young people; it's work coaches do with young people. The training and supervision that coaches receive is deeply experiential, requiring a personal commitment to applying psychological flexibility processes in their daily lives. Coaches are supported and encouraged to practice consciously noticing internal barriers to valued action – difficult thoughts, feelings and sensations – that show up in their own lives.  And they practice being open to these in the service of living a life with ever-increasing purpose, value and vitality. As well as benefiting coaches own lives, the intention here is to model psychological flexibility in the presence of young care leavers.

He does a lot of practical things with me. He's caring and supportive. It doesn't come across that he does it for money. He does it because he cares. 

The story so far

Young care leavers, even those who experience stable and loving foster care placements, can find the transition to independence a huge challenge. Whilst some foster carers are able to make themselves available for ongoing support during, and even after, this transition period, many young care leavers have no such support systems available. And even those who do can find this an extremely daunting and frightening phase of life.  

Curtis has been in the care systems since he was 15-years-old. Now aged 22, having moved into independent accommodation, he describes how 'Being in care was like being in a little bubble. And when you leave care you're out of that bubble in the world.'

The Reboot West team are accountable for achieving a number of outcomes at specific time-points. These include:

• Access: The number of young care leavers who access the program;
• Education: The number of young care leavers who access and sustain formal education placements and achieve qualifications;
• Volunteering: The number of young care leavers who enter into and maintain attendance within voluntary work placements;
• Employment: The number of young care leavers who enter into and maintain paid employment;
• Stability: Self-reported wellbeing and social stability.

At the time of writing this, two years after initial program set-up, current data indicates that 212 young care leavers are accessing the coaching and support services provided by the Reboot team; since working with Reboot, 101 have started formal educational programs (of which 73 have completed more than 50 per cent of the program and are still enrolled, and 56 have completed the full course and gained a qualification); 8 have started at university; 73 are in sustained, paid employment; 193 report feeling safe; and 198 report having a minimum of one valued, sustained, consistent relationship in their lives. These figures far exceed the targets set by the SIB program managers.

But inside these numbers are the real, personal, lived experiences of the young people accessing support through the project. Inside are their fears, worries and anxieties, as well as their hopes, dreams and aspirations.  

A commonly used metaphor in ACT work, typically known as the coin metaphor, goes something like this: 

What if I told you that this small coin represents all the treasure you hope to find in your life – can you imagine, for a moment, that it represents all of your hopes for the future. But it has two sides. On one side, here, are all of your dreams – all of the things that, in your bravest moments, you dare to believe might be possible. And on the other side is your fear; your worry; your concerns. You can take this coin – here; it's yours. It's your choice. Are you willing to make space for fear, for worry; for self-doubt, in order for your dreams to become realities? (adapted from Ciarrochi, Hayes & Baily, 2012).

Metaphors like this one are designed to target acceptance and willingness – willingness to consciously bring a little of our sometimes-painful internal world along for the ride, as we move our lives in valued, meaningful directions. The human psychological condition is such that we simply can't have one without having some of the other. And this is exactly the kind of experiential learning process that Reboot coaches are achieving in their work. As Curtis and one other young care leaver, Donnie, beautifully put it:

'Before Adam [Reboot Coach], I was a bit scared and thinking what am I gonna do, what am I gonna do with my life. But with Adam, he's sort of modelling me to get a better life, pushing me in the right direction to actually enjoy life.' (Curtis, 22-years-old)

'My Coach helps me with work and stuff. I've got a good work ethic now. I used to hate work but my Coach has helped me to get my head round it.  They've helped me with it. Now I love working.' (Donnie, 20-years-old)

But the success of the Reboot West project doesn't lie in pushing young care leavers into education, employment or training coercively or against their will. Quite the opposite, in fact. Evaluative feedback indicates that the key success factors lie in establishing therapeutic, positive and trusting relationships between one human being and another, and then using that relationship as a strong foundation upon which young people can explore their interests, their values, and what they most want to nurture and grow in their lives. After a period of time in the prison system, another young care leaver accessing Reboot, just 19 years of age, says it like this:

'The best things aren't necessarily the activities. It's him saying I've got potential, him telling me I've got insight and that he had hope in me even when I didn't have hope in myself. Sometimes he just listens to me complaining about shit. I haven't got other people to talk to about that kind of stuff. I respect him a lot. My Coach realized I just needed someone to talk to. Now I'm about to start work as a construction labourer.'

Where to from here?

If the service currently offered by Reboot West to our young care leavers is part of an unevenly distributed present that we want to transform into a more evenly distributed future, a radical transformation in the skills and approaches found in relevant organisations is required. Professionals on the frontline – social workers, coaches, youth workers and others – will need to flexibly apply models that help young people relate skilfully to their complex, rich and often painful internal worlds. 

Yes, we will require a robust and wide-ranging research agenda to understand what works, and for whom. And yes, this will need to carefully compare outcomes across a range of different psychological models, interventions and approaches. But we must continue to believe in the plasticity of the human condition, if we are to create the optimal conditions for those who've experienced significant early relational trauma and loss. We can think of no single group that deserves to learn these skills more than young care leavers.

- Duncan Gillard is Senior Educational Psychologist with the Bristol Inclusion Service. E-mail: [email protected]

- Louise Hayes is a clinical psychologist working in private practice in Australia.  E-mail: [email protected]

- Aoife McNally is an Educational Psychologist with the Bristol Inclusion Service. E-mail: [email protected]

- Kate Willis is an Educational Psychologist with the Bristol Inclusion Service. E-mail: [email protected]

The authors would like to acknowledge the following people: 

Their fellow trainers; Mary Stanley-Duke and Emma Balfour

Meghan Joyce (Reboot West Project Manager) and all of the Reboot team: Adam Ledner; Fran Rennison; Helly Saunders; Shelly Gilman; Lea Hill; Ben Riddell; Mark McCarthy; Beckie Wright, Emma Jones and Lucy White.

1625IP Leadership Team; especially Joanna Roberts, Ashley Ward, Dawn Taylor & Jamie Gill.

Editor's note: This article originally appeared online October 2020.

References

Burch, K., Daru, J. & Taylor, V. (2018).  Analysis of outcomes for children and young people 4 to 5 years after a final Care Order.  Social Research Number 29/2018. 

Fang, S. & Deng, D. (2020). A meta-analysis of the efficacy of acceptance and commitment therapy for children.  Journal of Contextual Behavioural Science.  10.  225-234.

Hayes, L. & Ciarrochi, J. (2015). The Thriving Adolescent. New Harbinger Publications, Inc.

Hayes, S., Barnes-Holmes, D. & Roche, B. (2001). Relational frame theory: A post-Skinnerian account of human language and cognition. Kluwer Academic/Plenum Publishers, New York.

Hayes, S. (2004).  Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies.  Behavior Therapy. 35. 33-54.

Hayes, S., Strosahl, K., Bunting, K., Twohig, M. & Wilson, K (2004).  What is acceptance and commitment therapy.  In S. Hayes & K Strosahl (Eds.), A practical guide to acceptance and commitment therapy.  Kluwer Academic/Plenum Publishers, New York.

Hayes, S., Strosahl, K. & Wilson, K. (2012). Acceptance and commitment therapy, second edition: the process and practice of mindful change. New Harbinger Publications, Inc.

Hayes, S. & Hoffman, S. (2017). The third wave of cognitive behavioral therapy and the rise of process-based care.  World Psychiatry. 16(3). 245-246.

Gloster, A. T., Walder, N., Levin, M., Twohig, M.P. & Karekla, M. (in press, 2020). The empirical status of Acceptance and Commitment Therapy: A review of meta-analyses. Journal of Contextual Behavioral Science. Doi: 10.1016/j.jcbs.2020.09.009

Morris, E. & Bilich-Eric, L. (2017).  A Framework to Support Experiential Learning and Psychological Flexibility and Supervision: SHAPE. Australian Psychologist.  52, 104-113.

Villatte, M., Villatte, J. & Hayes, S. (2016). Mastering the clinical conversation: language as intervention.  The Guilford Press.