University of Groningen ‘What I really needed was a voice’ Steenbakkers, Annemarie Theodora

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‘What I really needed was a voice’

Steenbakkers, Annemarie Theodora

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Steenbakkers, A. T. (2018). ‘What I really needed was a voice’: The psychosocial needs of youth in family foster care and the impact of traumatic experiences. Rijksuniversiteit Groningen.

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Summary

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Summary

Children in family foster care have the right to grow up in a safe and supportive environment that contributes to their well-being. These children often come from high-risk backgrounds characterized by maltreatment and abuse, which can contribute to the problems and obstacles they encounter, such as attachment difficulties, behavioral problems, and traumatic stress. Children with a history of sexual abuse are specifically at risk for negative outcomes such as placement instability and behavioral problems. In order to help youth in family foster care grow and cope with their traumatic experiences, it is important that their psychosocial needs are met in a way that aligns with their individual circumstances.

Maslow’s theory of human motivation describes five basic needs that are organized in a hierarchy. Lower order needs have to be adequately satisfied before higher order needs can be attended to. These needs are physiological needs (food, water, shelter), the need for safety, the need for love and belongingness, the need for self-esteem, and finally the need for self-actualization. The four upper needs can be considered psychosocial needs. Satisfying these needs leads to (further) growth and well-being, while failing to meet needs can inhibit this. Unmet needs can be satisfied by changing environmental factors, or changing individual or interpersonal actions, thoughts or feelings.

This thesis aims to describe and understand what the psychosocial needs are according to adolescents in family foster care and young care leavers (from here on ‘youth’). In order to capture the lived experiences of youth, this thesis describes two qualitative participatory studies that are conducted from a constructivist paradigm. The participation of youth is central in achieving the aims of this thesis, because they are experts of their own stories and can offer unique insights into their lives. The first study is an episodic interviews study wherein youth were invited to talk about their experiences in care, their needs and the impact of traumatic experiences. This study was conducted to provide input for the statement cards for the following study and to understand how specific needs related to traumatic events are experienced in every-day life. The second study is a Q methodological study that aims to identify groups of youth with similar configurations of needs and to explore whether youth with and without a history of sexual abuse have different needs. Youth who participated in this study sorted a set of statement cards regarding their psychosocial needs according to how important or unimportant these cards are to them. In addition to these empirical studies, a literature review was conducted to provide an overview and reflection on how the literature describes and operationalizes the needs of children in family foster care. The main research question of this thesis is: ‘What are the psychosocial needs of youth (formerly) in foster care and what is the impact of their traumatic background on these needs?’

Chapter 2 presents the results of a systematic literature review on the needs of children in family foster care and how to satisfy them. Maslow’s needs hierarchy is used as a framework,

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but adapted to fit the needs depicted in the international literature. Sixty-four empirical articles from six databases were reviewed and categorized (inter-rater agreement K = .78) into four categories: medical, belongingness, psychological, and self-actualization needs. The medical needs category indicates that children need to be as physically and developmentally healthy as possible, which should be promoted by their caregivers and health professionals. Regarding the belongingness needs, the importance of a sense of belonging to the biological family, foster family, friends and other significant adults is described. Preferably, these relationships are characterized by secure attachments, a sense of permanency, and emotional intimacy. Contrary to Maslow’s theory, the foster care literature does not focus on self-esteem needs, but on psychological needs in a broad sense, such as mental health, coping and identity. Sensitive parenting is important when satisfying these needs, as well as timely interventions for mental health issues. Finally, the self-actualization needs mainly pertain to children’s need to receive an education, which can be supported by connection to the same school, supportive foster parents, and educational interventions. In addition to these needs and ways to satisfy them, the literature review also displays many problems children encounter regarding their needs. While these are important to understand, the conceptualization of needs in many articles does not align with Maslow’s original definition, because problems and needs are used as synonyms. However, meeting needs promotes a healthy development while problems impede this. Addressing this conceptualization issue can initiate a shift from thinking about problems to thinking about what can be done to meet certain needs in a more holistic way.

Chapter 3 describes the psychosocial needs youth in family foster care experience and how they prioritize these needs. Furthermore, the differences between youth with and without a history of sexual abuse are explored. A Q methodological study among 44 youth (age 16-28), of which fifteen reported sexual abuse during their childhood, is described. Separate by-person factor analyses grouped youth with and without a history of sexual abuse who have similar needs together. Both analyses resulted in a four-factor solution, which were subsequently qualitatively interpreted to show the differences and similarities between and within the two groups. Two contrasts were present among these eight groups of youth, namely help and independence, and a retrospective or prospective orientation. The need for help highlights that children need the support of their environment to learn, grow and cope with distress. The need for independence illustrates the growing maturity and autonomy youth want to master. The other contrast shows that while some youth express the need to actively process past experiences, others indicate that they prioritize self-actualization needs and seem focused on their future. Although the needs of youth with and without experiences of sexual abuse are mostly similar, a second-order factor analysis indicated that one group of sexually abused youth have unique needs. These youth do not want an emotional connection to foster parents, but prefer a strictly instrumental, professional relationship.

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Chapter 4 explores whether foster parents and care workers recognize the needs of youth. Since they play an important role in satisfying the needs of youth and often advocate for youth and their needs in decision-making, it is important to know how closely they understand the viewpoints of youth and what differences exist. We focus on the needs of youth with a history of sexual abuse, because this experience is often not disclosed and difficult to discuss, which could make it more difficult to recognize the specific needs stemming from this experience. In this Q methodological study, the four shared perspectives of youth with a history of sexual abuse from chapter 3 were kept as output factors. It was explored how foster parents (n = 9) and care workers (n = 7), who sorted the statement cards for youth with a history of sexual abuse, related to these perspectives. The results show that foster parents mostly recognize the instrumental caretaking relationship some youth want regarding their emotional safety needs. Care workers on the other hand often align with the youth perspective that values the support of both foster and birth parents in shaping the future, while diminishing the importance of care workers’ own involvement. The two youth groups characterized by ambivalence and autonomy were barely recognized by both adult groups. Foster parents and care workers thus differ in how they believe youth value the roles of foster parents, care workers and birth parents. The discrepancy between youth and their carers should be taken into account when carers advocate for youth in decision-making, and illustrate the importance of including children and youth in this process.

Chapter 5 presents the results of a qualitative inquiry into what youth experiences as the impact of traumatic events prior to living in foster care. Youth in foster care have been disproportionately exposed to traumatic events, but this is often researched through a clinical lens. Youth’s views on the impact of these experiences can inform both their direct environment and the larger system around them about how to meet the needs stemming from these experiences. Episodic narrative interviews were conducted with 13 youth aged 15-23 (formerly) growing up in family foster care in the Netherlands. The interviews were subjected to open coding and organized in themes and sub-themes using thematic analysis. The impact youth experienced from traumas in the past could be grouped in three themes: Experiencing problems, Searching for stability and personal growth, and Experiencing no impact. The problems youth encounter as a result from their traumatic experiences are internalizing problems, anger, loss, social problems, traumatic triggers and lagging behind. These results highlight the clinical problems youth experience, related to posttraumatic stress symptoms and complex trauma. In addition to these issues, youth also indicate that their traumatic experiences can instigate a search for stability and growth. This is searched within the foster family, by preserving sameness, in finding answers about their past, in turning negative consequences into something positive, and in shaping the future with lessons from the past. Together with the finding that some participants do not experience negative consequences from all of their traumas or not in all situations, these results show that youth feel the possibility for a positive change after traumatic experiences.

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Chapter 6 focuses on if and when youth want to talk about their experiences prior to care and about being in care. Sharing these stories can benefit youth, because it enables them to make meaning of their experiences and to connect with their conversation partner. The episodic interviews with 13 youth were thematically analyzed to understand how youth experience these every-day conversations about their past and about being in care, which results in two themes. The theme ‘When’ includes references to the prerequisites for talking and considerations made by youth. How often youth talk depends on whether they consider themselves a talker or not a talker, and on how the conversation is started. There were four conditions that make it easier to share memories: people showing interest in their story, trusting the person they tell, having accepted what they tell, and having the skills to share these details. The last consideration youth make before telling their story, is ensuring they have the ownership and control over their story. The theme ‘Why’ includes references to the rationales for sharing or not sharing memories. Youth describe how refraining from talking sometimes protects them or other people from negative experiences. In contrast, youth also mention how sharing stories can give them a better understanding of themselves, and allows other people to better understand them. Finally, youth describe how they can process the past by talking about their memories, but also by engaging in other activities, such as reflection and sports. These results emphasize both the opportunities and obstacles for talking about their experiences. Moreover, the importance of creating the appropriate conditions in order for youth share is highlighted.

Chapter 7 finally provides a general discussion in which the results and methods of the preceding chapters are critically examined. Regarding the psychosocial needs it can be concluded that youth in family foster care differ greatly with regard to their most urgent needs and how they want these to be satisfied. Regarding the impact of traumatic experiences, it can be concluded that youth perceive a relationship between their past experiences and their needs, but that there is no clear one-on-one relationship between certain traumatic experiences and specific needs of children in family foster care. Regarding the methods used in this thesis, the applicability of Q methodology and the level of participation of youth are scrutinized. Moreover, other strengths and limitations related to the conducted studies are presented. Finally, this chapter discusses the implications of this thesis for future research and practice. Future research could for example try to assess whether meeting needs as youth have indicated indeed results in higher levels of well-being. In addition, the influence of different perspectives between youth and their caregivers regarding the most important needs and how to satisfy them can be studied. For practice, it is important to assess the individual needs of youth in foster care in order to promote their well-being, and this assessment should include the perspectives of carers as well as the perspectives of youth themselves. Meeting the specific needs of children in foster care related to their traumatic experiences can help them process their past, which should focus not only on the problems