Maladjusted Teenagers

The report from Dr Sophie Hallett at Cardiff University on services provided by Children's Services to sexually exploited young people in Wales provides a fascinating insight into the experiences of young people who received social work interventions during a period of ten years (see link to 'Keeping Safe?' in Further Reading below). Her findings raise concerns about the number of teenagers in care who do not have a settled home due to frequent placement moves and the plight of young runaways who go missing from home, sometimes for long periods. However, the response to this report in the media has revealed a major lack of understanding of the issues. This article offers an analysis of its findings within the context of concerns about serious difficulties in working effectively with teenagers who are under the care of Children's Services.

The complexity of the problems in Children's Services is difficult for most people to grasp. Children's Services has created a language of 'vulnerable children' and 'safeguarding' which disguises the fact that many of their difficulties today come from the marked increase in the number of teenagers in care. Firstly, the social work task of sharing responsibility with parents over the upbringing of their teenage children is complex. Then the rights of teenagers to be given appropriate care come up against the reality of tighter budgets and high staff turnover. The growth of privately run services is opposed by the social work profession because it believes the profit motive can have a damaging effect. However, unless service provision is informed by an appropriate professional knowledge base for skilled work with teenagers it is difficult to see how simply bringing services back in-house would change anything.

The predicament facing Children's Services is rooted in a society that is somewhat ambivalent about the adolescent stage of development and confused about what to expect of teenagers. Now that many middle class young people delay moving into the workplace and establishing a home and family of their own it might appear that the transition from childhood to adulthood has been extended. On the other hand, young people from disadvantaged backgrounds may have had experiences that push them prematurely into adulthood. Some of these young people simply need accommodation and practical support so that they can live independently and safely.

The provision of a secure base, whereby the young person feels a sense of belonging and security is the key to good social work practice. However, some young people in care are not in a settled home and so it is of vital importance that a supportive adult is made available to them. 66% of the young people interviewed for the above study reported 'having a supportive adult' as a positive outcome of intervention i.e. having a key worker who had developed a good relationship with them and understood their complex needs. This finding is of interest to social workers, particularly those required to take on a key role due to their in-depth knowledge of the young person and involvement over a long period of time. Social workers can be a lifeline to young people in their care because they offer practical help and support and often become the most consistently reliable person in their lives.

Over the past five years the number of teenagers in care in England and Wales has risen by about 20 per cent. While local authorities have made progress in recent decades in providing a safety net around younger children whose parents are struggling to meet their needs, their services for teenagers still have a long way to go. Many more teenagers are now being referred, due to concerns about sexual exploitation, exploitation by 'county lines' drug gangs and migrant teenagers but the current practice framework is really more appropriate for younger children. Social work practice is obviously concerned with meeting needs but this must include a better understanding of the maturational processes taking place during the adolescent stage of development. However, the complexity of social work intervention with this age group, together with resource constraints, can sometimes leave everyone floundering. Safeguarding is only one aspect of practice. Of equal importance is the provision of a support service that is underpinned by a sound understanding of the developmental needs of young people.

It is now taken for granted that adverse childhood experiences (ACEs), including abuse and neglect, negatively affect the development of children and young people. Social workers with an in-depth understanding of the psychological problems of the teenagers they are working with, such as attachment difficulties, are more likely to provide appropriate services for them. While a therapeutic intervention that addresses serious problems caused by early adversity can be helpful for these teenagers it would not be appropriate to offer long-term psychotherapy until they are in a secure and settled placement. Many teenagers who require social work help simply want a caring person who is genuinely interested in their difficult situation and tries to resolve their problems. However, the question of whether they need a social work response that is informed by a deeper understanding of their emotional and behavioural difficulties must also be considered. Donald Winnicott was an astute observer of the characteristics of normal adolescence and described the apparent 'rapid alternation between defiant independence and regressive dependence, even a coexistence of the two extremes at one moment of time'. This aspect of adolescent behaviour can make the assessment of a teenager's needs rather difficult. Furthermore, changes taking place associated with puberty and growth spurts may present additional concerns and challenges that also need to be acknowledged.

Adolescence is a necessary stage in human life and plays a crucial part in who we become as adults. In every human mind, from an early age, there is a continually growing sense of expectation and hope that is not only based on experiences in the family but a collection of observations and ideas picked up from other people and the wider social environment. If all goes well there is a burst of creative energy during adolescence that drives young people to find peers to identify with and new sources of fulfilment. Through a process of pursuing private hopes and fears and learning from trial-and-error they gradually discover their real selves and start to assume an adult identity based on an understanding of their personal strengths and limitations.

Social work practice with teenagers must be based on a sound understanding of the consequences of an earlier failure to meet a child's developmental needs which cause feelings of insecurity and lead to low self-esteem and low expectations. I believe the concept of the 'maladjusted teenager' can be applied to many of these young people - although I recognise that the word 'maladjusted' has fallen out of favour with liberal-minded people. There are other words with a similar meaning that can be used, such as 'damaged' or 'disturbed'. However, I prefer to use a word that puts the focus on personal growth and development and the very important task of learning to adjust to, and identify with, the norms of society. Essentially, I am concerned with a better understanding of unconscious motivation, something that is now regarded as a dubious concept by many people, and the way that hidden ideas can drive some young people to do things that are not in their own self-interest and cause harm to others. People in positions of power face very difficult ethical dilemmas when required to make decisions about maladjusted teenagers who have committed a serious offence.

Schools play an important part in promoting the mental well-being of young people but they often struggle to get the support they need from other agencies. There are often dilemmas for teachers in how to raise sensitive matters with the young person in a way that is both age-appropriate and respectful of their wish for privacy. When schools make a referral to Children's Services based on safeguarding concerns there is a risk of falling into the trap of a narrow focus on 'child protection' that would be inappropriate with this age group. Troubled and troublesome teenagers invariably present agencies with dilemmas and care must be taken to avoid unwittingly giving them permission to assume the victim status without a deeper understanding of the complexities of this approach.

There are some teenagers in foster care who do not have a settled home due to placement moves but cannot return to live with their family. Although efforts are being made to develop new strategies giving better support to foster families there must also be a realistic appraisal of the teenager who has no interest in being part of a family. It is sometimes a good idea to consider the benefits of residential care for certain teenagers, particularly for those who might prefer group living, as opposed to living in a family.

In the past residential care was seen as the last resort and catered for a mix of young people with a wide range of needs. In recent years there has been a move towards care homes with a more specialised function meeting the needs of a particular client group, and often providing education. Here in Wales about one third of residential placements are with agencies and the rest are local authority homes. However, there is a serious shortage of residential placements overall which often results in a lack of choice. A major problem for many authorities is often the difficulty in finding good quality care for young people whose problems are at the extreme end of the spectrum.

Whilst recognising the complexity of social work practice, I find it helpful to make a rough classification of the category the young person falls into in terms of presenting problems. One is the withdrawn, depressed young person who struggles with inner emotional conflicts and engages in self-harm or obsessive thoughts and actions, in order to manage painful feelings. The other is the angry, defiant young person who is more peer-oriented and acts out his or her intense feelings in provocative and anti-social ways. Both can be very difficult to reach because of their psychological state of mind. Obviously, the former may at some point need help from Mental Health Services and the latter may need help from the Youth Justice Service. However, if these services have little to offer and the situation deteriorates Children's Services may be required to step in on the basis of its legal duties. These young people may have problems associated with both mental ill-health and offending but often there is little clarity about what social workers can and should do about them.

Working class people often feel alienated from middle class professionals. Young people who are poor and working class may be wary of social workers, particularly if their safeguarding approach seems more suitable for younger children. A narrow social work focus on the assessment and management of risk and the sharing of confidential information can make some young people reluctant to accept the offer of a helping relationship. Often young people with a fragile sense of self and very rigid defences tend to over-react to a restraining influence from social workers, particularly when it intrudes into areas of their life that are personal and private.

The benefits of group living/residential care for troubled teenagers are increasingly being recognised but it is essential that staff are appropriately trained and supported for this work. Essentially, maladjusted young people need a containing environment in which staff can get to know them really well and are able to help them discover their own proneness to certain types of reaction and their need to learn new patterns of relating to people. Clarity of purpose for residential care is important as this is necessary for successful matching of the young person to placement.

Social workers may aim to compensate for the deficiencies in the family but the system in which they work has a somewhat 'hit and miss' approach to the provision of services for disturbed and troubled young people. At present the commissioning and planning of residential care is insufficiently geared towards meeting the complex needs of maladjusted young people whose behaviour is very difficult to manage. In some situations it will be necessary to find a placement away from the home area in order to protect the young person from the dangers that exist in their local community.

For a long time I have argued that residential care for teenagers should be recognised as an important resource and, although more expensive than foster care, might reduce the huge cost of managing out of control teenagers in the community. Some cases of teenage violence are reaching the point where stronger action is required. There is a great deal of public concern about those teenagers who pose an ongoing risk to the safety of others within the community and about the inadequacy of current arrangements for managing their behaviour and meeting their developmental needs. It is time for the social work profession to develop a more realistic strategy for tackling the problems of teenagers with complex emotional and behavioural difficulties.

Hilary Searing