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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 b s t r a c ta r t i c l e i n f o

Article history:

Received 6 December 2012

Received in revised form 21 May 2013Accepted 22 May 2013

Available online 2 June 2013

Keywords:

Placement

Disruption

Instability

Behavioral problems

Anti-sociality

Social context

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 problemsare by far the strongest

predictor for disruptions in care. Byexploringthe quality of careas experienced by young peoplethemselves,this

study suggests an alternative strategy. Findings suggest that disruptions occur as a result of complex social

relations, as when young peoplestruggle to t in among other troubled youth in demanding residential settings.

The paper concludes that labels such as behavioral problemsmay 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.

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 partic-

ular 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

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 livingconditionsfor 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 tra-

dition,predominantly quantitative studies involving a longitudinal per-

spective 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 genericproblemsof the children in need

of care. However, one nding emerges with remarkable regularity

over time, irrespective of national context: the key role ofbehavioral

problems. Thus, in trying to locate vital risk and protective factors in

Children and Youth Services Review 35 (2013) 14551462

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E-mail address:tbj@s.dk.

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http://dx.doi.org/10.1016/j.childyouth.2013.05.012

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terms of care disruption, almost every study that considers the individ-

ual 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

betweencaredisruption and the sociallyinexpedient 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 problemsare more likely to experience unstable

placements than cared-for children with other kinds of difculties.

At rst glance, the correlation between care disruption and behav-

ioral 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 re-

sultof difculties related to their conduct, e.g. in the wake of exten-

sive school truancy and conicts with adult authorities. Later on, the

placement appears to break down as an implication of these same be-

havioral patterns, e.g. when young people are being expelled from

placement settings. This element of recurrence has led some ob-

servers 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 under-

standing disruptions in care. Instead of looking at isolated elements

of risk and protection, I investigate care arrangements that are dis-

persed 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 candi-dates for public care in the rst place. However, arguing for the deci-

sive 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 break-

down 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 disrup-tion. The reason for so doing is that most other concepts tend to

carry unhelpful connotations, especially among social work practi-

tioners. For example, care breakdownis often viewedas the immedi-

ate 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, stud-

ies of care disruption constitute only a subset of the much wider liter-

ature 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 withVinnerljung 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 ofbehavioral problemsis a correspondingly intricate

matter and, as Berridge (1997) emphasizes, such problems may be

dened in a number of ways. This conceptual uncertainty is notice-

able from the literature, which has referred to behavior-related issuesas, for example, anti-social behavior (Sallns et al., 2004), conduct

disorder(Osborn, Delfabbro, & Barber, 2008) andemotional and be-

havioral difculties (Ward, 2009). Sometimes denitions are based

on clinical screening tools such as the Strengths and Difculties Ques-

tionnaire (SDQ) or the Child Behaviour Check List (CBCL); in other

cases denitions are less precise. However, even though the wording

differs,behavioral problemsand 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

Thendings in this paper come from the rst majorstudy of disrup-

tions 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 placementprocess (n = 45), and a longitudinal, quan-

titative 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 dis-

cussion. The twelve young people, aged 1621 at the time of the inter-

view, were selected randomly from the sample of 225 teenagers.

However, as disruption in care was the main analytical theme, a major-

ity of interviews were conducted with young people who had experi-

enced at least one unplanned placement termination. The number ofdisruptions 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 ini-

tial 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 thestudy.Theseinterviews focusedon 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 at-

tachedto disruptionsin care (if such eventshad taken place).In general,

these young people were profoundly outspoken and detailed in their

descriptions, and they demonstrated admirablepatience with the inter-viewers. Some of the interviews clearly exceeded theformatof account-

ingfor 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 pro-

cesses 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 in-

volved 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), case-

workers, 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 lo-

cate. On more rare occasions, such persons were found but not willing

to give interviews, as with a foster family with the record of a partic-

ularly 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 onSeeking the perspective of foster chil-

dren, 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 at-

tached to it several standpoints, or points of view , and that (u)

nderstanding comes from concrete experience that is tied to an objec-

tive 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 (mar-

ginalized) groups in terms of voicing their own standpoints and expe-

riences (ibid.: 125), Unrau reviews the ways in which the perspective

of foster care children is represented (or not) in research on place-

ment moves. Following Unrau's thinking this study is based on the as-

sumption thatgiving 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 de-

parture for this type of research, the voicing of young people's per-

spective 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 therapeu-tic residential units to secure accommodation and socio-pedagogical

homes. This last category, widely used for young people, is character-

ized 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 thenal data collection in 2009, 44% of the young peo-ple had experienced at least one unplanned care movement. The ma-

jority of these disruptions (62%) took place within the rst year of the

placement (Egelund et al., 2010; Olsson et al., 2012). While it may ap-

pear 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 ex-

planation. Importantly, no correlation was found in the Danish mate-

rial 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

settingincreased the risk of disruption, while placement in open resi-

dential caredecreased 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 qual-

itative study dealt only with a limited number of cases, the stories of

the 12 young people (and the views of the 45 key stakeholders) un-veiled 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 compre-

hensible only when viewed as a combination of multiple factors

working together in unfortunate ways. Moreover, from acare quality

perspective the presence or absence of disruptions clearly constituted

a too limited explanatory framework. All 12 cases represented de-

tailed stories of young people struggling to nd their way through ad-

olescence with vulnerable parents, complicated peer relations and

demanding placements. In these processes, care disruptions often

constituted important personal turning points as heralds of chang-

ing 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 an-

alyze in detail three individual cases of young girls going in and out of

various placements. My purpose is to explore the complex links be-

tween concrete events during the care process and the outcomes of

the placement with a particular view to care disruption. The social au-

thorities considered all three girls as having some sort ofbehavioral

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 else-

where. 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 astrongly anti-social person. Nevertheless, the three cases raise the

question of whether the notion ofbehavioral problemsis really the

most helpful conceptual frame for understanding the extensive oc-

currence of care disruptions.

The three cases do not differ signicantly from the larger qualita-

tive 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 atof 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 in-

stitutions. 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 win-

dow 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 funnylooks, 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!

Thecare 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 tellyou she could cry ifyou didn't show up for supper. The oth-

er 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. Onthe day of myarrival,he'swearing a T-shirtthat 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 straightto my room. He felt bad about it

and brought mea DVD and a lot ofgrapes.The staff was all right,but

it wasnot what I needed at thetime. 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 con

icts with the staff. When they real-ize she has been smoking hash on the premises with a younger resi-

dent, 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 case-

worker 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 in-

sights we've gathered over the years, concerning Julie's personal-ity, 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 asocio-pedagogical home without

the home, involving Julie living in a at of her own with close profes-

sional supervision. After some initial doubts, Julie begins to feel at

home. She points to the personal contact, Martin, as the real protago-

nist 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 ad-

vice 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 knowhe 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 discus-

sion whatsoever.

After a long period of turbulence and two complicated care disrup-

tions, 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 re-

lation 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 de-

cisions 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 anout-of-home placement at age 13 than what she saw as meaningful

when turning 17. High disruption rates may therefore somewhat re-

ect 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 choiceof 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 re-

turn. 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 acquain-

tances. 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 lit-

tle 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

anoverreactionon 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 comingover. 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 shewas 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 go-

ing to nd some solution. But somehow things were already out of

control. Sarah had decided that she didn't want to stay there any-

more. 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 appre-

ciate 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 dis-

ruption 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 re-

lated specically to institutional group care: serious conicts with

peers and adult authorities often play an important part in the deci-

sion 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 po-

sition 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 place-

ment 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 amongthe statistics of placements disrupting due to behavioral problems.

Indeed, the adults around her appear to agree that she is the one act-

ing inexpediently, even irresponsibly, to what they deem a minor

episode. Sarah views the situation the other way round: the disrup-

tion 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 exis-

tential loneliness and how it links with placement disruption is fur-

ther 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 walk-

ing through at least 11 placements, including foster care, kinship

care, emergency units, therapeutic institutions, psychiatric depart-

ments 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 institu-

tions. 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 every-

thing 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 de-

manding. At Amber House, however, after some turbulent begin-

nings, 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 physi-

cally restrain her. It was always me who was holding her. It would

be quite erce atrst, and you had to hold her really tightly. Then

slowly, you could feel that she was beginning to calm down, cer-

tain that someone else was taking responsibility. We had a lot of

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these conicts, several times a day for sometime. 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,

whenyou 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 saidfor years about these children that they're unable to connect emo-

tionally 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. Al-

though the staff at Amber House objects, the municipality chooses

to move Katie to a large residential setting for children with very di-

verse 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 ac-

tually 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 place-

ments 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 caredisruptions among young people. From Katie's case, one might won-

der 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, poten-

tially 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 be-longs to the group of young people often referred to asanti-social. As

the head of Amber House quietly remarks during our interview, not a

single piece of furniture was intactby 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 be-

tween 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 problemsare clearly nei-

ther 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 marked-

ly 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

disruptionsa 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 rela-

tions 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 them-selves, the biological parents, the care environment, and thecasework

process. Yet examining in detail the care careers of just a few adoles-

cents shows the critical need for focusing on contexts rather than iso-

lated 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 ex-

planatory framework for understanding the disproportionate occur-

rence of placement disruption.

This change of research perspective is in line withUnrau's (2007)

cogent suggestions from her review study on placement moves. In-

vestigating 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 fos-

ter children and parents:

Although some studies included parents and foster children as da-

ta source, placement data were not often gathered from them. In-

stead, parents and children provided data for other key study

variables, such as well-being measures or additional service histo-

ry variables. A few studies had caseworkers or foster parents ver-

ify 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 ad-

dress the research gap she has pointed out. The question remains what

we can learn about the meaning of care disruptions by qualitatively

consultingthe perspective of young people in care and other key actors.

To begin with, thinking of stability and continuity as indisputable qual-

ities 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

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involved (see alsoBarber & 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 place-

ment along with their changing needs, wants and aspirations. This fac-

tor 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 numer-

ous studies (and con

rmed by the present one), are clearly not satisfacto-ry, either to the young people and their families or to thesocial authorities

providing theservices. The key question here is theexplanatory power of

behavioral problems: does the strong correlation between disruptive

placements and the anti-social conduct of young people provides an ad-

equate framework for understanding this pronounced lack of care stabil-

ity? 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 problemsconstitutes a rather poorly dened con-

cept (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 problemsconstitutes a weak concept

with tremendous explanatory power(Vinnerljung, 2010, personal com-

munication). While the explanatory power of the concept is well demon-

strated by the existing research literature, the present study makes its

weaknesses clearly apparent. All 12 young interviewees exhibit behav-

ioral 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 obvi-

ously, 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 prob-

lemsas fully explaining the care disruptions. As Unrau (2007)dem-

onstrates, most studies on placement moves look only at case

records or include only case worker perspectives and the risk at-

tendant to limiting studies in this way is that of collapsingbehavior-

al problems into one generic phenomenon.

Second, the ndings from this study encourage us to take a stepforward to argue for the role ofbehavioral problemsas representing

more a symptom than an explanation of care disruption. A look at

young people's unstable care careers reveals how the quality of inter-

actions 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 particular-

ly) 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 infor-

mal 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 valuesystems, 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 set-

tings 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 ofnding 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 ofbehavioral prob-

lems concerns the reifying tendencies of the concept. Thendings 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 res-

idential 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 al-

ways been a crucial task (Egelund & Vitus, 2009; Levin, 1998). If we

want to move beyond the ascertainment that most current interven-

tions are largely unsuccessful in this respect a conclusion that in-

volves 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 DanishMinistry of

Social Affairs, while the development of this paper was supported

nancially by SFI The Danish National Centre for Social Research.

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1462 T.B. Jakobsen / Children and Youth Services Review 35 (2013) 14551462

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