Health, health behaviours and health promoting services for care leavers: perspectives of young people and LAC nurses

Abstract

This working paper reports findings from a qualitative study of care leavers’ and looked after children’s (LAC) nurses’ perspectives on the health, health behaviours and health promoting services for care leavers. Looked after children and adults with a prior history of being looked after tend to have poorer health and social outcomes, even when compared to populations with similar socio-economic backgrounds (Viner and Taylor 2010; Dregan et al . 2011). Additionally, very little is known about how looked after children and care leavers view their own health and lifestyles. This study explored care leaver and LAC nurse perspectives on health and health behaviours of young people leaving care, and what effective health promoting services for care leavers might look like. Sixteen young people leaving care in the south Wales area were interviewed, and a focus group with 14 looked after children’s nurses from mid, south and west Wales was also conducted. The first main finding was that the care leavers tended to identify their overall health in terms of psychological health, and most experienced difficulties in mental health and emotional well-being. Most care leavers reported at least one mental health problem such as depression. LAC nurses also identified mental health and inadequate access to mental health services as a concern. Emotional well-being was discussed by young people in terms of loneliness, self-harm and stress, and LAC nurses mentioned care leavers’ low self-esteem. The second main finding was the interaction between physical health, psychological health and social issues in care leavers’ lives. Physical and psychological health were regarded by the young people interviewed as being closely related to each other, for example smoking and alcohol were used by some care leavers as a coping mechanism for stress. Psychological and physical health also interacted with social factors in various ways. For example, poor emotional well-being reduced the amount and quality of sleep and increased sedentary behaviour, which then affected social participation. Wider social factors such as employment and housing also affected the health of this group, for example some interviewees valued employment for reducing financial-related stress and social isolation. Half of the young people interviewed mentioned financial problems being a significant source of stress, and most thought that lack of money had a negative impact on their physical health. Overall, the period of transition to independent living created challenges which made a healthy lifestyle difficult to achieve. Care leavers saw their health as primarily their own responsibility, though some lacked skills in accessing health and other services due to lack of confidence, organisational skills, and money to travel to services. Interviewees had mixed experience of public sector social and medical services, while eleven commented on positive experiences of voluntary sector support service. Care leavers identified several factors which they thought characterised good services: consistent and long-term staff; staff they could develop relationships with, who were caring and had good listening skills; services that could be contacted in flexible ways (e.g. by telephone, internet or face-to-face) and which had long opening hours; holistic services which could address multiple needs were also valued. Findings presented here on the multiple, interrelated factors that affect care leavers’ health suggest that holistic, accessible and consistent services could go some way towards improving health for this group. Given pressures on public services and the immediacy of care leavers’ other needs, health promotion is not often a priority for care leaver services. Nonetheless, health promotion to improve psychological and physical health would reduce short and long-term disadvantage for this group.