Fight,freeze or flee: Exploring youngsters’ strategies in dealing with youth care interventions

Abstract

Continuity of care is seen as a challenge for youth care services. Research on continuity of care in relation to youth care services is scarce, and there is a strong tendency to overly stress the managerial and technical aspects of care. However, research on continuity from a youngster’s perspective suggests a more complex construction of continuity. The connection with youth care services is especially under pressure in the confrontation with difficulties and critical moments. In this narrative study, we aim at gaining insight into youngsters’ different strategies in vulnerable situations when facing difficulties in their trajectories in relation to youth care interventions. By retrospective reconstruction of their trajectories in relation to youth care interventions, youngsters were able to express significant moments in their biographical timeline. The narratives are analysed using the framework given in literature on users’ coping strategies in relation to dissatisfaction in services: loyalty, voice, exit and neglect. We have chosen three topical life stories of youngsters to represent the research findings that illustrate identified strategies of fighting, freezing and fleeing care, which are to be viewed as translations of the Hirschman coping strategies. However, a deeper analysis of these interactions results in a more complex view on strategies and shows that these can be misinterpreted by youth care workers. Different elements such as timing, clinical overshadowing or the pre-structured nature of youth care interventions are linked to this mismatch between what youngsters want and what youth care workers offer. Options are presented to handle these difficult interconnections.

Keywords

Young people life history coping continuity of care youngsters' perspectives youth care interventions

Introduction

Youth care services can be difficult to access for youngsters in vulnerable situations (Osgood et al., 2005). Moreover, when youngsters are actually reached, they experience a wide range of challenges such as placement instability, receiving inadequate care, or care other than needed, and difficult transitions between services (Fernandes-Alcantara, 2018). Fragmentation of youth care, resulting in difficult connections between service providers, policies and care systems, is often mentioned as the main cause of these difficulties (De Winter and Noom, 2003). Moreover, specific transitions within care (Paul et al., 2013) and towards adulthood (Stein, 2006) appear to be problematic in maintaining continuity of care (Crimmens et al., 2004). As a response to these challenges, youth care reforms have specifically targeted access and continuity of care (Cortis, 2012; Naert et al., 2017).

In this paper, we discuss findings of research on experienced continuity of youth care in Flanders, the Dutch-speaking part of Belgium. Research on continuity of youth care is limited (Heaton et al., 2012) and, despite specific interventions and actions to improve continuity, the problem remains persistent and recurrent (Cortis, 2012). This has to do with the predominant focus on management continuity (Naert et al., 2017) in which technical components of continuity are emphasized, such as information exchange between service providers and management models to close the gap between youth services. The underlying rationale is that adjusting the ‘back stage’ in terms of technical issues will lead to experienced continuity at the ‘front stage’ (Krogstad et al., 2002). Through creating an organizational continuum of care, it is assumed that youngsters will experience a smooth and seamless care trajectory (Fontanella et al., 2015). Because it starts from an expert view, leading to predefined interventions that reduce youngsters’ impact on their own care trajectory (de Vos, 2015), this organizational orientation has a strong impact on how continuity is realized in practice (Reid et al., 2002).

In addition to management continuity, relational continuity has also been put forward as an important objective in youth care (Munson and Lox, 2012). Relational continuity has mainly been conceptualized as a continuous relation with one care provider (Naert et al., 2017), based on ideas from developmental psychology, stressing the importance of relational stability with caring adults to nurture a healthy development (Jones et al., 2007). The importance of real connections and trust in care trajectories is emphasized (Tobon et al., 2015), which matches perfectly with management objectives that try to ‘fix the system’ in order to create a seamless trajectory. Limited research on experienced continuity of care shows that relational continuity often goes beyond placement stability (Refaeli et al., 2017).

However, little is known about the continuity experienced by youngsters in youth care. By using a life-world perspective, this research places the experiences of youngsters central to explore the dynamics in the construction of continuity (Grunwald and Thiersch, 2009). Such a life-world perspective focuses on dynamic and interpretable ways in which material, social and cultural resources and structures can be captured as constraints, opportunities and limitations for youngsters to practice agency (Roets et al., 2013). The challenge is to embrace the relationship between agentic strategies of youngsters in shaping pathways in their lives and the ways in which structures, systemic forces and resources such as youth care interventions enable or disable individuals to do so (Grunwald and Thiersch, 2009).

Our aim was to capture the dynamic interactions between the agentic strategies of youngsters and interventions of youth care professionals and services. Hirschman’s (1970) Exit, Voice, Loyalty and Neglect framework was used to analyse youngsters’ strategies in relation to recurring youth care interventions. This framework was developed by studying the interactions and responses of people towards adverse economic situations and was adapted to look at human behaviour and strategic responses in a wide range of settings, such as reactions of employees towards declining and untoward institutional relations (Berntson et al., 2010), the context of therapeutic relationships (Derlega et al., 1993) and health-care provision (Brüggemann, 2017). Although Hirschman’s framework dates back to the 1970s, it is still regarded as a highly pertinent approach that is applicable in various contexts to explain how people cope with difficult and problematic circumstances (Brüggemann, 2017). In this study, it serves as a conceptual frame of reference for gaining an in-depth and theoretical understanding of youngsters’ strategies in relation to systemic and structural constraints and resources in youth care.

Research methodology

To explore the life stories of vulnerable youngsters, we used a narrative research approach in an attempt to capture the meaning of continuity of youth care interventions in relation to its context and the significance of transitions, relationships and material, as well as immaterial, resources in these retrospective accounts (MacDonald et al., 2005).

Research context

The youth care system in Flanders is organized along two main perspectives (1) directly accessible care versus specialized care accessible after expert referral and (2) voluntary care versus mandatory care imposed by a youth judge. This leads to a complex and broad array of interventions, from low-threshold prevention, to various kinds of family support interventions, to more reactive protectionist actions (Roose and De Bie, 2003). Historically, prevention of Special Youth Care interventions has been a leading principle in the child protection system since the second half of the 20th century, the underlying rationale being that limited welfare resources should be directed to those who need it most (Roose, 2006). This principle of subsidiarity leads to a pyramidal system, where more investments at the base of the pyramid should reduce interventions at the apex (Desair and Adriaenssens, 2011). Whereas recent reforms were directed at improving continuity of care and more distinction between directly accessible and non-directly accessible services, it has been a challenge to improve continuity of care (Roets et al., 2016).

Data collection

Youngsters were recruited in residential (n = 12) and low-threshold youth care services (n = 13) in the area of the city of Ghent, Belgium. To be eligible, youngsters had to be in care or followed by a case manager for more than two years. Residential services were typical long-stay services for youngsters between 12 and 18 years of age, while low-threshold services were local drop-in centres for youngsters between 15 and 25 years of age in vulnerable living situations. The latter services are located in neighbourhoods characterized by poverty, poor housing and few public facilities. Forty-two eligible youngsters were contacted and 25 provided informed consent for a biographical interview. The respondents’ ages ranged between 15 and 32 (mean age 20.6). We interviewed 9 women and 16 men. Reasons for non-participation were: having no time, something unexpected that came up or no longer willing to share their story at the time of the interview. Biographical interviews lasted one to two hours and took place in the youngsters’ natural environment. The study was conducted in accordance with the ethical guidelines of the authors’ university and was approved by the university’s ethical committee.

Biographical interviews were conducted to gain in-depth insights into the dynamic pathways of youngsters in their contacts with youth care. A retrospective approach promoted a deeper exploration of when, how and why youngsters enter and exit youth care over the course of their lives (Alcock, 2004). The issue of experienced continuity was considered a sensitizing concept, which gave us ‘a general sense of reference and guidance’ (Blumer, 1954: 7) in approaching the youngsters’ daily lives. The research process was facilitated by drawing a timeline with the participants. We started the timeline at the age of 12, as a marker that stirred up their memories, as most youngsters make a significant transition from elementary to secondary school at that age. Yet, participants were told that they could go further back in time if they deemed it helpful to tell stories about their early childhood. Participants were asked to discuss critical moments that were difficult or when things were going well, also linked with their relationships with significant others and resources that helped them. In an interactive exploration of these events, we identified how youngsters experienced youth care interventions as supportive or not. The biographical interviews were fully transcribed (Howitt, 2010).

Data analysis

In an attempt to gain an in-depth understanding of the agentic strategies of youngsters to handle complexities in contacts with youth care services and interventions they encountered, the documented retrospective pathways were analysed systematically (Millar, 2007). The data were analysed by engaging in a qualitative content analysis, which is considered a flexible strategy for the subjective interpretation of data content through the systematic classification process of coding and identifying themes or patterns (Hsieh and Shannon, 2005). We applied a directed approach to content analysis, in which the goal is ‘to validate or extend conceptually a conceptual framework or theory’ (Hsieh and Shannon, 2005: 1281). This directed approach to content analysis was elaborated using empirically based ‘feedback loops’ (Kohlbacher, 2006), which enabled us to support, question or expand the existing body of research. As mentioned above, we used Hirschman’s framework (1970) to identify strategies of voice, exit, loyalty and neglect in the narratives and experiences of youngsters. Hirschman’s framework starts from the idea that responses to declining institutional relations, and individuals’ dissatisfaction with these relations, differ on two dimensions − constructiveness versus destructiveness, and activity versus passivity − resulting in four types of coping strategies: voice, exit, and loyalty and neglect (Farrell and Rusbult, 1992). Whereas the voice strategy refers to every action that is taken – formally and informally – towards positive change, the exit strategy is every activity related to moving away from the unpleasant situation and includes thinking about leaving, or actually leaving. Loyalty is defined as a constructive, but passive, reaction in which the individual is waiting for conditions to improve and is closely related to the ‘neglect’ strategy, a reaction where one is passively subjected to worsening conditions (Derlega et al., 1993). All transcriptions of our empirical material were coded and codes were compared between researchers; three sub-themes emerged that serve as an analytical translation of the strategies outlined by Hirschman: fighting (voice), freezing (loyalty and neglect) or fleeing (exit).

We represent the research findings via three topical narratives of youngsters that illustrate the identified strategies, including details of each unfolding life story (Vandekinderen et al., 2012). The three narratives were chosen purposefully. They each present rich information of different stages in the youngsters’ trajectories. Moreover, they demonstrate different interactions and strategies between youngsters and youth care providers leading to a more in-depth theoretical understanding of the interactive nature of (dis-)continuity of care. As the chosen narratives illustrate, youngsters do not present a single strategy and cannot be reduced to the strategy they present at certain times in their trajectory. However, the narratives show how seemingly small actions and disconnections can have important repercussions over time.

Results

The story of Adrian – ‘I had the feeling that I had to fight all the time’

Adrian, now 32 and living on his own, has been in youth care from his 12 until his 19. He went through more than five youth care placements. For him, his trajectory is characterized by fighting various persons and institutions. He talks about different things he did to fight his placement in youth care (e.g. rule-breaking behaviour). Adrian sees these strategies as things he learned in order to survive, but they hinder him today.

I’m struggling with myself because I can’t adapt my behaviour to the ideas and targets I have. This has to do with the fact that, in the past, I had to behave in a certain way to survive, so to speak … Because certain things happened that formed me this way. I was ok with this for a long time, but now this limits me in the things I want to achieve.

The process he describes is especially related to complex problems in the family that were induced by inadequate communication, leaving him with the feeling of ‘being the problem’. Also, the fact that there was no real attention to the problems with his family and friends became very difficult to bear. In a sense, this was a traumatic accumulation that he also describes as something that still influences his life today.

It is not about the question ‘What is the problem with these youngsters?’ They need to ask the question ‘What is going on, not only with this youngster, but in general? What happened?’ Let us look … what is the history … why does he behave the way he does sometimes?

The lack of an in-depth and comprehensive view on what was going on was the reason for his anger towards youth care. In particular, feeling reduced as a person by different youth care providers is a very traumatic issue for Adrian. This led to his resistance and an accumulation of inadequate interventions, such as short-time placements in residential care, where he started to use drugs and had constant fights with care providers.

In the end, you know that interventions are limited in time and you start limiting the openness to connect with certain youth care workers. Because you know that then I go to this place and afterwards to another … […] I looked for someone to rely on … My father was no option, because he had problems of his own and I couldn’t count on my mother … but you lose interest in building a real relation … The youth care workers don’t go with you [from one institute to another], you know.

Adrian explains that his fight differed over time. On the one hand, he describes his difficult behaviour as resistance, but for him this resistance was also about closing the options to connect with new care providers. In the beginning of his trajectory, there were youth care workers that he connected with. Later, he describes the relations he had as only instrumental and without real attachment. For him, these periods were like living in a world with his own rules. Adrian describes this as learned behaviour that was not respectful and very disruptive towards professionals and very problematic for his personal well-being. He talks about the tension of feeling lost when he was placed in care, but in need of someone to really connect to. For him, youth care as a system did not succeed in doing what should be its core business: searching for who these young people really are and opening new horizons.

I think youth care should look for what drives youngsters, what they are good at. What were my abilities? (…) What are his strengths? That’s what I’ve missed. It was all about what was wrong with me. That was the continuity in my trajectory in youth care.

He labels his own trajectory as a ‘fighting strategy’, with three main characteristics: (1) it was harmful for him and made him feel less and less understood; (2) it continues to this day and bothers him in the aspirations he has in life and (3) it did not seem to be something that was recognized enough by the youth care providers at the time.

Laura’s experience – ‘There was no real connection, I froze’

Laura, a 17-year-old girl, had her first contact with the youth care system when she was eight years old. Her parents had just divorced, and she had a real hard time. She went to live with her mother. This was a very important moment, not only because of the pain she felt by the breakup in the family, but also because of the disruption this made in all areas that were fundamental for her stability and well-being at that time, especially school and friends. The follow-up by a school counsellor was not helping her.

It didn’t help me at all. At that age, you need something else. You need your parents back together again, you want to sit at the table at home with everyone. They can’t do much … They can’t help with the feeling of powerlessness in this situation.

For her, this was the start of difficulties and being bullied at school. She changed schools three times, mainly because of bullying. Again at that time, school interventions did not help her because they did not address the bullying. Instead, she felt like they wanted her to change in order to stop the bullying. This led to a big crisis at school, in which the mother took her away from school. She marks this as the beginning of a period of withdrawal on different levels and especially from care interventions.

At first, I became very aggressive, but also more distant and detached towards others, and that is, you know, partly also the reason why I don’t like talking to other people. Not like this [the interview], but making real friends and things like that, I don’t like that. I’m more at ease on my own, because I know that’s safe.

This withdrawal worsened when she was between 12 and 14 years old. She describes this period as episodes of crashing and pushing people away. At age 13, a new crisis happened at school, and she had to receive counselling at school.

I went to talk to school counselling because I was expected to. I didn’t have the feeling that something really happened there. It was against my will … They wanted to talk about the bullying, but I was busy with my family. This was really not what I needed. They got everything back from the past 13 years … It was just not ok.

This was not helpful for her and again she withdrew. She ‘froze’ as she calls it, while struggling with herself and with the lack of understanding from youth care workers. Although she went to the expected counselling sessions, she talks about them as passing by and not really meaningful to her. At the same time, she thinks the counsellor did not really know what was going on. As long as she went to the sessions every week, everything was ok. After a while, school counselling referred her to an ambulatory mental health centre. At first this was helpful, but trust was broken when the school counsellor talked about her to her mother without her knowledge. Again she felt betrayed and stopped going to the counsellor.

For Laura, a very helpful thing was her contact with Tim, her case manager, and other people from the youth centre she got in contact with when she was 13. When all else failed, she could rely on them for support and a listening ear. At age 15, Laura had problems with alcohol and feeling depressed, and she attempted suicide. They picked up on her signals and managed to help her, by being there when she needed it most and by being reliable.

He did what he said he would do. When he said: I will come and pick you up and bring you to the clinic, he came and we went together … He went to talk to my grandma, where I lived at that moment. He came over when I called.

She describes the connection to these people as something more than youth care. She now finds the ability or space to talk about difficult things. At the same time, there is time to relax and to do interesting things.

It is just enough. Sometimes you don’t feel like having a heavy conversation about problems, you just want a normal chat. I need that and … it’s better and better, because … ok, I’m stressed, let us drink a cup of tea or smoke a cigarette. We can talk about anything … and sometimes that is enough to forget everything for a moment!

Laura talks about different moments of conflict between what she expected and what youth care offered as interventions. The main strategy Laura talks about in these situations is to go along with the intervention chosen by the youth care workers and to ‘give them what they expect’. It seems as if this strategy is used when attempts to have an impact on the intervention are not working. When youngsters feel forced to take part in a care trajectory, the risk of disconnection is even bigger. As Laura tells us, she felt speechless and overpowered by these interventions. She talks about a mismatch regarding the timing and content of the intervention. The mandate of Tim, a youth worker who meant a lot to her, is linked to a contact that was already there, but also to a lack of pressure to talk about problems all the time. On the other hand, he was reliable and available when she needed him.

Helen – ‘I did everything to escape’

Helen, a young woman of 18, is tired of youth care and does not want to have anything to do with youth care anymore, or care in general. Her trajectory in care is one of fleeing. She was placed in care because of the difficult home situation. Her mother was absent at crucial moments, and the youth care system intervened. Helen did not understand what was happening to her and missed basic support and information at that moment. For Helen, the youth care system did not succeed in giving her time and space to come to terms with the situation. She ran away many times, which resulted in more restricted interventions. Helen was first placed in care at the age of 14 and went through four different residential institutions. The first episode was significant for the rest of her trajectory: at that moment, she started to protest silently at every intervention. She links this with interventions that were not adapted to her needs.

In the past … I’m not someone who easily shares … I was not a real talker, I didn’t say much. I kept everything inside and for myself. I thought: “I’ll take care of that myself, I can handle this.” This was also the reason why I didn’t talk to the psychologist in the first institute. It didn’t help of course that they pushed to get something out of me …

After a residential stay, home-based support was introduced. Again without any real connection to what she thought or felt at that moment. Home-based counselling ended after a big conflict with the youth care worker. In a way, this was her intention. She wanted to be left alone, but at the same time, she needed support. Trusting youth care workers was very hard for her after the first contact with care.

I had to put trust in them … that was very hard for me. This is still a problem. I can say a lot of things and talk to everyone, but sharing things that are really about me? … I don’t do that anymore.

Several short-term placements followed and she talks about a period ‘on her own’, running away and chaos. This rapidly escalated into a very difficult relation with youth care. For her, the difficulty in sharing personal things is related to the lack of empathy and insight in what was needed at certain moments. Running away and constantly looking for escape routes was the way she reacted to these interventions. She also mentions the lack of real impact on transitions in her trajectory.

I had no power to decide where I went. They just said: “You’re going to this place!” When I asked what this place was, the answer was: “We don’t know yet, we will see.” For me, that was very shocking … I’m used to … I want to know … to be prepared … so I looked the place up myself.

Although she dodges care interventions and is very sceptical towards all youth care, one service now seems to make a difference for her, and a special connection with a youth care worker is a big factor. The place she lives in now, a residential facility where she can learn through independent living and where individual counselling is provided, is a complete change for her. The way they interact is especially important to her. The youth care worker listens to what she wants in life. Also, looking at the past is not an option anymore, since she is tired of that.

I didn’t want to go back. I tried to find the predictability of the past. It was just, in these institutions … a different programme of the day. You had to follow the plan. Same thing in the following residential institute. Here (present support) this is less so. You can handle things the way you want. This is hard, because you are used to these plans. Now, sometimes I don’t know what to do because I have choices.

Helen regrets not being confronted with the same attitude when she was 14. She still feels very reluctant towards care. She is 18 and chooses to be in the residential setting she is staying in now. The connection with her own aspirations in life, and the openness to let her decide the moments where ‘the past’ is relevant to talk about, are the biggest changes. She calls this ‘affinity with who she is as a person’. For her, this change is based on the coincidence of meeting this new youth care worker and the way she was able to recognize the reasons Helen had to break with care.

The moment I got in contact with her here [name of the institute], it was not about: “What happened to you in the past?” or “What is the reason for this and that?” No, we talked about what I wanted to achieve and what I wanted to become and stuff like that. We could talk about the future!

Discussion

As it becomes clear in all three narratives, moments of crisis can be so powerful that they influence all further contacts with youth care, limiting or sustaining further use of support services or threatening continuity of care (Pinkerton and Rooney, 2014). The narratives of Adrian, Laura and Helen reveal different strategies in relation to these crises, which can be regarded as operationalisations of exit, loyalty, neglect and voice. From a life-world perspective, these strategies can be seen as the reactions of youngsters that are meaningful in understanding experienced (dis-)continuity of youth care. However, we noticed in our research that these strategies are generally not recognized, or they are misinterpreted, by youth care professionals and service providers.

The meaning of (dis-)continuity of care

For youngsters in our study, continuity of care is a complex subject. The experience of continuity in their lives is about much more than the presence of youth care interventions or youth care workers (Naert et al., 2019), whereas in the literature concerning continuity of care, the dominant rationale is on seamless care trajectories leading to closed circuits that prevent youngsters from falling through the cracks of the system (Naert et al., 2019). However, in the narratives of youngsters, while youth care interventions were present, they still experienced discontinuity. On the other hand, as is seen in other research, discontinuity in youth care interventions is not always problematic from a youngster’s perspective (Refaeli et al., 2017). It could be stated that the concept of ‘continuity of care’ in itself might be problematic as it emphasises the ‘care’ aspect and thus in itself strengthens a systemic approach (Ware et al., 1999). This approach might also be problematic because of the limited flexibility it can provide to adapt to the contextual and changing needs of young people evolving and growing up. In that sense, continuity of care is experienced as changing over time and for youngsters it maybe more visible and explicit at moments where it is absent or when this continuity of care provision is not helpful for them. Youngsters address different issues that are important to understand the experience of (dis-)continuity over time.

Recognizing ‘voice’ as main strategy

In the story of Adrian, his ‘fighting’ strategy was something that started early on as a reaction towards a lack of voice. For him, it was a way to take an active position towards youth care interventions, which he perceived as only directed at him being the problem. First, he talks about his behaviour as being a signal, later on it became more of a statement towards care, a way of showing agency towards a disempowering system that put him in the ‘problem’ position or the ‘failing subject position’ (Mannay et al., 2017). His strategy shifted from ‘fighting as voice’ towards ‘fighting as a way to disrupt’. Due to the experienced lack of continuity, it became more and more difficult for him to invest in the relation with care providers. Laura also talks about a disconnection at the start of her contact with youth care. At first she revolted, but when there was no connection with youth care services, she withdrew. This can be regarded as a shift from ‘voice’ to ‘neglect’, where her situation worsened, but this was not detected during the counselling sessions. Laura talks about ‘being stuck in time’ − and her strategy is very comparable with what Hirschman calls ‘neglect’. Still, she complied with the care interventions, showing up at every session. The youth care worker perceived this as loyalty, although for Laura these sessions had no use at all. At the same time, by being connected with professional youth welfare workers in her context, she talks about an ‘escape route’ that seems to make it easier for her to use the ‘neglect’ strategy in relation to youth care interventions. For Helen, the standstill in her trajectory is linked with what may be seen as an ‘exit’ strategy from the youth care perspective, although it was also about voicing her needs. She felt no real choice, and so her resistance towards the youth care system grew stronger over time. Although she was in care at the time of the interview, she was still very negative towards care. Strategies to get out of care and resist new care interventions are not taken lightly by youngsters (Goodkind et al., 2011). Only after recurring signals are not recognized or answered appropriately do youngsters give up. In the presented narratives, these strategies were repeatedly misinterpreted. As other research in health-care provision using the Hirschman model shows, this can be due to power imbalances in this relation (Brüggemann, 2017). As such, understanding the way strategies unfold over time and especially the reasons youngsters present to use strategies that seem harmful for them, is of major importance. In what follows, we discuss three elements that are linked to these misinterpretations: the reductive nature of problem definitions, the pre-structured nature of interventions and the mismatch of timing.

Reductive nature of problem definitions in youth care

Part of the disconnection described by the respondents is linked to the limited impact they have on the way problems are defined by youth care providers, especially when there is disagreement on what these problem constructions are. In the story of Adrian, the interactional and self-fulfilling nature of problem definitions becomes clear. His first experiences with youth care were negative, as he felt labelled as ‘the problem’. The reduction of complex situations is also illustrated in the other narratives. This disconnection can be linked to dominant discourses and rationales that evolved in youth care systems over time and lead to this reduction of impact of youngsters on problem definitions.

Historically, this can be related to an inherent tension between socialization and emancipation in youth care (McDonald, 2006), or between care and control (Van Haute et al., 2018). Some authors argue that the shift towards a predominantly socialization scope is the biggest problem in youth care today (de Vos, 2015). Our research shows that this might be reinforced by the omnipresence of a clinical-medical approach in youth care services. Despite an evolution towards comprehensive and multi-level approaches in youth care, interventions tend to start from an individual, diagnostic framework, including, at best, a contextual view (Foster and Spencer, 2011). While a socialization perspective incorporates a potential conflict in the relation between youngster and youth care worker, the increasing importance of a psycho-medical perspective may further reinforce the mismatch between youth care interventions and youngsters in vulnerable situations. Such a clinical perspective and associated discursive practices generate less space to address inherent conflicts in the relation between youngsters and youth care services. When an active position of ‘voice’ is reacted to with a re-translation within a psycho-medical problem definition, youngsters feel powerless. Youngsters’ strategies can be read as an answer to alienating interventions and power imbalances in care. The process of reframing agency as problematic and a result of its diagnostic markers resembles a specific form of diagnostic overshadowing (Thornicroft et al., 2007). Disagreement and anger − which can be seen as ways to express voice − are translated into youth care language as ‘problematic behaviour’, leaving youngsters with limited options. In the context of race, gender and diversity, this has been referred to as ‘acts of micro-aggression’ (Spencer, 2017). Irrespective of the motives, these strategies are numbing for young people. Unrecognized strategies and – as a consequence – unadapted responses from the youth care system can lead to gradual alienation and disconnection, as is seen in the results (Hill, 1999). Consequently, the way relational continuity is effectuated over time is very important for the experience of continuity of care. Only focusing on consistency of staff and ongoing relationships between youngsters and care providers is not enough and might undervalue the ambiguity and complexity of that relation.

The pre-structured nature of interventions

Space for negotiating the way interventions are constructed is limited due to the a priori and ‘fixed’ way that some interventions are offered. As a consequence, choices are limited, leading more easily to conflicts about what is being offered. As Biringer et al. (2017) showed in research on continuity in mental health care, choice – defined as the option to choose between different support options – is a very important aspect in the experience of continuity. Youngsters link their coping strategies to the absence of choice, as they feel encapsulated by a system that they experience as rigid and fixed in time and place. This conflicts with the way youngsters experience their situations at times of crisis (Thomson et al., 2002), given the gap between what they need and what is offered by youth care. The way these interventions are presented leaves no space for negotiation on the content of care (de Vos, 2015). Participants also mention the need to experience ‘normalcy’ in their lives, linking this to seemingly trivial things such as a day out with a sibling, hanging out with friends, being able to go home after school, etc. The intrusive nature of some interventions, together with alienation, may enhance the accumulative process of resisting care. Youngsters talk about moments of disconnection or escape as strategies to be ‘care-free’ for a moment. Again, youth care services often misinterpret these signals or overreact with control measures, leading to power struggles. However, youngsters’ strategies should also be seen as creativity and opportunities for connection. The narratives of youngsters show that forms of support connecting with the life-world of youngsters can help them find new options. It appears that youth care can make a difference if it is able to escape its own institutional control (Roose, 2006).

Timing and experienced continuity

The identified strategies are also linked to a mismatch in timing of youth care interventions with what is needed at different points in the life trajectories of youngsters. The absence of support at critical moments is seen as most problematic in relation to experienced continuity (Naert et al., 2019; Pinkerton and Rooney, 2014). The timeliness of interventions can be defined as ‘getting help when needed’ (Biringer et al., 2017: 6) and is of great importance, as it determines new relations with service providers. Even if there is a connection with service providers, support can be experienced as non-useful. New contacts with care provision are thus defined by previous experiences and the lack of engagement of the youth care system. In the narratives of youngsters, they expressed a lot of negative feelings towards youth care. By not being responsive to these feelings, these tend to accumulate over time and in different other contacts with care provision. These negative interactions can lead to further discontinuity for youngsters in need of support.

Youngsters also link the experience of discontinuity with a lack of focus on future perspectives in the interaction with youth care interventions. A lack of insight into the life-world of youngsters seems to result in a limited view on their abilities to construct a valuable future for themselves. This mismatch is further reinforced by unobserved or wrongly interpreted coping strategies. This again seems to reinforce the experience of ‘being stuck in time’, as some youngsters call it. We can relate this with what Bourdieu refers to as ‘the presence of the forth-coming’ (Bourdieu, 1997: 208). The experience of time is specific in the sense that what we call time is experienced only when the link between expectations and the world that is there to fulfil them is broken. Youngsters’ narratives suggest that this disruption generates a cumulative experience of disconnection. As Bourdieu (1997) shows, there is a constitutive power in the match between expectations in the here and now and the potential match between these and the lived realities that are situated in the future. Similarly, we see a disempowering tendency if these expectations are not met again and again. For the respondents, this resulted in paradoxes of ‘wanting affection and attention to their situations’ and, at the same time, using various strategies to flee from systemic interventions when not receiving these basic needs. Investment in what Bourdieu (1997) calls ‘the game’ − in this case, the interaction with youth care interventions − is linked to what is supposed to bring some kind of profit, and this investment disappears when the likelihood of its usefulness falls below a certain threshold. As other research with youngsters in vulnerable situations shows, having opportunities to discuss desirable futures from their point of view, instead of what others think of as desirable, is an important factor to open up new perspectives (Baillergeau and Duyvendak, 2017).

Concluding reflections

Research regarding the life course of youngsters showed the big impact of critical moments on their lives (Thomson et al., 2002). Despite the gravity of certain events, it is essential to contextualize these events in an interactive framework of subjectivity, circumstances and the broader social context. Having impact on the events appears to be fundamental to the further relation with youth care and the development of escape strategies. In Adrian’s experience, his attempts to have impact on decisions were not heard, and therefore his powerlessness resulted in accumulated anger towards youth care workers and the youth care system in general. Also in Laura’s narrative, the lack of impact is a reason to retreat. This calls for another praxis towards youth care, where continuity of care is realized in the co-construction and interaction within the relation between youngsters and care providers. The actual realization of continuity depends on the strength of the connections and relationships (Heaton et al., 2012) and the way youngsters are involved in decisions about care (Hallett, 2016). This calls for a more open dialogue, with space to negotiate without the immediacy of normative answers. The mismatch between the lived needs of youngsters and the inability to connect to these needs enlarges the gap between the life-world of the youngsters and the youth care interventions over time. From the narratives, this seems to be reinforced by the youth care system’s attempts to gain control.

Limitations of the study

By using three topical narratives to explore strategies of youngsters in relation to youth care interventions, we could uncover the rich details of complex interactional patterns. Although the other narratives were analysed, the focus on only three narratives does not do justice to all youngsters involved. Still, similar strategies and challenges were encountered in these interviews. While a profound understanding of youngsters’ strategies was the aim of this study, the focus on adverse situations and transitions may harm the sincere intentions and constant efforts of practitioners to cope with these difficult situations on a daily basis. By using a critical stance, this paper can be read as a metaphor of this daily struggle. Yet, as a former practitioner, the first author is well aware of these challenges. The paper should be regarded as a reflective endeavour regarding strategies to support youngsters and practitioners to deal with these complex situations.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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