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Transitioning to Adulthood:

Unaccompanied Asylum Seeking Young People

Leaving Care.

A qualitative study in Hamburg.

International Master’s Programme in Social Work and Human Rights Degree report 30 higher education credit

Spring 2013

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Author: Julia Ahrens

Supervisor: Ingrid Höjer

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Abstract

International research has shown that care leavers face a series of complex transition tasks on their way to adulthood. They have to master these with less emotional and financial support than their peers with access to family support. Consequently they are at higher risk of homelessness, unemployment and social exclusion. Unaccompanied asylum seeking young people leaving care face additional challenges due to their status as refugees with often un- regularized residence permits. Research findings suggest that a sound pathway planning can facilitate a more successful transition. This study explores how social workers structure the care leaving process for unaccompanied asylum seeking young people in Germany. It aims to determine external structural factors influencing this process and how the young people are perceived in terms of skills and resources as well as in terms of access to social capital. For this purpose nine semi structured interviews with social workers were conducted. The social workers identify a lack of guidelines and structure in the care leaving process. Furthermore they illustrate difficulties in facilitating a successful transition due to a severe lack of housing, the asylum process and the unpredictability of decisions of the funding agencies. The uncertainty of the young people’s stay in Germany due to pending asylum decisions additionally leads to mental health problems in the transition for the young people. The social workers perceive the young people as generally well equipped with skills and resources.

However they illustrate how these skills are neglected in the German system. They further describe the young people as rich in bonding social capital but as lacking access to bridging social capital. The social workers in this study see themselves as responsible for facilitating this bridging form of social capital but describe their struggle in trying to enable this.

Title: Transitioning to Adulthood: Unaccompanied Asylum Seeking Young People Leaving Care.

Author: Julia Ahrens

Key words: Unaccompanied Asylum Seeking Children/Young People, Youth, Transition

to Adulthood, Social Capital

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Acknowledgements

I want to thank everyone that helped me complete this long project! Especially I would like to thank:

All the participants for sharing your knowledge and opinions with me and dedicating some of your time to me!

Ingrid, for your advice, encouragement and helping me resolve my confusions!

Lisa, Imke, Steffi and Ingo for providing me with a home, support and inspiration during my stay in Hamburg!

Klod, for taking me to the beach and enduring my laments!

Eira, for locking yourself into your room and providing me with your valuable feedback!

Marianna you were my study buddy and stayed with me, every single day, throughout the whole time! I don’t know if I could have done it without you! And to Annie for joining this arrangement and teaching me all about comma rules (that I have already forgotten)!

And also all my classmates and teachers for the great time I had during these two

years!

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Table of Contents

Abbreviations...5

1 Introduction...5

1.1 Background...6

1.2 Aims and Research Questions...7

2 Unaccompanied Asylum Seeking Children in Germany...8

2.1 Numbers and Facts...8

2.2 Procedure...9

2.3 Situation in Hamburg...9

2.4 Follow up Care...11

3 The German Youth Care System...12

4 Previous Research...12

4.1 Germany...13

4.2 International Research...14

4.2.1 Care Leavers in General...14

4.2.2 Unaccompanied Asylum Seeking Care Leavers...15

5 Theoretical Framework...17

5.1 Youth, Transition to Adulthood and Refugee Youth...17

5.2 Social Capital...19

6 Methodology...21

6.1 Design of study...22

6.2 Recruitment Process...23

6.3 Reflections on Researcher – Respondent Dynamics...23

6.4 Data Management...24

6.5 Ethical Considerations...24

6.6 Validity, Reliability and Generalization...25

6.7 Limitations...26

7 Results and Analysis...26

7.1 The Respondents...26

7.2 Findings and Analysis: Care Leaving Process...27

7.2.1 Findings: Care Leaving Process...27

7.2.2 Analysis: Care Leaving Process...32

7.3 Findings and Analysis: Impact of External Structural Factors...34

7.3.1 Findings: External Structural Factors...35

7.3.2 Analysis: External Structural Factors...40

7.4 Findings and Analysis: Perceptions of Young People...42

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7.4.1 Findings: Perceptions of Young People...42 7.4.2 Analysis: Perceptions of Young People...49 8. Conclusion...52 Reference List

Appendix 1

Appendix 2

Appendix 3

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Abbreviations

CLCA Children Leaving Care Act

UNCRC United Nations Convention on the Rights of the Child

B-UMF e.V. Federal Association for Unaccompanied Refugee Minors (Bundesfachverband unbegleitete minderjährige Flüchtlinge e.V.) KJND Children and Youth Emergency Service (Kinder- und Jugendnotdienst) PTSD Post-Traumatic Stress Disorder

UASC Unaccompanied Asylum Seeking Children UASYP Unaccompanied Asylum Seeking Young People YWO Youth Welfare Office (Jugendamt)

1 Introduction

“I always had the feeling that no more than necessary is done. Youth care ends when you come of age then they have fulfilled their task. They make sure that you can more or less cope with the daily life tasks, but they don’t do much to facilitate a professional career. You have to do everything alone.”(Christian, 26, German care leaver)

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The situation of care leavers has not been given much attention by social policy and research in Germany. International research has shown that care leavers face a series of complex transition tasks on their way to adulthood. They have to master these with less emotional and financial support than their peers growing up with access to family support. This means they are at higher risk of homelessness, unemployment and social exclusion (Strahl & Thomas 2013). Unaccompanied asylum seeking young people leaving care face additional challenges due to their status as refugees and often un-regularized residence statuses (Wade 2011). This study explores the structure of the care leaving process of unaccompanied asylum seeking young people in a German context.

Due to the lack of attention given to the issue in Germany there is no definition of ‘care leavers’ available from a German context. However in an international context there are different definitions for what characterizes a care leaver. One example is given by the Children Leaving Care Act in Great Britain that defines a care leaver as a person leaving state care that has spent more than 13 weeks in this care until the age of 18. In this study the definition of the Care Leavers Association from England and Wales is used. This association is run by care leavers for care leavers, which is why their definition is chosen based on the assumption that it best represents their view. According to their definition a care leaver is:

1 http://www.spiegel.de/unispiegel/studium/universitaet-hildesheim-forschungsprojekt-und-netzwerk-fuer-care-

leaver-a-896344-5.html Quote taken form a magazine article on a care leaving assistance project at the

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“Any adult who spent time in care as a child (i.e. under the age of 18). This care would have been approved by the state through a court order or on a voluntary basis. It can range from as little as a few months to as long as one’s whole childhood (18 years). Such care could be in foster care, residential care (mainly children’s homes) or other arrangements outside the immediate or extended family. The care could have been provided directly by the state (mainly through local authority social services departments) or by the voluntary or private sector (e.g. Barnardo’s, The Children’s Society and many others). It also includes a wide range of accommodation. For example, it would include secure units, approved schools, industrial schools and other institutions that have a more punitive element than mainstream foster or residential care.“

(The Care leavers Associations (2013): online

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This study explores the care leaving process of unaccompanied asylum seeking young people that came to Hamburg before the age of 18. It is limited to those young people that have been placed in residential care. The focus is on the perspective of social workers on this process and their perception of the young people. In the following the importance of the topic and the aims and goals of this study will be illustrated.

1.1 Background

In the transition to adulthood young people placed in care are confronted with several challenges. They have often experienced adverse, traumatic events in their past and are additionally faced with the challenge of performing the transition to independent living with less support. The lower levels of support are due to a lack of a strong family network, financial resources and their often lower education levels. The transition to adulthood for care leavers also presents a more abrupt and compressed change in life circumstances than young people of the same age experience when living with their families (Stein 2011; Wade 2005).

Unaccompanied asylum seeking young people (UASYP) face further difficulties since their stay in the country is often not regularized, meaning their application is pending, and their future life chances are uncertain (Hancilova & Knauder 2011).

The series of transition tasks young people are faced with are among others finishing school, entering the labor market or higher education, moving out from home or out of care and starting a family. Across Europe research has shown that this transition has been remarkably extended over the last decades and is now a process of several years lasting far into the third life decade (Buchmann & Kriesi 2011). It is furthermore characterized by openness and uncertainty (Höjer & Sjöblom 2011). In the phase of transition young people generally experience some areas of their lives in which they are autonomous and independent, whilst there are others in which they stay dependent or fall back into dependency. This phenomenon is called “yoyo-transitions” (Stauber & Walther 2007). For young people placed in care the possibilities of falling back are usually very limited. They are expected to have a linear transition from adolescence to adulthood (Höjer & Sjöblom 2011), very much in contrast to how the majority of their peers experience it. Young care leavers are confronted with an additional structural trajectory in addition to the range of transition events and structural trajectories that all young people have to go through. They are leaving the institutional care system mostly without the support of a persisting family network. This is alarming, since research has shown that young people become more dependent on their families during their prolonged transition into adulthood. This emphasizes the need for adequate and sufficient support during the transition for young care leavers (Höjer & Sjöblom 2011; Stein 2011;

Wade et al. 2005).

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Care leavers face different and more obstacles than their peers. The moving out process takes place earlier and is in most cases irreversible, compressed and takes place faster. They have fewer resources to draw on in order to cope with this trajectory and other institutional transitions, such as ending school, often do not happen synchronized. A successful transition is judged on the basis of institutional and structural expectations and not so much based on the individual and subjective goals and wishes of the adolescents/young adults (Höjer & Sjöblom 2010; Stein 2011; Wade et al. 2005). According to Cashmore & Paxman (2006) young people who leave care and have to transition into adulthood without the support of their families have by definition less emotional, social and financial support. They also lack the possibility to

‘space out’ (Stein 2005). Stein (2005) here refers to a transition period where young people try new things, take risk and are in search of their identities. Due to not having the possibility of falling back into a previous or ongoing support network care leavers are expected to reach adulthood instantaneously (Stein 2005).

Being an asylum seeking young person leaving care adds further disadvantages to this life trajectory and renders the young people more vulnerable. Most of the young people experienced traumatic events before or during their flight from their home countries. This leads to an elevated risk of anxiety and depression (Wade 2011). Their transitions are significantly affected by their asylum claims and their immigration status is often unresolved.

They therefore do not only face uncertainty regarding practical issues such as housing, finances and also emotional networks, but also their general future about the stay in the country is insecure (Stein 2012). In different countries of the EU turning 18 even means to have less chances to get a permanent residence permit (Hancilova & Knauder 2011). The transition planning for this target group is complex, since many different outcomes concerning the stay of the young people in the country have to be taken into account (Stein 2012). This double status of being a care leaver and asylum seeker at the same time renders the question of pathway planning for this specific group even more important (Stein 2006;

Wade 2011).

1.2 Aims and Research Questions

Research findings indicate that a sound pathway planning can facilitate a more successful care leaving trajectory and facilitate a better transition to adulthood. This small-scale study explores how social workers in Hamburg, Germany shape the care leaving process for unaccompanied asylum seeking young people (UASYP) leaving residential care. A key aspect is the fact that the transition to adulthood for this target group is determined by the asylum process. It can be a facilitating or limiting factor for the individual futures, which is often at the time of transition still open to both options. The impact of this uncertainty and the options for social workers to influence this process or prepare the young people for all possible outcomes is a strong focus of this project. Social capital, as the resources deriving from networks and relationships based on mutual trust, can provide the potential to resolve identity conflicts and to cope with uncertainties on the route to adulthood (Helve & Bynner 2007).

Therefore it is also interesting to explore the social workers perception of the young people’s access to social capital. The main research questions are:

1. How is the care leaving process shaped and structured by the care system and the individual social worker and how does this affect the young people?

2. What external structural factors are influencing the care leaving process?

3. How are the young people perceived by the social workers in terms of skills,

relationships, networks and social capital?

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In order to find answers to these questions professional social workers were interviewed using semi-structured, qualitative interviews. The interviews took place in Hamburg, Germany so the study focused on the specific context there. International perspectives will nevertheless be discussed.

In the first step the situation of unaccompanied asylum seeking young people in Germany, and also specifically in Hamburg, is illustrated. A special focus here is on the process of the integration of the young people into the youth care system.

In chapter 3 the German youth care system is outlined to clarify the context of care in which the UASYP are placed.

In chapter 4 previous research findings on the topic of care leavers in general in Germany and internationally are presented. Following this, international research findings on the care leaving process of unaccompanied asylum seeking young people are described.

The theoretical framework for the analysis entailing the stage of youth, transition to adulthood and social capital is outlined in chapter 5.

Chapter 6 illustrates the methodology used to conduct this study and analyze the collected material.

Subsequently in chapter 7 the findings will be presented, analyzed and discussed before final conclusions are drawn in chapter 8.

2 Unaccompanied Asylum Seeking Children in Germany

This chapter provides an overview of the situation of UASC in Germany and especially Hamburg. It illustrates the procedure of taking these children and young people into custody and provides an overview of the number of young people coming unaccompanied to Germany.

2.1 Numbers and Facts

There is no systematic aggregated data on unaccompanied asylum seeking children (UASC) in Germany. The Federal Agency for Migration and Refugees (BMF) publishes numbers based on the overall asylum applications. These exclude those young people that never apply for asylum. The non-government organization (NGO) Pro Asyl published a summary of these numbers. According to this report there was a 9% increase in asylum applications of unaccompanied minor refugees in Germany in 2011. The number rose from 1.948 to 2.126 in comparison to 2010. The majority of these young people came from Afghanistan with 1.092 registered Asylum applications. Afghanistan was followed by Iraq, Somalia and Syria as countries of origin for UASYP that applied for asylum. Out of the overall number 11,6%

received the asylum status and further 28,4% protection out of subsidiary reasons (Pro Asyl

2013). In contrast to this approach the Federal Association for Unaccompanied Minor

Refugees (B-UMF e.V.) published much higher numbers for the same year. These are based

on the report of the Youth Welfare Offices (YWOs) and the number of young people they

took into custody. According to this report the number of UASC did not increase but

decreased in comparison to the year before. The number of UASC that were taken into

custody was 3700 and therefore much higher than the number of asylum applications. The B-

UMF e.V. indicates that only some German federal states provided reliable and inclusive data

whereas at least four states used data from unreliable sources and six further states were still

waiting for data of some receiving communes. This means that the actual number is even

higher. They additionally point out how even this higher number of 3700 only comprise those

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minors that were taken into custody and estimated to be under the age of 18 (B-UMF e.V.2012). The federal association demands a central acquisition of data to be able to appropriately plan for sufficient housing, clearing facilities and a transparent evaluation of the situation for UASC in Germany. (B-UMF e.V.2012) This lack of systematically aggregated data may be interpreted as a lack of interest in the target group. Without consistent numbers it is difficult for municipalities and states to appropriately plan the necessary resources to provide the UASYP with the needed care. The fact that they do not assign resources to this might be interpreted as neglect of the importance of appropriate care facilities and resources.

Further problems concerning these numbers will be discussed in ch. 2.3.

2.2 Procedure

If a UASC is found by any kind of official institution the responsible YWO has to be notified immediately. The YWO takes the children and adolescents that are assumed to be under the age of 18 into custody. A requirement for this is that they arrived without an adult that is willing or able to take care of them. Immediately after arrival a so called “clearing-procedure”

takes place. This is supposed to investigate the exact circumstances under which the child came to Germany. The procedure investigates where the family members are, determines the needs of the UASC and seeks to determine a possible perspective for the UASC (B-UMF e.V.

2013). The guidelines concerning this procedure determine that the UASC should be placed with a suitable person, in a suitable flat or a suitable institution. The procedure of placing a UASC differs in the 16 federal states and communes in Germany. It can take anywhere from a couple of days to three months and is handled by different institutions (B-UMF e.V. 2013). In the following chapter the specific situation in Hamburg, in which this study is located, is described in further detail.

2.3 Situation in Hamburg

The following information is based on an evaluation by the Federal Association for

Unaccompanied Minor Refugees (B-UMF e.V.) in cooperation with the Office of the United

Nations High Commissioner for Refugees (UNHCR) Germany. The number of

unaccompanied asylum seeking children that have been taken into custody in Hamburg has

been steadily increasing over the last years. In 2009 192 unaccompanied refugees were taken

into custody in Hamburg, while in 2012 the number rose to 623. These numbers only

comprise those children that were taken into custody by the youth services. They exclude

those that were determined as being over the age of 18, even though they claimed to be

younger. Since 2010 only around 50% were accepted as being under the age of 18 after the

initial examination or interrogation. Other than being rejected as underage some children

might be placed with suitable persons such as relatives. These are also not included in the

number on UASC in Hamburg. Furthermore there is no information on how many children

have been rejected at the borders or live in Germany undocumented (B-UMF e.V. and BMF

2012). Most of the refugees came from the Middle East and Africa, but only 13% were

female. The highest represented nation is Afghanistan, even though their number decreased

since from 70% in 2010 to 52% in 2012. 78% of the young people were between the ages of

16 and 18. The average age was 16,0 in 2012. When they reach the age of 18 while they are in

the initial care institutions custody ends and they are referred to a homeless shelter or special

housing for asylum seekers. Only 45% of the young people placed in an initial care institution

receive ongoing care in the youth care system (B-UMF e.V. and UNHCR 2010). For this

study this means that the focus is on a very small group out of all the young refugees that

come to Germany unaccompanied. The young people that this study is about are the ones that,

for unknown reasons to the researcher, make it into the youth care system. There is no official

information available about the future of those that were rejected as unaccompanied minor

refugees after their arrival.

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So far there is no regularized procedure for taking UASC into custody in Hamburg. The Children and Youth Emergency Service (KJND) is the main actor in this process. They are notified if any UASC is found, take them into custody and place them in a preliminary institution for newly arrived asylum seeking children. There, social workers decide together with legal guardians and the appointed YWO about the future of these adolescents. Because of the growing number of UASC some of them are placed with the KJND instead of in appropriate institution due to the lack of capacities. The maximum stay in one of these preliminary institutions should be 90 days, but the average stay in the initial care in 2010 was 108 days and therefore longer than desired. The stay is often prolonged due to the lack of appropriate follow up institutions or because the clearing procedure could not be finished in time (B-UMF e.V. 2011).

The decision to take the young person into custody is based on certain considerations.

Determining factors are whether the person is foreign, came unaccompanied and has no relative or other person willing or able to take care of him/her. Besides this the decision is based on the report of the person and on the principle that unaccompanied minors are in need of protection. In cases where the age is not documented it has to be determined. This is done through collecting biographical data, the assessment of the physical appearance, as far as it is possible to see without having to use special instruments or taking the clothes off. If the age is obviously above 18, the city of Hamburg will refuse to take the young person into custody. In cases of doubt the young person will be assumed to be under age, but a medical examination will additionally be ordered. If the young person is obviously under age he/she will be taken into custody. The estimation of age is done by at least two social-pedagogues. They should have many years of work experience with young people. The medical examination takes place in the university clinic by a forensic doctor. If necessary the development of the wisdom teeth will be looked at, additionally the jaw or/and the collarbone might be x-rayed. If the young person is assumed to be under age, the procedure of taking him/her into custody will be continued. The age assessment is an administrative act, so that the young persons can appeal against this decision. This procedure of age assessment has been criticized extensively for ethical reasons and because of not complying with the United Nations Convention on the Rights of the Child (CRC) by the B-UMF e.V. They state that especially during puberty the determination of age is very difficult and due to the severe consequences that follow for the individuals, it should be taken by appropriate institutions (B-UMF e.V. 2013). For further information and discussion see a report by Smith and Brownlees 2011

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. The people who have custody (parents) of the young refugees are usually not available or reachable so the YWO immediately orders a legal guardian as a next step (B-UMF e.V. and UNHCR 2010).

There is no information available on the reasons for the low number of young people receiving ongoing care. A possible reason could be that those not receiving further care are close to turning 18 and are considered not in need of youth care. It might also be that those young people with little prospects of staying in Germany do not receive it because the authorities consider it as a waste of resources. Underlying this perception of the young people as not needing care is the asylum law that considers young people legally of age at the age of 16 rather than at 18. This is an arbitrary reduction of the age of maturity and therefore leaves many young people between the ages of 16 and 18 in Germany without the needed support.

The Federal Association for Unaccompanied Minor Refugees (B-UMF e.V. 2013) criticizes

this as contradicting the Article 1 of the UN-CRC that defines a child in need of protection as

a person under the age of 18. The German law leads to young people under 18 applying for

asylum without receiving support in the process. It furthermore means that many are

accommodated with adults instead of in appropriate youth welfare institutions. The B-UMF

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e.V. (2013) criticizes that some municipalities still treat 16 and 17 year old UASYP as adults and do not take them into custody at all. Even though Hamburg acts differently the number of young people receiving ongoing care shows that they are also disadvantaged. Germany has withdrawn its reservations on the CRC to treat foreign children differently. Despite this, the B-UMF e.V. remarks that the steps taken to put this withdrawal into action are not sufficient.

The federal government even goes so far as to not consider young refugees over the age of 16 as minors at all (B-UMF e.V. 2013). This view renders the withdrawal of the reservations on the CRC practically void.

The initial care should take place in an appropriate shelter. This should either be an institution especially for unaccompanied minor refugees or other youth residential care homes. The young person stays here for approximately 3 months until he/she can be integrated into the youth care system. In the initial care institution the care is provided round the clock, by mostly pedagogic staff. The young people are furthermore provided with clothes, food, shelter and other material necessities (B-UMF e.V. and UNHCR 2010). In this initial care they will also receive medical treatment and, if necessary, vaccinations. They get help with organizing their daily life, such as starting school, getting in touch with contact persons and organizing leisure activities. They will furthermore work on resolving the legal status, initiate the asylum procedure (if over the age of 16) and try to regularize their stay in the country. The first care institution is responsible to assist the young people in overcoming and coping with their situation and try to make plans for the future. They receive individual counseling hours for support and orientation in their new everyday life. Another aspect of care concerns the contact to other supportive institutions such as asylum rights groups. They will also be introduced to the German language through a course, to Germany as a country and the everyday routines.

The initial care will also contribute to investigating if the custody can be ended. For that they determine the amount of support these young people need, if there are relatives in the country and if a return in the home country is possible. Together with the appointed YWO the initial care institutions assist in finding an appropriate follow up home. It is possible to provide the young persons with financial support to get legal support for their asylum claims (B-UMF e.V. and UNHCR 2010). All minor refugees are obliged to attend school. If they are not able to speak the language yet, they will be placed in literation classes and/or preparation classes.

After changing to a “normal” school they will receive additional support with the German language for another year (B-UMF e.V. 2010).

2.4 Follow up Care

After the stay in the initial care institution some of the young people are placed in residential youth care. In Hamburg these are normally residential youth groups where they live in groups with other UASYP and are cared for by one or two social workers. These settings aim to prepare the young people to live independently. Already in these homes they live quite independently and usually only receive support during the day. At night there is often a person living in the same house that is on call for emergency situations. All the social workers interviewed in this study work in these more independent setting. Another possibility is more intensive care including around-the-clock care for young people with very high needs. This much more expensive solution is rarely chosen for this group of young people (B-UMF e.V.

and UNHCR 2010). The process of leaving these less intensive care institutions is the subject

of this small-scale study. These institutions are not exclusively designed for unaccompanied

refugees. However in some cases projects choose to only take in UASYP instead of mixing

them with German citizen youth. To illustrate these settings the following chapter provides a

short introduction to the German youth care system.

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3 The German Youth Care System

Even though the German Social Act Book VIII on Youth § 42 was amended to fully include UASYP into the protection of the youth welfare law, the B-UMF e.V. (2013) describes this as not fully implemented. According to the association the practices differ in all federal states and 25% of all minors are not taken into custody at all (B-UMF e.V. 2013). In the following chapter the situation for youth in Germany in general will be described to illustrate the context of this study.

More than half of the young people that are placed in care in Germany leave care before the age of 18. Less than 40% leave care between the ages of 18 and 21 and less than 5% over the age of 21. The youth care system is generally oriented at an institutionalized life course and the support therefore focused on helping the young people succeed in education, not becoming delinquent, living independently at a certain age and finding an employment (Köngeter, Schröer & Zeller 2008).

The German Social Care Act (SGB VIII) provides, on the one hand, a coherent legal framework for all 16 states in the federal republic; its implementation is, on the other hand, left to the municipalities. Central to the SGB VIII is the right for all young people up to the age of 27 to receive support in their upbringing and education. Here the family as the place of upbringing is central and the state support subsidiary to family care. The state functions as a supervisor of the parents’ care to make sure that they live up to their children’s right to a good upbringing (Köngeter, Schröer & Zeller 2008). The provision of these services is organized by the communal Youth Welfare Offices. Nevertheless the law provides the possibility that these are carried out by private bodies, which are in fact the main providers of child, youth and educational support services. The YWO though remains responsible for the care management. This has as a result a complex situation of cooperation of parents (or legal guardians), young people/children, private bodies and the YWOs (Köngeter, Schröer & Zeller 2008).

The main form of residential child care takes place in decentralized group homes. For young people over the age of 16 the situation is more complex. It is in this context that the present study is placed. The youth welfare system offers support for this group either in form of assisted living in single or group accommodation or in form of counseling. Furthermore the transition into vocational employment is central to this age group. Therefore the two social laws II and III that provide support with finding employment and providing unemployment benefits become important for care leavers. Even though the SGB VIII has strong legal priority before the other two legal systems, apparently municipalities enforce an early transition of care leavers into the SGB II and III systems, that instead on support and care focus on demand and support (Köngeter, Schröer & Zeller 2008). After leaving the youth care system the young care leavers have no access to further support by the system. This study also looks into how social workers try to facilitate access to support networks after care. In the following chapter national and international research findings central to this study are presented.

4 Previous Research

In this chapter findings of previous research studies on the topic of care leaving are described.

The number of research studies on this area in Germany is limited and it appears that no research studies have been conducted on the care leaving process of UASYP specifically.

Therefore more studies from an international context will be presented. First findings from

different countries on the care leaving process generally will be presented, followed by

studies that explicitly focused on the group of unaccompanied asylum seeking young people.

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4.1 Germany

There has been limited research on the status passage of leaving care in Germany so far, although the number is growing. Most research related to this topic was conducted about different developments in the life of young people after leaving care. One of the first studies interviewed more than 900 young people with standardized questionnaire asking about the time after care leaving and the success rates of the care leavers in relation to employment, legal behavior and social exclusion and highlighted the precarious situation of care leavers for the first time (Pongratz & Hübner 1959 cited in Köngeter, Schröer & Zeller 2012). A later study from 1987 sent questionnaires to 29 providers of public residential care about the achieved school certificates of the young care leavers. The central result was that care leavers had limited success in school and education (Bieback-Diel, Lauer & Schlegel-Brocke 1987 cited in Köngeter, Schröer & Zeller 2012). Another quantitative study from 1990 analyzed the data from a Youth Welfare Agency about care leavers. Here it was concluded that institutional care does not lead to criminal behavior or social exclusion (Bürger 1990 cited in Köngeter, Schröer & Zeller 2012). These and more studies (Hansen 1994; Wohlfahrtsverband Baden 2000 and JULE 1998) concentrated on the effects of support during care on outcomes after care, but less on the stage of the transition itself.

Studies with a stronger emphasis on insights into the care leavers’ experiences and on processes during transition emerged recently. Finkel (2004) conducted 15 biographical narrative interviews with young women three years after leaving care. He concluded that the development of an individual life design depends on the institutional support schemes given during the care leaving process. Another qualitative study based on semi-structured interviews from Normann (2003) concluded that moving out of care too early can cause problems in the process of developing an independent life design. A nationwide qualitative study (INTEGRA 1998-2003) showed that it is of relevance for young care leavers to know that there is the possibility of continued support after leaving (Köngeter, Schröer & Zeller 2012). Research which takes the institutional structures into account, that facilitate and shape the transition and the transition efforts as well as resources of the young care leavers, is still lacking (Strahl, Mangold & Ehlke 2012).

One project launched by the University of Hildesheim and the IGfH “Nach der stationären Erziehungshilfe - Care leavers in Deutschland” is researching this presently. They have published a first research report in January 2013. The project focuses on good practice examples of transition support in Germany and places this into an international perspective. It evaluates international best-practice examples from mostly European countries and analyses possibilities for integrating those into the German systems (Thomas & Sievers 2013). First results of qualitative interviews that were conducted with professionals in Germany as part of the research project show that the care leaving process is rarely oriented at the needs of the young person, but rather at the institutional structures of the care home. The funding agencies (Youth Welfare Offices) follow the legal guidelines that a young person should live independently at the age of 18 and only in special cases receive further institutional care.

Thomas and Sievers found that the support given during the transition seems to focus mostly on practical skills, such as being able to do their grocery shopping, live independently and handle their finances. Independence is constructed instead of reached naturally through an individual maturing process. The professionals pointed out how the young people were pushed into independence without having reached the inner state of feeling ready beforehand.

Further preliminary results are that the given support during the transition is restricted due to

financial requirements. A gradual decrease in the level of support seems not possible because

of strict separations between the funding of residential and ambulant care. After-care support

is furthermore not institutionalized and often provided on a voluntary basis; overall the

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professionals have no information about the situation of the young people after leaving care (Thomas & Sievers 2013). The most common transitional support seems to be in a kind of assisted living with flexible support levels. The period of funding by the funding agencies vary. Some provide funding until the age of 18, others until 21 (Thomas & Sievers 2013).

There is a growing number of research studies on the topic of care leavers in Germany. The focus on their cause seems to shift from care outcomes to transition conditions. No research though was found that was conducted on the situation of unaccompanied asylum seeking young people leaving care. Their situation differs from their citizen peers in many ways, especially regarding the uncertainty of their future stay in the country. It seems necessary to conduct studies on this topic in a German context as well as in order to find out what specific support this group needs in the transition process in order to make a successful status trajectory.

4.2 International Research

The topic of care leaving has received more attention in an international research context.

These studies on young people leaving care in general and subsequently on unaccompanied asylum seeking care leavers are presented in the following.

4.2.1 Care Leavers in General

Internationally there have been more research studies on the topic of the actual care leaving process, some even with a special focus on unaccompanied asylum seeking young people.

The special situation of UASYP during the care leaving process has not been focused on strongly in the international European research field either. However the number of researches looking at their situation seems to be growing. General findings from the United Kingdom (UK), Sweden, Australia, Romania and other European countries indicate that citizen care leavers experience a compressed and more abrupt transition into adulthood than their peers that live with their families, who on the contrary experience a prolonged transition (Barrie &

Mendes 2011; Hancilova & Knauder 2011; Höjer & Sjöblom 2011; Stein 2006; Stein 2012;

Wade et al. 2005).

A Swedish study found that there are no specific care leaving programs in Sweden. Höjer &

Sjöblom (2011) interviewed 111 care services managers. They found that the practices differ

notably throughout the municipalities but there is usually no designated “leaving care” social

worker, although some have routines or explicit plans for this transition. In the UK on the

contrary a Children’s Leaving Care ACT was passed in 2000 (CLCA) which grants every

child the right to a well-planned preparation process (Wade 2011). Despite this Wade (2011)

and also Barrie & Mendes (2011) found that citizen young people leaving care often feel ill-

equipped for life after care. Stein (2006) reviewed international research studies and

concluded that they often leave care much earlier (at 18 instead of mid/late 20s) than their

peers leave home and are in greater danger of homelessness. He also identified that young

people and social workers in the UK often thought that the care leaving moment was too

early. Conclusions for a good preparation process were made by Stein (2012) and Wade

(2011). Stein (2012) found that good care leaving practice identifies the needs, involves the

young people in decision making, provides ongoing support, provides a continuity of staff and

has trained carers specifically for the transition. Identified areas that need special attention are

being and feeling safe, informal support (friends, networks), finances, housing, education and

employment (Stein 2012). Wade (2011) concludes, based on an evaluation of research

evidence, that preparation should take place gradually throughout the time in care in a context

of stability and security. It should facilitate the formation of new attachments and maintain

existing links and relationships. Education should furthermore be encouraged and the

preparation properly integrated into the child care planning.

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In terms of perceptions of the young care leavers by the social workers there are some findings from Sweden. Höjer & Sjöblom (2011) found that even though the interviewed care managers were aware that the right time for moving out is different for each person, they thought that the right moment to terminate care was when the young people had completed school, not when they were personally ready for that. They furthermore lacked awareness in recognizing the special needs of young care leavers in comparison to their peers. Another interesting finding in this context was the fear of the social workers that the young people might stay dependent on them. At the same time they acknowledged the young persons’ needs for ongoing support after leaving care (Höjer & Sjöblom 2011). In another study where 16 care leavers between the ages of 18 and 22 and their parents, social workers, foster carers and or institutional staff were interviewed they found that social work managers often revealed an

“administrative” attitude towards the situation of the young care leavers (Höjer & Sjöblom 2010).

An Australian qualitative study by Maunders et al (1999) that involved focus groups with almost 200 care workers found that a positive experience in care, self-confidence and a feeling of self-efficacy, the availability of mentors, ongoing support after care by the same carers, family contact while, during transition and after care could assist the young people during their transition. Based on their findings they suggest establishing care policy that inhibits preparation, support during the transition and aftercare as a general model. According to a research evaluation by Osborn & Bromfield (2007) there is a large number of research studies in Australia evaluating care leaving policies, practices and legislation. They identify a great need for specific care leaving policies. Mendes & Moslehuddin (2006) in this context compared the care leaving provisions and policies in the US, UK and Australia. They found similar concerns in the different countries regarding income inadequacy, insufficient access to services and social networks and lack of access to employment for care leavers. Overall Osborn & Bromfield (2007) conclude that Australian research on care leavers and their outcomes teaches that they are at risk of negative life outcomes such as homelessness and criminality. They need more assistance for employment, independent living, social and emotional skills before they can live independently. They further identified that a sense of stability, security and continuity are determinants of good care leaving outcomes. They found recommendations for a minimum of care leaving standards and support to care leavers up to age 25.

These studies like the majority of care leaving research did not look specifically at the context of UASYP leaving care. In the following some research doing so will be presented.

4.2.2 Unaccompanied Asylum Seeking Care Leavers

Some research in the UK has a specific focus on asylum seeking young people leaving care.

Stein (2012) found that this group often received poorer housing and care especially in respect to care leaving services. Furthermore, this group has high levels of unmet mental health needs and their transitions are further affected by their asylum claims (Stein 2012). Approaching the age of 18 showed to be a stressful time for them. Their immigration status was mostly about to expire and the future prospects very insecure. This is also a time with a big workload for social workers, dealing now also with asylum questions. This period was therefore also characterized by what Dixon et al. (2006) call “working with uncertainty”, which made sound pathway planning extremely difficult. Different outcomes were possible, one being deportation for which the young people should be equally prepared (Dixon et al. 2006).

Jim Wade (2011) focused on the intersection of social work and the asylum seeking process

in the pathway planning process. This question of pathway planning is especially relevant

concerning this group, since most of the unaccompanied children arrive as teenagers in the

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UK and are therefore quickly confronted with the transition into an independent life.

According to Wade (2011) too little is known about what kind of support unaccompanied asylum seeking young people need during care and in the care leaving process and about how these young people are coping especially in comparison to their citizen peers. Some research though suggests that unaccompanied refugees show less troublesome behavior than their citizen peers (Dixon et al. 2006). Further findings (Dixon et al. 2006) on young people that came to the UK as unaccompanied asylum seeking minors are that this is due to their late arrival in the UK (usually between the age of 14 and 15) have shorter stays in the care system, entered care at an older age and show less troublesome and criminal behavior. At the time of leaving they were more likely to be placed in follow up supported housing than their peers with citizenship. More research suggests that UASYP are more likely to continue education after care (Dixon et al. 2006).

The special condition of UASYP is a general concern that makes pathway planning for this target group more complicated and multifaceted (Wade 2011). Because of the uncertainty regarding the future Wade (2011) suggests social work should have the resources for parallel planning a long term future in the UK, transitional planning while not having a permanent resident status, but also a possible return to the home country. The planning should also take into account the different rights and entitlements these young people face in contrast to their peers, when it comes to work, social security and education. Wade et al (2005) point out how the circumstances of immigration status significantly influence the self-perception and future plans of the target group. Those with a positive asylum decision were able to make plans for their future with the feeling of having their own lives in their hands, whereas those with an uncertain status felt that decisions over their lives were in the hands of others. So they were not able to make plans for the future, but focused on the everyday tasks (Wade et al. 2005 cited in Wade 2011). Wade also found that the level of pathway planning depends on the level and intensity of support of care that was given before (2011). He furthermore emphasizes the need for legal representation and advice in the asylum seeking process as part of the pathway planning. Those young people whose asylum claims were rejected are often allowed to stay in the UK until the age of 18 and then have to leave. In these cases the intersection between asylum law and social work becomes most evident and confronts the social workers with big difficulties that they can very little do about. Wade (2011) concludes that even though the confrontation with the prospect of having to return confronts social workers and young people with big challenges, preparation for that should be included in the pathway planning process.

This has to be realistic, take place over time and take account of all possible outcomes (Wade 2011).

Another report focusing on UASYP confirms their precarious situation regarding their asylum status in most European countries. Hancilova & Knauder (2011) report on the situation of unaccompanied asylum seeking children in Austria, Belgium, Czech Republic, France, Hungary, Italy, Netherlands, Slovakia, Slovenia and the United Kingdom. They point out how precarious the situation for UASYP is after turning 18. Because of losing their status as unaccompanied minors, they also often lose their prospects on a regularized stay in the country. Moreover in many of these countries they lose most of their resources and are often faced with homelessness. They further drop out of education following the often sudden relocation and worsening of life circumstances. The situation of care and support according to this report dramatically changes for UASYP after turning 18 also in the UK; in some countries it also means a loss of legal support and advice (Hancilova & Knauder 2011).

Findings from a research review by Mendes and Barrie (2011) on Australia and the UK

support these results. They describe how in 2007 only 11% of the UASYP in the UK were

granted asylum, while the rest had an uncertain legal status, overshadowing their lives,

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present and futures. Mendes and Barrie (2011) show how two systems, the one of child protection and the immigration system intersect in their situation of transition. According to them the latter is given priority in the decision for transition and after care support. Another deficiency they found in the UK was that UASYP are often not given appropriate pathway planning because of their short stay in care and not all seem to enjoy their full entitlement to transition support according to the Children’s Care Leaving Act 2000 (Barrie & Mendes 2011). Even though the UK implemented improvements concerning the transition planning because of the CLCA 2000 on a policy level there is a lack of research concerning the actual practices for UASYP. Barrie & Mendes (2011) emphasize that unaccompanied asylum seeking young people leaving care are a neglected group in research and should receive more attention to be able to meet their needs during this difficult trajectory of their lives.

5 Theoretical Framework

The way social workers chose to structure the trajectory affects the young people’s transitions to adulthood. Theoretical considerations about the life stage of youth and the challenges involved in the transition to adulthood can assist in analyzing the implications of the care leaving process for the young people’s trajectory. It furthermore looked at psychological implications of the situation of young refugees. Social capital is another perspective chosen here. Its effects have proven to be able to provide young people with the needed resources in order to make the transition to adulthood more successfully. Their access to social capital and ability of generating this from the social worker’s perspective will be looked at.

5.1 Youth, Transition to Adulthood and Refugee Youth

Furlong & Cartmel (1997) suggest regarding the life stage of youth as a state of semi- dependency, as a bridge between the dependence of childhood and the independence of adulthood. This concept of youth is bound to a certain social and economic context. It is socially variable, since it is conditioned by social norms, economic circumstances and social policies (Furlong & Cartmel 1997). Stauber & Walther (2006) refer to the stage of youth as the time that is spent in education. This stage has not only become prolonged but also de- standardized. Furling & Carmel (1997) illustrate in line with this how in the 50s and 60s young people were able to make quite direct school to work transitions and gain financial independence at the age of 15 or 16, which is no longer the case (Furlong & Cartmel 1997).

Stauber & Walther (2006) differentiate between different transition regimes in Europe that are shaped by the welfare state structure and employment patterns. The German regime is an employment-centered system based on a highly differentiated and selective school system that separates children at the age of 10 based on their performance. This leads to only one third gaining access to higher educational systems. Stauber & Walther (2006) formulated the hypothesis that in this system cultural capital is no longer sufficient to make successful transitions to adulthood, but that individualized networks of social capital are needed. Young people all over Europe, according to Stauber & Walther (2006), have to learn how to deal with yoyo-transitions and develop a sense of self-efficacy and self-presentation. Young migrants are especially identified as being at risk of internalizing and individualizing disadvantages arising from their position in society and, through that, lose aspiration and motivation. In Germany skills are still connected to certificates needed as entry requirements to the labor market. Transitioning under these circumstances means a constant yoyo- movement. While moving towards autonomy in one area they might fall back in another area.

This combined with individualization tendencies shift responsibilities of structural short

comings to the individual and gives importance to social capital in the form of networks and

connections (Stauber & Walther 2006).

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Young people stay dependent on their parents or the state longer than before due to prolonged transitions from school to work life. This mostly concerns finances, which has an impact on their autonomy in terms of living conditions. Young people have to go through different interrelated transitions such as moving away from home, moving on from education to work and founding their own family (Furlong & Cartmel 1997). Furlong & Cartmel (1997) argue that in this prolonged state of youth dependency the future has often become uncertain and is seen as filled with risks, which jeopardizes the formation and maintenance of a stable identity.

Those young people with better access to social and financial support are less vulnerable to consequences resulting of failure and are more likely to make successful transitions. This means that the risks of unsuccessful transitions are as unevenly distributed as the needed resources and depend on the social position of the young person (Furlong & Cartmel 1997).

The protraction of the period of transition to adulthood can have negative consequences for the formation of a stable identity for those young people whose future is uncertain. Young people often perceive the current times as filled with risk and uncertainty and lack clear frames of reference to establish adult identities (Furlong & Cartmel 1997). Weller (2011) emphasizes how identity formation during adolescence is furthermore closely connected to social networks. Salmela-Aro (2007) additionally points to the fact that during the transition to adulthood social ties change. The young people disconnect from their parents and at the same time connect to peers, who play a significantly increasing role in their lives. The UASYP come from a different cultural and socio-economic background than citizen youth with different conditions for the stage of youth. In this study they will nevertheless be placed in the conditions of the host country, since that is where they spend this time of their life.

The special situation of unaccompanied asylum seeking young people also has to be looked at from a psychological perspective. Adam & van Essen (2004) describe the phase of adolescence as a period of separation-individuation. This means that they have the task to separate from family ties and strive for autonomy and independence and learn to be alone. As an unaccompanied refugee they experience an additional separation, which entails multiple losses and creates a tremendous shock. They are faced with the challenge of finding orientation in a new cultural system under difficult conditions. They face double loss in terms of loss of family and environment as they leave the home cultures and countries. This endangers their development of a stable identity. This is caused by the absence of “trusted identification models” (Adam & van Essen 2004, p.524). That can lead to feelings of loneliness and insecurity because autonomy is forced on to them by a separation that occurs too suddenly, especially if it results from the deaths of the parents. Adam & van Essen (2004) emphasize the need for a safe and secure environment as well as stable support and care to prevent further severe obstacles for their identity development. The authors illustrate how adolescent refugees have most often experienced traumatic events and very often suffer from post-traumatic stress disorder (PTSD), have a tendency towards depressive behavior and increased anxiety. Additionally to the possible violence experienced or witnessed by the young people they are faced with the disruption of the family which is an extremely stressful event in the life of a young person. UASYP face an accumulation of distress causing factors.

These factors are the situation in their home countries that exposed them to chronic stress, followed by the flight itself that in many cases lasted for years during which they faced severe difficulties, abuse, further violence and loss. Another strain is the situation in the host country where they face role conflicts, language difficulties and legal problems. These strains cause symptoms similar to PTSD such as insomnia, lack of concentration, impulsive outbursts, avoidance, anxiety and intrusive thoughts and feelings. Adam & van Essen (2004) summarize to the point the problems refugee young people face in exile:

 “Personal, community, and cultural losses;

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 Multiple separations and need for parental and family support and care;

 Familial conflicts ad psychic disturbances;

 Long-lasting uncertainty as to acquiring residency in the new country and starting up a normal life;

 Minimal facilities and common violence in reception centers;

 Limitations to education and freedom of movement;

 Social marginalization and discrimination.” (529)

They identify negative consequences for their mental stability because of living in exile without mutual support systems. In the host country they face strong disadvantages compared to the youth from the host society. Even if they now live in better conditions they face very little chances for social development (Adam & van Essen 2004). Posttraumatic reactions are provoked by the uncertainty and insecurity in their present lives. The uncertainty of their stay in the country triggers the reliving of previous traumatic events and enforces the tendency of children and adolescents to expect a repetition of traumatic events. This hinders them in developing positive expectations for the future and long-term perspectives. Here Adam & van Essen (2004) emphasize strongly how it is a misunderstanding that the most traumatic events of a young refugee lay in the past and that problems concerning the asylum claim in the host country were merely minor factors. They identify the accumulation of stress from the past, present and expected future as the contributing factors to the adolescent’s psychopathology.

They identify the present stress caused by the uncertainty of stay as the main hindering factor for coping with their past experiences. For treatment Adam & van Essen (2004) advise among others to reestablish safety and predictability and focus on regaining control. This refers to the problems associated with their feeling of not being able to decide about their lives and being in control. If the feeling of helplessness dominates it is a great obstacle in developing independence and autonomy (Adam & van Essen 2004).

5.2 Social Capital

Even though the concept of social capital is discussed, applied and understood in various ways it can be broadly understood as the “values that people hold and the resources that they can access, which both result in and are the results of collective and socially negotiated ties and relationships” (Edwards, Franklin & Holland 2003: 2). This usually takes place with people that have a similar background in values and norms. Putnam and Coleman who are both theorists of social capital highlight, according to Reynolds (2011), the importance of resources in this context that emerge and are reproduced through social networks. Reynolds (2011) illustrates Putnam’s differentiation of social capital into its ability of creating

‘bonding’ and ‘bridging’ networks. Bonding is the aspect of social capital that is directed inwards into a homogenous group and trust and reciprocity within this. Bridging, on the other hand, is directed outwards and considered that kind of social capital that builds connections between different social groups and generates inter-community contacts (Reynolds 2011).

The strong bonding networks within ethnic groups seem to indicate that people like to connect

to people with similar socio-cultural factors. Here the possibility exists that young people

develop negative social capital, for example if their networks restrict them in choosing their

own lifestyles. It may also reinforce unequal power relations within ethnic groups. (Reynolds

2011). Helve (2007) also points out how these bonding relationships within groups can lead to

social exclusion in wider social networks during the transition to adulthood in contrast to

bridging social capital. Both Putnam and Coleman are criticized for not sufficiently

considering how social networks reproduce patterns of inequalities such as class, ethnic and

gender inequalities (Reynolds 2011).

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Bourdieu (1986) on the other hand regards social capital as a reproducer of inequality and furthermore identifies more forms of capital that are important in this process such as cultural and economic capital (Reynolds 2011). Economic capital can be transformed directly into money whereas the other forms need certain conditions to develop. Cultural capital is inherited and embodied by the whole family. It is therefore accumulated throughout the socialization process. This time of accumulation of cultural capital depends on the time disposable the family can give to the person that is free from economic necessity (Bourdieu 1986). Cultural capital is further described as embodied goods and dispositions and also comprises education (Tolonen 2007). This kind of capital is acquired quite unconsciously according to Bourdieu (1986) in contrast to social capital. Social capital depends on the other kinds of capital. These influence the volume of social capital one can accumulate as well as the size of network one can mobilize. Symbolic capital is the shape either of these forms of capital can take on if recognized and perceived as legitimate. This means that those with power in society are able to use their social networks more effectively (Tolonen 2007).

Stauber & Walther (2006) emphasize how the possibility for ‘bridging’ social capital should be facilitated on a policy level. Even though the networks between social groups are often based on weaker obligations of reciprocity they can provide new possibilities and open gates to the labor market. They further emphasize young peoples’ needs for emotionally charged relationships that give support, safety comfort and encouragement. Experiences of social isolation here can go along with demotivation and cutting off of social relationships. Families as well as professionals or other adult key persons are important providers of ‘weak and strong ties’ as well as peers and youth cultural systems (Stauber & Walther 2006).

According to Barn (2011) care leavers are often required to make the transition from care to no care and from dependence to independence earlier than youth living at home and do not have the possibility to rely on their families if they fail. They are lacking the safety and support network of a family and additionally often experience instability in their placement.

This leads to a sense of uprootedness and lack of belonging. The results are social exclusion and marginalization, but also “questionable ways of making sense of their ethnic identities”

(Barn 2011). According to Barn (2011) social capital is therefore a worthy concept for

analyzing the situation of young people leaving care. The author spotlights the additional

vulnerability of ethnic minority care leavers. They not only experience loss and bereavement,

loss of family and friendship ties, loss of neighborhood networks, instability in care, but also

racial and ethnic discrimination. Research suggests that access to family and community

networks indicates access to social capital (Barn 2011). Barn (2011) assumes that care leavers

that have experienced loss and instability in their upbringing have difficulties maintaining a

sense of community networks, trust and reciprocity. The author identifies certain key factors

that promote connectedness among care leavers. These are education, work and community

networks (apart from good relations to the birth families). Trust and reciprocity are born out

of access to family and community networks. Young people growing up in care are in danger

of losing these ties due to instability experiences in their upbringing. The transition from care

to the community is a further crucial experience that might leave the young people very much

alone. Barn (2011) found in her study the precarious upbringing experiences and the

implications for their transition from care to community and into adulthood. The absence of

stable family and other networks and the instability experienced during their upbringing have

a “cumulative effect”. This can lead to homelessness, unemployment, criminal behavior,

substance abuse and young parenthood but also to low confidence, low self-esteem, lack of

belongingness and feelings of isolation and marginalization. Stability and permanence are

shown to be the most important factors (Barn 2011).

References

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