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empirical and theoretical work. In conclusion, it is suggested that there is a need for more studies
programme evaluation, there has been little reference to the lack of theoretical
exploration (Courtney & Hughes, 2003).
Children and Youth Services Review
28 (2006) 422434
www.elsevier.com/locate/childyouthgrounded in theory.
D 2005 Elsevier Ltd. All rights reserved.
Keywords: Young people; Care; Attachment theory; Focal theory; Resilience; Empirical work; Social exclusion
1. Introduction
There is a substantial body of international research studies, both quantitative and
qualitative, on young people aging out of care, but very few of these studies have been
informed by theoretical perspectives. Also, whereas the weakness of the empirical
portfolio has been highlighted, especially the need for more outcome monitoring andYoung people aging out of care:
The poverty of theory
Mike Stein
Social Work Research and Development Unit, B Block, Alcuin College,
University of York, York YO10 5DD, England
Received 9 March 2005; received in revised form 27 April 2005; accepted 8 May 2005
Available online 5 July 2005
Abstract
Although there is a growing body of international empirical work on young people aging out of
care, very few of these studies have been informed by theoretical approaches. Set in the context of
social exclusion, this paper explores three perspectives that may contribute to a greater
understanding of the main findings from empirical research: attachment theory; focal theory;
and resilience. Each perspective includes a discussion of the implications for practice in linking0190-7409/$ -
doi:10.1016/j.c
E-mail address: [email protected] front matter D 2005 Elsevier Ltd. All rights reserved.
hildyouth.2005.05.005
press; Chase, Knight, Warwick & Aggleton, 2003; Priestley, Rabiee & Harris,2003).
Broad (1999), discussing the findings from his policy survey of leaving care teams
in England, has argued that the problems of young people leaving care were derived
from a mixture of dsocial justiceT issues (structural exclusions and inequalities) dsocialwelfareT issues (poor parenting) and dtechnical difficultiesT (skill deficits). Leavingcare workers responding to his survey suggested that young people would benefitThe purpose of this article is to explore potential theoretical directions. Set in the
context of social exclusion, three different perspectives will be introduced: attachment
theory; the focal modal of adolescence; and resilience. The discussion will draw, where
available, upon the small number of studies that have engaged these perspectives, as
well as discuss the links with the main empirical research and the implications for
practice.
2. The social exclusion of young people aging out of care
International research has shown the high risk of social exclusion for young people
aging out of care. They are more likely than other young people to be homeless or
on the streets, be young parents, have poorer educational qualifications, lower levels
of participation in post-16 education, higher levels of unemployment, offending
behaviour, and mental health problems (Asquith, 1999; Biehal, Clayden, Stein &
Wade, 1995; Bilson, Armstrong, Buist, Caulfield-Dow & Lindsay, 2000; Broad, 1998,
1999; Cashmore & Paxman, 1996; Council of Europe, 1994; Courtney, Piliavan,
Grogan-Kayor & Nesmith, 2001; Dixon & Stein, 2003; Festinger, 1983; Harwin,
1996; Kelleher, Kelleher & Corbett, 2000; Morgan-Klein, 1985; Pinkerton & McCrea,
1999; Smit, 1995; Stein, 2004; Stein & Carey, 1986; Stein, Pinkeron & Kelleher,
2000).
In European social policy discourse, social exclusion has come to mean both
material disadvantage and marginalisation. Whereas the former is usually associated
with low income and relative poverty, the latter refers to the way groups may be
excluded, omitted or stigmatised by the majority due to characteristics such as gender,
age, ethnicity, appearance or behaviour. Also, these two meanings are often linked,
merging causes and outcomes such as unemployment and social isolation (Hill,
Davis, Prout & Tidsall, 2004).
In this context, the international research evidence summarised above, suggests
young people aging out of care are among the most excluded groups of young
people in society. Many experience a cluster of problems both whilst they are in
care, including stigma, especially at school, and after they age out of care,
including dependency on benefits, mental health problems and loneliness (Courtney
et al., 2001; Dixon, Lee, Wade, Byford & Weatherly, 2004; Stein, 1994). Specific
groups of care leavers may face additional disadvantages: young minority ethnic
people; young disabled people; and young parents (Barn, Andrew & Mantovani, in
M. Stein / Children and Youth Services Review 28 (2006) 422434 423from policies to address the former although they are usually offered assistance with
the latter, especially after they leave care (Broad, 1999).
3. Theoretical perspectives and their implications for practice
3.1. Attachment theory
Bowlbys groundbreaking theoretical formulations of the links between early adversity
leading to later emotional and behavioural problems, and young childrens attempts to
cope psychologically with the loss of a parent, combined with Ainsworths classification
of attachment behaviour within a variety of distinct care giving environments, laid the
foundations of attachment theory (Howe, 1995). Theoretical work on attachment and loss
has documented the impact of actual or threatened separation on young children and
patterns of behaviour produced by unsatisfactory interaction with parents, as well as
separations per se (Ainsworth & Eichberg, 1991; Bowlby, 1973, 1982a,b).
Research has also explored how disturbances in attachment are reflected in the way a
child sees the world and processes informationvia an internal working modeland how
these processes may lead to enduring styles of relationships in childhood, adolescence
and adulthood. It has been suggested that children develop one of four basic internal
working models which give rise to distinct attachment styles: secure attachment patterns
experiencing their caregiver as available and themselves positively; ambivalent
patterns experiencing their caregiver as inconsistently responsive and themselves as
dependent and poorly valued; avoidant patterns experiencing their caregiver as
consistently rejecting and themselves as insecure but compulsively self-reliant;
disorganised patterns experiencing their caregivers as either frightening or frightened
and themselves as either helpless or angry or controlling. Each pattern is associated with a
characteristic set of emotional and relationship behaviours (Bretherton, 1991; Crittenden,
1992; Downes, 1992).
A consistent finding from research studies of young people aging out of care, carried
out between 19802004, has been their experience of instability and placement disruption
following their initial or later separation from their birth families. In these studies between
3040% of young people had four plus moves and within this group between 610% had a
very large number of moves as many as ten or more (Stein, 2004).
Qualitative studies have added to this picture. For the young person dplacementmovementT often meant an abrupt end to a foster care or childrens home placementaccompanied by a sense of failure, guilt and blame, as well as changing carers, friends,
neighbourhoods, schools on several occasions (Biehal et al., 1995; Dixon & Stein, in
press; Kelleher et al., 2000; Pinkerton & McCrea, 1999; Stein & Carey, 1986).
Downes (1992) has carried out one of the very few studies of care leavers grounded
within attachment theory. She draws on attachment theory to offer a framework for
understanding adolescents reactions to the experience of being fostered. Her work is
based on an intensive study of the interaction between fostered adolescents and foster
family members in 23 time limited placements over a two and a half year period.
Her findings show the difficulties many of the young people had in accepting help or
committing themselves to close relationships, often because of past difficulties, including
rejection in their birth families. They may become either highly dependent on others or
M. Stein / Children and Youth Services Review 28 (2006) 422434424highly independent, keeping people who are important to them at arms length. Unless this
is addressed, these patterns of relating may continue into adulthood, thus denying them
satisfaction in personal relationships, and the help they may need, especially during
transition (Downes, 1992).
Sinclair, Baker, Wilson and Gibbs (2005) in their study of the outcomes of young
people leaving foster care found a strong attachment to at least one adult was associated
with dgood outcomesT, (as defined by foster carers, young people and a measure of well-being). Some young people were able to establish and maintain good relationships with a
member of their birth family from whom they could get support, or a sustained
relationship with their foster family, or have good relationships with their partner and their
partners family. There were examples of formalising attachments with foster carers within
the study foster carers being paid a retainer while a young person was at university and
then full board when they returned.
3.2. Attachment theory: implications for practice
Attachment theory offers a perspective for understanding the life stories of young
people aging out of care (Howe, 1995; Schofield, 2001). It provides a framework for
exploring their separation from their families and the circumstances surrounding it, their
care careers including placement disruption or stability, and the legacy of these
experiences for their lives after care.
Assisting young people who are unable to remain with their birth parents should begin
with a shared process of assessment, exploring attachment behaviour through patterns of
interaction with significant adults and peers. The identification of patterns of attachment
(as identified above) may guide the work to be undertaken by the foster carers, their social
worker and the young person.
In general terms there is the need to provide young people with stable foster placements
that can help them overcome their earlier problems and provide them with a strong
emotional platform for their journey to adulthood. Young people need to be able to
experience their foster carers as a secure base, to provide them with opportunities and
active encouragement to explore and become confidant in the adult world.
However, knowledge of attachment patterns may also point to more specific aims and
interventions. Downes (1992) gives a number of examples. The aim in interaction with
anxiously attached young people is to increase their confidence in the availability and
reliability of attachment figures, as evidenced by young people increasing their distance
range from foster parents and other significant adults, but without losing the capacity for
closeness. By contrast the aim of work with emotionally detached young people is to
encourage and enable them to test themselves out in less distanced interactions, to move
closer to their foster carers. Foster carers may also support young peoples efforts to
reappraise their relationships with parents and other significant attachment figures. It is
through the achievement of what Downes calls these dpsychosocial tasksT that youngpeople are able to make progress in negotiating the transition to adult life: dthe tasks ofthe placement is to enable adolescents to negotiate the transition to adult life
successfully. They will be helped in doing so if they are able to increase their capacity
for making trusting relationships with adults and peers and to manage more flexibly the
M. Stein / Children and Youth Services Review 28 (2006) 422434 425way they regulate physical and emotional distance between themselves and othersT(Downes, 1992, p147).
3.3. The focal model of adolescence and transitions
Focal theory or the dfocal model of adolescenceT is concerned with how young peoplecope with changes in their lives. It was developed by Coleman partly in response to the
sharp divergence between the dempiricalT view of adolescence, derived from research, andthe dclassicalT view, derived from psychoanalytical and sociological perspectives (Cole-man, 1974, 1978, 1979, 1980). Coleman has argued that a wide range of research provides
little support for psychoanalytical or sociological theories which misrepresent adolescence
as a time of either great psychological disturbance or deviant behaviour.
The model grew out of a study of normal adolescent development which tested large
samples of young men and young women at the ages of 11, 13, 15 and 17, and elicited
from them attitudes and opinions about a wide range of relationships. Data was gathered
on self-image, being alone, sexual relationships, parental relationships, friendships, and
large group situations. The material was analysed in terms of the constructive and negative
elements present in these relationship situations, and in terms of the common themes
expressed by the young people involved in the study.
The findings showed that attitudes to all relationships changed as a function of age, but
more importantly the results also indicated that concerns about different issues reached a
peak at different stages in the adolescent process. For example, conflict with parents
peaked at 17, fears of rejection from peer group peaked at 14, and anxiety over sexual
relationships peaked at 11 years of age. The model suggests that at different ages particular
sorts of relationship patterns come into focus, in the sense of being the most prominent,
but that no pattern is specific to one age only. Thus the patterns overlap, different issues
come into focus at different times, but simply because an issue is not the most prominent
feature of an age does not mean that it may not be critical for some individuals.
Coleman argues that the focal modal differs from developmental stage theory in three
respects: first, the resolution of one issue is not seen as a sine qua non for tackling the next
stage; second, the model does not assume the existence of fixed boundaries between stages
and, therefore issues are not necessary linked to a particular age or developmental level;
third, there is nothing immutable about the sequence involved (Coleman & Hendry, 1999).
The model has been tested empirically and received support through large research
studies carried out in Scotland, the United States and New Zealand (Hendry, Shucksmith
& McCrae, 1985; Kroger, 1985). In addition, Simmonds and Blythe tested the proposition,
contained within the focal model, that those who adjust less well during adolescence are
likely to be those who have to face more than one interpersonal issue at a time (Simmonds
& Blythe, 1987). The authors documented the life changes occurring for the young people
in their study, and related the number of changes to outcome measures such as self-esteem
and academic performance. They concluded that among boys and girls, those who
experienced a greater number of life changes were at greater risk in terms of the outcome
variables.
3.4. The focal model: implications for practice
M. Stein / Children and Youth Services Review 28 (2006) 422434426How might this perspective apply to young people aging out of care? A consistent
finding from studies of care leavers is that a majority move to independent living at just 16
or 17, whereas most of their peers remain at home well into their twenties, and for many of
these young people, leaving care is a final event, there is no option to return in times of
difficulty. Also, they often have to cope with major status changes in their lives at the time
of leaving care: leaving foster care or their childrens home and setting up a new home,
and for some young people starting a family as well; leaving school and finding their way
into further education, training or employment, or coping with unemployment. In short,
their journey to adulthood is both accelerated and compressed (Stein, 2004). They are
denied the psychological opportunity and space to focusor to deal with issues over time
and are expected to undertake their journey to adulthood, from restricted to full
citizenship, far younger and in far less time than their peers (Lister, 1998).
Also, as youth transitions have become more extended in post (or late?) modern
societymore risks and opportunitiesthe family plays an increasing role in providing
financial, practical and emotional support (Beck, 1992; Giddens, 1991; Joseph Rowntree
Foundation, 2002). But for many care leavers their family relationships at this time may be
missing or problematic rather than supportive (Biehal & Wade, 1996).
In addition, whereas the process of social transition has traditionally included three
distinct, but related stages: leaving or disengagement; transition itself; and integration into
a new or different social state, for many young people leaving care there is the expectation
of instant adulthood (Hart, 1984). They often miss out on the critical preparation stage,
transition itself that gives young people an opportunity to dspace outT, provides a time forfreedom, exploration, reflection, risk taking and identity search. For a majority of young
people today this is gained through the experience of further and, especially, higher
education but many care leavers, as a consequence of their pre-care and care experiences,
are unable to take advantage of these educational opportunities (Jackson, 2001; Social
Exclusion Unit, 2003). Their journey to adulthood or full citizenship is, in effect, a
conflation of these three stages into the final stage.
In summary, the focal model points to the need for more recognition of the nature and
timing of young peoples transitions from care. This will include the opportunity for more
normative transitions, giving young people the emotional and practical support they will
need into their early twenties, providing them with the psychological space to cope with
changes over time, as well as recognising the different stages of transitions, including the
significance of the middle stage, transition itself.
3.5. Resilience
The origins of resilience as an empirical and theoretical construct were derived from
the evidence that many children of schizophrenic mothers thrived despite their high risk
status (Garmezy, 1974; Masten, Best & Garmezy, 1990). Werners ground breaking
studies of children in Hawaii led to the expansion of resilience research to include
multiple adverse conditions such as poverty, parental mental illness, maltreatment, chronic
illness and catastrophic life events (Luthar, Cicchetti & Becker, 2000; Werner, Bierman &
French, 1971).
Resilience can be defined as the quality that enables some young people to find
M. Stein / Children and Youth Services Review 28 (2006) 422434 427fulfillment in their lives despite their disadvantaged backgrounds, the problems or
adversity they may have undergone or the pressures they may experience. Resilience is
about overcoming the odds, coping and recovery. But it is only relative to different ages
and cultures, and risk experiencesrelative resistance as distinct from invulnerabilityand
is likely to develop over time (Masten, 2001; Masten & Powell, 2003; Rutter, 1999;
Schofield, 2001).
Luthar and colleagues have identified three theoretical perspectives as guiding
resilience research: first, a triarchic framework identifying the risk and protective
processes in relation to children and young people, their families and their wider social
environments; second, ecological theory exploring the influence of different contexts
varying in proximity to the individual child; and third a structuralorganisational
perspective, grounded in the belief of continuity and coherence in the unfolding of
competence over time, and the importance of individual choice and self-organisation
(Luthar et al., 2000). The main thrust of empirical work has been to identify the risk and
protective factors in relation to children and young people, their families and their wider
social environments.
The resilience of young people from very disadvantaged family backgrounds has been
found to be associated with: a redeeming and warm relationship with at least one person in
the family or secure attachment to at least one unconditionally supportive parent or
parent substitute; positive school experiences; feeling able to plan and be in control; being
given the chance of a dturning pointT, such as a new opportunity or break from a high-riskarea; higher childhood IQ scores and lower rates of temperamental risk; and having
positive peer influences (Rutter, Giller & Hagell, 1998).
A research review of the international literature on resilience factors in relation to
the key transitions made by children and young people during their life cycle has added
to this picture. As well as the first three factors identified above, the authors conclude
that children and young people who are best equipped to overcome adversities, will
have: strong social support networks; a committed mentor or person from outside the
family; a range of extra-curricular activities that promote the learning of competencies
and emotional maturity; the capacity to re-frame adversities so that the beneficial as
well as the damaging effects are recognised; the abilityor opportunityto make a
difference, for example, by helping others through volunteering, or undertaking part-
time work; and exposure to challenging situations which provide opportunities to
develop both problem-solving abilities and emotional coping skills (Newman &
Blackburn, 2002a,b).
As suggested at the beginning of this article, many young people leaving care have
very poor life chances compared to their peers, but not all do. Research studies
completed since the 1980s suggest that in broad terms young people leaving care fall
into one of three groups: young people dmoving onT who are very resilient and ableto manage well after care; dsurvivorsT who are just about coping but whose resilienceis closely linked to the professional and personal support they received; and dvictimsT who are very disadvantaged and need sustained support (Biehal et al., 1995; Dixon
& Stein, in press; Pecora et al., 2004; Sinclair et al., 2005; Stein, 1990; Stein & Carey,
1986).
What are the links between empirical research on care leavers and the resilience
M. Stein / Children and Youth Services Review 28 (2006) 422434428promoting factors identified above? Why do some young people leaving care, against all
odds, cope well and what are the implications for practice?
3.6. Promoting resilience: implications for practice
Young people who experience stable placements providing good quality care are more
likely to have positive outcomes than those who have experienced further movement and
disruption during their time in care. Stability has the potential to promote resilience in two
respects. First, by providing the young person with a warm and redeeming relationship
with a carer or as detailed above, in the account of attachment theory, a compensatory
secure attachment which may in itself reduce the likelihood of placement breakdown
(Rutter et al., 1998). Second, and not necessarily dependent on the first, stability may
provide continuity of care in young peoples lives, which may give them security and
contribute to positive educational and career outcomes (Jackson, 2002, 2003; Jackson &
Thomas, 2001).
Helping young people develop a positive sense of identity, including their self-
knowledge, their self-esteem and self-efficacy, may also promote their resilience (Gilligan,
2001). And although not explicitly recognised as a variable in the research literature on
resilience, identity could be seen as connected to, as well as a component of, key
associations: feeling able to plan and be in control; the capacity to re-frame adversities so
that the beneficial as well as the damaging effects are recognised; personality or lower
rates of temperamental risk (Newman & Blackburn, 2002a,b; Rutter et al., 1998).
Helping care leavers develop a positive identity is linked to first, the quality of care and
attachments experienced by looked-after young people a significant resilience
promoting factor discussed above; second, to their knowledge and understanding of their
background and personal history; third, to their experience of how other people perceive
and respond to them; and finally, how they see themselves and the opportunities they have
to influence and shape their own biography.
Having a positive experience of school, including achieving educational success is
associated with resilience among young people from disadvantaged family backgrounds
and young people living in care (Newman & Blackburn, 2002a,b; Rutter et al., 1998;
Sinclair et al., 2005). Research studies completed on young people leaving care since the
beginning of the 1970s show low levels of attainment and participation beyond the
minimum school leaving age. However, good outcomes are associated with placement
stability, gender (young women do better than young men, as reflected in national data), a
carer committed to helping the young person and a supportive and encouraging
environment for study. This may also include the foster families own children providing
help and acting as role models (Biehal et al., 1995; Jackson, Ajayi & Quigley, 2003).
There is also evidence that young people who have had several placements can achieve
educational success if they remain in the same school and this also meant that they were
able to maintain friendships and contacts with helpful teachers. Also, late-placed young
people who may have experienced a lot of earlier placement disruption, can succeed in
foster care, although this was seen by young people and their foster carers as more of a
service relationship than a substitute family (Jackson et al., 2003).
School or care itself may also provide turning points (Rutter et al., 1998), open the door
for participation in a range of leisure or extra-curricular activities that may lead to new
M. Stein / Children and Youth Services Review 28 (2006) 422434 429friends and opportunities, including the learning of competencies and the development of
emotional maturity and thus promote their resilience (Newman & Blackburn, 2002a,b).
Indeed, resilient young people had often been able to turn their negative experiences at
home, or in care, into opportunities, with the help of others.
Preparation for leaving care may also provide young people with opportunities for
planning, problem solving and the learning of new competencies all resilience
promoting factors (Newman & Blackburn, 2002a,b; Rutter et al., 1998). This may include
the development of self-care skills personal hygiene, diet and health, including sexual
health; practical skills budgeting, shopping, cooking and cleaning; and interpersonal
skills managing a range of formal and informal relationships. Preparation should be
holistic in approach, attaching equal importance to practical, emotional and interpersonal
skills not just, as in the past, ddomestic combat coursesT for young people to manage ontheir own at 16 (Stein & Carey, 1986; Stein & Wade, 2000).
As the discussion of focal theory and transitions suggests, many young people leaving
care have compressed and accelerated transitions to adulthood which represents a barrier
to promoting their resilience. They are denied the psychological opportunity to focus to
deal with changes over time which is how most young people are able to deal with
problems and challenges. Also, as discussed above, they may often be lacking the range
and depth of family support of their peers and they may be denied the opportunity to
dspace outT a period of risk taking, reflection and identity search.The resilience of young people after leaving care, is closely associated with their care
experience and the support they may receive. As suggested above three doutcome groupsTcan be identified from research studies.
First the dmoving onT group are likely to have had stability and continuity in their lives.They have welcomed the challenge of independent living and gaining more control over
their lives often contrasting this with the restrictions imposed while living in care,
including the lack of opportunities to make or participate in decisions, which affected their
lives. They have seen this as improving their confidence and self-esteem. In general, their
resilience has been enhanced by their experiences after care and they have been able to
make good use of the help they have been offered, often maintaining contact and support
from former carers (Schofield, 2001; Sinclair et al., 2005).
The second group, the dsurvivorsT, had experienced more instability, movement anddisruption while living in care than the dmoving onT group. What made the difference totheir lives was the personal and professional support they received after leaving care.
Specialist leaving care workers, key workers, as well as mentors the latter identified in
the international review as a resilience promoting factor (Newman & Blackburn, 2002a,b)
and different family members, or some combination of support networks, could help them
overcome their very poor starting points at the time of leaving care and thus promote their
resilience (Biehal et al., 1995; Clayden & Stein, 2002; Dixon & Stein, 2003; Marsh &
Peel, 1999).
The third group, the dvictimsT, was the most disadvantaged group. They had themost damaging pre-care family experiences and, in the main, care was unable to
compensate them, to help them overcome their past difficulties. After leaving care they
were likely to be unemployed, become homeless and have great difficulties in
maintaining their accommodation. They were also highly likely to be lonely, isolated
M. Stein / Children and Youth Services Review 28 (2006) 422434430and have mental health problems. Aftercare support was unlikely to be able to help
them overcome their very poor starting points and they also lacked or alienated
with non-experimental designs, that is evaluated interventions with no random allocation
adulthood. PhD Thesis, University of York Library, York.Barn, R., Andrew, L., Mantovani, N. (in press). Life after care: A study of young people from different ethnic
groups. Joseph Rowntree Foundation, York.
Beck, U. (1992). Risk society: Towards a new modernity. London7 Sage.or pre-intervention matching of groups, most often without a comparison group (Courtney
& Hughes, 2003; Stein, 2004). In addition to these single project evaluations there are
examples of user studies, surveys and cohort studies but far fewer studies with
experimental or quasi-experimental designs (Stein, 2004). The state of empirical
knowledge is predominantly descriptive rather than evaluative.
Second, and central to the rationale of this paper, most of these studies are detached from
theory in terms of context, conceptual exploration or theory building. This paper has
presented three different perspectives and attempted to link these with selected empirical
findings: attachment as an example of theory; the presentation of the focal model of
adolescence as an example of a theoretical model; and resilience as an example of a concept.
But these are not the only theoretical possibilities. Baldwin (1998) and Horrocks (2002), for
example, have applied life course theory to explore transitions. Also, the relationship
between developmental perspectives, including a life span approach, and the three selected
approaches remains contested are they conceptually and theoretically integrated or
distinct? (Coleman & Hendry, 1999; Luthar et al., 2000).
Finally, it is recognised that this paper is very much a beginning, derived from selected
theoretical approaches and perspectives. But it does demonstrate in a small way that
linking empirical and theoretical work has the potential to enhance our understanding of
aging out of care issues, as well as the theoretical foundations of practice.
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This paper began by suggesting that the main body of international research on young
people aging out of care has been largely empirically driven as distinct from theoretically
based. This observation merits further discussion.
First, although there is both quantitative and qualitative research in this field, recent
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Young people aging out of care: The poverty of theoryIntroductionThe social exclusion of young people aging out of careTheoretical perspectives and their implications for practiceAttachment theoryAttachment theory: implications for practiceThe focal model of adolescence and transitionsThe focal model: implications for practiceResiliencePromoting resilience: implications for practice
ConclusionReferences