Exploring Foster Carers' Motivations and Experiences with Mental Health Training, Lecture notes of History

Download Exploring Foster Carers' Motivations and Experiences with Mental Health Training and more Lecture notes History in PDF only on Docsity! 100 Chapter 4 4 QUALITATIVE APPROACH 4.1 INTRODUCTION This chapter will outline the qualitative data collection methods used, describe the analytic techniques employed as well as presenting the findings from this phase of the research study. The findings will be fully discussed with links to current literature identified in Chapter 1. The characteristics of the research participants have been outlined in Chapter 3 and therefore will not be repeated within this chapter. 4.2 DATA COLLECTION I collected data from two cohorts over a period of three to four months for each cohort between 23rd April and 17th July 2009 (Cohort One) and 15th October 2009 and 5th February 2010 (Cohort Two). This exploratory qualitative study used two methods of data collection including semi-structured audio-taped interviews and a personal reflective diary. The semi-structured interviews were administered immediately pre training, post and following training at 12 weeks. The personal reflective diary was administered immediately after the training and then collected and used within the 12 week follow up interview. These two methods of qualitative data collection were used to illuminate the experiences of foster carers, to gain a sense of change over time of each foster carer’s journey after receiving the training. The main method of qualitative data collection was that of semi-structured interviews and this was chosen in order to allow foster carers to tell their story in their own words and to uncover areas and ideas that were not anticipated at the beginning of the research (Pope & Mays, 2000). The diary method was also chosen to complement the data gathered in the final semi-structured interview and to capture foster carers’ reflections upon their 101 experiences since completing the training. This provided a more intimate record otherwise hidden, of a 12 week period of time, between the training and the final interview (Zimmerman & Weider, 1977). A detailed definition and description of both the personal reflective diaries and semi-structured interviews are explored below. 4.2.1 A DIARY INTERVIEW A diary interview method complemented the data gathered within the interviews. Diaries are defined as records or logs of professional activities which enable people to record events thoughts feelings or observations as they go along acting as an aide memoir. There are many examples of studies that have used this method of data collection, for example, Burgess (1994) used food diaries within many of the research projects he conducted. Zimmerman and Weider (1977) in their study of cultures in America, used diaries as ‘an observational log’ which was maintained by participants and used as a basis for intensive interviewing; a similar approach was used within this research project. Diaries were given to foster carers at the end of the training programme to include both a free flow description sheet and a reflective section. The free flow description sheet was deliberately unstructured so they were free to write about events and feelings (identified by them) regarding their experience of this training and its impact, if any, on the child they care for. The reflective section was also unstructured and the foster carers were asked to reflect upon the knowledge, if any, they gained from the training. At the front of the diary a standard reminder informed each foster carer that the diaries would be collected prior to the final interview and used to explore their experiences further in the final interview. However, each foster carer was given the option of keeping the diary once the interview was completed. It was anticipated that the diaries would provide additional data by capturing foster carers’ reflections of experiences since completing training. The diaries also acted as an ‘aide memoire’ at the follow up interview and led to further exploration of any areas that seemed significant. This process converted the diary as a source of documentary data in its own right, into a question generating device. There are ethical issues to be considered when using a diary interview method in 104 The interview schedule was divided into five main sections of the interview with the aim of exploring patterns and associations in order to understand the experiences of foster carers. The first section focused upon the foster carer’s motivation to attend the training. It was hoped this would uncover a clearer understanding of their perception and enthusiasm for training as it currently remains voluntary. It was anticipated that exploring, through sensitive probing, might reveal a greater understanding of expectation, purpose and role of training. Section two covered the foster carer’s previous experience of training. It was hoped this might reveal an understanding of why they were motivated or unmotivated to attend and highlight previous experience or knowledge of training from the mental health services. Section three explored their individual needs and expectations from the group. It was hoped that this might reveal their current situation and how this related to their motivation to attend the group training. Section four probed further to explore any problems or anxieties about attending group training. Section five was an open section that was used to explore any other aspects of their experience that might be relevant to illuminate the experience. Finally a closure section was included, thanking the foster carer for their participation in the first stage and arranging a follow up appointment after the training. 4.2.2.3 POST TRAINING INTERVIEW SCHEDULE The schedule included further instructions for the researcher to outline the purpose of the post training interview and provide reassurance regarding the maintenance of confidentiality and anonymity. By this point in time, I felt a rapport was developing between us, as I had met the foster carers on two previous occasions during the pre- training interviews as well as throughout a two-day training programme and as a result they appeared more relaxed and willing to share personal stories. The questions in this section were inductive, looking for patterns and associations, in order to collect information with the purpose of shedding new light upon the experience of training and covered five main sections as below: 105 Section one explored the foster carer’s experience of attending the group training. It was hoped this would provide information, in their own words, about the training, shed insight into the knowledge gained as well as how their perception or understanding, if any, of their child’s needs had changed. Section two focused upon how the group helped or supported the foster carers in any way. It was hoped to gain understanding of how the training might be helpful. Section three focused upon any difficulties the foster carers might have encountered and whether there would be anything that needed to change or be done differently. This related to the objective of gaining information about the strengths and weaknesses of the group and the areas that might need changing in order to shape the direction of future training. Section four aimed to explore whether their expectations of the training were met. It was hoped that this might reveal limitations in the training in terms of meeting the needs of foster carers. Section five further explored foster carer’s satisfaction with the whole training package. This was an open section within which further probing regarding content, environment, facilitation of the training might be revealed. A closure section thanking the foster carer for their involvement and setting a date for the 12 weeks follow up interview was included. 4.2.2.4 FOLLOW UP TRAINING INTERVIEW SCHEDULE Finally the follow up schedule for the twelve week follow up interview included an introduction, an assurance of confidentiality and a focus upon the purpose of the follow up interview. Throughout the data gathering, I reminded the foster carer of the support networks they could access throughout the process of this research project which included the learning development officer and their family placement social worker. The topic guide was created with reference to the aims and objectives of the project, the questions were also inductive in nature and covered five main sections as below: Section one focused upon whether attending the training had helped over the last twelve weeks. Again the question was open in order for the direction of the interview to come from the foster carer. It was hoped that a clearer understanding of their experiences over time would shed light upon their perception of how the group 106 had helped support the care, if at all, over the 12 weeks following training. Section two focused upon the ongoing support for foster carers from within the group. It was hoped this would reveal the amount of networking and peer support that was gained through the process of training. This would also help with the aim of focussing the direction of the foster carer in terms of support gained from attending a training group. Section three revisited the difficulties or changes that foster carers might recommend as a result of attending the training. It was hoped this might gain an understanding of their experience of this over time. Section four explored the foster carer’s expectations and satisfaction of the training. It was hoped that this might shed light on the strengths or limitations of the two-day training over time. Section five was an open question regarding any other issues the foster carer might have relevant to the research. Again the aim was to explore any additional issues they might want to discuss. A closure section included thanks to them for their participation and a reminder that reports would be sent out to each of them towards the end of 2011 to summarise the findings of the project. I informed the foster carers that academic supervisors may read a selection of the transcribed interviews to aid the thematic development and confirmation. I paid particular attention to leaving the foster carer in a positive frame of mind by valuing their contribution, time and commitment over the 12 week period. 4.2.2.5 VENUE I carried out the interviews at a mutually convenient time and place for the foster carers. For the convenience of the foster carers, this included a combination of settings depending on their preference: either a training room within the local foster carers’ training centre, a clinic within the CAMHS setting or the foster carer’s home. Out of the 63 interviews that took place over the twelve week period 22 were in a clinic setting and 41 took place at home. Attention was paid to privacy when a clinic setting was chosen to avoid interruption with the use of a ‘do not disturb’ sign. To ensure a less formal atmosphere and encourage the foster carer to feel relaxed, I provided comfortable chairs and a small low coffee table to minimise the barrier between myself and the foster carer. I also offered a choice of seating so that they felt in control of where they sat in the room. 109 4.2.2.10 PARTICIPANT VALIDATION OF THE INTERVIEWS According to Lewis and Ritchie (2003) the validity of findings is traditionally understood to refer to the correctness or precision of the research reading. The validity in this context refers to validity of representation, understanding and interpretation. I felt it was important to accurately reflect the views of the foster carers and therefore I wanted to clarify with the foster carers that the verbatim transcripts reflected their views in full. As I did not receive the written verbatim transcripts of the interviews until November 2009 due to a three month delay in transcribing post initial interviews (lack of administration support and resource constraints on purchasing transcription equipment), I began a preliminary thematic analysis using the audio recordings and read a summary of this through with the foster carers prior to the subsequent interview. The foster carers were given the option of receiving the full written verbatim transcripts once transcribed which could be made available up to November 2010 in order to have the opportunity to add, delete or change anything. In addition, each foster carer was offered the option of a visit from me to clarify the transcripts at any time, however nobody requested such a visit. Many of the foster carers reported that they were very busy and already felt overloaded with record keeping within their profession and opted for a verbal discussion of previous interviews prior to the next one. All the foster carers accepted the summary outlines and did not request a copy of the verbatim transcripts but instead requested an executive summary or full version of the final research report. 4.2.2.11 VALIDITY An additional step was undertaken to ensure transparency of the data analysis process. I conducted all of the interviews and the subsequent independent analysis, however, each of my academic supervisors used the initial coding framework to independently code two foster carers’ complete data sets of pre, post and follow up interviews. A critical discussion followed regarding the coding category for the ‘motivation to attend’ theme in order to account for and separate the intrinsic and extrinsic motivations and the ‘previous personal experience’ and ‘work experience’ sub-categories. The coding framework was discussed alongside transcripts and 110 differences were debated until final agreement was decided upon. I took account of the suggested changes, re-visited the framework and then recoded the remaining interviews (Bell, 2005). Involving more than one researcher in the coding stage addressed reliability issues of the coding categories and aided the transparency of decisions made. 4.3 DATA ANALYSIS 4.3.1 DIARY INTERVIEW ANALYSIS All 21 foster carers agreed to fill in a diary however, only six completed them. This consisted of four foster carers from Cohort One and two foster carers from Cohort Two. An interpretive approach to analyzing the data was used based on thematic content analysis with key themes that arose from the analysis explored and discussed in the final interview with six foster carers. Thematic content analysis is a descriptive presentation of qualitative data that identifies the frequency of themes that emerged from the reflective section within the diary. 4.3.1.1 DIARY INTERVIEW FINDINGS Data were collected across the 12 week period. The data captured was limited and the diary entries minimal. However, the diaries did capture six foster carers’ reflections of experiences with their individual foster children following completion of training. There were three common themes identified as follows: (1) five foster carers felt they had gained more understanding of their foster child’s emotions, (2) three foster carers had gained personal insights and (3) four foster carers gave examples of putting new knowledge into practice following training. The individual diaries were used as both a question generating devise in the follow up interviews and acted as an ‘aide memoire’ at the follow up interviews to lead to further exploration of any areas that seemed relevant to discuss in more detail. 111 4.3.2 SEMI-STRUCTURED INTERVIEW ANALYSIS 4.3.2.1 FRAMEWORK APPROACH An interpretive approach to analyzing the qualitative data was adopted using the Framework Approach to aid, thematic content analysis. The framework approach which “was developed during the 1980’s at the National Centre for Social Research” (Ritchie & Spencer, 1994, cited by Ritchie et al, 2003, p.220) was selected because it uses a matrix-based analytical method to provide a systematic way of managing the data which is considered rigorous. The framework approach to the analysis enabled me to both systematically describe, as well as interpret, significant units of meaning from a large body of data in order to illuminate and shed light upon the experiences of foster carers. The indexing process was useful in developing a coding system, which enabled key themes to emerge as well as providing a systematic approach to sorting codes into smaller interpretive units. I chose this method because, although I wanted to pursue an open minded and exploratory approach to uncover the uniqueness of the foster carer’s experience of mental health training, framework method is designed so that others as well as the primary researcher can view the analytical process and the ongoing interpretations. I found the ability to record as well as graphically display reduced and synthesised data (which could be traced back to its original source) was a particular strength of this approach (Ritchie & Spencer, 2004). However, it still allowed emergent ideas and concepts to be captured so that the analysis of the data remained grounded in the original text. It was important that I did not become blinded by the framework but that it enabled, rather than restricted, the sorting of and interpretation of the data. This approach was also considered a more appropriate method to analyse the data as it also permits both deductive and inductive questions to be explored, unlike other more philosophical approaches to qualitative data (Richie et al, 2003). My analysis started deductively from the aims and objectives already identified for the study which were to explore the experiences of foster carers attending the training, to evaluate the knowledge gained, to identify strengths and weaknesses of the training whilst allowing inductive questioning to arise from the data. This study will 114 describe the codes with notes on their meaning in order to understand why I had chosen each code when I re-read the transcript in the future. I also recorded the date I created each code. This process of labelling, sorting and synthesising, brought yet deeper familiarisation with the available data (Ritchie et al, 2003). 4.3.2.4 STAGE TWO: IDENTIFYING A THEMATIC FRAMEWORK This stage involved identifying recurring themes and ideas and linking these to a conceptual framework. The concepts of the framework approach drew upon issues introduced from a priori knowledge of the aims of the study in the topic guide and a review of the literature. This led to the beginnings of categories and sub categories when developing a framework. The eventual reading of the transcripts enabled further development of ideas and recurrent themes and codes were placed in the text. Corrections and explanatory notes were made separately and cross references between initial themes were made. An analysis of the field notes which were set out as an observational and reflective diary also enabled me to develop an initial list of themes and concepts from the first pre training interviews. Table 16 provides an example of this which is also noted in the audit trail (see Appendix 22) Table 16: Observational and Reflective field notes Observational/ Reflective field notes: Field notes Informal Chat: Thanked X for agreeing to take part, introduction, aims of project, role as researcher and trainer, discussed involvement and confirmed consent and ethical issues. Aware a little nervous about first interview. Read over notes made in practice runs with colleague. Reminded myself to leave ample time for participants to feed back and slow down questions. Initial Thoughts: Aware that foster carer is nervous. Gave reassurance and used humour. Self motivated to improve knowledge and positive attitude to seeking out training. No previous training. Spoke about own experiences. Reflection on initial recurring themes: Knowledge, learning the steps. Expecting benefits. Communication with children. High expectations of support needed. Interested in topic area. Links to wider issues: Guidance from learning and development led through skills to foster programme. Role of Nurse Facilitator: No previous contact with this foster carer. No questions related to my role. 115 Key themes such as ‘motivation’ and ‘expectations’ were indexed and allocated codes which were tagged to the data in the transcripts; for example, code 2.1 was tagged to any interview where by what was said reflected the sub theme ‘advised by other’ and included subcategories such as ‘family members’. Key ideas and initial themes were identified and combinations of lists of possible indexes were explored. Table 17 shows an initial example of the chronological log relating to the types of themes developed within the pre- training interviews. This process was repeated for all ten themes and details of this are in the audit trail. The initial index of first theme ‘Motivation’ was altered to include the CWDC training portfolio as a separate subcategory. Table 17: Initial index of themes for pre-interviews Index Categories Subcategories Associations/ Clustering Explanations 2.1 Motivation Advised by others. CWDC folder. Carers Family placement. Extrinsic motivations clustered together. Beginning of journey. Care Standards act. Peer Group pressure. Supervision 2.2 Motivation Self motivated Attended training before. Intrinsic motivations clustered together. Previous experience. Updates. 2.3 Motivation Understand child Why they came into care. Attachment issues. Help others. Developmental issues. Emotions behind behaviours. Importance of chronology. Previous training. 2.4 Motivation Personal Reflection Experiences from own family or children or Carers with and without experience. Need for more training. Promote advocacy. Importance of 116 work experiences. Confidence. Confirmation. awareness of own history. 2.5 Expectations Knowledge Update on research. Refresh recall prior knowledge. Professional carers 2.6 Expectations Support from network Network Keep in touch. Understanding systems. Gain phone numbers. Views from other carers. Carers with and without experience Prevent isolation Share good practice. Valuing peer support. 2.7 Expectations Understanding of mental health Awareness of mental health. Challenging preconceptions and stigma. Mental health awareness. Stigma Good practice. 2.8 Expectations Previous support Percentage of good and bad experiences. Learn from other carers. Carers with experience. Share good practice. 2.8 Expectations Benefits Health. Knowledge. Understanding Carers without experience. Thirst for knowledge. 2.9 Expectation Challenges Stigma. Fears Prejudice. Understanding of mental health. Mental health issues. Thirst for knowledge. 119 provided a systematic approach, as it was necessary to go back to the original transcription on many occasions, for further investigation or refinement of the thematic analysis. Original verbatim excerpts provided the original language of each interview and were identified by the use of quotations. Once the whole data set had been indexed, each theme was revisited in order to identify relationships between the different themes and subtopics within the data, a process referred to by Ritchie and Lewis (2003) as ‘distilling the evidence’. 4.3.2.7 STAGE FIVE: MAPPING AND INTERPRETATION The final stage involved mapping the range and nature of the phenomenon and identifying associations between views, in order to explain the findings (Pope & Mays, 2000). This was a combination of research aims and the themes that emerged from the data. According to Green (2004) the importance of using diagrams and tables to physically explore the relationships and associations between the concepts is paramount. Ritchie and Lewis (2004) refer to this as the ‘real’ task of analysis. I found the framework enabled an ordered approach to viewing the themes so that dimensions, features and categories were identified. In addition, the lateral dimension of the matrix helped me to identify patterns and associations within the data and I began to develop explanatory accounts by being able to look across a series of concepts over a range of cases. Appendix 19 provides a photograph of how the charts were placed together for cross-referencing. MAPPING THE RANGE Mind mapping was used as a technique in order to pull together associations and explanations for themes and provided a visual ‘viewing platform’ within which I could explore connections within the categories and themes through a trajectory of experience over time. Figure 14 demonstrates an example of theme one and Figure 15 shows a photograph of theme nine as originally drawn. Buzan (1995) describes this mind mapping technique as a way of using both the left and right side of the brain in short bursts in order to process information. I found this process enabled me to hold an overall structure in my mind of all the themes. A separate sheet of paper was used to categorise different elements of the phenomenon or theme which 120 enabled the similarities and differences to become clearer and I also considered the relevance of the data analysis with that of the research aims. Please refer to Appendix 20 for a copy of this process for all themes I discovered. CWDC Care standards Professionalization Mandatory/voluntary Self Motivated Extrinsic Updating curiosity to learn Cultural changes influenced Raise healthy by policy/act children Advised Supervision Ownership of need for Role of co-ordinator Self development Peer pressure Experience of work Skills to foster Programme Work (1) CAMHS support Motivation CAMHS waiting to attend lists ‘Do it for myself’ Network Skills to foster mental health Chronology Understanding Experience of skills training Stigma mental stability of Carers awareness of own Health networking placement history Policy updates confidence Advocacy Personal Awareness of history Parent differently Figure 14: Mind Map of Theme 1: ASSOCIATIONS/EXPLANATIONS Figure 15: Photograph of a Mind Map of Theme Nine in the original format Pre Interviews Intrinsic 121 In addition, a central chart was used which displayed a mixture of demographic data and classifications developed in the descriptive stage of analysis. Figure 16 is a photograph which shows a section of the central chart. This chart was developed to record the journey that all foster carers appeared to have travelled through and also aided the process of reflection and interpretation of the data (see Appendix 21 for a photograph of the full central chart). This was shared with supervisors to aid transparency and although this was not part of the framework approach it was useful in providing a sense of the whole of the data set. This process of detection within a theme involved looking at the themes across all the cases and identifying broader associations within and between themes which helped in the presentation of the findings. Figure 16: Photograph of a section of the central chart INTERPRETATION This broader investigation of the categories and themes led to identification of further associations. Once associations were identified it was then necessary to explore why they existed. The meaning of the associations was explored as some explanations given were of an implicit nature, for example, those that were derived from the data, not actually spoken, but from the ‘gist’ of what was said. Others were of an explicit nature those, for example, that were actual quotes from the foster 124 CAMHS Training mental health training. 4.4.1 DISCOVERY OF THEMES The aim of the qualitative research was to explore what it was like for foster carers to attend mental health training. I was interested to know how they experienced coming together as a group to learn new knowledge. How did they perceive the needs of their child after the training? What could they share about the current and future training needs? In Figure 17 the findings from this exploration have been set within a conceptual framework I developed which portrays the interconnectedness of the experience of training and knowledge over time and represents the links with various theoretical perspectives regarding how adults learn (Knowles, 1998). This overarching journey of experience as portrayed in Figure 17 sets out the 10 themes gained from the qualitative data as foster carers ‘started out’ with a mixture of motivations, hopes and expectations, ‘travelled through’ the training process and shared their immediate reactions before finally ‘moving on’ over the 12 weeks to digest what they had experienced, reflect upon the skills they had gained and share a sense of self actualisation and a deeper understanding of these experiences (Knowles, 1973). 125 OVER-ARCHING JOURNEY FOR FOSTER CARERS EXPERIENCING MENTAL HEALTH TRAINING 10 THEMES AND CONNECTIONS, ASSOCIATIONS AND EXPLANATIONS Figure 17: Conceptual framework Develop Own Training PRE-TRAINING POST-TRAINING FOLLOW-UP TRAINING J O U R N E Y B E G I N S HOPES IMMEDIATE REACTION REFLECTION STARTING OUT Theory of motivation (Reiss, 2000) MOVING ON Reflective practice (Schon, 1983) TRAVELLING THROUGH Learning by experience (Knowles, 1973) ƒ Sharing Experiences ‡ Emotional Needs „ Knowledge ˆ Personal Insights  Motivation … Format ‰ Parenting Skills ‚ Expectations † Personal Issues Š CAMHS Support Motivated Realistic Expectations Digesting New Knowledge Experiencing: Eye Opener Personal Reflection Group Process Confidence/ Skills Personal Growth Emotional need of children T H E O R Y 126 A copy of this framework in the original format is shown in the photograph in Figure 18. Figure 18 Photograph: Mind Map of Conceptual Framework in Original Format The ‘starting out’ phase refers to the beginning of the journey and reveals the first two themes, that of motivation and expectation. The ‘travelling through’ phase describes the immediate reactions expressed by foster carers after the training in the post training interviews. This includes the findings from themes three, four, five and six which were sharing experiences, knowledge, format and personal issues. Finally the ‘moving on’ phase refers to the findings that surfaced at the end of their journey and includes themes seven, eight, nine, and ten which were emotional needs, personal insights, parenting skills and CAMHS support. Verbatim quotes have been selected that best illustrate and provide the richest examples of the theme or sub category described. For each theme, there is a description accompanied by illustrative quotes. However, in some instances, the quotes used have been reduced in content, indicated by dotted lines, to remove utterances or irrelevant content so as to best illustrate the theme described, whilst retaining its essence. 129 Previous personal experience Motivation varied with regard to previous personal experiences. In total seven foster carers came into the training hoping that they might understand various aspects of their own personal history. A male I interviewed who was training to become a foster carer had a real grasp of how easy it could be for children to enter care through no fault of their own. He spoke with a real sense of empathy for children in terms of their lack of control over people and events and described his own experiences: the loss of a significant attachment figure which had led to him moving from relative to relative as a child. This had led to a motivation to understand how to support other children. “My own personal experience as a child, I can actually see how certain life patterns have emerged because of what happened to me as a kid.” P24 Line 252-254 Another male foster carer whose family had fostered when he was a child was aware of his need to do things differently for children that were placed with him. Increased awareness of his own childhood and personal experiences had led to his desire to avoid repeating the patterns of parenting he had received. This intrinsic motivation to ‘make a difference’ was expressed throughout his pre training interview. “I can avoid the situation I had as a child with my own children and also other children.” P1 Line 75 Extrinsic motivation Extrinsic motivations can be defined as those motivations that have an external feature for example: codes of practice, incentives in terms of financial gain, 130 qualifications. These are referred to as the subcategories; ‘advised by others’, ‘training portfolio’ and ‘desire to understand children’. Advised by others A total of nine foster carers were motivated to attend the training through the advice they received from the Learning and Development Officer (LDO). The LDO co- ordinated their training through the process of the ‘skills to foster’ programme that was part of their induction and assessment. A female foster carer was advised to attend by another foster carer who had attended previously. Another foster carer who had many years experience found the support she gained from discussing the training with the training co-ordinator and family placement social worker had proved invaluable. She appeared to have a very informal and relaxed experience of contacting other professionals to advise and guide her. The role of the LDO was referred to as an important one by a further eight foster carers. In total three foster carers referred to the process of identifying potential training through the training calendar and three were contacted directly by the LDO describing her approach as very much ‘keeping in touch’ and ‘letting us know about useful training’. “….so whenever something comes up I usually discuss it with our training co- ordinator (LDO) or she tells us things that are about it” P16 Line 18-19 Training Portfolio In total four foster carers mentioned that they were motivated by their desire to complete their Children’s Workforce Development Council (CWDC) folder. This folder includes standards to support training and development of foster carers in England. In April 2008, changes regarding the measurement of competences were changed. All seven standards are now in place and the attachment training provides 19 competences to post training approval. A male foster carer appeared to feel strongly that evidence should be provided to prove your ability to become a foster carer. He was a highly skilled professional and stressed the importance of 131 developing the personal skills to ensure he could provide a child with a good chance of having a substitute family. This foster carer expressed his views firmly when speaking about the rules and regulations regarding being a foster carer and the requirement to meet the minimum standards required. “I suppose it is similar to being a parent but there’s so much to it obviously with different rules and regulations. And yes you should have to do the relevant courses to meet the minimum standards that they require.” P22 Line 69-71 Another male foster carer referred to the portfolio as an incentive to attend training due to the time limitation imposed on completing the folder which was one year post fostering. He felt being time bound was useful as it gave him boundaries around which to complete the training and prompted him to take action sooner. “…you have a book that you have to prove….you have got to tick them off, there are different elements of the book to become a foster carer. I know you’ve got a year to do it in ….” P23 Line 69-72 Previous work experience In total 13 of the 21 foster carers referred to their previous work experiences as foster carers, residential workers and social workers, as being a key motivating factor for attending the training. Previous experience of this training course had helped one female foster carer maintain a placement of a young person who presented with attachment difficulties. She appeared to be very emotional when talking about the difficulties she had encountered and how the training had helped her to reflect upon how to parent him differently. 134 the desire to gain increased knowledge and understanding of mental health, of their children and of their own self awareness. There was also a significant number of new foster carers in both groups who appeared motivated to attend the attachment training as a result of attending an introductory programme facilitated by the LDO called ‘Skills to Foster’. They were eager to fill in their portfolios and learn from others and use the group as a way of networking. Their enthusiasm for learning seemed to have been stimulated by the core training. 4.4.2.2 THEME TWO: Expectations This theme refers to fosters carers’ thoughts and feelings regarding the planned training course on attachment. There were a wide range of different expectations depending upon the experience of the foster carers. In total five subcategories emerged which included; gaining knowledge, gaining support from the network through the training, an understanding of mental health issues for children in care. Specific expectations in relation to new or experienced foster carers were split into two cluster groups. Gaining Knowledge Just over half of the group, 13 foster carers referred to gaining knowledge as an important expectation of the group. This ranged from an expectation to increase their personal knowledge base in relation to: mental health, to gaining an understanding about different systems within social care, to understanding the unique experiences of the child they cared for. “I mean I just wanna learn more really, I mean nobody can stop learning can they, more knowledge or the more every child has a different experience, you know a different experience to deal with” P4 76-78 135 A female foster carer who had attended the training on two previous occasions referred to an expectation of developing a sense of ‘knowing’ an instinctive response, something that may become internalised and hopefully, leading to an almost ‘automatic’ response in parenting skills. She had cared for many children in the past and felt that the knowledge she had gained by repeating the training had helped her to develop a way of therapeutically parenting, which she felt had worked. She expected the training to include examples of therapeutic models of parenting and a discussion about what works for children with mental health difficulties. “I want it to be natural to know this information, if you get enough of the information and get the information over and over again it builds up and becomes natural to you because you just know it rather than going back to look in a book all the time.” P5 Line 70-73 Understanding the terminology regarding mental health issues was also raised by one new foster carer. He had an expectation that the training would define many of the mental health labels that had been written in reports regarding the children he cared for. He expressed frustration that diagnostic labels used were difficult to understand and as a result he was not sure how to help his foster child. “To also know exactly terms that are used in attachment…..to give me the knowledge and skills that can be helpful” P10 Line 66-69 Support from the network Just under half of the foster carers (nine) commented upon the need for support from the network as one of their main expectations from the group training. Their expectations reflected a desire to build up a sense of peer relationships and support. 136 “There’s always somebody there that can tell you a little bit more so you’re getting that more experience and knowledge from them of what they have done.” P4 Line 83-84 A female foster carer spoke about how isolating it can be when fostering. She had previously fostered a child with severe mental health difficulties and had found she had no network of support. She described how she had attended courses in the past and gained telephone numbers from other foster carers and this has helped in times of crisis. Another female foster carer described the loneliness she had felt in the past when she lacked adequate peer support. “…it’s really nice to hear you are not the only one…you are not alone. I’ve just been through the same thing.” P9 Line 111-112 “ …you’ve got all the phone numbers and the support that’s down the line if we do get a child that has problems.” P3 Line 38-39 New foster carers placed an importance and value in sharing experiences with more experienced foster carers. Many foster carers talked about a sense that it is good to ‘hear you are not the only one who has difficulties’. This sense of community among foster carers was reflected across all levels of carers, new and experienced carers. A need for a buddying system in training was also referred to. Understanding of Mental Health In total 13 out of 21 foster carers talked about expecting to receive information about mental health issues. They had read the training programme in the training calendar and expected to learn about how healthy and unhealthy attachment 139 “I keep going to the courses also updates because everything is always changing, they are always saying things, you know what you did last year we don’t do this year.” P5 Line 74-76 Experienced foster carers hoped for an opportunity to actively share their experiences, to learn from others and explore how to resolve problems. A female foster carer with 15 years experience of fostering who had cared for 35 children during this time appeared to be very relaxed about training within a group setting. She had previously attended the training three times over the last seven years and had found her knowledge and understanding of this field had grown and with it her confidence in sharing her experiences and ideas. “As a foster carer for 15 years I’ve come across quite a few different problems that have been resolved in various ways that I think I can bring to the group and share. I am also more than happy to pick other peoples brains as well from within the group.” P6 Line 52-55 Previous experience of training appeared to give foster carers confidence to help others resolve problems. A 50 year old foster carer talked about her experience as a parent and carer and became very animated when she spoke about a sense of mastery of parenting skills developed after previous training. Some shared that they wanted to continue to do well with their existing child, but also wanted to take time to revisit and consider, with support and help, more deeply about their needs. To summarise, many foster carers expected to gain increased knowledge regarding the mental health needs of children in care, knowledge about referral systems and awareness of up to date policy and guidance. There was a significant expectation that this training would lead to increased support from the network. Foster carers expected to meet other foster carers and develop buddying systems and peer support 140 in order to prevent social isolation. Also foster carers seemed to value the support they might get from meeting up with their peer group. Foster carers anticipated that gaining more understanding of their child’s mental health needs would aid their confidence in parenting, in order to help challenge prejudice and advocate for their child. The two subgroups of experienced and new foster carers had different expectations depending upon how many years they had fostered and whether they had attended the attachment training before. New foster carers’ knowledge and awareness of mental health issues was more limited and therefore their expectations of the training were lower. Overall for experienced foster carers their expectations of training were high and they saw it as meeting a combination of needs that included gaining support from their peer group and reinforcing a sense of community; learning to challenge stigma and to gain knowledge and building awareness of good practice amongst foster carers. 4.4.3 TRAVELLING THROUGH: POST TRAINING THEMES Within the post training interviews themes three, four, five and six emerged. These four major themes were identified as: sharing the experiences of the other foster carers, knowledge, format and personal issues. Within these main themes, the following 13 subcategories emerged: hearing the experiences of other foster carers, CAMHS support, networking, increased understanding, underpins practice, emotions behind behaviours and parenting skills, content, atmosphere, handouts, managing stress, personal histories and isolation. 4.4.3.1 THEME THREE: Sharing Experiences of Other Foster Carers In the post training groups a recurring theme was that of the value of listening to the experiences of other foster carers. This was repeated for both experienced and inexperienced foster carers. A number of positive themes emerged from hearing stories from a mix of foster carers regarding how they cared for children with emotional health difficulties, how they had made use of CAMHS support and how the existing network of foster carers functioned. 141 Hearing the experiences of other foster carers New foster carers emphasised how listening to the experiences of others gave them confidence in their ability as foster carers. This included having a different perspective on fostering, offering an expert view, talking through difficult times and finding others who were experiencing the same anxieties as themselves. Acknowledgement of the variety of knowledge within the room was a relevant and interesting point. Both male and female foster carers reported they valued the level of expertise within the group. “…helpful to hear people’s experience of what, as we haven’t had a child in place yet so obviously to hear other foster carers talk about their experiences was good.” P1 Line 20-22 “…there was such a nice mix of so many different people and …also there were some new foster carers there who were actually experts in their own fields but to do with people” P5 Line 7-9 More experienced foster carers referred to the importance of hearing about attachment relationships from other foster carers. They felt this helped expand their knowledge of what works in practice. Hearing advice from a foster carer was acknowledged as different to hearing advice from social workers. “When I first started attachment training it was not talked about so much and it’s nice to know how far it has moved on and people’s opinions and I like the different levels of carers and experiences.” P9 Line 12-13 144 “ You were more neutral and not seen as a social worker” P23 Line 32-42 “…although I know you are part of the system…You come across as being neutral.” P23 90-95 Increased access to mental health services and the importance of this has been raised in many other evaluative studies. Training is not just about educating but rather provides a range of opportunities for foster families to gain support (DfES, 2005b). Statutory guidance on promoting health and wellbeing for LAC identified a big variation in terms of access to mental health provision. The CAMHS/LAC team are a dedicated service which has existed for 11 years through which time a considerable amount of knowledge and expertise in relation to the emotional and mental health needs of children in care can be shared through training and in order to strengthen the much needed links and relationships with foster carers and front line professionals (Stanley, Riordan & Alaszewski, 2004). New foster carers commented upon the fact that many foster carers on the training had had direct experience with the CAMHS services which reassured foster carers that a service may be available to them if they have a child placed with them who has mental health needs. Networking As part of sharing experiences networks began to develop across the two cohorts. A total of six foster carers emphasised networking as a key outcome of receiving training. Some more experienced foster carers were linking in with other foster carers on the course to offer telephone support. It was likened to ‘an extended family’. “..different procedures, different people, different contacts and support.” 145 P9 Line 134-136 “Just to be more aware and like I said, because there is now this extended network that you can draw on.” P16 Line 222-223 A new male foster carer spoke of his fear of support not being available. Hearing the stories from other foster carers led to some anxiety as to the lack of support as foster carers disclosed in-depth descriptions of crisis situations. “…there has to be a network……I think the only worrying thing for me was the fact that it was quite apparent that sometimes the network’s not there.” P24 Line 457-459 Despite some worries about the lack of support raised from sharing experiences, the majority of foster carers felt this process of listening to each other was a major gain from attending the course. Foster carers referred to enjoying a mix of foster carers at all levels attending the group. Disclosing of experiences and real stories seemed to help foster carers to put theory into practice. A sense of networking and peer support was valued by foster carers who felt that attending the course had led to a reduction in their sense of isolation. They felt the facilitators were neutral and there was a sense of safety when sharing information in the group and an increased understanding of how to access mental health services. Herbert and Wookey (2007) also found that foster carers in their study appreciated the open debates and the freedom to express disagreement. They also referred to the role facilitators’ play in maintaining safety within the group particularly when, many of the foster carers within their study, were overwhelmed with behavioural problems presented by their child which were of a clinical nature and required intensive support that was not met through the training group (Herbert & Wookey, 2007). This evaluation immediately 146 after the training gave me a sense that many foster carers were still processing the experience, digesting the information and reflecting upon the personal implications. 4.4.3.2 THEME FOUR: Knowledge to ‘Complete the Jigsaw’ This theme arose in the post training interviews for 18 out of the 21 participants. The content of the course included modules on Attachment Theory, neuroscience and the effects of chronic trauma upon executive functioning. Within this theme which focused upon the knowledge gained, three subcategories were identified which included, understanding and insight into the behaviours presented by their foster children, how this knowledge had underpinned their day to day parenting, how identifying the emotions behind the behaviours had proved useful and a reflection upon parenting skills. Understanding and Insight Foster carers discussed how they had gained a greater understanding and knowledge of the mental health needs of children and young people. Also, more crucially, they spoke about the part this played in increased understanding and in promoting emotional health. They described a sense of empowerment they felt after having acquired new knowledge. They referred to a huge learning curve of understanding and a change in attitude. They began to reflect upon their lives and how they had acted. This process helped them to gain more insight and one foster carer likened this to finding the missing piece to ‘completing the jigsaw’. “It certainly changed my understanding and my awareness and also you know my whole attitude changed after that course.” P1 Line 49-50 “….made me realise perhaps with some of the children I’ve worked with in the past, why they acted in the way they did.” P2 35-37 “I think it’s given me more, you know more insight now for the children of the 149 P5 Line269-270 “ ..without the course, I think it would have been almost impossible to put both pieces of the jigsaw together to see where things are coming from.” P24 Line 395-397 There is a sense of empowerment beginning to surface from the data. The link between empowerment through new knowledge and increased confidence in the process of advocating for the child comes to light within this theme. The capacity to maintain a stable placement may increase as they find solutions to manage difficult behaviours. Feedback also led to foster carers challenging their perception of mental health. “ When you think of mental health issues you think of somebody being quite thick maybe, your first impression of mental health……a lot of this you may not know….but they’ve been through a trauma and it’s learning to deal with that and what that means in terms of their mental health.” P16 Line 53-58 Emotions behind Behaviours Knowledge about emotions increased and 14 of the 21 participants commented upon this. The training seemed to answer some fundamental questions about children’s behaviour. “…it kind of opened my eyes to why the child could be behaving like that where as before, you know I could have been blinkered in my thoughts and reactions.” P1 37-41 A male foster carer described his tendency to focus on the challenging non- compliant behaviours of his child without considering the connection they may have to emotional difficulties. He described how he had reflected upon his own behaviours as a result of the training which led him to ‘ease up’ on his own 150 children. He spoke about giving his children quick effective consequences after incidents involving challenging behaviour. Other foster carers also referred to ignoring behaviours and not taking them personally and the importance of being curious and talking out aloud about the behaviours. “If I have a child who comes home all stroppy now I don’t think what have I done to upset you…I think what’s happened that’s upset you today?” P5 Line 44-50 An understanding of the emotions behind the behaviour led to a sense of empowerment for some foster carers in relation to advocating for their child. They were becoming the experts in relation to understanding the behaviours of their child and their thirst for knowledge was clear. Parenting Skills In total 14 out of 21 foster carers referred to parenting skills which surfaced from knowledge. An understanding of similarities and differences with their own children and foster children was raised. Many foster carers seemed to learn from others how to deal with behaviours rather then to react to them. They expressed a sense of awareness of their existing skills and an affirmation that what they were doing was good. A female foster carer who had been fostering for twenty years and had fostered over 180 children felt she had become ‘stuck in her ways’ and welcomed the opportunity to explore her parenting style using a different approach. She spoke about being more proactive, providing more help to her foster children and becoming less chastising. This foster carer seemed to be recognising the need to do some things differently. 151 “All of the symptoms applied and it made me actually re-look and think how well we’ve done with him.” P7 Line 179-181 “ ..It’s much better to be properly prepared and to be fully aware ….I am under no illusion.” P12 Line 292-294 Foster carers’ feedback suggested that they were well prepared and had gained from learning techniques that they could use to help young people express themselves. In summary, foster carers referred to the ‘jigsaw effect’ of the training within which missing pieces of knowledge fell into place enabling a fuller understanding of their child. A high percentage of foster carers felt their expectations regarding gaining knowledge had been met and exceeded. Some of these foster carers were requesting a ‘next level’ in attachment training. It appeared that, with the jigsaw complete, the foster carer’s confidence in dealing with challenging behaviour appeared to have increased. It could be argued that these skills may lead to the prevention of placement breakdown as described by one foster carer. “Well I have found it very useful and I’m convinced that it’s helped maintain a couple of placements that I’ve had.” P6 Line 26-27 4.4.3.3 THEME FIVE: Format and content This theme related to the way in which the training was set up and designed and the content and delivery of the training. A total of 17 out of 21 foster carers commented on both the content and format of the session in the post training interviews. 154 course as a result the following year. It appeared important for the male foster carers to share their experiences with their wives to aid similar parenting approaches. “She’s been reading the paperwork as well to, she wasn’t able to come, so it’s a few bits between us.” P3 Line 183-184 Relevant articles linked to the training were also given out and led to some foster carers reading more detailed research evidence. Many had ordered the books and given handouts to colleagues in their network. Again, foster carers felt the more research evidence they gained about attachment and mental health the more they felt prepared and informed to support future best practice. “I thought that was useful and the references you could go away and study in your own time the bits that interested you.” P6 Line 100-102 “So when you read up you’ve got all that there to back you up as well so your not just reading something you taking what came out from there as well.” P16 Line 207-208 Atmosphere Many foster carers commented upon the atmosphere they experienced during the training. This was not a topic area identified in the interview guides but arose spontaneously. They noted there was a relaxed atmosphere and everyone was able to talk about feelings and experiences. “Very open and relaxed and everyone was able to talk about how they feel and different experiences within caring for children.” P1 Line 65-67 155 “I thoroughly enjoyed it and I think that probably because I was familiar with most of it that it was a very comfortable place to be.” P6 Line 49-51 Safety was mentioned as foster carers felt they could interrupt the training, ask questions and say what they wanted. A female foster carer, who had previously received very little training, surprised herself in that she felt very relaxed within a large group. “I thought they were a nice group. I felt very safe there, I felt as if I could say anything that I wanted to say, if I had something to say.” P12 Line 52-53 “When we first came in, it was a very big group and quite intimidating just the look of it but I think that’s probably one of the best ones I have been on.” P16 Line 11-13 Another foster carer commented on the mixture of foster carers and the dynamics of the facilitators enabling a good rapport which, in turn, appeared to enable people to be more open. “The dynamics between you and your colleague were really good and complimented each other the way it happened and made it not too much.” P20 Line 160-162 “You had a good rapport with the other lady….and I think people tended to open up a little bit more because of that.” P23 Line 120-121 156 In summary then, many foster carers were satisfied with the format of the training in relation to the delivery and requested a follow up training workshop to reflect upon new learning. The content of the session met their expectations and they found this new information interesting and supportive in their practice. Many shared the content with family and professional colleagues. The handouts had been a useful refresher and foster carers reported having a thirst for more evidence for their practice through further reading. The atmosphere enabled the disclosure of practical experiences and the importance of the facilitation within this process was highlighted. They felt it was useful to place this training in tandem with skills to foster. For some new foster carers, the return to the classroom environment was unfamiliar, yet they wanted to repeat this experience soon after. They liked the mixture of theory and practice. There were some areas to improve upon which were the amount of information one foster carer described as ‘overload’ and for another the amount of group interaction and the need for increased group activities was also raised. Although issues regarding content have been highlighted in the satisfaction questionnaire, the process of interviewing foster carers identified a desire by the foster carers for subsequent follow up sessions. This was not mentioned before and yet this was a key issue for many foster carers. As found in many other studies, the level of satisfaction expressed by foster carers was high and many shared the content with family and professional colleagues. Foster carers talked about the usefulness of being able to share the information with their partners who had not attended the training. Laybourne et al (2008) also commented upon the role of partners and recommended that they attend the training too. 4.4.3.4 THEME SIX: Personal issues Personal issues arose from the post training interviews. In total four of the 21 foster carers referred to a reflection process occurring during the training group. A foster carer commented upon not taking things so personally. She found that she was to ‘slow things down’ by taking time to reflect upon her child’s behaviour which enabled her to have a calmer home. 159 Emotions behind behaviours: A total of 16 out of 21 foster carers commented in detail about their increased understanding of the emotional needs of this group of children and through this greater understanding talked about observing and perceiving their child’s behaviours in a totally different way. This led to an increased ability to be more positive about their child, for example, understanding that there may be a reason why their child is extremely angry. They linked the feelings regarding their past to their present behaviours “…the way children behave and the reasons behind it. Where before I would have looked at it in a totally different way.” P1 Line 48-50 “…its made me understand the sorts of behaviours that they’ve presented in the past….I can reason with them more.” P2 Line 47-51 “…going on these all these courses you suddenly see it’s all clear….there is a reason for what they are doing and why they are doing it.” P3 Line 137-142 Having reflected upon the training over 12 weeks many foster carers spoke about how important this explanation about emotions and behaviours helped in practice. “There’s a reason behind all their behaviours and having it explained makes it clear.” P9 Line 43-44 This helped the reflection process for foster carers and tolerance levels generally. 160 “I actually think what it has actually done is given me a more open mind on issues when you see them……you can see something that’s on the news which can be quite disturbing and it raises lots of people’s anger however, just having done that little bit you can see that there may well be reasons as to why that might have happened.” P24 Line 27-32 In addition, reasoning with children and helping them to make sense of what they were saying and doing helped foster carers understand and listen more. A foster carer referred to gaining more understanding of the child’s developmental needs and how a child may regress and for what reasons. She was able to talk about how her foster child had regressed when her brother was taken ill. The foster carer was able to understand the reasons for this regression and was able to support the child through it. “Sometimes she needed to go back to being a baby and being a toddler…and when you deal with their emotional needs the rest seems to fall into place.” P5 Line 246-250 As in the post training interviews, the issue regarding not taking things personally was also seen as important after twelve weeks. “Some of the things I used to react quite badly sometimes like taking it to heart and being miserable and hurt and looking at a child and thinking ‘oh god she’s just doing it to hurt me’ and now I know she’s not doing it because she wants to hurt me there is something else.” P10 Line 308-329 Self awareness of emotions and the interplay between these were highlighted. 161 “ ..because my young person finds it very difficult to express her feelings, I was expressing feelings for her to let her know that it was okay. I think the attachment theory really sort of brought that fresh into my mind” P 14 Line 62-65 After 12 weeks many of the foster carers retained knowledge regarding children’s emotional needs. There seemed an openness of mind with a consistency over time of their perceptions of the children’s needs. A female foster carer summed this up well when stating it ‘all clicked into place’. “It’s helped me carrying on doing this skills to fostering thing because it’s reiterated all the time about attachments and it’s helped me understand the behaviours.” P12 Line 44-46 “I mean really, until I went on that training and things all clicked into place, that’s why her behaviour was like that” P27 Line 34-35 “I think it’s made me calmer and more able to listen to her.” P29 Line 178 Knowledge Foster carers’ knowledge had been measured quantitatively pre, post and follow up training and the results indicated a significant retainment of knowledge over time. Within the qualitative findings 16 out of 21 foster carers referred to a sense of gaining knowledge in the follow up training interviews. Some foster carers felt that the training had given them increased understanding about their children in placement. 164 “We’ve all exchanged numbers plus with the extra courses now you’re getting to hear different carer’s stories…as a buddy.” P3 Line 227-237 “I get support from all of them, actually there’s quite a few carers there that I still see on all the courses and we keep in contact which is really good” P4 Line 213-216 “I think being part of the group I mean and listening to experiences of others and sharing my own experiences, you kind of get a feel for the whole that things aren’t just happening to you.” P6 Line 19-22 “I think for carers its being able to get together and talk about different experiences, it’s good to know when you get together with carers that you are not the only ones” P9 Line 411-41 Keeping in contact felt meaningful to foster carers so training brought foster carers together. A foster carer referred to the lack of a base for foster carers, where support could be on an ad hoc basis ‘as and when you need it’. Foster carers identified that a base would enable them to feel more supported and in turn valued. Without this base, training provides a virtual base, which fulfils a similar function in terms of their need for a place where foster carers can keep in touch and catch up. “…there was a base there and we did use it, we would have coffee mornings…we chatted about the difficulties and picked up tips….there has to be a place, a venue ….we’re not recognised enough to have a designated venue.” P6 Line 178-187 “There is supposed to be support and when I first became a foster carer, there 165 was a sort of a liaison group and it was run by foster carers and they would have meetings but that seemed to die a natural death.” P27 Line 798-800 It appeared that some key foster carers made this ‘ad hoc’ support a reality by being proactive in encouraging contact. “I have got good support I would say that you know if I needed any support there’s a number of carers I could phone and they would be at the end of a phone.” P14 Line 219-222 “ A lot of support for instance I met up with a foster carer a lot of times going out for a cup of tea and then we would visit each other.” P10 Line 636-637 In total three couples attended the training groups and spoke about having benefited from having their partners on the training. They felt they had gained the same knowledge and had a chance to discuss issues further. “I was able to talk to my husband cos he was in the same group and we had discussed it….I have a better understanding and so does my partner and as we are going to look after the same young person it helps when we’ve got the same knowledge.” P20 Line 150-152 Another foster carer expressed frustration as they felt more could be done for foster carers in order to increase internal support between foster carers more formally. “ There must be a way, I mean they’ve got the system, you should be able to go 166 into the system and sort of put in a keyword attachment and should be able to give you a list of all those carers that have got children and have specialised groups so that at least then you know we’ve all got the same problem.” P27 Line 672-680 Insight The majority of foster carers (19 out of 21) commented upon how the training had led to insight and awareness about the difficulties a child has. Foster carers referred to it changing their outlook and referred to it as an ‘eye opener’. This was in relation to both their own birth children and foster children. “It was such an eye opener and made you understand more…it opened my eyes to how I could make better attachments…simply because of looking at things in different ways.” P1 Line 50-66 “ Certainly gave me a clearer view of maybe looking at things or a wider view instead of just jumping on the bandwagon, you opened up awareness and it did give you insight into thinking about things…..If she (foster child) was sat there now she’d say to you I have changed completely.” P 26 line 580-582 Some foster carers felt that they had approached problems differently and had an increased awareness of their own behaviours. They reported a sense of not taking issues personally and reflected more upon the circumstances that led to the behaviours. “Take a step back and look at what is happening and why…it’s about looking at it from a different angle or reminding you that there is another angle.” P6 Line 34-55 169 Reflecting for some foster carers led to them experiencing a sense of failure that they did not get help for their child help sooner. “I feel a bit of a failure because I didn’t get her any additional help….but then that was timing, but I should have pursued and ensured that she got some help.” P26 Line 584-594 Impact on school Immediately after the training two foster carers acted as advocates on behalf of their child in the school environment. A female foster carer reported back about how she now supports her child with lists, reminders, as well as praising them for good work and for not getting into battles. “It has worked a bit in that he has changed and even his teacher will now remind him to make sure he has things in his back to come with and I’ll remind him too when going to school” P4 Line 31-34 “School work is absolutely brilliant but would only pick up on the bit he wasn’t doing that well and not the masses he was doing well so we’ve swopped that around. We don’t mention the bit he is not doing so well but we help him with it.” P9 Line 216-219 “To do some lists for him, just as gentle reminders so he doesn’t forget them. So that when he does go to school, you know he’s not excluded from things because he’s forgot them.” P 9 Line 96-100 170 Impact on home In the home environment, foster carers shared what they felt had been the impact of the training upon their daily lives. Some foster carers described increased involvement in children’s activities. A foster carer described listening more carefully to her children at the end of a school day. She felt this was having an impact upon the quality of their relationship. “I did actually work with them a bit more than what I would do normally. Baking cakes and things like that and I got a lovely card from them; they made me a special card.” P13 Line 55-57 “We have got a good bond and we talk a lot and I think the main, the most important thing is to listen especially when she comes home from school.” P29 Line 165-169 In summary, personal insights were gained which led to increased confidence in practice described by many foster carers. They reported an increased ability to access support and described changes in practice at home and school and expanded upon the personal insights they had gained and how they worked through this within their own family. 4.4.4.3 THEME NINE: Parenting Skills In the post training interviews, ‘Parenting Skills’ was identified as a subcategory of the knowledge theme as foster carers reported that they gained an increased confidence when dealing with challenging behaviours, a sense of being more able to advocate for their child, and an increased awareness of their parenting skills. In the follow up interviews foster carers gave more detailed descriptions of increased parenting skills around three main subcategories: confidence, parenting in practice and parenting activities. 171 Confidence There was a sense of growing confidence in foster carers which seemed to have been retained over time. Foster carers felt more equipped to care for children who presented with emotional health difficulties which also added to their sense of confidence. A foster carer described her ability to advocate for her child as empowering. Her success in advocating for her child in an education setting in the post training interviews had led to further meetings with professionals within which her knowledge of the research seemed to empower her. “….it boosts your confidence to know that you can help these youngsters by coming in(to school) and doing things differently.” P4 Line 234-236 “…more than anything I feel out of all the courses I have been on that’s the one that has changed me the most…I feel it has equipped me more because it’s changed me.” P1 Line 239-399 This sense of increased knowledge and parenting backed up by evidence was helpful in giving foster carers a ‘morale boost’ as they began to see the results. It also helped one foster carer with their next child in placement. “…does make you feel good about yourself because you know you are doing the right thing….a bit of a morale boost and then you do see results and that works really well.” P5 Line 57-65 “It gives you a lot more confidence and I’d say when the second one first came here it gives you perspective on the individual child.” P9 Line 294-295 “It gave me some confidence…only now I have seen my successes.” 174 spending time to reflect upon the child’s behaviours which lead to increased understanding. “To think about their history, of how she grew up and I always feel like maybe I should have done it differently…..I used to be frustrated about some of the things because I had children who are really in bad shape.” P10 Line 36-37 “While it’s fresh in you mind I think you start thinking about things and taking things on board. Some of the things that I’ve done, I’ve looked at them in a different way.” P16 Line 19-21 Another two foster carers spoke about not overreacting to a child’s behaviour but rather approaching difficulties in a more relaxed way. “It was one of our worries on the skills to fostering course, how would I react about smearing (of faeces)….and I am pretty sure that doesn’t happen often. Well probably would have exploded to be quite honest and now probably still wouldn’t be happy but whatever it was it wouldn’t quite be the end of the world for me that it would have been.” P24 Line 519-527 “ You just need to be much more relaxed about everything, when she says I am not doing it we are just completely relaxed about it….It didn’t wind me up, I just said well I will just read the papers and then when you decide to do it I will help you and I do help her a lot.” P29 Line 107-121. 175 Activities Many foster carers introduced more fun activities into their routine which they found made a difference. “He missed out on the fun parts of it, so I ran a bath and put bubble bath and a toy in the bath and it was an absolute joy…I could hear him playing in the bath and the gratitude for what I had done.” P9 Line 257-262 “I did work with them a bit more than I would normally, baking cakes and things.” P13 Line 55-57 Foster carers felt empowered by a sense of gaining parenting skills. Their confidence in their abilities increased after 12 weeks and they had implemented various strategies which had led to signs of success. 4.4.4.4 THEME 10: Experience of CAMHS support and training There were two main subgroups highlighted within this theme by 19 foster carers and included future training needs from CAMHS and support needs generally. Training needs: Foster carers’ comments ranged from wanting more training in order to add to existing knowledge, to being content with repeating this training once every two years. “I don’t think anything needs to be changed. I would like to go a step further now.” 176 P1 Line 216-217 “I think perhaps refreshers sort of once a year would probably be helpful because you don’t realise how much you forget.” P2 Line 311-315 “I think that was enough with a lot of other courses that are going on as well, but I think you should keep doing them…every couple of years just to refresh themselves.” P4 Line 232-234 “I think it has updated all the time and I think you have to be reminded.” P5 Line 502 “ What it does is you attend the course every few years and then go back to it and it’s really good to revisit and put into focus if what you are doing is the right thing and how you are doing it.” P9 Line 280-282 “I found it very useful and I think it’s something that sort of in a couple of year’s time I would like to repeat again.” P5 Line 60. Foster carers seemed to enjoy attending different courses and sharing knowledge, including research and began reading further around the issues raised in the training. The average time for repeating the training was two yearly. A foster carer who had attended previous training which was made up of a mix of professionals seemed to enjoy a group with foster carers only. She felt that there was no feeling of being judged and she felt foster carers relaxed and were more open about their experiences. 179 P4 Line 91-98 In addition, another foster carer was shocked that the local CAMHS/LAC service was so small given the statistics nationally with regard to the mental health needs of children in care. “45% of looked after children with mental health issues……so why isn’t there more of you? There obviously needs to be more acces.s” P 24 Line 379-392 To conclude, foster carers felt the training helped them to decide if they needed to seek CAMHS support and had raised awareness of local services. 4.5 DISCUSSION OF QUALITATIVE FINDINGS 4.5.1 JOURNEY OF DISCOVERY: 10 THEMES The experience of the training groups for new and experienced foster carers was varied and rich in description and detail. The semi-structured interviews, together with the diaries and the observational notes kept by myself, led to the emergence of ten key findings which demonstrated a journey of learning, which was for some initially overwhelming, but for many eventually empowering. A mind-map was produced for each theme which demonstrated the connections and associations with wider aspects of foster care in practice. The importance of understanding the many forces that operate within the ‘field’ for foster carers helped me illuminate deeper meaning from the data (Lewin, 1951). This illuminative evaluative process was enlightening and paid attention to the complex interrelationships that occur for foster carers in relation to the wider administration and regulatory system, policy guidelines, regarding training, the pre and post approval arrangements, the creation of portfolios, the supportive role required from the learning and support development officer, the demands made upon foster carers in respect of meetings throughout the data gathering period. As in other studies, foster carers’ concerns 180 regarding their perceptions of the local authority and social workers varied from very positive to extremely negative. Foster carers reported a journey which came alive through the ten themes that have been identified in detail in the findings. Figure 19 and 20 represent the stages of the journey for new and experienced foster carers and represents how many foster carers chose to repeat the experience in order to gain deeper awareness and understanding of the mental health needs of the children in care. Journey Through Training: New Foster Carers Figure 19: Stages through training for new foster carers Figure 20: Stages through training for experienced foster carers Journey Through Training: Experienced Foster Carers Revisiting training Travelling Through Training Moving Higher Starting Out Moving On Travelling Through Training 181 The first two themes will be discussed in more detail within this section due to the fact that they contribute new findings in light of the connections with other findings in the field of literature over the last 15 years. This does not mean to say that they are more important than the other eight themes however, there are limitations with regard to the word count within this thesis and therefore findings which have already received attention within the field will be discussed in less depth. 4.5.1.1 STARTING OUT: Motivation and Expectations The ‘starting out’ phase led to new findings related to the pre training phase for foster carers within which they expressed a combination of their intrinsic and extrinsic motivations and their realistic expectations. The findings within the pre training interviews suggested that, in relation to motivational factors, foster carers within both cohorts who attended attachment training highlighted that a key motivating factor was the desire to understand their children and themselves and gain the skills to parent. Knowles (1998) refers to the idea that human beings seek personal adequacy in the process of learning and identified that adults are motivated to learn as they experience needs and interests that will be satisfied through learning. This highly motivational factor was confirmed in the findings as many intrinsic and extrinsic desires led to foster carers expressing the need to learn new techniques, reinforce existing skills and gain awareness of mental health issues. In addition many of the experienced foster carers who had attended the training before spoke about their experiences in practice and how the knowledge gained through the training had supported them through difficult times. This is referred to by Knowles (1998) as the process of learning that occurs when adults are orientated to learning through life experiences. Experienced foster carers had also been encouraged by the Learning and Development Officer (LDO) to take part in the process of training through an introductory programme for new foster carers within the ‘Skills to Foster’ process. In April 2008 the Training, Support and Development Standards for foster carers outlined seven standards of skills that every foster carer should evidence by completing a portfolio workbook of training they had attended. The experienced foster carers reported that their part in the co-facilitation of the ‘Skills 184 satisfaction post training (Robson and Bryant, 2009). Within my reflective journal I considered the importance of having met foster carers prior to the training as this helped in terms of considering the whole context within which the training was offered. The recent charter for foster carers and the NICE/SCIE guidance (2010) suggests considering local needs of foster carers when training. Unless some discussion occurs with providers of mental health training then this may be missed along with an opportunity to co-create learning. The role of the Learning and Development Officer is also an important one to consider in future research. The facilitation of the training programme for foster carers and the importance of mental health training as a core training for new foster carers is a significant one. There seemed to be an acknowledgement that this training was seen as having an important role to play in the development of core competencies and skills which require evidencing through the seven standards CWDC portfolio. Laybourne et al (2008) report that this was a shortcoming in their training and recommended that support officers (family placement workers) are able to attend the training as these practitioners are ideally placed to reinforce some of the important concepts. There was also evidence that foster carers’ expectations seemed realistic and in line with the training programme’s aims and objectives, in relation to increasing knowledge regarding the mental health needs of LAC. There was a sense that foster carers expected to develop networks of support as a result of attending training. New foster carers regarded this training as meeting a myriad of needs which included reducing the fear of isolation and a lack of support. This need for support fits with the extensive findings gained by the CWDC (2005). The CWDC found that the process of training, in addition to completion of minimum standards, provides a structure for foster carers within which their educational and support needs will be met. Training of foster carers has now become and established part of fostering practice. Further National Vocational Qualification (NVQ) training is now provided by all agencies across the public independent and private sectors (Sinclair et al, 2004). 185 4.5.1.2 TRAVELLING THROUGH: Instant post training reactions The ‘travelling through’ phase describes the immediate reactions expressed by foster carers post training which confirmed existing findings in the field and included an increased awareness of the emotional and behavioural needs of the children in their care, a process of personal reflection, increased knowledge and confidence in their skills in practice and satisfaction in relation to the format and content of the training. This evaluation immediately after the training gave me a sense that many new foster carers were still processing the experience, digesting the information and reflecting upon the personal implications for them. The real stories based on the experiences of other foster carers seemed to reassure foster carers that they could manage to care for children with challenging behaviours in the future with the right support and helped many foster carers understand theory in practice through experience. For some more experienced foster carers, this sense of participation in contributing to the knowledge base seemed to empower them further and reduce isolation. This collaborative approach to learning through which foster carers learn from each other when sharing their experiences helps to build upon existing understanding, by connecting new information and skills to prior knowledge (Warman et al, 2006). The importance of making sense of what they know in practice and encouraging reflection on practice has been discussed in depth within other studies (Golding & Picken, 2004; Gurney- Smith et al, 2010) and fits with theories of learning which emphasise the self direction of learning (Knowles, 1973). Learning is a personal interpretation of the world and the key to training is to acknowledge the foster carers’ perceptions of their children before moving them forward to gain new insights (Burns, 2002). A quarter of the foster carers linked the training to an increased awareness of their own personal history. There seemed to be an initial immediate response to the training which, for some foster carers, led to the beginning of a journey of reflection upon their own past. Foster carers highlighted they were feeling calmer, slowing down and not taking the behaviours of children personally. There seemed to be an 186 increased ability to tolerate stress. Personal issues regarding stress, foster carers’ own histories and coping within the system were discussed. Foster carers described feeling more connected to their foster child and optimistic about the future for them This change in the behaviour of foster carers may be as a result of the interplay of forces and is explained well in Lewin’s ‘Field Theory’ (1951) which discusses how learning occurs as a result of two changes which include (1) a change in the internal needs and motivation of individuals and (2) a change in cognitive structures in the field itself. Through the introduction of mental health training into the ‘field’ of foster carers it may be possible that a change in behaviour could occur as perception of increased parenting skills led to a sense of empowerment and knowledge regarding the emotions of children. Many foster carers perceived the training had led to increased stability for children in their home and empathy for the child. This raised my awareness of the importance of a follow up training group to support this process and journey. An awareness of the complex nature of the combination of experiences was also interesting in that the foster carers were talking about how the training affected them on many levels in relation to the children they cared for, their own histories, awareness of the experiences of other foster carers and an understanding of the complexities of the system within which they work. In summary for many it was aptly described by a new foster carer as ‘eye opening’ and for an experienced foster carer as ‘completing the jigsaw’. Although an evaluation immediately after the training group gave a broad understanding of the experience of foster carers it was not the whole picture. The importance of follow up evaluation over time is significant in terms of our understanding of the experiences of foster carers in practice. 4.5.1.3 MOVING ON: Personal growth and reflective practice Finally, the ‘moving on’ phase occurred, within which foster carers described experiencing a sense of personal growth, an increased confidence in their skills, an increase in their role as advocates and more in-depth understanding of the emotional needs of children. They also expressed a desire to design their training in terms of