Youth-centred practice: Positive youth development practices and pathways to better outcomes for vulnerable youth

Children and Youth Services Review 46 (2014) 160–167

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Youth-centred practice: Positive youth development practices and pathways to better outcomes for vulnerable youth Jackie Sanders ⁎, Robyn Munford Practice Research and Professional Development Hub, Private Bag 11 222, Massey University, Palmerston North, New Zealand

a r t i c l e

i n f o

Article history: Received 18 June 2014 Received in revised form 19 August 2014 Accepted 22 August 2014 Available online 1 September 2014 Keywords: Positive youth development Resilience Risks Outcomes Services

a b s t r a c t This paper reports on a longitudinal study of 1012 youth (aged 13–17 years). Half were clients of two or more services and were followed for three years to enable analysis of the impact over time of services delivered using positive youth development practices (PYD). Youth completed self-report questionnaires administered by trained interviewers. It was hypothesised that youth reporting two positive service experiences at Time 1 would report better wellbeing and resilience and lower risk at Time 3 than youth reporting inconsistent or two negative service experiences at Time 1. MANCOVA was used to determine the relationships between service quality and wellbeing, resilience, and risk, with three covariates that assessed the presence of positive relational resources (with caregivers, friends and school) around youth. Results indicated that service quality at Time 1 had a positive effect on wellbeing and resilience at Time 3, but not on risk levels. The importance of consistent use of PYD approaches across services is discussed, as is the need for services to more directly address risk levels for vulnerable youth. © 2014 Elsevier Ltd. All rights reserved.

1. Introduction

1.1. Positive youth development

Positive youth development theory and practice (PYD) is increasingly shaping the adolescent research, policy and practice agenda (Lerner, 2005). It has an important role to play in building our understanding of the issues confronted by vulnerable youth and the configuration of services and supports that can best assist this group of young people to develop and thrive. Because of its emphasis upon the theory–research–practice nexus, PYD has an important contribution to make in this specific domain of youth research (Lerner, 2005). The current study seeks to shed light on the role that multiple service involvement plays in positive outcomes for youth who are exposed to elevated levels of adversity and who may also have fewer resilience resources with which to manage this exposure. The study is concerned with understanding whether, and under which circumstances, multiple services constitute positive resources vulnerable youth can draw on as they navigate a pathway through adolescence.

Drawing on work from positive psychology and the strengthsperspectives, PYD redefined adolescence so that young people were no longer primarily understood as being:

⁎ Corresponding author. Tel.: +64 63569099. E-mail addresses: [email protected] (J. Sanders), [email protected] (R. Munford).

http://dx.doi.org/10.1016/j.childyouth.2014.08.020 0190-7409/© 2014 Elsevier Ltd. All rights reserved.

… broken, in need of psychosocial repair, or [as] problems to be managed (Roth, Brookes-Gunn, Murray and Foster, 1998). Rather, all youth are seen as resources to be developed. [Lerner, 2005] This shift in focus from adolescence as a period of deficit and difficulty to one characterised by tremendous growth and potential was important for the overall study of adolescence, and it was critical for research and programme development with vulnerable young people where their problems had historically defined them as risky and as problems to be solved (Case, 2006). A PYD lens redefines the risks youth confront as zones of challenge to which positive resources can be applied in a manner relevant to their particular socio-cultural context. This does not mean that risks should be dismissed or diminished but rather that they must be understood as comprising only one part of a young person's social ecology. In this way, PYD constitutes an optimistic orientation and vocabulary that speaks of potential and recognises the plasticity of human development, even in the face of significant adversity.

J. Sanders, R. Munford / Children and Youth Services Review 46 (2014) 160–167

As an ecological approach, PYD focuses attention on the young person in their social and cultural context (Lavie-Ajayi & Krumer-Nevo, 2013). It recognises that there are diverse pathways through adolescence and that these pathways reflect the dynamic interplay between each young person's own individual characteristics and the resources and risks arrayed around them. Whilst not the only relevant factor in terms of adolescent wellbeing, for instance material resources (Ungar et al., 2007) also play an important role, relationships are nonetheless a critical dimension of the adolescent developmental project (Lerner, 2005). From a PYD perspective, when young people have mutually beneficial relationships with the people and institutions in their social world they will thrive and contribute (Heinze, 2013). This applies equally to youth who have many supportive resources as it does to those who are facing significant challenges. In this context, a key task for researchers and practitioners is to locate the places that hold potential for positive growth and development. Positive youth development occurs when opportunities are made available to youth in meaningful ways and when relationships support young people to develop their own unique capacities and abilities. The current paper focuses on relationships as a particular sub-set of supportive resources. Equally, however, we recognise that material resources play an important role in outcomes for youth facing high levels of risk. As Ungar et al. (2007: 295) note in their elaboration of the seven resilience tensions, access to material resources including financial, educational and employment opportunities, as well as access to basic resources such as food and safe shelter are a fundamental part of resilience for vulnerable youth. Development is dynamic and bi-directional; young people actively engage with their social and physical environments and the people within them, shaping and being shaped by these interactions (Benson, 2006). Psychosocial services can potentially form part of this dynamic equation and contribute both relational and material resources that enhance development. Whilst supportive relationships cannot compensate for a lack of material resources, relationships do have the potential to open up new networks and to provide opportunities for emotional connection and attachment; factors that have a powerful influence on outcomes in adulthood (Schofield & Beek, 2009). Whilst the current paper focuses upon relationships as supportive resources, this is not an argument for ignoring the role of material resources in positive outcomes for youth facing adversity. 1.2. Multiple system engagement and positive outcomes Over recent years attention has increasingly focused upon understanding the ways in which interventions offered by multiple service systems (e.g., child welfare, mental health, special education and juvenile corrections) combine to have an impact on outcomes for vulnerable youth (Berzin, 2010; Haight, Bidwell, Marshall, & Khatiwoda, 2014). For instance, the contribution of collaborative practice for ‘cross-over’ youth; that is youth who are concurrent clients of the child welfare and juvenile justice systems, has been considered (Haight et al., 2014). Indeed, young people who face the most risk, or who face the most complex mix of challenges as they move through adolescence, are typically clients of more than one service system (Ungar, Liebenberg, Dudding, Armstrong, & can de Vijver, 2013). Given this, there is good justification for examining the complex interactions between multiple services, the resources youth have available to them from within their own social ecologies, and the relationship of these to risk reduction, resilience enhancement and improved wellbeing (Sanders, Munford, Liebenberg, & Ungar, 2014; Berzin, 2010; Ungar et al., 2013). As noted above, PYD approaches focus attention upon the wider social ecology of youth (Lavie-Ajayi & Krumer-Nevo, 2013). The relationship between the nature of youth need and the type of services they receive is influenced by the particular needs or risks young people bring into service encounters and by factors in their social ecology (Dodge, Murphy, O'Donnell, & Christopoulos, 2009; National Research Council & Institute of Medicine, 2009; Santisteban & Mena, 2009;

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Skovdal & Campbell, 2010; Swenson, Henggeler, Taylor, & Addison, 2009). In this context, involvement in multiple services could constitute either a developmental asset available to vulnerable youth, mitigating their risks and enhancing their capacity to achieve good outcomes (Mitchell, 2011), or it could constitute a risk factor (Ungar et al., 2013). For instance, there is evidence that suggests that rather than promoting positive outcomes, involvement in more than one service system is related to higher risk and poorer outcomes (Garland, Aarons, Brown, Wood, & Hough, 2003; Haapasalo, 2000; Hazen, Hough, Landsverk, & Wood, 2004; Kroll et al., 2002; Loeber, Farrington, Stouthamer-Loeber, & Van Kammen, 1998). There are a number of reasons why this might be the case. It might be that involvement with more than one service occurs as a result of higher levels of risk and that this causes greater challenges for service providers. It might also be that multiple service engagement reflects a reduced capacity of young people to engage successfully with service providers. However, poor outcomes for vulnerable youth who have been involved in multiple services cannot be attributed solely to their reluctance or inability to engage with providers, to their background risk or to limited availability of resources in their social ecologies. If outcomes do not improve questions also need to be directed at service quality; has this been consistently high across services and were services delivered in ways that were meaningful to young people? Research indicates that the latent capacities and individual characteristics of young people explain only a small amount of the variance in outcomes among service users (Cicchetti, 2010; Sroufe, Egeland, Carlson, & Collins, 2005). Service quality and fit across all service systems have been found to have a greater influence on outcomes than the individual qualities of clients (DuMont, Widom, & Czaja, 2007). Indeed, it has been demonstrated that the quality of the interactions care workers have, and the relationships they build with vulnerable children and youth improve outcomes later in life (Bastiaanssen, Delsing, Kroes, Engels, & Veerman, 2014), again lending support to the contention that service quality plays an important role in improving the chances of good outcomes. Such findings are consistent with PYD practices which emphasise the critical role of relationships, particularly with adults, in creating meaningful opportunities to facilitate good outcomes. Good outcomes can be achieved irrespective of the personal characteristics of the individual concerned when vulnerable clients are provided with appropriate resources and supports and can form positive relationships with professionals (DuMont et al., 2007). There is evidence to suggest that service provision achieves the best outcomes for youth when professionals encourage active involvement of the young person and demonstrate respect for them, their family and culture (Ungar et al., 2013). Such data provide empirical support for the PYD argument that the social ecology that surrounds vulnerable youth is as important as the particular characteristics of the young person in terms of creating potential for change. This includes the nature of the services they receive (Browne et al., 2001; Obrist, Pfeiffer, & Henley, 2010; Saewyc & Edinburgh, 2010) and in this connection, service delivery can include both socio-emotional and material components. Clients are more likely to make and sustain change when services pay close attention to meeting their needs, as clients understand these (Duncan, Miller, & Sparks, 2004). It is important therefore to understand the features of multiple interventions that do make a positive difference in the lives of vulnerable young people. There is now a strong evidence-base that links PYD-based practice with positive changes for very vulnerable youth (Eccles & Barber, 1999; Eccles, Barber, Stone, & Hunt, 2003; Gardner, Roth, & Brooks-Gunn, 2008; Grossman et al., 2002; Heinze, Hernandez Jozefowicz, & Toro, 2010; Larson, 2000; Larson, Hansen, & Moneta, 2006; Scales, Benson, & Mannes, 2006). For instance, in a recent study that examined in detail the quality of a single service experience by youth who were concurrently involved in more than one service system, increased resilience and better outcomes were observed

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when services were respectful and provided opportunities for young people to exercise personal agency during treatment (Ungar et al., 2013). These components of service delivery; respect and agency, reflect a PYD orientation to practice (Urban, Lewin-Bizan, & Lerner, 2009). The issue of service quality is complicated, however, when youth have concurrent engagement with more than one service system (Haight et al., 2014). If service delivery is intended to mitigate risks and support positive change, the adoption of PYD practices and consistent and integrated quality service delivery across systems would appear to have much to offer in terms of improving the likelihood of good outcomes. The study presented in this paper explores this issue and examines the contribution of PYD practices to service quality and outcomes for vulnerable youth. 2. The study The present study addresses a gap in current knowledge concerning the ways in which services from more than one service system (child welfare, juvenile corrections, educational services additional to mainstream classroom programing and mental health) intersect. It examines the role that consistent service quality from two services has on outcomes for youth over time when the impact of background relational resources around youth are controlled for. We were particularly interested in understanding the way that involvement with a number of services influenced outcomes for youth who were exposed to large amounts of risk and who therefore faced substantial challenges in navigating a safe course to adulthood. Whilst it is to be hoped that services would contribute to wellbeing, resilience and better outcomes for vulnerable youth, the potential of multiple services to promote the achievement of change have not, to date, been systematically examined and, as noted earlier, the evidence is equivocal with regard to whether or not multiple service involvement always brings benefits for youth. This study seeks to address this component of service delivery. Specifically we hypothesised that: 1. Youth who have two consistently positive service experiences at Time 1 will report better wellbeing at Time 3 than youth who have inconsistent or two negative service experiences, controlling for the background presence of positive relational resources in youth lives. 2. Youth who have two consistently positive service experiences at Time 1 will report higher resilience at Time 3 than youth who have inconsistent or two negative service experiences, controlling for the background presence of positive relational resources in youth lives. 3. Youth who have two consistently positive service experiences at Time 1 will report lower risk at Time 3 than youth who have inconsistent or two negative service experiences, controlling for the background presence of positive relational resources in youth lives. 2.1. Method 2.1.1. Participants The data upon which this paper is based forms part of a larger, longitudinal study, the Successful Youth Transitions Programme. It is part of a five-country (Canada, China, Colombia, South Africa, and New Zealand), mixed-methods study of patterns of resilience, risk and service use of more than 7000 young people. The research was approved by the University Ethical Review Board prior to the commencement of interviews. This analysis concerns a sub-set of the New Zealand sample (n = 506). This sub-set consisted of purposefully selected youth who were identified by service providers as clients in the following service systems: mental health, juvenile justice, child welfare and educational (other than mainstream classroom programming) systems, during the six months prior to participating in the study. To be included in the sample, these youth (the vulnerable group) were also required to have elevated contextual risks in their families and neighbourhoods. This was identified from data collected at the time of the first administration of

the survey (see Tables 2 & 3). Based on published research, it was reasoned that this combination of involvement in multiple services and the presence of elevated levels of contextual risks, made youth vulnerable to poor psychosocial outcomes (Sanders et al., 2014; Mitchell, 2011). These youth completed a survey instrument three times at approximately annual intervals between 2009 and 2013. The retention rate from Time 1 to Time 2 was 89%, and from Time 2 to Time 3 was 96%. Analysis in this paper considers data collected from these youth at their first interview (Time 1) and their third interview (Time 3). For purposes of baseline comparison, a second group of youth was also surveyed at Time 1. This group, the comparison group (n = 506), was recruited from the same communities as the vulnerable group and selected on the basis of similar demographic characteristics (i.e. age, gender and race/ethnicity). To be allocated to the comparison group youth were required to not be currently involved in services even though they came from the same neighbourhoods as youth in the vulnerable group, and to not be exposed to the elevated levels of contextual risks noted above. The total sample in the analysis was 1012. The mean age of the vulnerable group was 15.35 years (SD = 1.16) and for the comparison group 15.17 years (SD = 1.39). Table 1 details the demographic profiles of the two groups and it can be seen that they were similar on demographic variables, the variables on which they were matched (i.e. age, sex and ethnicity). However, the two groups differed significantly on all other variables including their living circumstances and a range of risk and resilience measures, even though they were living in the same neighbourhoods (Tables 2 and 3). In terms of living arrangements, comparison group youth were concentrated in households that involved their biological family (97.8% compared with 74.3% for vulnerable group youth) and vulnerable group youth were distributed across other types of living arrangements. There were also differences between the two groups on all dimensions of risk and resilience captured in the survey (Table 3). Of particular note are the large differences between the two groups on a history of abuse and neglect (η2 = .86), individual risk (η2 = .59), chronic need (η2 = .52) and family risk (η2 = .22). In relation to resilience (η2 = .015) and community risk (η2 = .08) the effect sizes of the differences between the two groups were moderate, but nonetheless significant. These patterns of difference between the social ecologies of youth in the vulnerable group and the comparison group point to an accumulation of risks around vulnerable group youth and a diminished quantity of resilience resources available to help vulnerable group youth cope with this elevated adversity. 2.1.2. Measures Resilience was measured using the Child and Youth Resilience Measure (α = .91, CYRM-28; Liebenberg, Ungar, & Van de Vijver, 2012). Items are rated on a 5-point scale from 1 = does not describe me at all to 5 = describes me a lot. CYRM assesses individual resources including

Table 1 Demographic characteristics. Vulnerable group

Gender Female Male Age 15 years and under 16+ years Ethnicity Maori Pacific Island Pakeha Total

Comparison group

N

%

N

%

221 285

43.7 56.3

218 288

43.1 56.9

285 221

56.3 43.6

285 221

56.3 43.6

237 96 173 506

46.8 19.0 34.2

237 96 173 506

46.8 19.0 34.2

p

.899

1.000

1.000

J. Sanders, R. Munford / Children and Youth Services Review 46 (2014) 160–167 Table 2 Living arrangements at Time 1. Vulnerable group

Comparison group

N

%

N

%

376 35 64 31 506

74.3 6.9 12.6 3.1

495 10 0 1 506

97.8 2.0 0.0 0.1

p

.000 Biological family (incl. relatives) Family-like setting (e.g. foster care) Residential facilities Living independently Total

personal skills (such as ability to problem solve, cooperation, and awareness of personal strengths), peer support, and social skills; relationships with primary caregivers including physical and psychological caregiving; and contextual resources that facilitate connection to culture and community, the role of religious and spiritual beliefs, and engagement with and relevance of education. In the current study α = .88 at both Time 1 and Time 3. Individual risk was assessed via four measures that captured both internalising and externalising dimensions. The 12-item version of the Centre for Epidemiological Studies Depression Scale (CES-D-12-NLSCY; α = .85; Poulin, Hand, & Boudreau, 2005) measured risk of depression among participants. Participants rated each item on a 4-point scale from 0 = rarely or none of the time to 3 = all of the time with some items being reverse scored. This measure compares favourably to other depression measures such as the Beck Depression Inventory (Wilcox, Field, Prodromidis, & Scafidi, 1998). In the current study Time 1 α = .80; and Time 3: α = .82. Externalising risk was assessed using two subscales of the 4-H study of Positive youth development (α = .73; Theokas & Lerner, 2006); delinquency (frequency of behaviours such as theft, vandalism and aggression) and risk (frequency of use of substances including alcohol, tobacco, and other drugs). Individual items are rated on a 5-point scale from 1 = never to 5 = 5 or more times. The alpha coefficients in the present study were .87 and .82 at Time 1; and .88 and .71 at Time 3 respectively. Externalising risk was also assessed using the Conduct Problems subscale of the SDQ questionnaire (Goodman, 2001), which includes shortness of temper and inclination for aggressive and violent responses, lying, theft and bullying. Items are measured on a 3-point scale from 0 = not true to 2 = certainly true (α = .60) with some items being reverse scored. In the current study α = .74 at Time 1 and α = .63 at Time 3. 2.1.2.1. Normative wellbeing status (wellbeing). A combined measure was created that captured wellbeing status of youth at Time 3. This measure Table 3 Risks and resilience resources at Time 1.

CYRM resilience Individual risk Chronic needa Abuse/neglect historyb Family riskc Community riskd

Vulnerable group

Comparison group

M

M

SD

SD

t

df

74.52 11.08 80.45 10.28 −8.81 1010 34.61 14.87 14.88 9.87 24.84 877.84 2.39 0.91 0.12 0.32 21.87 627.97 2.84 2.50 0.26 0.88 52.73 627.04 11.48 6.91 7.60 3.60 59.83 15.05 54.11 14.29

p

η2

.000 .015 .000 0.59 .000 0.52 .000 0.86

11.17 760.14 .000 0.22 6.19 1010 .000 0.08

a Questions measured how many times in their lifetimes youth had used 35 different services across the health, mental health, education (additional to mainstream schooling), welfare and justice systems. The number of services used served as a proxy measure to define chronic need over the lifespan. b Measured by youth reports of current involvement and past investigations and interventions from statutory child welfare authorities. c A composite score (Sanders et al., 2013) measuring parent/caregiver presence and the nature of the relationship with parent/caregivers. d Assessed via a composite score measuring sense of community danger using items from the Boston Youth Survey.

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was designed to assess four aspects of youth lives that were considered to be markers of a baseline level of wellbeing for young people in this country, for this reason it is labelled ‘normative wellbeing status’. Whilst pathways through adolescence can be expected to be diverse and dynamic, subject to a range of internal and external influences the term ‘normative wellbeing’ is used here to refer to a baseline of wellbeing characteristics that it would be hoped all young people in New Zealand would be able to be supported to achieve. Pro-social behaviour was assessed using the SDQ pro-social behaviour subscale (Goodman, 2001; α = .66) which assesses youth capacity for kindness, sharing and concern for others on a 3-point scale from 0 = not true to 2 = certainly true. In the current study α = .63. An adapted and reversescored list of questions from the fourth and fifth cycles of the Canadian National Longitudinal Survey of Children and Youth was used to obtain information surrounding the nature of peer groups. In the current study α = .85. Life satisfaction was measured using the Satisfaction with Life measure (Diener, Emmons, Larsen, & Griffin, 1985; α = .87) in which youth ranked five questions assessing their overall satisfaction with life on a five point scale from 1 = strongly disagree to 5 = strongly agree. In the current study α = .84. Educational involvement was assessed by an answer to a single yes/no question that asked if youth were enrolled in any school subjects at the time of the survey. Youth did not have to be attending a mainstream school to answer yes to this question. For instance, they could be enrolled in correspondence school and pursuing their schooling at home, or attending an alternative education programme in their local community. Three covariates were selected for measurement at Time 1. Consistent with a PYD approach these measured the presence of proximal supportive relational resources in the lives of young people as they came into the study. Covariates were selected that represented three key relational domains in youth lives that are known to potentiate positive development; family/caregivers, friends/peers and school (Heinze et al., 2010; Lerner, Almerigi, Theokas, & Lerner, 2005; Ungar et al., 2013). 2.1.2.2. Quality of caregiving relationship. Youth were asked to rate the quality of the relationship that they had with male and female parentfigures. These figures could be biological parents, other adult relatives, foster parents, or another adult who acted in a parent role in their lives at the time of the survey. They rated the amount of affection they received from both of these parent-figures on a five point scale from 1 = a great deal to 5 = none at all. In the current study α = .77. 2.1.2.3. Positive peer group. An adapted and reverse-scored list of questions from the fourth and fifth cycles of Statistics Canada's National Longitudinal Survey of Children and Youth was used to obtain information surrounding peer activity. Questions asked youth to rank how many of their friends engaged in a range of activities such as smoking, drinking and breaking the law. Youth ranked their answers on a scale from 0 = none to 3 = all. In the current study α = .91. 2.1.2.4. Positive school environment. Three questions assessed the extent to which youth experienced school as a safe place and to which they experienced a sense of belonging when at school. They were also asked to rank the extent to which the last mainstream school they attended was a good place for them. Questions used a 5-point scale from 1 = not at all to 5 = very much (α = .61). 2.1.2.5. Consistent service quality. Drawing on PYD theory, the independent variable was created from a Time 1 service quality score composed of 13 questions that assessed youth experience of personal agency (overall satisfaction with the service, having a say in how the service is provided, relevance and accessibility of the service) and staff respect (respect and sensitivity for youth and their whānau/family including their beliefs, and staff engaging in clear communication with youth) in services they had recently used. Adapted from the

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J. Sanders, R. Munford / Children and Youth Services Review 46 (2014) 160–167

Youth Services Survey, this descriptive measure assessed youth satisfaction with services as a whole, with a particular focus on the extent to which youth experienced service delivery as responsive to their situations and which engaged appropriately with their family or caregivers. It included questions such as: “The people helping me stuck with me”; “I had a say in how this service was delivered to me”; “Staff were sensitive to my cultural and ethnic background”; “I had someone to talk to when I was in trouble”; “I could get the service when I needed it”. Items were rated on a 5-point scale from 1 = strongly disagree to 5 = strongly agree. Youth completed the set of 13 service quality questions on two services of which they had current experience. In the current study, Service 1 α = .92; Service 2 α = .93.

Table 4b Multiple comparisons of Time 1 and Time 3 scores on the three dependent variables.

3. Data analysis

significantly higher scores, followed by the inconsistent and then the negative groups (which were similar to each other). By Time 3, the gap apparent at Time 1 between the inconsistent and negative groups on the resilience measure had closed; that is, the negative group made greater resilience gains over time than the inconsistent group. The positive group retained its position as the highest scoring group on wellbeing and resilience. Risks decreased over time for all three groups and the pattern seen at Time 1 of the positive group having significantly lower risk than the inconsistent and negative groups was retained.

In order to evaluate the impact over time of service quality, the vulnerable group was divided into three sub-groups based on their answers to the consistent service quality questions at Time 1. The group was divided in the following way: 1 Consistent positive service quality experiences (youth reported two positive service experiences at the Time 1 interview, n = 124); 2 Inconsistent service quality experiences (youth reported one positive experience and one negative service experience at the Time 1 interview, n = 185); 3 Consistent negative service quality experiences (youth reported two negative service experiences, n = 197). This grouping allowed for examination of the effects over time of consistency in the service quality experience for the three sub-groups of vulnerable youth on the three dependent variables (wellbeing, resilience and risk). Prior to any analyses, missing data analysis was conducted. Results showed that 1.68% of the data was missing and data was missing at random (MAR). Missing data was replaced using maximum likelihood estimation (EM; Enders, 2010). Continuous variables were examined for normality, linearity, and homoscedasticity; all variables were within acceptable limits. T-tests were used to determine differences between the vulnerable group and the comparison group. ANOVA, MANOVA and MANCOVA were then used to investigate the effect of consistent service quality on three dependent variables measured at Time 3 (wellbeing, resilience and risk) controlling for the effect of the three supportive relational resource variables (family/caregivers, friends/ peers and school) available to youth at the time they entered the study. 4. Results

Wellbeing T1a Wellbeing T3a Resilience T1b Resilience T3a Risk T1a Risk T3a a b

Positive:negative

Positive:inconsistent

(p)

(p)

Negative:inconsistent (p)

.000 .000 .000 .000 .006 .002

.000 .000 .000 .000 .012 .001

.349 .998 .004 .432 .977 .929

Tukey HSD. Games–Howell.

4.2. Impact of the quality of the service experience on outcomes for youth at Time 3: normative wellbeing status, resilience and individual risk Multivariate (MANOVA) analyses indicated significant differences between the three service experience groups in terms of the three dependent variables (λ = .953, F = (6, 1002) 5.724, p = .000). Specifically, the positive group reported higher levels of wellbeing and resilience and lower risk at Time 3 than the other two groups (Table 5). The addition of three proximal relational covariates (quality of the caregiving relationship, a positive peer group and positive school environment, at Time 1) in a MANCOVA moderated this effect slightly (λ = .963, F = (6, 996) 3.176, p = .004) but the overall impact of consistent service quality remained. Of the three covariates, a positive peer group had the largest overall effect on the combined dependent variable, whilst the quality of the caregiving relationship and a positive school environment had moderate effects (Table 6). Post hoc (Bonferroni) analyses of the univariate outcomes (adjusted for the three proximal relational resource measures) indicated that young people in the positive service experience group retained the advantages in terms of wellbeing and resilience over time that were seen in the MANOVA, but that the quality of the service experience at Time 1 did not appear to have any long term impact on risk levels when the impact of the covariates was taken into account (Table 7).

4.1. Differences within the vulnerable group over time 5. Discussion In terms of changes across time on the three dependent variables (Tables 4a and 4b), ANOVA indicated that all three groups improved their wellbeing scores over time, with the positive group returning

The measure of consistency in service quality allowed us to assess the extent to which two service providers adopted PYD practices and

Table 4a Means scores for the three service quality groups at Time 1 and Time 3 on the three dependent variables. Consistent service quality Negative

Wellbeing Time 1 Wellbeing Time 3 Resilience Time 1a Resilience Time 3 Risk Time 1 Risk Time 3 1 a

Inconsistent

Positive

M

SD

M

SD

M

SD

f

df

p

η2

6.96 9.25 70.48 73.76 35.93 27.74

1.71 1.85 10.95 12.18 14.79 13.17

7.21 9.24 74.02 75.21 35.94 28.23

1.76 1.75 10.61 11.13 13.93 13.29

8.12 10.12 81.75 80.30 30.85 22.69

1.72 1.62 8.08 10.62 15.67 12.83

17.69 11.45 46.79 12.98 5.59 7.63

2 2 2 2 2 2

.0001 .0001 .0001 .0001 .0041 .0011

.065 .043 .157 .049 .021 .029

Result significant at the .05 level. Welch's F.

J. Sanders, R. Munford / Children and Youth Services Review 46 (2014) 160–167 Table 5 Impact of service quality on outcomes at Time 3. Consistent service quality Time 3

Wellbeing Resilience Risk

Negative

Inconsistent

Positive

M

SD

M

SD

M

SD

f

df

p

η2

9.25 73.76 27.74

1.85 12.18 13.17

9.24 75.21 28.23

1.75 12.18 13.29

10.12 80.30 22.69

1.62 10.62 12.83

11.45 12.98 7.63

2 2 2

.000 .000 .001

.044 .049 .029

worked in empowering and respectful ways with youth, taking active account of cultural identity, family circumstances and values, and encouraging active involvement of youth in resolving the issues or challenges they were confronting (i.e. encouraging youth agency). The measure was based on the PYD theoretical position that when youth are actively involved in service delivery, experience services as respectful, are able to form positive relationships with staff, and are given opportunities to make appropriate decisions about interventions and programmes, better outcomes are achieved (Bastiaanssen et al., 2014; Duncan et al., 2004; Heinze et al., 2010). There appeared to be a sustained positive effect in terms of wellbeing for youth when they experienced two services as respectful, empowering, and encouraging their agency (i.e. their active involvement in the intervention) at Time 1. Young people in the positive service experience group also demonstrated the highest resilience processes of the three groups. When the impact of proximal relational resources in young people’s own environments (such as those from family/caregivers, friends/peers and school) were controlled for, detectable effects of two positive service experiences remained over time both in terms of wellbeing and resilience resources (supporting hypotheses one and two). When background positive advantages such as relationships at home, with friends, and through school were controlled for, youth who had two positive service experiences were able to sustain some developmental advantages over time. The picture is somewhat different when risks are considered. Both ANOVA and MANOVA suggested that the positive service experience group retained advantages on risks over the course of the study. However, when the presence of background supportive relational resources present prior to the study were controlled for, these advantages disappeared (providing only partial support for hypothesis three). This analysis therefore, provides some support for PYD arguments that outcomes are better for vulnerable youth when services work in respectful and empowering ways. It raises some concerns, however, about the role of risk in the lives of vulnerable adolescents and its interaction with service provision. ANOVA and MANOVA indicated that the positive service experience group began the study with some advantages that were still present at Time 3. However, the MANCOVA suggested that even PYD-oriented service provision across two services appeared unable to have a sustained effect on risk reduction over time when background benefits from positive relationships available within in the social ecologies of youth were taken account of. Young people were selected into the vulnerable group by virtue of their elevated risks, as well as their service involvement, and so the differences between these youth and the comparison group on the risk measure were to be expected, but the lack of differences in risk levels at Time 3 between the three service quality groups was not expected. Even when youth received consistently empowering and respectful interventions at Time 1 their

Table 6 Relationship between Time 1 proximal supportive resources and the combined dependent variable at Time 3 (normative wellbeing status, resilience and risks).

Positive peer group Quality of caregiving relationships Positive school environment

df1

df2

f

p

η2

3 3 3

498 498 498

16.49 6.59 6.08

.000 .000 .000

.090 .038 .035

165

risk levels remained as high as those of youth in the other two service experience groups at Time 3. These findings suggest a need for service providers to focus particular attention upon how they address risk in the lives of vulnerable young people. This includes paying attention to how they understand risk and how risk interacts with other aspects of youth ecologies across a wide spectrum because it did not appear that any combination of service quality was able to contribute to significant reductions in risk levels. Neither did background relational resources available to youth influence risk levels over time. The risk levels to which these young people were subject were profoundly higher than those confronted by their peers on more normative pathways (in the comparison group) and even though youth experiencing positive services were able to achieve better wellbeing and resilience than those youth in the inconsistent and negative service experience groups, it is of concern that their risk levels remained at similarly high levels to young people in the other two service experience groups. Whilst the risk levels of all three groups did reduce over the course of the study, by Time 3 they still remained significantly higher than those of the comparison group some three years earlier. This result points to the need for further investigation into how the long-term impacts of risks youth confront during childhood and adolescence influence their transitions into adulthood. Based on this analysis, there is an argument that practitioners need to attend carefully to how other providers engage with youth because inconsistent service experience had an equally strong relationship with lower wellbeing and reduced resilience as did negative service experiences. One provider working in empowering and respectful ways could not overcome the negative effects of another provider working in disempowering and disrespectful ways which then resulted in poorer outcomes for this group of vulnerable youth. In this regard, recent research (Ungar et al., 2013) has argued that it is the quality of interactions professionals have with youth that creates the possibility for positive development in youth who face many challenges. Elsewhere, youth who experienced two positive service interventions were found to achieve levels of wellbeing that were close to those of youth who did not face elevated adversity, such as those in the comparison group in the current study (Sanders et al., 2014). Consistently positive experiences with service providers may therefore contribute to young people's long-term outcomes and resilience above and beyond the specific influence of the interventions they receive. Findings here point to a consistent set of relationships between how multiple services are delivered (i.e. respectful, tuned well to youth circumstances, empowering, provide opportunities for youth to exercise agency) and the extent to which vulnerable youth are able to do well. They provide support for arguments made elsewhere (Haight et al., 2014) for practitioners across service systems to develop their capacity to consistently adopt PYD practices and to engage in interventions that place the needs of youth at the centre of focus. As other authors note, such work is not at all straightforward. It requires attention to the alignment of services across systems at the structural, policy and programme level, in addition to the development of practitioner capacity in terms of professional interactions with youth and with each other (Bastiaanssen et al., 2014). Multiple service engagement does, given these findings, have the potential to be a developmental asset for vulnerable young people who confront high levels of risk and who face many challenges in navigating a safe pathway through adolescence. Young people who face the greatest challenges will usually be clients of more than one service. Given this, it is reasonable to assume that the combined efforts of a number of practitioners will accumulate in such a way that they close the gap in life chances between those youth who face these substantial challenges and their peers who are able to progress along more normative developmental. Findings from this study suggest that benefits from multiple system engagement will not occur spontaneously, however. For multiple service engagement to contribute to better outcomes, it is necessary that service providers actively take account of how other professionals are engaging with these very vulnerable young people. This

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Table 7 Relationship between service quality and normative wellbeing status, resilience and risk at Time 3. Time 3 dependent variables

Service quality

Inconsistent

Consistently negative

Wellbeing

Consistently positive Inconsistent Consistently positive Inconsistent Consistently positive Inconsistent

.005

.004 1.000 .001 .909 .116 1.000

Resilience Risk

study indicates that young people were able to sustain better wellbeing and resilience when they experienced two service providers working in empowering and respectful ways with them. These findings suggest that it matters a great deal what each provider does in their work with each individual young person and that practitioners need to pay attention to how other professionals work with their clients. There is potential for providers to work constructively with each other to ensure that their interventions are consistently respectful and empowering. The findings illustrate that all interventions matter and inconsistent service engagement and consistently negative service experience will compromise positive outcomes for vulnerable youth. Further, they suggest that consistently respectful and empowering interventions have effects that endure over time. A focus on interagency and inter-professional practice that pays attention to the manner in which providers interact with young people, particularly those facing the greatest risks, would appear to be an important focus for both policy makers and practitioners. 5.1. Limitations There are several limitations to this study that should be noted. First, it was not possible to draw a random sample of the vulnerable group youth because the study was concerned with the experiences of youth across systems and there was no single database that allowed us to identify youth with the combination of risks and service engagements we required. Instead, youth were systematically identified from service provider caseloads in specified locations to achieve area saturation. This approach allowed access to a large group of youth who met the research criteria, but it posed some challenges in terms of the external validity of the findings. Although we went to considerable effort to include all relevant youth in each locality, we cannot determine whether the youth included in the study were a special population whose characteristics influenced their patterns of service engagement, shaping the interactions they had with service providers. Second, considerable effort was invested in training interviewers to know all the services available in an area and to be able to assist youth to identify accurately the services they used and to complete the questionnaire accurately. However, the data used for this analysis is self-report data and as such is susceptible to the issues others have identified (see for example, Stiffman et al., 2000). Finally, the data on service experiences is drawn from a single point in time (Time 1), and as such we do not know whether services used prior to the survey, or subsequently between the first and final interview also influenced the dependent variables. A prospective study is needed that would closely follow youth over time as they move between services and which can also take account of other potentially mediating factors that intervene in youth lives as they navigate through services. The findings do however demonstrate that there is a need for greater understanding of the complex interactions between high levels of risk, youths' social contexts and effective service responses. 5.2. Conclusion This study of service use experiences among youth who are clients of multiple service systems provides support for the adoption of PYD practices with vulnerable youth. In particular, respectful and empowering practices delivered by two agencies concurrently appears to have a

.015 .050

sustained impact on the capacity of vulnerable youth to achieve better levels of wellbeing and resilience than their similarly vulnerable peers. The quality of the relationship between professionals and their young clients appears to have an impact that endures beyond the end of the intervention. Even when the proximal relational resources available to youth might be thought to precondition them to be more receptive to and able to work with service providers, are taken account of, having two positive service experiences does make a difference to wellbeing and outcomes. These service experiences do not, however, appear to have any lasting impact on their overall levels of risk. Further work is required to expand our understanding of the strategies that assist young people to positively manage their risk levels and how these also impact on outcomes in the long-term.

Acknowledgement The authors thank the Ministry of Business, Innovation and Employment (MAUX0901) for funding this research programme. They also gratefully thank all the young people and their supporters who participated in the research. Finally, they acknowledge the contribution of The Donald Beasley Institute, Kapiti Youth Support, Youthline Auckland and all the other researchers who helped with the research.

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