Health and Wellbeing

The health inequalities in our society, especially when taken internationally, are stark and have been revealed and made worse by COVID-19. Health literacy around the world is irregular, particularly in communities that struggle to even get basic access to healthcare, and the long-term links between poverty and health are becoming more evident.

Focussing on UN Sustainable Development Goal 3: Good Health and Wellbeing, our publishing in this area examines the issues and looks toward providing solutions. Our COVID-19 Collection, for example, showcases our content on the pandemic, in order to encourage broader perspectives and collaborations across global and disciplinary boundaries.

Bristol University Press and Policy Press are signed up to the UN SDG Publishers Compact. In Health and wellbeing, we aim to address the following goal: 

Health and Wellbeing

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This chapter summarises Chapters 3–6 under the categories of the proposed three aspects of planning – two of which have been present, in various guises, since the start of the book – what/who matters (central to Archer’s model of reflexivity and planning, and richly discussed by care-leavers in this study), and a sense of personal time and planning (initially via some care-leavers’ scepticism about future-oriented planning), and the third, shared deliberation and shared planning strongly ‘present’ in the secondary analyses in Chapters 3–6. These three aspects (of planning) might each be viewed as strengths, in contrast to the view that ‘lack’ of future-oriented planning might be regarded as a vulnerability. The chapter, read together with Chapter 8, can provide a ‘live iteration’ in which qualitative data are summarised from Chapters 3–6 and, in Chapter 8, the work of Michael Bratman is discussed, whose work interplays in a deeply fascinating way with the voices of the young people in Chapters 3–6. His idea of the ‘remarkable trio of capacities’ for planning is a major source of the idea of the three-aspects model of planning for this book, in interplay with Archer’s work on reflexivity in social context, and re-imagined via young people’s sense of personal time.

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Chapter 2 sets out the argument for Transitional Safeguarding. Putting it bluntly, the current safeguarding system does not work for many young people and represents poor use of public resources. Binary adults’ and children’s safeguarding legislation, policy, and practice frameworks create gaps for young people to fall into; this binary fuels other binaries such as the categorisation of young people as either vulnerable or culpable. Transitional Safeguarding seeks to redress these binaries and span such boundaries. The chapter outlines the six key principles that underpin Transitional Safeguarding: being evidence-informed; ecological; contextual; developmental and transitional; relational; and equalities-oriented. These address the current challenges in safeguarding young adults, exemplifying the ‘both/and’ ethos of putting Transitional Safeguarding into practice, leadership, and policy development.

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The conclusion draws together the key discussion points outlined in the book, including the core elements of system transformation in this area. We identify important components at micro and macro levels. At a micro level, the experiences of young people are key – unless they are placed at the centre of this work, then their needs will not be fully understood or addressed. At a macro level, various systems and structures govern and influence this work and we have explored some of these for children and adult safeguarding that contribute to (but are not solely responsible for) gaps in safeguarding practices with young people. We end with an outline of core components for leading change moving forward.

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Chapter 4 provides an overview and commentary about ‘emerging adulthood’ as a developmental stage. There are key theoretical frameworks and concepts that offer useful insights into understanding young people’s development, and therefore can influence how we articulate and further develop Transitional Safeguarding. However, these frameworks have some limitations and there are important critiques to be aware of, for example, the theory of ‘emerging adulthood’ is situated in a particular economic, social, and historical context which is not universal and may not stand the test of time. It is more helpful to move beyond age-stage developmental theories and instead engage with the complexity and heterogeneity of young people’s lives and identities. Life Course Theory seeks to do this in part, although there may also be limitations about the applicability of this theory outside of westernised environments. The need for theoretical frameworks to reflect diverse contexts chimes with Transitional Safeguarding’s attention to the principle of equality, equity, diversity and inclusion, the impact of trauma on development links with the relational principle, and the developmental imperative for young people to be afforded choice and voice, which is central to the participative principle.

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Care-leavers interviewed in our studies expressed strong emotions. When participants articulated what and who matters, this was usually done with deep feeling. When forward planning was discussed, some participants powerfully rejected the idea of planning ahead. Moreover, the research interview’s focus on internal conversations often triggered discussions about very strong, often profound, accounts of emotions linked to birth parents and siblings, foster parents and foster siblings, peers and friends, and sometimes services and professionals. In this chapter, following philosopher Martha Nussbaum’s work, emotions are framed as ‘suffused with intelligence and discernment’. Furthermore, the chapter ‘grapple[s] with the messy material of grief and love, anger and fear’, and stretches our senses of time by reminding us that healing usually takes time, and that young people in transition from care may have much experience of the details of emotions, time, and planning. Building also on work by philosopher Matthew Ratcliffe on emotional intentionality, emphasis is placed in this chapter on the circumstances of being in care and leaving care (see Chapter 1), which can involve multiple emotion ruptures during childhood and adolescence, and then the complex process of transition (from out-of-home care) itself, and emerging adulthood as an opportunity to make sense of, revise, reframe, and form new and renewed relationships, and plan – in the broadest and most flexible sense.

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Interweaving the narrative voices of care-leavers in the secondary analyses reported in this book (Chapters 3–6, and summarised in Chapter 7), this chapter provides a detailed account of philosopher Michael Bratman’s ‘remarkable trio’ model of planning agency, followed by a reformulation of one aspect of Bratman’s model – the cross-temporal aspect, based on the wide range of experience of time and planning discussed by young people in this book, as well as a wider literature on subjective and alternative time. Interplaying with young people’s voices summarised in Chapter 7, this chapter reflects on each aspect of a non-dogmatic three-aspects model of planning (what matters, shared deliberation, and a sense of personal time) focused on young people with experience of compounded adversity. Each aspect is regarded as a potential strength (in contrast to the idea that lack of future orientation might be regarded as a vulnerability or deficit requiring an intervention). The chapter ends with an account of expressive logics and counterlogics for planning: this dynamic logic may be regarded as forming a potential basis for practice-based collaborative and co-design work on planning during transition from out-of-home care (see Chapter 10).

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This book powerfully sets out the case for Transitional Safeguarding, a new approach to protection and safeguarding designed to address the needs and circumstances of young people from mid-teens to mid-twenties who are falling between the gaps in current institutional and professional systems, often with devastating results. Addressing these gaps in the current system, it outlines how the specific needs of young people can be met through this approach. Written by leading experts in this area with strong practice networks, it presents up-to-date evidence for its effectiveness, using examples from practice to illustrate the ways in which services are beginning to develop a more transitional approach.

The book begins with the voices of young people: it is imperative that they are placed at the centre of this work. They enable professionals to understand what is wrong with existing systems, structures, and services as well as what is positive and valuable. Practitioners working with young people need knowledge and skills, and legal literacy. The book explores some of the differences and similarities in existing legal and policy drivers in children and adult safeguarding that contribute to (but are not solely responsible for) gaps in safeguarding practices with young people. Professionals working at all levels in local services can be creative within policy and practice frameworks to work around blocks and barriers created by the wholly separate systems for those aged under and over 18. Transitional Safeguarding requires system changes involving leadership at all levels to advocate for, drive, and deliver change that makes a difference to young people’s lives.

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Chapter 9 contains a cross section of examples to provide a picture of what is emerging locally to put the principles of Transitional Safeguarding into action. We hope that they prompt and inspire others to consider how their local area or service might be able to do things differently, to ensure that young people can be and feel as safe as possible. No one area has the complete solution, and all are on a journey with this work. The way in which change happens is a process, not a single transformative event and this chapter explores four typologies, which help situate and understand each of the examples within the system transformation that needs to be achieved.

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The introduction sets out what is covered in the book. It begins by defining the term ‘Transitional Safeguarding’ and explains the origins of it. This is an emergent concept and as such the book marks a moment in time where we (the three authors) take stock of the work we have done over the past six years and look to possible futures. We want the contents of the book to inspire, start discussions, and bring about changes to the way we support young people to be and feel safe.

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In addition to outlining its purposes, and structure, this introductory chapter to What Matters and Who Matters to Young People Leaving Care: A New Approach to Planning contextualises the book, discussing its origins in qualitative research on care-leavers’ internal conversations. Why internal conversations? Sociologist Margaret Archer proposed that internal conversations may act as reflexive ‘mediators’ between agency and structure. The chapter discusses the book’s standpoint that care-leavers bring a rich hoard of reflexive experience to all aspects of planning, including – for some young people – a deep and detailed scepticism about future-oriented planning. The centrality, for the book, of young people’s reflective and autobiographical answers to the internal conversations research interview question ‘Which areas of your life matter most to you at the moment?’ is discussed. The interview transcripts of even those young people who were ‘struggling’ the most had a rich and expressive narrative about what mattered most and who mattered most in their lives. The chapter introduces the notion that planning may not, for some young people, begin with future-oriented goal-setting. The idea of an alternative and non-dogmatic three-aspects approach to planning is introduced, with implications for a wide range of cross-disciplinary services working with care-experienced young people.

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