case study young person

Young people case studies

Case studies are an important way of gaining insight into individual young people’s experiences of custody and resettlement.

Theme: Transition to community

Adisa found it difficult to adjust to life outside after he was sentenced to custody when he was 16

Daniel had served a number of previous prison sentences. He talks about dealing with ‘freedom’

James’s project worker met him on his day of release to ease his anxieties about being in unfamiliar places and using public transport

Michael spent his 21st birthday on remand in prison. After being released straight from court, it took him some time to get used to a different routine

Theme: Trauma

Ash was referred to the vulnerable prisoner unit due to ongoing investigation into historic head injuries, following episodes of impulsive and erratic behaviour

Theme: Family

Curtis and his partner Emma both have experience of custody and drug dependence. Emma’s mum helps them look after their children

When Lance was younger, his family were supported by his local youth offending service (YOS). As an adult under probation, this no longer happens

Lee’s mum is under pressure to stop visiting him. He’s about to lose what family he has. Lee doesn’t know that yet

Shelley wouldn’t call her ex-friends a gang but some might see it like that. She had no family to speak of. As a care leaver, social services were supposed to support her – Shelley’s case worker showed her how to ask for what she needed

Tyler’s mum was scared of her son and the dangers he brought into their home. Tyler and a number of his associates were arrested for attacking another young man. The fall-out brought the situation to a head

Theme: Gangs

Rory was always fighting at school, which led to his exclusion. He felt more confident in a gang of peers

When Kaden was in a gang, he was respected and had money to spare. He’s now crime-free and aspires to be ‘a normal fella’. He could readily find a quick and easy way to ‘make ends meet’, but has so far resisted

On release from prison, Jordan required education or employment, housing outside of gang territory and support to comply with his licence agreement

Due to gang affiliation, Daniel was forbidden to return to his home area. His project worker introduced him to his new home town and helped him to establish tentative roots

While serving a custodial sentence, Aidan resolved to change his behaviour and “get out of the gang”. Once released, a resettlement project supported his choice

Theme: Diversity

Andrew has benefited from culturally appropriate counselling, advocacy and support and a multi-agency approach to his resettlement needs

Jason, from the Travellers’ community, arrived at HMP Ford unable to read and write. A culturally competent intervention helped him to keep in touch with his family

In prison, Faarooq met Muslims who, like him, had “trouble with the idea of citizenship”. Support in the community has shown Faarooq that he can “be a Muslim and a British Citizen and be proud of both”

Kwame, a Muslim of West Indian heritage, was offered a choice of resettlement projects; one reflected his interest in sport and fitness. When out jogging in the park with his case worker, Kwame opened up about his life, experiences, and hopes for the future

Peter is Black British, but never felt that he ‘fitted in’ or belonged. By the time he was 23, he had spent seven years of his life in custody. Peter has not been reconvicted in almost two years, and attributes much of his progress to his mentor

Lisa’s desire to use her time in custody positively and take part in education enabled her to secure employment upon release. Her relationship with prison staff and positive attitude led her to be deemed suitable for release on temporary licence (ROTL) that helped secure her qualifications and employment

Concerns about the high risk of harm relating to Jon’s gang-affiliation meant that he needed to be relocated upon release.

After being relocated upon release from prison because of his gang-association, Aaron felt lonely and isolated. He needed through the gate support to help him through this challenging time.

Would Jake fall back on his previous bad ways while living in a hostel?

“The first two weeks is the test. [It] proves whether someone is going to re-offend or not.”

How Kayleigh overcame her uncomfortable feelings after being released from custody

Theme: Young women and girls

After being released on temprorary license, Linda knew what she wanted – she just didn’t know how to achieve her goal. Linda’s mentor helped her make the necessary practical steps to achieve her dream of going to univeristy.

Sarah was shy and found it hard to trust people after having been let down frequently in the past. After her release from prison, a mentor slowly gained her trust by attending dance classes with her, and helped her with job and grant applications. Sara has since had a number of interviews.

After being granted release on temporary licence from her prison sentence, Dina used the opportunity to meet with her mentor and work to create personal goals which have helped turn her life around.

Adam has ADHD. His home life had been particularly difficult and traumatic. When he was released from Youth Offenders he needed a high level of support and encouragement in order to turn his life around.

Ches had an emotionally traumatic upbringing. His offending behaviour began when he was 13 years old. He has ADHD and has found it difficult to resist peer pressure

Darren grew up in an environment where committing crime was something to aspire to. The local Police classed him as a Priority Prolific Offender or PPO. With time and effort he managed to completely change the way that he led his life and is now working full-time and is crime free.

Jack’s persistent offending was connected to his misuse of drugs and the lifestyle that accompanied him on a modern housing estate. He is trying to make a break with his past and find full-time training and employment.

Jason witnessed drug-taking by his parents from an early age. On release from custody he had a restrictive curfew in addition to high intensive supervision at the YOT. He faced problems with finding a place to live and his paranoia and poor mental health didn’t make it easy for him to live in a hostel-type environment in the meantime.

Katy’s troubled home life led her to develop a significant drug habit which quickly developed into an addiction. Katy witnessed the violent death of her boyfriend. She began to get more and more involved in criminal activity in order to buy the drugs she needed to block out the emotional hurt and associated bad memories.

Martin formed a bond with the YIF resettlement team which was helped by them bringing him some lunch on the day of his release from YOI. He tried hard to engage in the programme of activities that was provided. Progress was gradual, however he managed to deal with some of the issues which had previously been a problem in his life.

Matthew had an extensive criminal history when he was referred to the YIF project via Probation. He had a history of mental problems which included self-harm. He admits that his crimes were often committed under the influence of alcohol, although accessing the support services that he needed was often the biggest problem that he faced in terms of not reoffending.

When Petey was seven years old his substance misusing father used to give him amphetamines which made it difficult for him to concentrate at school. As he got older, Petey spent time living in care and later on he spent time in custody for violent offences. Eventually he became homeless whilst also suffering from psychiatric illness.

Sean drifted into criminal behaviour with a group of his friends. After he left school he was dealing drugs and he thought that he wouldn’t get caught. After serving a custodial sentence he became involved with the YIF project and within a year was a peer mentor and role model for others.

Steven was considered to be at medium risk of reoffending when he was released from his first custodial sentence. Without a strong network of family and friends, he found resettlement quite difficult. In addition, Steven struggled with substance misuse and mental health problems.

Wayne came out of YOI and went straight into a job that had been organised for him by the YOT. After this particular work had dried up Wayne was able to get involved with a bike project which led to his participation in the Coast to Coast race for charity. He has not reoffended and has become involved with some peer mentoring.

Trauma (19)
Young women and girls (15)
Transition to community (15)
Engaging young people (11)
Family (11)
Diversity (9)
Participatory approaches (4)
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Story-telling in Youth Work

Case study 1

THE VERY FIRST MOVES IN INVOLVING YOUTH CLUB MEMBERS IN SETTING UP A LOCAL YOUTH FORUM

The workshop group was made up of two local youth workers, three students on a youth and community work qualifying course and three of the course tutors. All but one were women. Two were black. The facilitator was a white man.

The worker whose story is the basis of this case study was very new to the youth club concerned when the events she describes occurred.

The case study focuses on two areas opened up for analysis and debate by the group’s ‘unpicking’ of the story.

THE YOUTH WORKER’S STORY

My overall aim when I started out was to get together a group of young people to take action on issues affecting them in their area. I hoped that doing this would eventually encourage them to form a local youth forum. As I was new to the club I had to start from scratch in making contact with the young people there and building up some sort of relationship with them.

My very first attempt to do this was on one of the first evenings I was in the club. I noticed a small group – three girls and a boy – chatting round a table in the coffee bar and decided to approach them. I walked across the room and introduced myself and started a conversation with them. I told them that I’d grown up in the area and that my family still lived there. I asked them what they thought of the area and had they any concerns about it. After a while I tried to test out whether they’d be interested in doing anything about any of the things they mentioned.

‘UNPICKING’ THE STORY

A. Negotiating the very first moments of a contact

Youth worker: I walked across the room (to the young people) …

Focusing in on this single sentence in the worker’s narration brought to the surface some potentially significant features of the practice which she seemed to have largely taken for granted:

She had made this approach to four young people who did not know her – an action which in everyday life would be unusual and even perhaps socially risky. Nonetheless, she‘d just assumed that it was a ‘given’ element of her practice as a youth worker.
In making that ‘journey’ of just a few feet, she’d had to deal with the kinds of tensions and uncertainties which anyone launching themselves onto a group of strangers was likely to feel.
These feelings were likely to be sharpened by the fact that her action wasn’t just a casual or random one. It was made with the deliberate aim of starting a planned longer-term piece of work which, to succeed, would have to prompt interest and eventually motivation in the young people.
The youth worker’s mind was concentrated, too, by the knowledge that the young people were there by choice, probably mainly to spend ‘free’ time with each other. She therefore had to make her move knowing that, however politely or even perhaps non-verbally, they might choose to tell her where to go – a response, she accepted, which they’d be fully entitled to make.
why she had ‘automatically’ chosen to use her first name;
whether there were any implicit assumptions in doing that about, say, how she wished to be seen by the young people or about the kind of power relationship she assumed she would have with them – and which she needed to convey to them.
Group questioning also revealed that even before she made the approach to the young people, she had made a tentative reading of their relationships with each other so that, when she opened the conversation, she sought eye contact with the one boy in the group because, she’d concluded, he seemed – seemed – to be the shyest of the four.

B. Exploring the personal-‘professional’ boundary

Youth worker: I told them I’d grown up in the area (of the club) and that my family still lived there.

The group’s ‘unpicking’ of this passing comment brought to the surface for explicit debate some significant issues about the existence and nature of personal-‘professional’ boundaries in youth work. Though it was recognised that what was shared didn’t involve any particularly intimate personal disclosures, broad agreement emerged that:

As in other practices, such boundaries existed and needed to be observed in youth work.
For youth workers, however, they were often, and often needed to be, more permeable – because, for example, if young people were to be willing to share something of their more private selves in what was an entirely voluntary relationship with the youth worker, they needed to see something of ‘the real person’ in that worker.
Here, too, the offer of even ‘low key’ personal information of this kind, at least potentially, conveyed an important message about the worker’s openness to a more equal power relationship with the young person – as evidenced for example when young people say of youth workers –‘they treat us like adults’.

POSSIBLE DISCUSSION POINTS

Was this youth work?

If so how – for example when tested against IDYW’s ‘cornerstones’ of youth work as outlined in the workshop programme? (See Story-telling workshop programme: a template )

Some possible links to the IDYW ‘cornerstones’

In setting herself the long-term goal of helping to set up an area youth forum with young people, the worker made explicit her overall understanding of youth work as informal education .
However, as her tentative first approach to the young people in the club showed, she took their voluntary involvement in the club and its activities as a given. It also demonstrated her assumption that her engagement with them would be in and through their peer networks.
In beginning by asking the young people: ‘So what do you think about the area where you live?’, the worker also assumed that any educational opportunities that developed would start from young people own agendas, some (perhaps most) of which would prioritise issues in their here-and-now.
This starting point also seemed to recognise youth work as a democratic practice which would seek to tip balances of power in young people’s favour.
At least implicitly, the discussion about boundaries took as its starting point youth work’s commitment to developing mutually trusting and respectful relationships with … young people .
In combination, the worker’s strategic aim to help set up an area youth forum and her ‘on-the-spot’ decision to address her first comments to the young man in the group could be seen as an example of youth work as an improvisatory yet rehearsed … practice.

Teenagers: learning from case reviews

Summary of risk factors and learning for improved practice around working with teenagers.

Published case reviews highlight that practitioners sometimes struggle to work with teenagers who are experiencing complex issues. Interventions can focus on tackling challenging behaviour, rather than exploring the underlying causes and risk factors. This sometimes causes practitioners to lose sight of the fact that teenagers are children in need of protection.

The learning from these reviews highlights that professionals need to listen to teenagers, but also be able to balance the young person’s wishes with their best interests. Intervention needs to be timely and appropriate.

Published: February 2021

Browse our full series of learning from case reviews briefings

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Find out how you can apply the lessons from case reviews and improve your practice to help protect children and young people.

Browse through our list of child safeguarding practice reviews, serious case reviews, significant case reviews and child practice reviews which were added to the National case review repository between 2019 and 2023.

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Related resources

Young person in conversation with an adult

Our online course will help you to understand your safeguarding responsibilities and learn how to act appropriately and confidently to protect the young people you work with.

Learn about new research from the Safer Young Lives Research Centre (SYLRC) covering how to best support adolescent mental health and wellbeing after sexual abuse .

Key messages about the criminal exploitation of children and young people in England based on rapid reviews received by the Child Safeguarding Practice Review Panel between July 2018 and March 2019.

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Regional champions
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In 2017, the Contextual Safeguarding programme (CSP) began partnering with local authorities to begin testing the Contextual Safeguarding (CS) framework in practice. This project was the first systematic attempt at evaluating the extent of the programme’s reach and impact. The Reach and Impact (R&I) workstream aimed to evidence the value that the CSP adds in terms of influencing policy and practice in response to extra-familial harm (EFH). Below is one of the case studies from the Reach and Impact Project. This case study describes how Contextual Safeguarding has influenced local systems and practice to improve the lives of young people experiencing or at risk of extra-familial harm. Names and some details have been changed to preserve young people’s anonymity.

What was the issue?

Oliver (15) had been known to children’s social care for a good proportion of his life and moved in and out of care placements and his mother’s home. Since the age of 13, he had frequent missing episodes from home and care placements, often for a considerable period. Peer mapping exercises identified that Oliver has connections with various groups of young people known for “gang” related activities across the borough. Oliver had been stopped by the Police on numerous occasions relating to these connections and criminality, which resulted in youth justice intervention and court orders. Oliver disclosed neglect and emotional abuse from his mother and other family connections, including abuse around his mixed-race identity. These experiences acted as a ‘push factor’ for spending considerable time away from home or with other young people. Oliver had been excluded from school and he attended a Pupil Referral Unit, increasing his vulnerability further.

What was the response?

Concern for Oliver’s safety and vulnerability to criminal exploitation was frequently raised at multi-agency ‘high risk’ panels through multiple referrals or peer mapping exercises. Peer mapping occurred as part of the Youth Justice Service’s (YJS) prevention project. A coordinated response between the youth justice and children’s social care teams involved:

Practitioners known to Oliver were allocated for direct work, which drew upon the principles of relationship-based practice.
The practitioners worked closely with Oliver to co-develop a safety plan.
At Oliver’s request, a trusted member of staff at his school was nominated as his lead professional.
A referral was made to Forensic Children and Adolescent Mental Health Service (FCAMHS) for assessment of speech, language and communication needs assessment.
A referral was also made to drug and alcohol services to secure a substance misuse worker.
FCAMHS worked with Oliver around anger management and emotions.
Partnership work was initiated with a service providing specialist support to young people at risk of or experiencing criminal exploitation and associated harm. Oliver was allocated a key worker.
A family group conference was held by the social care team due to ongoing concerns with Oliver’s treatment at home and to help identify any other family connections.
A residential therapeutic placement was found to increase safety and provide enhanced support, as relocation and entry into care became necessary.

What were the challenges?

Oliver disclosures of his home life highlighted the continued emotional abuse he was experiencing, which at times reduced Oliver’s readiness to connect with his practitioners. A change in key worker that Oliver had built a trusting relationship disrupted the work for a short time. Restrictions arising from the Covid-19 pandemic hindered the timeliness of the therapeutic intervention due to lack of face-to-face appointments.

What difference did this make?

The relationship-based and therapeutic work were central to this response and reduced Oliver’s risk of further exploitation and harm. The completion of a speech, language and communication needs assessment helped the team develop or adapt their way of communicating. Relationship-based practise helped support Oliver to open-up about his vulnerabilities around his home life and the harm and exploitation he experienced among his peers. Oliver’s choice to nominate a lead professional at his school was respected and this formed the basis of much of his contact, which was monitored during multi-agency meetings. Oliver was able to build significant trusting relationships with practitioners and key workers and was consistently keeping to his appointments. Oliver’s voice informed the safety planning and practitioners sought his perspective on what safety means to him and how practitioners can help him feel and be safe. Rescue and Response provided emotional support and mentorship with others with shared experience and were available outside of the working hours of practitioners where there is a need to communicate with someone. Being receptive to the support a drug and alcohol service helped Oliver reduce usage reducing the risk of going missing and engaging in harmful activity with peers.

Oliver reported feeling safer in his environment and his physical and mental health improved. Oliver was safer in therapeutic placement as he was unreachable by “gang” affiliates who had previously targeted him at home and whilst in care. Moreover, the therapeutic placement provided opportunity for engagement with practitioners trained in trauma-informed practice and youth mental health. Oliver has also built trusting relationships with workers in the home, which led to disclosures about his experiences and his self-harming behaviours. Oliver has settled at a new school with additional support put in place with staff that understand his vulnerabilities and how he may present. There has been a significant reduction in Oliver’s missing episodes and peer activities leading to his criminalisation.

What did we learn?

It is essential to practice due care and diligence when assessing a case, to fully understand the young person’s chronology and vulnerability to extra-familial harm and not default to standard routes and responses. There is a need, therefore, to for creative and intuitive responses that establish a relationship with young people for direct work that is meaningful for them. It proved beneficial to coordinate the response across the youth justice and social care teams, alongside bringing in specialist partners, so to effectively identify Oliver’s needs and tailor the direct work accordingly. When commissioning youth service providers, it is important for the YJS or social care teams to be persistent in finding and negotiating high quality, tailored support that they can be confident will make a difference to a young person. However, each planned activity should be introduced when the young person is well-placed to benefit from it. In Oliver’s case, for example, work around building a positive identity will follow when his mental health and wellbeing has stabilised. There is wider need for services to invest in community outreach to help change perspectives on youth and build safe spaces and capacity for guardianship.

Minority Stress for Care Experienced Young Queer People: A Case Study

Original Article
Published: 16 November 2021
Volume 15 , pages 501–510, ( 2022 )

Cite this article

Lynne McPherson ORCID: orcid.org/0000-0002-3356-2216 1 ,
Kathomi Gatwiri 1 ,
Nadine Cameron 2 &
Janise Mitchell 3

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Young people who are placed in out-of-home care are amongst the most vulnerable in our community. Removed from or rejected by their families, they must learn to live with carers who may be strangers. They may have experienced the trauma of abuse or neglect. Post care, they may experience further social isolation and marginalisation due to limited social capital. These challenges are compounded for queer young people placed in out-of-home care. This study adopted a case study approach to explore the lived experience of two young adults growing up queer in and out of out-of-home care in Australia. Our investigation was framed by two complementary theoretical frameworks. The first, a model of minority stress, is informed by queer perspectives and enabled an exploration into the adverse impact of enduring stigma and prejudice associated with homophobia and transphobia on young people’s capacity to thrive. The model of social capital was then employed to inform an analysis of relationships between queer young people in out-of-home care and trustworthy adults. The findings suggest that queer young people growing up in out-of-home care experience minoritised stress, with lasting negative implications. The presence however, of trustworthy adults who challenge dominant heteronormative assumptions and work to support queer young people can be experienced as stabilising and restorative.

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Introduction

Evidence suggests that young people in out-of-home care often come from troubled family backgrounds, where a safe and secure base is absent (Beek & Schofield, 2004 ). They manifest complex needs, which are underpinned by histories of the trauma of abuse, abandonment, neglect and deprivation (Gatwiri et al., 2018 ; McPherson et al., 2018 ). Because experiences of child abuse and neglect are intersectional and informed by variables such as age, race, gender, disability and sexual orientation, queer youth in care are likely to have additional trauma history or challenges due to their minority sexual orientation and gender identities (Schofield et al., 2019 ). LGBTIQA + is an acronym that represents lesbian, gay, bisexual, transgender, intersex, queer/questioning, asexual and a number of other terms, including non-binary and pansexual, to describe people’s experiences of gender, sexuality and sex characteristics (Australian Institute of Family Studies, 2019 ). An umbrella term, ‘queer’ describes a range of sexual orientations and gender identities and, as such, will be adopted for use throughout this paper.

The specific needs of queer youth in out-of-home care systems appear to have been under-researched. Agencies supporting young people in out of home care have, in some instances, produced helpful guidance for staff working with LGBTIQA + youth (CREATE, 2021 ), however a dearth of scholarly knowledge may contribute to less-than-safe practices which “have been complicit in causing additional trauma and poor outcomes” for this cohort of young people (Cook & Cohen, 2018 , p.1). Unlike other identifying characteristics such as race, age and gender, sexual orientation still remains on the margins of demographic data in child welfare systems (Woronoff et al., 2006 ). In the United States, queer youth are overrepresented in the child welfare system and report significant health disparities due to “experiences of discrimination, marginalization, and an overall lack of acceptance” (McCormick et al., 2017 , p. 27). The actual prevalence of queer youth in out-of-home care in Australia and elsewhere is unclear, due in part to the stigma associated with ‘coming out’ (McCormick et al., 2017 ). Young people in care are likely to be highly scrutinised by staff members due to the common misconception that LGBTQ youth are more likely to sexually abuse other young people in care (Brandon-Friedman et al., 2020 ).

As Meyer ( 2003 ) argues, the prejudice and social stress associated with living with a minoritised sexual identity can be traumatic for queer young people in care. Queer youth are more likely to be rejected by family members (meaning a lesser chance of being reconciled/reunited with family), less likely to receive medical and mental health services that are affirming, more predisposed to depression, likely to have a higher number of suicide attempts and more likely to use addictive substances; they also register higher rates of psychopathology (Cochran et al., 2002 ; Ryan et al., 2009 ).

It is now well recognised that the transition from care for young people universally may be extraordinarily challenging, given their lived experience of abuse and neglect in the care of their family and for many, whilst in the care of the State (Mendes & Snow, 2016 ). This transition for queer youth, however, may bring even more challenges. Cochran et al. ( 2002 ) report that they have higher rates of risk factors on a range of health and behavioural measures and poorer socio-economic outcomes compared to heterosexual young people. Queer youth are over-represented in homeless shelters, and remain there for longer periods, with those exiting the care system experiencing additional stress and obstacles (Coolhart & Brown, 2017 ). These negative outcomes demonstrate that more attention with regard to the sexual orientation and gender identity of queer young people in out-of-home care would be critical in creating a safe environment. Mallon and Woronoff ( 2006 , p. 118) suggest that “the welfare of LGBT children, youth, and families cannot be adequately enhanced as long as the larger society, hetero-centrically oriented and heterosexually controlled, ignores their existence”. Additionally, Woronoff et al., ( 2006 , p. 6) argue that:

LGBTQ youth need to feel that they are not condemned and stigmatized for something they cannot change and that is an important part of them—their sexual orientation or gender identity. They need to be cared for in an environment that shields them from, not exposes them to, bias and prejudice. They need to be free from anti-LGBTQ slurs and harassments. They need to feel loved, not hated, for who they are. They need to know that the child welfare system and adults who care for them are on their side.

Unfortunately, the invisibility of research and practice guidelines for working with queer youth in out-of-home care can contribute to the erasure of their experiences by practitioners and other peers (McCormick et al., 2017 ). Put simply, a significant gap in the research surrounding queer youth may be attributed to the lack of knowledge and understanding among practitioners about the lived experiences of queer youth in out-of-home care. In Australia, this research is in its infancy. The current study begins to address that gap.

Theoretical Frameworks

Two theories were integrated to frame this study. The first, a ‘minority stress’ model which is informed by queer perspectives and sociological and psychological theories, attempts to conceptualise the “adverse effect of social conditions, such as prejudice and stigma, on the lives of individuals and groups” from minority groups (Meyer, 2003 , p. 675). The stress of enduring prejudice and the discrimination of sexual identity minoritization in the form of homophobia or transphobia can strain an individual’s capacity to cope and thrive. This model enables us to explore whether and to what extent queer young people in out-of-home care experience an exacerbation of minoritised stress due to their sexual orientation and gender identities. The second, an adaption of social capital theory, has a focus on how and if affirming relationships with adults taking on the role of “empowerment agents” can facilitate the development of a healthy and positive self-regard (Barker & Thompson, 2015 ). The two theories (discussed below), in tandem, enabled an in-depth exploration of young peoples’ lived experience in out-of-home care.

Minority Stress for Care Experienced Young Queer People

In considering queer perspectives, traditional categorisations of gender which view heterosexuality as the standard norm of sexual expression and identity are deemed as oppressive and limiting. The universalisation of heteronormativity erases queer experiences in society, including in out-of-home care systems. Queer perspectives probe heteronormativity as a cultural system and a location of privilege that structures social life around it. This is, for example, through the structuring of families, relationships, sexuality and identity, and is seen as a social construction that produces heteronormative binaries. Chevrette ( 2013 , p. 172) argues that the “signifier, ‘queer’ disrupted the homosexual/heterosexual binary, countered categorical models of sexual identity, and examined the cultural, historical, and political discourses around which sexuality is constructed”. As such, in recognising the expressions of queer identities and practices and the embedded hetero practices, structures and systems that shape our world, we utilise minority stress theory to argue that the continued stress of minoritization, under the weight of heteronormativity, impacts on the psychological, mental and social wellbeing of queer young people in out-of-home care.

This theoretical framework highlights how chronic, psychosocial stressors related to discrimination, stigma and victimisation inform the negative health outcomes of queer young people (Kelleher, 2009 ). The social external structures embedded in the heteronormative scripts of our society shape the social and self-identities of queer people. Meyer ( 2003 ) suggests that there are three processes of minority stress that inform the experiences of queer individuals. These are “(a) external, objective stressful events and conditions (chronic and acute), (b) expectations of such events and the vigilance this expectation requires, and (c) the internalization of negative societal attitudes” (p. 676). An identity that is constantly under attack and threatened by prejudice and discrimination is strained and exhausted by the continued exertion of energy that is required to maintain one’s sense of self-identity and self-concept. Within this, an intersectional conceptualisation of minority stress is also necessary. Black, Indigenous and queer young people of colour face double marginalisation due to their race and sexual orientation (Bowleg et al., 2003 ). Minority stress explores how identities are shaped socially through the process of self-categorisation. This means that when a particular group is viewed and therefore categorised as different from the acceptable norm, it triggers processes of exclusion and marginalisation.

For young people in out-of-home care, minority stress may be experienced through rejection, abuse, prejudice and discrimination from peers, caregivers and other adults. Although overt discrimination is frowned upon, covert heteronormative practices that are still embedded in child welfare institutions can exclude the unique needs of queer youth. Wilson et al., ( 2014 , p. 11) argue that in the child welfare system, practices of prejudice against queer youth are commonly expressed through them being deemed as difficult to foster, and/or blamed for expressing their sexuality, which can lead to isolation to avoid them “preying on other youth” or for “their own safety”. Because of these continued practices, the child welfare system is not often viewed as a safe and supportive place for queer youth (Woronoff et al., 2006 ). In fact, the homophobia, transphobia and heterosexism embedded in society and institutions of child welfare problematize queer youth, while at the same time erasing their unique experiences and making them feel invisible (Woronoff et al., 2006 , p. 6). This reveals that, unwittingly or otherwise, the dominant child welfare policies and practices can serve to exclude queer youth in care. Woronoff et al., ( 2006 , p. 9) argue that in order to improve the experiences of queer youth, “combating homophobia and the heterosexist assumptions that pervade the child welfare system should be the number-one priority”.

Social Capital Theory

Trustworthy relationships take on central significance for the developing young person in out-of-home care. The theory of social capital asserts that relationships that are “resources and key forms of social support embedded in one’s network or associations, and accessible through direct or indirect ties with institutional agents” (Stanton-Salazar, 2011 p. x). The concept of an ‘institutional agent’ (Stanton-Salazar, 2011 ) facilitating the development of ‘linking social capital’ (Barker & Thompson, 2015 ) is central to this framework and is defined as an individual who occupies one or more hierarchical positions of authority. Such an individual, situated in a young person’s social network (for example, caregiver, coach or teacher), manifests their potential role as an institutional agent when, on behalf of the young person, they act to directly transmit (form supportive relationship), or negotiate the transmission of, highly valued resources (e.g. access to education, contact with family and friends, housing and support) (Barker & Thompson, 2015 ). Whilst the significance of relationships is theorised, relationships alone may not constitute ‘capital’ (Barker & Thompson, 2015 ). Three critical components must exist for a relationship to be realised as social capital. Firstly, there needs to be contact with the person or people; secondly, this connection must enable access to valued resources; and thirdly, the connection takes place in the context of a trusting, reciprocal relationship (Barker & Thompson, 2015 ).

For young people in out-of-home care, we theorise that such ‘agents’ could be carers, teachers or other adults who both understand and enact direct and negotiated transmission of valued relationships and resources and practise in ways that promote social justice and challenge oppressive or unjust regulations or requirements. Given the highly problematic lived experience faced by young queer people in out-of-home care, drawing on theories of minority stress and social capital uniquely positions this research to investigate identified problems and potential solutions.

Methodology

The aim of this research, based on the identified literature and theoretical framework, was to explore the experience of young queer people living in out-of-home care.

Study Design

A case study approach was selected to generate an in-depth understanding of the experiences of queer young people in out-of-home care, following the methodological path identified by Yin ( 2009 ). Case studies do not endeavour to identify ‘typical’ cases, nor make comparisons across cases, but do seek to develop an understanding of the phenomenon being studied (Yin, 2009 ). Considering the dearth of research involving this cohort in an Australian context, this approach, founded within an overall qualitative paradigm, emphasises the role of the researched in analysis and interpretation (Yin, 2009 ). A key focus of the approach is the way in which people make sense of their lived experience and their world whilst understanding that subjective human understandings of events and experiences may change over time and may be sensitive to difference in social contexts.

Sampling, Recruitment and Data Collection

A recruitment advertisement was placed on mainstream social media, circulated by LGBTIQA youth support organizations and posted on queer youth friendly social media sites. To be eligible to participate, they had to be young adults (18–29 years) who identified as queer and had experience of being in out of home care. After 8 months of a targeted recruitment strategy which included consultation with LGBTIQA + advocacy groups, organizations and community leaders, only four people responded with only two of those being able to meet the criteria for inclusion. Ethical approval to conduct the research was granted by the Southern Cross University Human Ethics Committee: project number 2019/169.

A schedule for in-depth interviews was developed by the research team based on the identified research question and in close consultation with an identified co-researcher who identified as young and queer with lived experience of out-of-home care. Emerging from this consultation the following broad questions were agreed for the interview schedule.

Reflecting on what brought you into out of home care…what do you believe you needed most at that time? To what extent were those needs met or not met?

Reflecting on your relationships whilst in care, how were they experienced by you and with whom?

What helped or enabled you to develop your sense of sexual and gender identity?

Consistent with a semi-structured interview design, each question served as a discussion starter for the respondent to elaborate upon and raise and relevant issues as they chose to. Researchers then sought to clarify and extend responses by inviting respondents to elaborate. These in-depth interviews were conducted digitally using zoom technology as a response to the safety concerns surrounding the COVID-19 global pandemic restrictions and face-to-face contact. Informed written consent from participants was obtained via email prior to the interviews. Following each of the interviews, which lasted between 2 and 2.5 h, participants were provided with a draft transcript for comment or correction.

Data analysis was undertaken using both deductive and inductive strategies. Both inductive and deductive, or “theoretical” thematic analysis processes were used to organize and present the data (Braun & Clarke, 2006 , p.84). A six-step process was followed which included: a) becoming familiar with the data, b) individual research team members generating initial codes based on the aim of the study, c) grouping codes into emerging themes as a team of researchers, d) discussing and reviewing the themes, e) integrating the named themes with theoretical frameworks and f) constructing the report. This method enhanced the theoretical validity as the research team initially worked to code independently before discussing and agreeing on the emerging themes. The theoretical thematic analysis was undertaken as a parallel process, enabling researchers to code for and focus on the data in the context of minority stress theory (Meyer, 2003 ) and linking social capital theory (Barker & Thompson, 2015 ). At the completion of analysis undertaken by the team of three researchers, themes were identified and reported on.

Results: A Snapshot of the Participants

What follows is a de-identified snapshot, of each of the young-adult research participants. Pronouns used are consistent with those preferred by each. We have used pseudonyms throughout this manuscript to protect the respondent’s privacy. The first participant, Liam, (he/him) identified as ‘proudly queer’, was aged between 20 and 30 years, and was strongly involved in promoting social justice on LGBTIQA + issues via community and social media platforms. Liam, along with his three younger siblings, was removed from the care of his parents in suburban Australia when he was around six years of age. The initial removal followed a series of reports to the statutory child protection service concerning family violence and concerns about parental mental health. Liam reported that his father was “extremely violent” and that his mother struggled with severe depression and suicidality. Having been removed from home, he then spent a number of years living in five different foster care placements, alternating with trial periods back at home. He recalled a particularly distressing incident: a phone call to let him know that a parent had died as a result of suicide. Despite the placement and relational instability that Liam experienced, he noted that he was almost always able to remain at the same school and, on all but one occasion, was placed together with his siblings. For the most part, Liam recalled a sense that he was constantly just ‘trying to survive’ emotionally whilst in various placements, never quite fitting in or included in family life. One point of difference in his care trajectory was a short-term placement with two women who were said to be ‘friends’ living together. Liam experienced care from this couple that was warm, nurturing and non-judgemental. Following an extended period in his fourth or fifth foster care placement, Liam briefly returned home to live with his father as a teenager. He subsequently moved to live independent of his family and the care system and has now been in a stable living arrangement for almost a decade.

The second young adult, Tim, (he/him) identified as an Aboriginal transgender male. He was aged between 20 and 30 years and his contact with out-of-home care was intermittent from the age of nine years where he was in informal placements with either a grandparent or a family friend for extended periods. The concerns leading to these placement arrangements were the experience of physical abuse, where on one occasion Tim was hospitalised with a severe injury. The experiences of placement, both with his grandparent as a kinship carer and a family friend as a ‘kith’ carer, were experienced by Tim as continuous and stable relationships with extended family, rather than as “removal” and placement within the care system. He recalled fondly as he talked about his grandmother who taught him about his culture and accompanied him by train and bus to school each day. Despite this stability, Tim identified a number of health challenges and complex personal needs that are ongoing due to his childhood adversity. At the time of the interview, he was living in his “former foster sibling’s apartment”, offered as a safe space throughout the COVID-19 global pandemic. Tim was pursuing a higher degree in research at an Australian University.

Thematic Discussion

Overall, findings suggested that early adversity, marginalisation and the violence of homophobia whilst in care and/or within the wider community were directly experienced by Liam and Tim. Both readily recalled and recounted aspects of their lived experience of out-of-home care with a level of distress. Themes emerging from in-depth interviews suggest the pervasive presence of marginalisation and an exacerbation of minoritised stress, considering intersections of developing queer identities with race, early adversity and being different because they did not live at “home”. Three core themes were identified and are discussed below.

Theme 1: Minoritised Stress Associated With Homophobia and Heteronormativity for Young Queer People

Both Liam and Tim spoke of the challenge to consider their sexual and gender orientations whilst living in care, given the considerable emotional demands of surviving emotionally on a ‘day to day’ basis. Whilst both said that they knew that they were queer whilst in care, it was not ‘safe’ to come out for some years. For Liam, it was not until he began to live independently, aged 18 years that he publicly identified as queer, initially to his housemates. For Tim, however, it was a two-stage process where he first identified as queer to his (supportive) kinship carer, however did not come out as Trans until he was at university, and also living independently. The implications of this theme are discussed on three levels: homophobia, invisibility/ lack of appropriate support, and stigma and discrimination. At the first level of consideration, we argue that the homophobia that queer youth face takes a psychological toll. This affects young people’s sense of self, forcing them, in part, to deny and repress the expression of their sexual identities (Woronoff et al., 2006 ). In out-of-home care, homophobia is demonstrated through overt actions of violence that may be enacted verbally, physically or psychologically. Youth in care can be the “easy” target of violence by their peers (Cameron et al., 2019 ), yet are consequently labelled as “provocative or aggressive” if they fight back or defend themselves (Mallon, 1992 , p. 551). The fear of being outed or experiencing homophobic bullying contributes to negative mental health outcomes for queer youth in out-of-home care. Tim reflected on the normalisation of heterosexuality, as well as homophobic violence he experienced growing up, as follows:

There was so much [homophobic] bullying, and there’s a lot of acceptance (of that) in high schools. In the university I was at, I was able to finally find those communities, which was really helpful. I came out as bisexual when I was 21 but I knew I was Trans when I was 18, but that was when I had first heard the term.

Other forms of homophobia were more covert and can be enacted through silence and the lack of representation of non-hetero bodies in popular culture, books, media and communities. Liam reflected that:

I think, growing up … it was a very homophobic environment. I didn’t have any role models. I didn’t have any family who were queer. My mother grew up in a very conservative Irish Catholic family. Went to the best all girls’ school in the state. She was quite proper, and so was my Nan. I never felt comfortable, even with my parents.

Bringing lived experience as an Aboriginal young person, Tim discussed heteronormativity as a form of a violent colonial ideology which sought to binarize people. In his description, Indigenous worldviews on gender pre-colonization were fluid and not confined through the performativity of gendered expectations. Tim stated:

Being First Nation, we experience gender in a very different way. The gender binaries arrived with colonization. It wasn’t in our culture before white people came in and applied it to us. We have different cultural roles in our society which aren’t based on gender, it’s based on whether you have a more nurturing spirit or a more warrior, fighting spirit. It had nothing to do with gender, but then white men came in and said, nurturing ah, must be women, warrior, must be men.

Tim’s experience and reflection compel us to further theorize the impact of colonization on Australian First Nations people. It has been suggested that Indigenous Australians have been constructed as being “straight” only since European settlement, with accounts of Aboriginal sexual and gender diversity “mostly absent in the recordings and interpretations of histories” (Bayliss, 2014 , p. 1). Added to this complexity is the dominant Eurocentric expectation that Indigeneity implies a lack of sexual and gender diversity. For a queer Aboriginal adolescent already struggling with their developing identity the weight of colonization bore heavily in this context and adds to the impact of minority stress.

Whilst there may be an increased acceptance of LGBTQ + people in society, stigma-based victimisation and marginalisation remain a serious problem. The stigma emanating from homophobia or transphobia is often expressed not just in personal interactions but is also embedded in the larger social and structural practices of out-of-home care. Experiences of queer youth in out-of-home care reflect the culture of heteronormativity which reinforce feelings of “being different”. Consistent stigma resulting from homophobia or transphobia can result in queer youth viewing themselves as unlovable, bad or different. Tim argues that “the most challenging thing was handling other people’s curiosity and other people’s discrimination and stigma”. Experiences of stigma, which include bullying, homophobic micro aggressions, harassment, disapproval, victimization or violence, are associated with poor mental health outcomes.

Tim reflects that “I knew I was queer when I was younger but didn’t come out” because “the worst thing you could be called was gay or a lesbian. There was that whole thing of, ‘eww, that’s disgusting that person must be a lesbian because that’s so gross”. Gower et al. (p. 2) argue that “the more frequently enacted stigma is experienced and/or in multiple contexts, the greater the likelihood of proximal stressors (e.g. social withdrawal, identity concealment, and internalised homophobia) and the more likely one is to experience minority stress”.

One impact of the perceived stigma associated with identifying as queer for Liam was a delay in publicly identifying as queer until he had left the care system, his family home and his teenage years behind:

Oh no, I didn’t come out until I was 20. Dad was a very religious person growing up, he and his first wife were very religious, and they played in the band at church. Even though he was an absolute arsehole, isn’t that the way, the ones that preach the loudest are usually the pricks?

The stigma and homophobia are compounded by the fact that there are few services that offer safe and appropriate services to queer youth in out-of-home care. Our findings support international evidence that queer youth face substantial additional challenges compared to their heterosexual counterparts in the welfare system. Generally, there is an ‘invisibility’ and lack of appropriate support which impact on the development of a positive sexual identity. Mallon et al. ( 2002 ) found that, on average, queer youth in out-of-home care settings receive fewer services than their heterosexual counterparts. Liam reflected on the lack of appropriate resources that might have enabled him to positively reflect on his identity;

There were never any children’s books, or any discussions about attraction or playing with boys or playing with girls, it was still really hush, hush … The teachers can only teach, and then the parents need to reinforce it at home. And if it’s not reinforced in school, it’s the parents reinforcing it, usually from their own experiences of oppression, marginalization, stereotyping.

Liam recalled that, in his experience, there were so many ways in which he felt invisible or ‘different’, relating those experiences to the lack of visibility of queer people in foster care and the wider community:

Talking about feeling different, we didn’t even have that (information and resources) around mental health. We barely do now, …but back then we didn’t even have books about depression or trauma and what it all means. Or to be in out of home care. I think lots of things could have been done, not just at a foster care level, but also at a family first and child protection level and within the school level.

The lack of available, visible and accessible support was a concern for Tim, who found it harder to reconcile his gender identity in a timely way. Due to the pervasiveness of homophobic or transphobic environments, queer youth must first assess the safety of ‘coming out’ or disclosing their sexual identity, which adds to the daily stressors of minoritization (The Center for the Study of Social Policy, 2016 ). Many fear that the disclosure will be accompanied by rejection or abuse. McCormick et al. ( 2017 ) argued that queer youth report being treated differently as soon as foster carers, peers or staff learn of their sexual orientation. In our case study, Tim reflected that he was “too scared to come out because [he] couldn’t find any support for Trans people”. He added that having to hide his sexual identity for fear of their safety “was really hard because I was hiding this part of myself for years”. In their study, Ragg et al. ( 2006 , p. 259) found that many queer youth organize their lives in a way that ensures the least likelihood of rejection. This means adopting strategies like withholding their identity, dating outside of their gender preference, self-isolation and internalizing homophobia as a way into the heteronormative “ideal”.

Studies report that due to their inexperience or discomfort of working with queer youth, practitioners can consistently question their sexual identity in an effort to “convert” or “return them to the normal” heterosexual identity (Jenkins & Johnston, 2004 ; Ragg et al., 2006 , p. 247). The lack of services for Trans people contributes to their invisibility within the welfare system. Although Tim argues that things are “getting better now”, he adds that “trans people are [still] almost invisible”. In the event that these professional support services are available, the majority are deemed “incompetent and unresponsive” to the needs of queer youth (Ragg et al., 2006 , p. 246). Tim found that:

The structured supports that were in place that I could find, they were transphobic, there just wasn’t anything specifically for Trans people. I was [later] involved with 1911 (pseudonym- a queer support and advocacy organization) but even their resources were quite limited.

Oakley and Bletsas ( 2018 ) argue that the lack of appropriate provision of services for this population is due to the lack of recognition of their identities as queer. Australian researchers reported that within the broader service provision landscape, young queer people are not sufficiently catered for (McNair et al., 2017 ). Queer young people in out-of-home care often describe a system in which homophobia, transphobia and general ignorance about the needs of this population are pervasive.

Theme 2: Relationships Facilitating the Development of Social Capital

It is essential that queer youth feel cared for by adults who are well informed and who make active efforts to unlearn any homophobic biases they may hold and engage with the young people from a place of unconditional positive regard and acceptance. Affirming relationships validate the queer experience by acknowledging the struggles of living through and with a minoritised sexual identity. Ragg et al. ( 2006 , p. 258) argue that “when the [LGBTQ] youth describes concerns or feelings, having them affirmed as real and important helps them integrate their internal reality into their identity”. Tim suggested that the affirming and loving relationships that he had with his carer (Susie) and grandmother made a positive difference to his overall experience of care. He reflected:

I think I needed different things from both Susie and my grandma. And I think I got those things from both of them which is really nice. From grandma, when I was a kid I acted like a boy and I thought I was a boy. And growing up I didn’t know what transgender was and what it meant. And I didn’t know anything about the sexual and gender diverse community. Susie knew quite a bit about the LGBTI community, and she really welcomed that conversation which was really lovely … If I’d been with anyone else in out of home care, that conversation could have gone very differently.

This narrative indicates the active and available presence of a trusting relationship, acting clearly as an ‘agent’ for Tim in relation to his developing identity and social capital (Stanton-Salazar, 2011 ). Susie challenged the status quo, which for Tim was a homophobic school culture, whilst offering an emotionally safe space for Tim, when he was ready, to have a conversation more directly about his own developing identity.

In Liam’s experience, affirmation from adults came from a brief experience of care with a lesbian couple. Liam notes that the couple introduced themselves as ‘friends’, which he later attributed to a wider issue of homophobia in the 1990s in suburban Australia. Unlike other placements where he recalled feeling different, marginalised and bullied, this placement is recalled with fondness:

I don’t know, they just made me feel very welcome. They used to drive us around a lot. They had a minivan. They drove us to all the activities we had to do … Maybe it was just having two women around as well. I always felt more comfortable around women. Perhaps because my dad was very abusive during that time. I don’t have any traumatic memories from my time with Anne and Sophie, whereas the other caregivers I had negative experiences … They seemed very together, and I liked that.

Whilst the relationship between this couple and Liam was not to be an ongoing one, it offered a level of warmth and nurturing that he did not experience in other, hetero-sexual placement relationships. It is theorised that this experience was a useful resource for Liam as he began to explore his own sexual identity. Liam also experienced some adults in his school communities as affirming and safe. For example, some teachers took care of him over the weekends in the event of emergency situations until another foster care placement could be established. These relationships offered the stability that his foster care arrangements (with multiple placements) did not. Relationships with teachers also affirmed and encouraged his academic and creative talents. Liam thrived and extended himself academically, describing himself as “always a clever kid”;

My teachers were very supportive of me … And even some of the teachers took care of us as foster carers during some traumatic times as well. Some of the teachers would look after us over a weekend period where we needed to be immediately removed and there were no foster placements. We had a real community around us. The teachers did become like our parents in a way. I think that’s important to note as well. Primary school was our only real stability.

The power of the school as a resourceful community is evidenced by these stories. Teachers who were willing to identify and build on young people’s identified strengths, such as engagement in drama and the arts for Liam, offered an important source of reassurance and validation. The experience of literally being cared for (in emergency placement situations) in addition to being cared about offered Liam a sense that he was worthy and connected to a community. On the other hand, Tim articulated an absence of queer or Indigenous community support throughout school and the overwhelming sense of relief he experienced when he eventually connected with a local queer support service in the community that he described as a “lifesaver”. However, he still struggled to connect with a queer group that would also affirm his Indigeneity:

Because I came out when I was already at university, I was able to find the queer community on campus, so the Queer Collective and the queer party scene and all that which was really, really useful. [However] … There was no one who could really connect with me. There were a few people who worked there who were People of Colour, and they could kind of get it from their perspective as being a Person of Colour, but there was no one with a First Nations background. There was no one there to talk to about what it was like to be a Trans person and how to navigate cultural activities and how to come to terms with being Trans in your culture in comparison to being Trans and being white.

Both Liam and Tim identified connection to adults (teachers or carers) and communities that were affirming and trustworthy, offering a stable presence and an alternative perspective to the homophobic views and attitudes that were prevalent within the community. These relationships were transformative for both. Trusted adults and safe communities challenging homophobic views and attitudes, directly or indirectly, offered a powerful and empowering resource for Liam and Tim. Relationships with these ‘agents’ seem to have assisted both, to some extent, to work toward not only claiming their queer identity with pride, but proactively advocating for global change and, for the most part, enjoying stable and connected lives.

Theme 3: Overcoming Adversity Through Advocacy

Both Tim and Liam spoke with pride about their accomplishments as young adults who have become active in advocacy roles in a number of ways. In describing their involvement in the community, each identified their current connection to social justice and the desire to create a world that was a safer place for queer young people. Tim reflected that he was part of the committee that designed and created the Trans Hub Community. He is also highly engaged in social media as a way to connect with other socially isolated queer youth. He adds:

I do Instagram takeovers and I do interviews [on those platforms]. I am always advocating. Because if something like that was out when I was dealing with my identity it could have saved me years of pain and confusion.

Liam also spoke with great personal insight about both his activism and his career choice to enter the helping professions:

It [working in the helping professions] came very naturally to me. It felt comfortable and safe. I liked the idea of being a counsellor and using my experiences of empathy and vulnerability in my work. And then I realised it was really advocacy, what I was doing in my work. Then I became very agitated about the world, and I began to exercise a lot of my experiences through my practice and the years of internalising the effects of my story.

Recognising the complexity of identity and circumstance, Liam also noted that:

I am privileged. I’m able to use my maleness, my whiteness, my privilege, my education, but also my vulnerableness and those marginalised identities to drive and fuel some of the work I do which can support those spaces where people feel they might not feel welcome.

Despite the adversity faced by Liam and Tim prior to and throughout their care experiences, both have made considerable gains post-care in their respective educational and/or employment achievements, voluntary and/or advocacy work, and housing and relationship stability. They both report strong and supportive relationships with some family members and excellent educational outcomes.

Implications for Researchers and Practitioners

The damaging impact of homophobic attitudes, values and beliefs for people who identify as queer is gaining some recognition globally (Brandon-Friedman et al., 2020 ). In addition, some international research highlights the difficulties experienced by queer young people in out-of-home care who may face multiple forms of marginalisation as a result of intersecting vulnerabilities and difference. An important consideration for practitioners emerging from this study is the power of trustworthy relationships with adults who hold the power to challenge dominant hetero-normative narratives, as well as social capital in the form of affirming queer-safe communities that can be easily accessed when needed. This case study found that such relationships and communities were pivotal in enabling queer young people to feel that nothing was ‘wrong’ with them. Developing an identity that is neither stigmatised nor pathologized is a critical aspect of developing a healthy sense of self in emerging adulthood. More than merely challenging the status quo, these relationships with adults in positions of power (relative to the queer young person) may also be seen as instrumental in the young person stabilising emotionally and working toward the fulfilment of their personal and career objectives. The implications for researchers can only be hypothesised within the limitations of the study. This was an extremely difficult group to recruit to participate in the study. A case study approach was therefore utilised to make meaning and visibilize the stories of Liam and Tim which provided an in-depth understanding of the lived experience of being in out-of-home care for queer young people. A clear implication for future research involving this cohort would be to strategize the recruitment strategy. A more formalised research partnership with an LGBTQ + support agency may be of value.

Limitations of the Study

Findings from this case study do not suggest that they are generalizable; however, they do suggest a need for a larger-scale study and the untapped stories within this community of young people in out-of-home care.

This study explored the lived experience of two queer young adults who had each spent part of their lives growing up in out-of-home care in Australia. Theories of minority stress and social capital were employed to provide a critical analysis of the challenges faced and, conversely, the impact of linking social capital that may facilitate the development of helpful resources and connections. The findings suggest that sustained experiences of minority stress can be overwhelming, rendering young queer people unable to explore their developing sexual and/or gender identity in the context of simply “trying to survive” in out-of-home care. The findings suggest also suggest that the presence, of trustworthy adults who challenge dominant heteronormative assumptions and work to support queer young people can be experienced as stabilising and restorative.

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This project was funded by the NSW Department of Communities and Justice. Declaration: On behalf of all authors, the corresponding author states that there is no conflict of interest.

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• Queer young people in out-of-home care can experience stress associated with sexual identity minoritization, compounded by their ‘in care’ status

• Queer young people in out-of-home care may lack supportive social connections

• Adults playing a key role in the queer young person’s life can facilitate the development of their social capital

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McPherson, L., Gatwiri, K., Cameron, N. et al. Minority Stress for Care Experienced Young Queer People: A Case Study. Journ Child Adol Trauma 15 , 501–510 (2022). https://doi.org/10.1007/s40653-021-00420-7

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DOI : https://doi.org/10.1007/s40653-021-00420-7

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Pros and Cons

What Types of Case Studies Are Out There?

Where do you find data for a case study, how do i write a psychology case study.

A case study is an in-depth study of one person, group, or event. In a case study, nearly every aspect of the subject's life and history is analyzed to seek patterns and causes of behavior. Case studies can be used in many different fields, including psychology, medicine, education, anthropology, political science, and social work.

The point of a case study is to learn as much as possible about an individual or group so that the information can be generalized to many others. Unfortunately, case studies tend to be highly subjective, and it is sometimes difficult to generalize results to a larger population.

While case studies focus on a single individual or group, they follow a format similar to other types of psychology writing. If you are writing a case study, we got you—here are some rules of APA format to reference.

At a Glance

A case study, or an in-depth study of a person, group, or event, can be a useful research tool when used wisely. In many cases, case studies are best used in situations where it would be difficult or impossible for you to conduct an experiment. They are helpful for looking at unique situations and allow researchers to gather a lot of˜ information about a specific individual or group of people. However, it's important to be cautious of any bias we draw from them as they are highly subjective.

What Are the Benefits and Limitations of Case Studies?

A case study can have its strengths and weaknesses. Researchers must consider these pros and cons before deciding if this type of study is appropriate for their needs.

One of the greatest advantages of a case study is that it allows researchers to investigate things that are often difficult or impossible to replicate in a lab. Some other benefits of a case study:

Allows researchers to capture information on the 'how,' 'what,' and 'why,' of something that's implemented
Gives researchers the chance to collect information on why one strategy might be chosen over another
Permits researchers to develop hypotheses that can be explored in experimental research

On the other hand, a case study can have some drawbacks:

It cannot necessarily be generalized to the larger population
Cannot demonstrate cause and effect
It may not be scientifically rigorous
It can lead to bias

Researchers may choose to perform a case study if they want to explore a unique or recently discovered phenomenon. Through their insights, researchers develop additional ideas and study questions that might be explored in future studies.

It's important to remember that the insights from case studies cannot be used to determine cause-and-effect relationships between variables. However, case studies may be used to develop hypotheses that can then be addressed in experimental research.

Case Study Examples

There have been a number of notable case studies in the history of psychology. Much of Freud's work and theories were developed through individual case studies. Some great examples of case studies in psychology include:

Anna O : Anna O. was a pseudonym of a woman named Bertha Pappenheim, a patient of a physician named Josef Breuer. While she was never a patient of Freud's, Freud and Breuer discussed her case extensively. The woman was experiencing symptoms of a condition that was then known as hysteria and found that talking about her problems helped relieve her symptoms. Her case played an important part in the development of talk therapy as an approach to mental health treatment.
Phineas Gage : Phineas Gage was a railroad employee who experienced a terrible accident in which an explosion sent a metal rod through his skull, damaging important portions of his brain. Gage recovered from his accident but was left with serious changes in both personality and behavior.
Genie : Genie was a young girl subjected to horrific abuse and isolation. The case study of Genie allowed researchers to study whether language learning was possible, even after missing critical periods for language development. Her case also served as an example of how scientific research may interfere with treatment and lead to further abuse of vulnerable individuals.

Such cases demonstrate how case research can be used to study things that researchers could not replicate in experimental settings. In Genie's case, her horrific abuse denied her the opportunity to learn a language at critical points in her development.

This is clearly not something researchers could ethically replicate, but conducting a case study on Genie allowed researchers to study phenomena that are otherwise impossible to reproduce.

There are a few different types of case studies that psychologists and other researchers might use:

Collective case studies : These involve studying a group of individuals. Researchers might study a group of people in a certain setting or look at an entire community. For example, psychologists might explore how access to resources in a community has affected the collective mental well-being of those who live there.
Descriptive case studies : These involve starting with a descriptive theory. The subjects are then observed, and the information gathered is compared to the pre-existing theory.
Explanatory case studies : These are often used to do causal investigations. In other words, researchers are interested in looking at factors that may have caused certain things to occur.
Exploratory case studies : These are sometimes used as a prelude to further, more in-depth research. This allows researchers to gather more information before developing their research questions and hypotheses .
Instrumental case studies : These occur when the individual or group allows researchers to understand more than what is initially obvious to observers.
Intrinsic case studies : This type of case study is when the researcher has a personal interest in the case. Jean Piaget's observations of his own children are good examples of how an intrinsic case study can contribute to the development of a psychological theory.

The three main case study types often used are intrinsic, instrumental, and collective. Intrinsic case studies are useful for learning about unique cases. Instrumental case studies help look at an individual to learn more about a broader issue. A collective case study can be useful for looking at several cases simultaneously.

The type of case study that psychology researchers use depends on the unique characteristics of the situation and the case itself.

There are a number of different sources and methods that researchers can use to gather information about an individual or group. Six major sources that have been identified by researchers are:

Archival records : Census records, survey records, and name lists are examples of archival records.
Direct observation : This strategy involves observing the subject, often in a natural setting . While an individual observer is sometimes used, it is more common to utilize a group of observers.
Documents : Letters, newspaper articles, administrative records, etc., are the types of documents often used as sources.
Interviews : Interviews are one of the most important methods for gathering information in case studies. An interview can involve structured survey questions or more open-ended questions.
Participant observation : When the researcher serves as a participant in events and observes the actions and outcomes, it is called participant observation.
Physical artifacts : Tools, objects, instruments, and other artifacts are often observed during a direct observation of the subject.

If you have been directed to write a case study for a psychology course, be sure to check with your instructor for any specific guidelines you need to follow. If you are writing your case study for a professional publication, check with the publisher for their specific guidelines for submitting a case study.

Here is a general outline of what should be included in a case study.

Section 1: A Case History

This section will have the following structure and content:

Background information : The first section of your paper will present your client's background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses.

Description of the presenting problem : In the next section of your case study, you will describe the problem or symptoms that the client presented with.

Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted. Any screening or diagnostic assessments that are used should also be described in detail and all scores reported.

Your diagnosis : Provide your diagnosis and give the appropriate Diagnostic and Statistical Manual code. Explain how you reached your diagnosis, how the client's symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.

Section 2: Treatment Plan

This portion of the paper will address the chosen treatment for the condition. This might also include the theoretical basis for the chosen treatment or any other evidence that might exist to support why this approach was chosen.

Cognitive behavioral approach : Explain how a cognitive behavioral therapist would approach treatment. Offer background information on cognitive behavioral therapy and describe the treatment sessions, client response, and outcome of this type of treatment. Make note of any difficulties or successes encountered by your client during treatment.
Humanistic approach : Describe a humanistic approach that could be used to treat your client, such as client-centered therapy . Provide information on the type of treatment you chose, the client's reaction to the treatment, and the end result of this approach. Explain why the treatment was successful or unsuccessful.
Psychoanalytic approach : Describe how a psychoanalytic therapist would view the client's problem. Provide some background on the psychoanalytic approach and cite relevant references. Explain how psychoanalytic therapy would be used to treat the client, how the client would respond to therapy, and the effectiveness of this treatment approach.
Pharmacological approach : If treatment primarily involves the use of medications, explain which medications were used and why. Provide background on the effectiveness of these medications and how monotherapy may compare with an approach that combines medications with therapy or other treatments.

This section of a case study should also include information about the treatment goals, process, and outcomes.

When you are writing a case study, you should also include a section where you discuss the case study itself, including the strengths and limitiations of the study. You should note how the findings of your case study might support previous research.

In your discussion section, you should also describe some of the implications of your case study. What ideas or findings might require further exploration? How might researchers go about exploring some of these questions in additional studies?

Need More Tips?

Here are a few additional pointers to keep in mind when formatting your case study:

Never refer to the subject of your case study as "the client." Instead, use their name or a pseudonym.
Read examples of case studies to gain an idea about the style and format.
Remember to use APA format when citing references .

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011;11:100.

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011 Jun 27;11:100. doi:10.1186/1471-2288-11-100

Gagnon, Yves-Chantal. The Case Study as Research Method: A Practical Handbook . Canada, Chicago Review Press Incorporated DBA Independent Pub Group, 2010.

Yin, Robert K. Case Study Research and Applications: Design and Methods . United States, SAGE Publications, 2017.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Diabetes Care for Children & Young People

Vol:05 | No:01

Children and young people’s diabetes care: Case study

12 Jul 2016

This case study demonstrates the physical and psychological difficulties faced by many young people with type 1 diabetes. Over the year following her diagnosis, Max had a deterioration in glycaemic control despite reporting that little had changed in her management. Detailed assessment revealed a number of psychosocial factors that were preventing her from achieving good control. However, working with her multidisciplinary team, she was able to address these issues and improve her blood glucose levels. This article outlines these issues and the action plan that Max and her diabetes team drew up to overcome them.

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This case study represents the challenges and issues, both physical and psychological, faced by a young person with type 1 diabetes and the support given by her diabetes multidisciplinary team (MDT). Implications for practice are addressed using current evidence-based research. The names of the child and family have been anonymised to protect their identity.

Case study Max (a pseudonym) is a 17-year-old girl who was diagnosed with type 1 diabetes 4 years ago at the age of 13 years. She and her mother were shocked and upset by the diagnosis, and both felt its management would be too great a task to take on by themselves.

Max is an only child and lives with her mother, a single parent. She attends the local state comprehensive school and is popular with her peer group. Her mother was very involved in her care and diabetes management from the onset. Despite this, her diabetes control deteriorated over time ( Table 1 ). In October 2012, her HbA 1c was 56 mmol/mol (7.3%); however, over the next year, this increased to 84 mmol/mol (9.8%) in July 2013. She found it difficult to count the carbohydrate portions in her food and her injections were hurting much more than when she was first diagnosed. She also expressed a fear of hypoglycaemia and of “looking stupid” in front of her friends.

Max and her MDT discussed treatment options to improve her glycaemic control. She refused insulin pump therapy but agreed to a blood glucose monitor and bolus advisor to assist with her regimen of multiple daily insulin injections (MDI). She is now using the bolus advisor confidently and has had regular one-to-one sessions with a psychologist. She is having fewer hypoglycaemic episodes and her HbA 1c has improved; in January 2016 it was 69 mmol/mol (8.5%) and in April 2016 it was 58 mmol/mol (7.5%).

Discussion Diagnosis Max and her mother were extremely shocked and upset by the diagnosis of type 1 diabetes and the potential severity of the condition and intense management required. Both felt it would be too great a task to take on by themselves.

Kübler-Ross and Kessler (2005) suggested that a diagnosis of diabetes is a life-changing event comparable to the experience of loss, and that children and families will often go through the five stages of grief defined by Kübler-Ross (1970) and outlined in Box 1 . They use this as a coping strategy to enable them to eventually acknowledge the condition. However, many families never reach the fifth stage of acceptance and many will fluctuate between the stages.

Although Max and her mum did accept the diagnosis eventually, at times both of them reverted to the earlier stages of grief. The diabetes MDT supported the family from diagnosis and will continue to support them throughout their time within the paediatric diabetes service, through the transition period with both paediatric and young people’s teams, until discharged to adult diabetes care.

The diabetes MDT was established after the Best Practice Tariff was introduced in 2012. It consists of doctors, nurses, dietitians, a psychologist and a personal assistant. It is well recognised that the MDT needs to work together in close cooperation to achieve good practice, and this can be strengthened by using written protocols, guidelines and targets (Brink, 2010). Logic would suggest that centres with MDTs and the same approaches and treatment regimens would have similar outcomes, yet the Hvidøre Childhood Diabetes Study Group has shown this is not the case (de Beaufort et al, 2013). In terms of glycaemic control, there were notable differences in patient outcomes across 21 diabetes clinics, all of which were committed to MDT-based practice. Although factors such as age, type of insulin regimen and socioeconomic status were shown to have some influence over specific outcomes, they did not explain the apparent differences between these clinics.

Family/social history Max is an only child and lives with her mother, a single parent. East et al (2006) suggested that rapid social change over the past 20 years has seen a marked increase in the number of mother-headed single-parent families. Max attends the local state comprehensive school, where she is generally doing well. She is popular with her peer group. La Greca et al (1995) suggested that peer relationships are important in diabetes management, as children and young people (CYP) may receive considerable emotional support from their friends. However, on occasions, Max’s peer relationships have had a counterproductive effect on her, and she feels she is different from her friends as the only one who has diabetes. This at times affects her self-esteem and impacts her diabetes control.

Max’s mother was very involved in her care and diabetes management from the onset. Anderson and Brackett (2005) suggested that parents typically take on most of the responsibility for management of diabetes when children are young or newly diagnosed.

Deterioration in diabetes control Max’s diabetes control had deteriorated since her diagnosis ( Table 1 ). In October 2012, her HbA 1c was 56 mmol/mol (7.3%), which indicated a good level of diabetes control and a reduced risk of diabetes complications, as suggested by the DCCT (Diabetes Control and Complications Trial; DCCT Research Group, 1994). At her subsequent diabetes clinic appointments up to July 2013, she reported that “nothing had really changed,” except she “didn’t have time to think about her diabetes,” although she felt guilty because she knew she could make herself ill and her mum would get upset. She stated that it was hard counting the carbohydrate portions in her food and her injections were hurting much more than when she was first diagnosed. Her height and weight remained static.

Diabetes care is greatly influenced by psychosocial factors when they obstruct people’s ability to manage their diabetes and achieve good metabolic control. A team-based approach to addressing an individual’s ability to cope is critical (Kent et al, 2010). It is important for healthcare professionals to be aware of how CYP think at the different stages of their development, as their understanding of illness and chronic health conditions is often greater than that of their peers. Jean Piaget (1896–1980) investigated cognitive processes in children, calling them “schemas”. By the time children reach around 12 years of age, they can describe illness in terms of non-functioning or malfunctioning of an internal organ or process. Later in development they can appreciate that a person’s thoughts or feelings can affect the way the body functions, which demonstrates an awareness of psychological factors (Taylor et al, 1999).

Spear (2013) proposed that we can begin to understand how young people with type 1 diabetes think, feel and behave if we consider the cognitive and biological changes that occur during adolescence. Glasper and Richardson (2005) suggested there is now a growing awareness that CYP are able to make their own decisions if given information in an age-appropriate manner. Gillick competence identifies children aged under 16 years as having the capacity to consent to their own treatment if they understand the consequences (NSPCC, 2016).

Butler et al (2007) suggest that adolescence is a time of upheaval when young people have to deal with the influence of peers, school life and developing their own identity, as well as all the physiological changes that occur. Young people with type 1 diabetes have the added responsibility of developing autonomy regarding the self-management of their condition. Hanas (2006) suggests that parents should continue to take part in their child’s diabetes care into adolescence and not hand the responsibility to the young person too early. Snoek and Skinner (2002) suggest that intensive self-management of diabetes is complex and time-consuming, and creates a significant psychosocial burden on children and their families.

There are significant challenges for CYP to engage in effective diabetes self-management. Several of these were identified with Max and her mother:

Deterioration in diabetes control.
Difficulty with carbohydrate counting.
Insulin omission.
Fear of hypoglycaemia.
Painful injections.

Action plan An action plan was discussed between Max and the MDT. As she was on an MDI regimen (a long-acting insulin at bedtime and rapid-acting insulin with meals), a bolus advisor/blood glucose monitor was demonstrated and discussed with her and her mum. Max felt she would be able to use this to help eliminate the calculations which, although she was capable of doing them, she often lacked time to do so. With further discussion, Max said she was “scared of getting it wrong and having a hypo”. Insulin pump therapy was discussed but she did not want to “have a device attached to my body because it would remind me all the time that I have diabetes”. Insulin pump therapy is recommended as a treatment option for adults and children over 12 years of age with type 1 diabetes whose HbA 1c levels remain above 69 mmol/mol (8.5%) on MDI therapy despite a high level of care (NICE, 2015a).

The National Service Framework standard 3 (Department of Health, 2001) recommends empowering people with diabetes and encourages them and their carers to gain the knowledge and skills to be partners in decision-making, and giving them more personal control over the day-to-day management of their diabetes, ensuring the best possible quality of life. However, if a diabetes management plan is discussed in partnership with a (Gillick-competent) young person but they elect not to comply with the plan despite full awareness of the implications of their actions, then the diabetes team should support them whilst trying to encourage them to maintain the treatment plan. This can be very difficult and frustrating at times, as a healthcare professional is an advocate for the patient, and promotion of the best interests of the patient is paramount.

Psychology involvement Max was reviewed by the psychologist to assess her psychological health and wellbeing. The psychologist used the Wellbeing in Diabetes questionnaire (available from the Yorkshire and Humber Paediatric Diabetes Network) to assess her and identify an optimal plan of care.

The psychology sessions were focussed on her issues around the following:

Worry about deterioration in control.
The consequences of insulin omission.

Max had a series of one-to-one appointments and some joint sessions with the paediatric diabetes specialist nurse and/or dietitian, so this linked into other team members’ specialities.

Carbohydrate counting and use of a bolus advisor The dietitian assessed Max and her mother’s ability to carbohydrate count using a calculator, food diagrams and portion sizes, and both of them were able to demonstrate competency in this task. Garg et al (2008) have shown that the use of automated bolus advisors is safe and effective in reducing postprandial glucose excursions and improving overall glycaemic control. However, this can only be true if the bolus advisor is being used correctly and is confirmed as such by comparing blood glucose and HbA 1c results before and after initiation of the bolus advisor, and observing the patient using the device to ensure it is being used safely and correctly.

Barnard and Parkin (2012) propose that, as long as safety and lifestyle are taken into consideration, advanced technology will benefit CYP, as inaccurate bolus calculation can lead to persistent poor diabetes control. These tools can help with removing the burden of such complex maths and have the potential to significantly improve glycaemic control.

Insulin omission and fear of hypoglycaemia Max also expressed her fear of hypoglycaemia and of “looking stupid” in front of her friends. She admitted to missing some of her injections, especially at school. Wild et al (2007) suggest that a debilitating fear of hypoglycaemia can result in poor adherence to insulin regimens and subsequent poor metabolic control. Crow et al (1998) describe the deliberate omission or reduced administration of insulin, which results in hyperglycaemia and subsequent rapid reduction in body weight. Type 1 diabetes predisposes a person to a high BMI. Adolescent girls and adult women with type 1 diabetes generally have higher BMI values than their peers without the condition (Domargård et al, 1999). Affenito et al (1998) observed that insulin misuse was the most common method of weight control used by young women with type 1 diabetes. However, Max’s weight remained stable and there was no clinical indication that she was missing insulin to lose weight; rather, it was her fear of hypoglycaemia that drove her to omitting insulin at school. With the use of the bolus calculator, she was reassured about her calculations for insulin-to-carbohydrate ratios, but it was reinforced with her that the device would only work efficiently if she used it correctly with each meal.

Painful injections Max also highlighted that her injections were now more painful than when she was first diagnosed, and this was causing her distress each time she had to inject. Injection technique was discussed with her and demonstrated using an injection model, and her injection technique was observed and appeared satisfactory. She was using 5-mm insulin needles and so was switched to 4-mm needles, as recommended by Forum for Injection Technique (2015) guidelines.

Appropriate technique when giving injections is key to optimal blood glucose control; however, evidence suggests that injection technique is often imperfect. Studies by Strauss et al (2002) and Frid et al (2010) revealed disturbing practices in relation to injection technique, with little improvement over the years. Current diabetes guidelines do not include detailed advice on injection technique, and only the guidance on type 2 diabetes in adults (NICE, 2015b) makes any reference to providing education about injectable devices for people with diabetes. However, the older Quality Standard for diabetes in adults (NICE, 2011) recommends a structured programme of education, including injection site selection and care (Diggle, 2014).

Conclusion The issues and concerns this young girl had were identified and addressed by the diabetes MDT. She was assessed by several members of the team, and a credible, evidence-based action plan was put into place to assist her and her mother to manage her diabetes at this difficult time. Max is now using the bolus advisor confidently and having fewer hypoglycaemic episodes, and her HbA 1c has improved. She prefers using the 4-mm injection pen needles, although she remains hesitant when giving injections; she will still not consider insulin pump therapy. Her one-to-one sessions with the psychologist have now ceased, but she is aware she can access a psychologist at clinic on request, or if the MDT assesses that her psychological health has deteriorated.

When a child in a family develops a chronic condition such as type 1 diabetes, effective communication is vitally important to address issues with the family at the earliest stage so that problems can be discussed and, hopefully, resolved before they escalate out of control. Upon reflection, the team could have become more intensely involved at an earlier stage to prevent Max’s diabetes management issues and stop her HbA 1c from reaching such a high level. Furthermore, the new NICE (2015a) guideline has set the target HbA 1c at ≤48 mmol/mol (6.5%), so there is still some work to be done. However, the outcome of this case appears to be favourable at present.

Affenito SG, Rodriguez NR, Backstrand JR et al (1998) Insulin misuse by women with type 1 diabetes mellitus complicated by eating disorders does not favorably change body weight, body composition, or body fat distribution. J Am Diet Assoc 98 : 686–8 Anderson BJ, Brackett J (2005) Diabetes in children. In: Snoek FJ, Skinner TC (eds). Psychology in Diabetes Care (2nd edition). John Wiley & Sons, Chichester Barnard K, Parkin C (2012) Can automated bolus advisors help alleviate the burden of complex maths and lead to optimised diabetes health outcomes? Diabetes Care for Children & Young People 1 : 6–9 Brink SJ (2010) Pediatric and adolescent multidisciplinary diabetes team care. Pediatr Diabetes 11 : 289–91 Butler JM, Skinner M, Gelfand D et al (2007) Maternal parenting style and adjustment in adolescents with type I diabetes. J Pediatr Psychol 32 : 1227–37 Crow SJ, Keel PK, Kendall D (1998) Eating disorders and insulin-dependent diabetes mellitus. Psychosomatics 39 : 233–43 de Beaufort CE, Lange K, Swift PG et al (2013) Metabolic outcomes in young children with type 1 diabetes differ between treatment centers: the Hvidoere Study in Young Children 2009. Pediatr Diabetes 14 : 422–8 Department of Health (2001) National Service Framework: Diabetes . DH, London. Available at: http://bit.ly/18OpAzL (accessed 24.02.16) Diabetes Control and Complications Trial Research Group (1994) Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. J Pediatr 125 : 177–88 Diggle J (2014) Are you FIT for purpose? The importance of getting injection technique right . Journal of Diabetes Nursing 18 : 50–7 Domargård A, Särnblad S, Kroon M et al (1999) Increased prevalence of overweight in adolescent girls with type 1 diabetes mellitus. Acta Paediatr 88 : 1223–8 East L, Jackson D, O’Brien L (2006) Father absence and adolescent development: a review of the literature. J Child Health Care 10 : 283–95 Forum for Injection Technique (2015) The UK Injection Technique Recommendations (3rd edition). Available at: http://bit.ly/1QeZU2E (accessed 24.02.16) Frid A, Hirsch L, Gaspar R et al (2010) The Third Injection Technique Workshop in Athens (TITAN). Diabetes Metab 36 (Suppl 2): 19–29 Garg SK, Bookout TR, McFann KK et al (2008) Improved glycemic control in intensively treated adult subjects with type 1 diabetes using insulin guidance software. Diabetes Technol Ther 10 : 369–75 Glasper EA, Richardson J (2005) A Textbook of Children’s and Young People’s Nursing . Churchill Livingston, London Hanas R (2006) Type 1 Diabetes in Children, Adolescents and Young Adults (3rd edition). Class Publishing, London: 329, 349–50 Kent D, Haas L, Randal D et al (2010) Healthy coping: issues and implications in diabetes education and care. Popul Health Manag 13 : 227–33 Kübler-Ross E (1970) On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy and Their Own Families . Tavistock Publications, London Kübler-Ross E, Kessler D (2005) On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss . Simon & Schuster UK, London La Greca AM, Auslander WF, Greco P et al (1995) I get by with a little help from my family and friends: adolescents’ support for diabetes care. J Pediatr Psychol 20 : 449–76 NICE (2011) Diabetes in adults (QS6). NICE, London. Available at: www.nice.org.uk/guidance/qs6 (accessed 24.02.16) NICE (2015a) Diabetes (type 1 and type 2) in children and young people: diagnosis and management (NG18). NICE, London. Available at: www.nice.org.uk/guidance/ng18 (accessed 24.02.16) NICE (2015b) Type 2 diabetes in adults: management (NG28). NICE, London. Available at: www.nice.org.uk/guidance/ng28 (accessed 24.02.16) NSPCC (2016) A Child’s Legal Rights: Gillick Competency and Fraser Guidelines . NSPCC, London. Available at: http://bit.ly/1Tj6DcF (accessed 24.02.16) Snoek FJ, Skinner TC (2002) Psychological counselling in problematic diabetes: does it help? Diabet Med 19 : 265–73 Spear LP (2013) Adolescent neurodevelopment. J Adolesc Health 52 (Suppl 2): 7–13 Strauss K, De Gols H, Hannat I et al (2002) A pan-European epidemiologic study of insulin injection technique in patients with diabetes. Practical Diabetes International 19 : 71–76 Taylor J, Müller D, Wattley L, Harris P (1999) The development of children’s understanding. In: Nursing Children: Psychology, Research and Practice . Stanley Thornes, Cheltenham Wild D, von Maltzahn R, Brohan E et al (2007) A critical review of the literature on fear of hypoglycemia in diabetes: implications for diabetes management and patient education. Patient Educ Couns 68 : 10–5

Do youth workers have a role in improving diabetes transition services?

Cgm for children and young people with type 1 diabetes: nice criteria and effects of decision fatigue and alarm fatigue , improving paediatric diabetes in england: areas of focus, delays in accessing continuous glucose monitoring in people with type 1 diabetes, celebrating may ng: the woman behind the obe, fiona campbell awarded an obe for services to paediatric diabetes, diabetes transition: a time to act.

Can the involvement of youth workers improve diabetes care for young people transitioning to adult diabetes services?

The impact of decision fatigue and alarm fatigue in children and young people using continuous glucose monitoring

NHSEI National Clinical Lead for Diabetes in Children and Young People, Fulya Mehta, outlines the areas of focus for improving paediatric diabetes care.

16 Nov 2022

NICE guidance urges local trusts to improve processes and advocate for CGM use in children and young people.

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Why Are So Many Young People Getting Cancer? It’s Complicated

J ust this month, two young, high-profile public figures announced that they have cancer. First, Olivia Munn, 43, disclosed that she was treated for breast cancer after catching it early. Days later, Kate Middleton, 42, announced she has been receiving treatment for an unspecified form of cancer .

Their diagnoses spotlight a troubling trend: both in the U.S. and around the world, cancer diagnoses are growing more common among adults younger than 50. By 2030, one recent study estimated , the number of these early-onset cancer diagnoses could increase by roughly 30% worldwide—and the number of people who die from their conditions could rise by about 20%.

“The most striking finding in the last decade has been this rise in incidence rates among young adults,” says Ahmedin Jemal, senior vice president of surveillance and health equity science at the American Cancer Society (ACS).

Cancer is still most commonly diagnosed among people older than 65 . In the U.S., only about 12% of cancers are diagnosed among adults younger than 50, according to ACS data . A woman in the U.S. has about a one in 17 chance of being diagnosed before she turns 50, while a man has about a one in 29 chance, the ACS says. (Women are more likely to be diagnosed largely because breast cancer is so common.)

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But those odds are gradually getting worse. In 2019, about 103 cancers were diagnosed among every 100,000 U.S. adults younger than 50, up from about 100 in 2010, according to a 2023 study in JAMA Network Open . That may seem like a small overall increase, but it’s not a good sign—especially since, during the same period of time, incidence rates among older U.S. adults decreased. “It’s almost like the curves have reversed themselves,” says Dr. Richard Barakat, director of cancer care at Northwell Health in New York.

For certain types of cancer, the numbers are especially striking. Colorectal cancer is now diagnosed among young adults almost twice as often as it was in the 1990s, according to one 2022 study , and the JAMA Network Open researchers found that other types of gastrointestinal cancer are also on the rise among this population. Early-onset breast cancer is becoming more common too, with its incidence rising by almost 4% among U.S. women every year from 2016 to 2019, according to a 2024 study . Even lung cancer, a disease typically associated with older cigarette smokers, is now to a surprising degree affecting younger women , even those who have never smoked, says Dr. Matthew Triplette, a pulmonologist at Fred Hutch Cancer Center in Seattle.

What’s driving these trends? Triplette says he doubts there’s “some new, very dangerous cancer risk factor out there that’s causing tons of excessive cases in younger folks.” Cancer is a complex disease influenced by a mixture of genetics, lifestyle choices, and environmental exposures, so it’s unlikely that there’s a single explanation for the data.

Instead, it’s likely a mix of things. Eating lots of processed foods , not getting enough exercise , and drinking too much alcohol are all risk factors for cancer, and all of those issues are widespread in modern life. A 2019 study co-authored by Jemal found that many of the cancers growing more common among U.S. young adults are linked to obesity, which now affects about 40% of U.S. adults under 40 .

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Researchers are also studying the gut microbiome’s role in cancer development . Everything from what you eat to the medications you take can affect the health of your gut microbiome, Barakat says, so it’s feasible that aspects of the modern diet—or the medical system’s over-reliance on antibiotics —could have trickle-down effects. Exposure to pollutants in the environment could play a role, too, Triplette says.

Even big societal changes could have an impact, Jemal says. For example, research shows that women who give birth to their first child at 35 or younger tend to have a lower risk of breast cancer. In many countries, increasing numbers of women are now choosing to have children later in life or not at all, which could be reflected in cancer rates, Jemal says.

To help lower the risk of cancer, everyone can benefit from evidence-backed health advice like eating a balanced diet, getting plenty of exercise, and not smoking or drinking heavily. But, ultimately, each individual’s chance of getting cancer is different. People with specific risk factors—like genetic markers or a family history of cancer—should consult a doctor about early screening and other preventive measures, Barakat says. Getting a head start can be crucial, he adds, because people with genetic predispositions to cancer are often diagnosed fairly early in life.

It’s also important, Barakat says, to know your body and see a doctor if you think something is wrong. “When I look at some of the patients who were diagnosed with early-onset colorectal cancer, they had symptoms, but nobody thought that a 30-year-old had colon cancer,” he says. The longer it takes to detect cancer, the harder it may be to treat—so it’s important not to assume everything is fine just because you’re young and seemingly healthy.

Of course, every episode of gastrointestinal distress or bloating isn’t a sign of something serious; often, these issues are nothing more than uncomfortable. But if you're having unusual symptoms that “continue for a long time, you definitely have to look into it,” Barakat says. "And doctors have to be more aware and be a little bit more suspicious.”

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Write to Jamie Ducharme at [email protected]