Transitions: co-production and supporting care leavers

Introduction

Young people accessing social care face many challenges when they reach adulthood. The transition out of care typically happens very abruptly after young people turn 18 (Atkinson and Hyde, 2019). Young people living in the family home can take on adult responsibilities gradually, but care leavers often don’t have enough time to adjust to adult life. Instead, they may experience what some researchers call ‘instant adulthood’ (Alderson et al., 2022). 

The speed of this shift from care to independence means that young people can be unprepared, which can make them vulnerable. 

Support available to care leavers

Care leavers usually have less family support than other young people. They also tend to lose access to support from services over the course of the transition. This can damage their well-being and make them less prepared for adulthood. 

How young people feel supported by social care services also has an impact on how smooth the transition to adulthood is. Care leavers in several studies report not being listened to by professionals (Alderson et al., 2022; Atkinson and Hyde, 2019). This can make young people mistrust professionals, which in turn makes it harder for them to form positive relationships (Alderson et al., 2022; Atkinson and Hyde, 2019). 

Improving care leaver transitions

Feather et al. (2023) show that successful transitions for care leavers need three things: 

1. robust social policy
2. commitment to promoting social, emotional, and material support
3. relationship based practices built on a commitment to reduce the challenges faced by care leavers.

Defining co-production

Co-production can be difficult to understand. It’s been described as a ‘slippery, woolly and muddled concept’ that’s used to describe many different things (Masterson et al., 2022). At its heart, co-production is when services are designed and run by staff and citizens working together equally. 

For care leavers this means giving young people and professionals the same amount of control over decisions made during the transition. There are reasons why this isn’t always a realistic goal, which we’ll explore in more detail in this evidence summary. Other terms, which are sometimes used alongside (or instead of) co-production include:

• co-design – where power for making decisions about designing and allocating services and resources is shared with people who access care (SCIE, 2022; Slay and Stephens, 2013)
• co-delivery – where people who access care (ideally those who have taken part in co-design) are involved in running the service (SCIE, 2022; Conquer et al., 2024)
• co-evaluation – when people who access care are involved in evaluating and reviewing services (SCIE, 2022).

These were once treated as separate activities, which could be done as well as (or instead of) co-production. Now they are recognised as different parts of co-production (SCIE, 2022). For clarity we use the term ‘co-production’ throughout this summary, except where clearly specified in the evidence.

Co-production in legislation

Children’s right to take part in decision making processes that affect them is protected by Article 12 of the United Nation’s Convention on the Rights of the Child (UNCRC). This means that there’s a legal obligation for social care services to include young people when planning for their transition out of care. Young people must be allowed to voice their opinions, and their opinions must be taken seriously by decision makers (Davies et al., 2019).

In Wales, an obligation to involve people who access care in service design and delivery is part of the Social Services and Well-being (Wales) Act 2014. The Act’s Codes of Practice say that co-production is essential to fulfilling this obligation. 

But while co-production is essential to legislation in Wales, it’s not always clear what this means. The impact of the Social Services and Well-being (Wales) Act 2014 has been evaluated several times since its introduction. These evaluations show that both people accessing and delivering social care struggle to understand the way co-production is defined in the Act (Andrews et al., 2023). People report feeling confused about exactly how they are meant to co-produce services (Andrews et al., 2023). The final report on these evaluations concluded that the Act is not clear about how co-production differs from other forms of partnership working (Llewellyn et al., 2023). As a result, many projects may have been described as having been ‘co-produced’ when this wasn’t actually the case (Llewellyn et al., 2023).

Equality in co-production

Co-production helps people collaborate and make decisions together. In theory, equality is always the goal for co-production, but it can be difficult to achieve. There are many reasons why people might not be able to take part in co-production equally. It can be difficult to get everyone together in the same place at the same time because of other commitments, ill health and so on (Flinders et al., 2016). Some people may need support to understand research terminology or boost their confidence when interacting with services. Professionals may need training to build equal relationships with other co-production participants (Farr et al., 2021). Safety restrictions can also prevent equal participation, such as when two of the people involved have restricted access to one another. This can be a major challenge when working with care-experienced young people, who are more likely to have restricted access to family members (Jackson et al., 2020).

Many barriers can be addressed by working with people involved in co-production and thinking about their needs during the process. But the power dynamic between children or young people and adults is complicated. Not much research has looked at co-production’s ability to even out this imbalance (Kiili et al., 2021; Lundy, 2011). Because of this, most of the research discussed in this summary looks at how co-production can recognise and respond to differences in power. 

Challenges of putting co-production into practice

Good co-production can improve social care. However, it’s difficult to know what good co-production looks like, as it varies a lot in different situations.

Some practical things also make co-production challenging to put into practice. These can include:

• costs (time, money, resources)
• clashing with standards set out in policy or legislation (Farr, 2018).

Professional knowledge versus people with lived experience

One of the biggest challenges of co-production is being comfortable moving outside of accepted ideas about best practice. In co-production processes, people who access care have gained knowledge through first-hand experiences. Professionals involved in the process will have knowledge through qualifications and training, as well as their experiences in practice. Knowledge gained through qualifications is often seen as more valuable than lived experience (Rose and Kalathil, 2019; Turnhout et al., 2019). This means that when the purpose of co-production is to find the “best” course of action, practitioners can hold more power than people who access care and support (Turnhout et al., 2019).

It’s important to be aware of this bias and find ways to address it during co-production processes. This helps to make sure that power is distributed as evenly as possible. One way to achieve this is by embedding reflective practices into co-production. Giving space to talk through individual power positions and biases at the start and throughout the co-production process may also be helpful as power dynamics change constantly (Farr, 2018; Rose and Kalathil, 2019; Ärleskog et al., 2021).

Changing perceptions of young people

Care-experienced young people have first-hand insight into how well care services meet their needs (Kiili et al., 2021; Fern, 2014). Despite this, their knowledge isn’t valued as much as professional knowledge. This is partly because adults often struggle to understand young people’s knowledge and thought processes. Adults can interpret children and young people’s behaviour as irrational, leading to assumptions that they’re unable to make informed decisions (Davies et al., 2019). Fern (2014) carried out research with young people who had resisted social workers’ interventions. The findings showed that disengagement was often a response to unhelpful interactions with social workers in the past. This highlights the importance of listening to young people’s perspectives and preferences.

Many social care workers believe that children and young people are inherently vulnerable and in need of adult care and protection. This belief is reinforced by social care legislation, which stresses the need to protect young people (Jackson et al., 2020). But while safeguarding is important, it can also restrict young people’s participation in co-production. Professionals might try to protect young people from too much stress or responsibility, but this can undermine their confidence and limit their involvement in decision making (Davies et al., 2019). It’s important that young people can take control over their lives and engage in positive risk taking during the transition to adulthood. More information about positive risk taking can be found in our evidence summary on Supporting people to make decisions about their care.

Co-production and gradual transitions

It’s important that young people can increase their involvement in decision making at a pace that feels comfortable for them. In the context of care leavers, this helps prepare them to take on adult responsibilities when the time comes (Liabo et al., 2017). This results in better outcomes than the kind of abrupt ‘instant adulthood’ discussed earlier (Alderson et al., 2022). A young person involved in a co-production project with care leavers in England describes how the process supported their transition into adulthood:

Co-production and relationships during transitions

Care leavers need strong support networks to navigate the transition successfully. Care leavers say that they like having access to flexible support to help them manage their transition (Atkinson and Hyde, 2019; Liabo, et al., 2017). They also report that they dislike relying on professionals to make decisions. Young people would prefer if professionals could act as facilitators (Atkinson and Hyde, 2019). Strong relationship based practices are needed for this to work (Feather et al., 2023).

Co-production can help care leavers to develop support networks while learning the skills they need to maintain these relationships. Young people may struggle to maintain support networks when they do not feel listened to, or if they are not able to have their basic needs met. This means that professionals need to take care leavers’ concerns seriously and be prepared to give unconditional support during the transition in order to ensure a positive outcome (Atkinson and Hyde, 2019). 

Conclusion

This evidence summary shares recent research on how co-production can improve the experiences of young people leaving care. It discusses the challenges that need to be addressed for co-production to be effective. These challenges include lack of value placed on young people’s knowledge, the idea that they can’t make serious decisions, and the lack of trust they may feel towards professionals. 

Research shows that there are ways that co-production can respond to these challenges. This can include addressing power differences, making sure that young people are taken seriously, and developing strong relationships during transition. Good co-production can tackle existing problems in the move out of care. It reducing the chances of poor outcomes for care leavers by giving them control over decision making, helping to build a support network, and providing opportunities to develop adult skills.