Using Adolescent-Focused Low-intensity Life Story Work: Video learning resources

What do we know about kind of more low intensity work? 

So, what we do know is that low-intensity life story involves a carer recording potentially valuable parts of a child's everyday life. This could be for example through a diary or drawn picture with a kind of anecdote underneath it. 

We also know that the carer and the child can discuss these, and this may help the child to understand or indeed process, re-frame, and consolidate their experiences. We also know this is kind of adolescent focused life story, which should be adolescence, um, driven. It should be flexible to needs the adolescent, and that it should kinda start and use everyday opportunities to, to have these conversations. 

When we ask our question - how do we raise the bar?

From a research point of view what we need to do is move from good intentions to good evidence. So again if I return to kinda nice guidelines for a moment - nice guidelines state that the effectiveness of life story work is close related to its quality.

So if that's the case? it's vital to understand firstly what does good quality, adolescent focused low-intensity life story work look like? And secondly, how, why, and for whom, and in what circumstances can good quality, adolescent focused life story work be implemented. 

The final question then becomes - how effective and cost effective is it? 

Now today we're gonna be talking about trying to answer first two of those three questions. The question of, um, what does good look like in this domain and also kind of how, why, to what extent, and for whom it can be done in real life. Okay so, if we begin to address the first element of that question, then the first question.

So we conducted some of the Quadro scoping review, uh, which was published in 2021. And what this did was bring together, all the evidence we all the kind of like published literature, either, um, kind of in academic journals or any kind of, um, local authority websites and things and pulled together all the evidence. And then from that we analysed that and we concluded that good quality, uh, life story approaches were person centred. 

So again, sensitive understanding to the needs and communicative preferences of the young person. They tended to be longer term pieces of work that involved creating and or working with meaningful artefacts, and this was supported by confident trained carers. We also acknowledged that within that review the idea of kind of re-traumatising was a consideration. However, one of the kind of counter arguments for that was, if a young person wants to discuss kind of a traumatising memory, then if re-traumatisation is gonna take place, is it not better to kind of take place in the care and relationship that a trusted carer provides. Um, in a kind of adolescent kind of focused and and facilitated way. 

We also had kinda conversation in relation to kind of the ownership of the narrative. And on, the kind of, the understanding that, whilst we have kind of professionalised records of the, of the, the childhood a young person experiences which will sometimes clash, inevitably with, um, kind of the adolescents’ young person's view, there was a, a need to kind of coach on construct where possible because, you know there were the lived experience of that particular adolescent.

So in terms of first question that kind of what, that's really what good looked like. In terms of low-quality practices, these were rushed, uh, often incomplete accounts. They used cold language, uh, professionalised discourses and and phrases, and they failed to include different perspectives from the young person's past. Uh, and again, we can all kind of probably relate to that and think about our own practices where those things, uh, have perhaps happened for a variety of different reasons. Or indeed in relation to how, attempts were perhaps made to, to work with, uh, liaise with birth family members. And again, every, every young person's kind of journey or, or point on that spectrum or continuously be likely to differ. 

• McAdams, D. P. (1989). The development of a narrative identity. Personality Psychology, 160–174. https://doi.org/10.1007/978-1-4684-0634-4_12.
• Askelund, A. D., Schweizer, S., Goodyer, I. M., & van Harmelen, A. L. (2019). Positive memory specificity is associated with reduced vulnerability to depression. Nature Human Behaviour, 3(3), 265-273.
• Prince, D. M., Epstein, M., Nurius, P. S., Gorman-Smith, D., & Henry, D. B. (2019). Reciprocal Effects of Positive Future Expectations, Threats to Safety, and Risk Behavior Across Adolescence. Journal of Clinical Child and Adolescent Psychology, 48(1), 54–67. https://doi.org/10.1080/15374416.2016.1197835.
• Orlowski, E. W., Bender, A. M., & Karver, M. S. (2023). A systematic review and meta-analysis of clinician behaviors and characteristics related to alliance building with youth clients. Clinical Psychology Review, 102. https://doi.org/10.1016/j.cpr.2023.102273.

• Life story work – what it is and why it matters: Webinar | Research in Practice

• Life Story Work: Practice Tool (2022) | Research in Practice

What I'm gonna do is just quickly walk through each one of those um, those uh, segments.

As I mentioned we, we have this thing of this continuum of life story work, we have this low intensity stuff that I think we're sort of intuitively doing in lots of pockets. Uh, and we also have this kind of higher intensity stuff and I think, for me what I want to do is, I acknowledge that you know more high intensity kinda, trauma focused, um, life story work it is absolutely - and this isn't me saying like don't ever do that I'm not saying that at all - it absolutely has a place.

What I'm saying is, there are actually lovely, lovely, lovely, uh, ways in which we can hold onto everyday magic those anecdotes that we'll all have in our relationships with young people, in a way which gives young people with care experience, uh, a resource a, a, a repository of positive memories as to, we, yeah I'm sure there's some research out there in relation to the prevalence of negative memories and how, if you have negative circumstances they are, more readily available. And actually I think you know particularly young people we work with and support, there's a need to kind of readdress that balance and I think, at the moment within, within the system there's a lot for us to do. 

Okay so I'm just gonna briefly talk you through, kind our initial, our initial guidance. So, adolescent focused low-intensity life story should be flexible and person centred. So what this allows is, uh, it ensures how, why, when, by whom and to what extent this sort of work is delivered, fits the needs of the individual adolescent and their circumstances. So, again if you think about, those kind of again variety of different things - stability, placement type, point of the care during the adolescent graduate adolescent entrant, readiness in inverted commas, has to be kind of first accepted around that.

Following up I think there's also just an acknowledgement for this sort of work we're talking about there's no bad time to start it, so it should start as early as possible make use of everyday opportunities. 

So everyday opportunities should be used to engage adolescents in preserving reflecting on their life experiences. And again it should be very clear, this is about the kind of the everyday, I'm not suggesting where a young person walks to, walks into a new foster care placement, the foster carer is there taking selfies or, filming them walking in. What, no, no what I'm saying is there are, ways in which perhaps a foster carer can just write a brief note, um, to an adolescent. 

Don't have to kind of give it straight away just - remembering important things. So like, for me, when we think about the mundaneness of your life, and that could be, a certain pair of trainers 

or in a certain bedroom, that mundaneness becomes meaningful when it stops.

So for example there, should all be aware a young person with care experience, the ability to return to their kind of foster caring bedroom when they used to live when they leave, in many cases isn't, isn't there. So actually, well that's quite mundane when that placement ends or that, that, that young person moves on, the ability to go back to their kind of, well bedroom's gone as well. So there are ways in which we can kind of, record every dayness, in ways which are helpful 

and positive and can start every day basically straight away. 

In terms of number three, adolescent focus low-intensity life story work should begin in the present day, as this grows trust in caring adults and relationships. So again, sharing everyday life experiences helps establish trusting relationships with caring adults. So again, we're not talking here about sitting down and having a therapeutic intervention, we're talking here about moaning about the weather, you know, going to holiday to Cornwall for example and it raining all, all week and then one, there's one day when it looks nice. Just the everydayness that we all perhaps take for granted that, is retained in kinda longer term, relationships within birth families or longer-term placements, but actually those teens, again, particularly in a variety of different ways can sometimes move around more frequently. Giving, providing a, a resource or a, a repository I should say for, those things to be shared and remembered is, is vital. 

And again as, as I mentioned in, in the guideline it grows trusting relationships. Having - even if the young person not directly involved them self - having somebody write kind of almost like weekly diary entries about their shared life with you, it, it shows that a young person's valued and helped to, to create trust. It can also help to give the young person that continued invitation to kind of get involved. And again, there's a lot of different ways we could, we can be creative with that.

And number four kind of starts to push, uh, kind of pull us towards that. 

So, adolescent focused low-intensity life story should involve co-construction of narratives because this improves coherence, and authenticity. So adolescents should be supported to construct a narrative that makes sense and feels authentic to them. And again this is I think another way in which we kind of, try to distinguish it a little bit of more high intensity approaches. Although I think that co-construction still has a multi play where suitable is - it is about the everyday. And therefore, where wherever possible continually inviting an adolescent 

to kind of participate in that, whether that's just picking a photograph to put in a, a weekly entry or a photo album or - whatever it may be. I struggle to understand how that, how narratives, 

that aren't...involved or don't always involve the young person can feel authentic. 

Now, again I, there's a variety of different situations which again why we're doing research where that is appropriate. But I think that, it's one of the things that we, we kind of, erm in particular our care leader representatives, felt really passionate about. 

So number five is, adolescents should be supported to control how their lives are recorded, and preserved, uh, in relation to adolescent life story work wherever possible and whenever possible. So they should control the processes involved so they feel ownership and power over their own story, analysis captured and represented. This should support, should be supported in controlling that in terms of recording it, and preserving it, and also in terms of the production of artefacts. So, for example if you are the young person's wanting to get involved let's say in, in taking pictures of their bedroom before they leave, you can have permission to go in there or, or even just kind of writing down descriptions if they, if they don't wanna get involved in it - those sort of things where you can be creative here. 

And number six, adolescent focused low-intensity life story should provide adolescents with somewhere to begin future support, future storytelling, and I think that's, one of the things that really kind of resonates with me quite a lot and lots of young people as well. Supporting adolescents to communicate about their lived experiences by providing storytelling prompts.

This helps adolescents through transitions whether that's within or beyond the care system. 

Supposed viewed in the way I like to look at it I guess is kind of breadcrumbs out, the more breadcrumbs you have available, the better stories you can tell.

So we are storytellers and I think that, our stories are better more easily told with kind of artefacts. Again, we don't have to think about, kind of show and tell, in relation to kind of younger children and how that, how powerful that can be in terms of storytelling. And I think that, with adolescent focused um, low-intensity life story work, giving adolescents somewhere 

to begin future storytelling is massively important. Again, particularly when we think about the kind of, the life course impact of care experiences.

And number seven, adolescent focused low-intensity life story should be, should record positive aspects of everyday experiences. There's a, a need to, or a uh habit and or indeed both, uh, where the care system records professionalised records and professionalised views of events. Uh, now for me within this sort of work there's an opportunity to focus on more, experiences that are more, positive. But things have happened in adolescent lives that promote the development of positive identity and positive future expectations. 

So we know that, a variety of different mental health and wellbeing, uh, reasons and papers and all that sort, that's massively important. If we think about young people accessing care records after the various stages, they can do that. It's not a fair representation of kind of time and care, and not every day and not every interaction is, is like that. And therefore, for me if we're doing this work with young people, we need to think about positive aspects of their experiences. 

And the final guideline in relation to adolescent low-intensity life story work, is that it should include support of adolescents, caring adults, and others involved in supporting adolescents with this work. And should prepare, uh, trainer trained carers, uh, and also the adolescents to support themselves wherever possible. 

What I mean by life story work, why are we doing it? 

So, f-for me when we think about kind of life story work, big questions always come to my mind. So kind of the eternal question of who am I? Uh, where do I come from? Uh, where importantly for the young people we work with and support kind of where can I go? So these are kind of the important identity questions that lots of us will answer, uh, and tell as part of everyday life, that would be you know. And for young people and children and young people with care experience, lots of them have kind of more important identity questions, which may have more kind of sensitive answers that need to be found. So that's what for me, really the-the core theme throughout kinda life story work.

So, for me the ability to tell stories is a key part of everyday life. We are storytellers as humans, uh, and often as I mentioned the most important story we tell, is often about who we are. So when we meet people in society, we're normally called upon to tell this story. It also informs our own kind of self-understanding as we tell familiar stories and weave in new experiences.

So in childhood, our conversations with others, especially kind of those with-with birth family members, are important. And it gives information about how we fit into our family histories and our society and our communities. And also, if we carry on particular family characteristics and that could be kind of physical in terms of bald hair and blue eyes, or indeed kind of, you know, kind of a, I don't know, a sense of humour for example.

So as I said, earlier children and young people who have disrupted life experiences, they can struggle to pull together information which enables, uh, them to create what's commonly known as a coherent life story. That is a story which can be easily understood by others, and again, kind of told and, um, by the young people themselves and again weaving in new experiences. These young people also as I mentioned, may have significant questions about their real-life experiences which they understandably want answers to.

Now I'm a big fan, uh, and advocate particularly in relation to life story work and more contemporary understandings of identity. And these understandings move identities this, this thing away from an individual. And so it's not about somebody having a possession of a coherent identity, it's about kinda something the individual does they have an identity performance, for example. So this is helpful when we think about life story with teenagers, because actually, the everyday life experiences of kind of teens with care experiences very different to the, the kind of young people and the people that those classic psychological theories are, are built upon.

So if we think about identity as more of a fluid and situated and dynamic concept, that allows us to think about, how, telling one story becomes linked to both context and also kind of what's going on within it. So this way of view and identity is really helpful as the emphasis about identity comes upon a relationship context. So identity in this particular way of looking at things, it's um, when they're kind of more of social construction is kind of a, a type of relativist kind of perspective is important. And it's important 'cause we start to realise on the idea that, all the versions of reality are possible enters, enters conversation, but also an individual becomes almost in many ways a kind of incomplete patchwork of high-highly complex, partially constructed, inconsistent sub identities.

And in many ways this is really important - so we all have this kind of mixture of incomplete ingredients, and we use those every day in different contexts to kind of construct or display an appropriate sub identity. Uh, and this is important, so these kind of more narrative approaches’ psychology emphasise humans as storytellers. And again, we, we use stories as I mentioned at the start to kinda, as a way to make sense of ourselves and also through others. In that way, particularly in our culture many cultures across the world, probably throughout human history, the sharing and retelling of stories becomes a way to enhance the understanding of important life events and sequences, and also their relationship their sequential relationship to each other. 

And in this way, life story work becomes a way of facilitating kind of the organisation of these kind of identity performances and these incoherent mixed kind of patchwork of identity and live experiences. So this is important for me in, in the context of life story work, 'cause this brings or begins to move the way from more kind of attachment based understandings. Now, I'm aware that a great deal of kind of conventional life story approaches are, kind of underpinned by that kind of relation through, um attachment based, um, theory. 

And again, for lots of us that's why these, um, available life story approaches are very much rooted in child early childhood, as opposed to kind of more teen and adolescence which is what I'm interested in. But what this kind of, more um, kind of discursive or linguistic based view of language does, uh, is allow us to move towards more of an relationship based approach. And that in itself begins to really allow us to think about, the relationships and the conversation we have with young people every lap at every turn, as a potential therapeutic alliance. 

And again for me, one of the cornerstones of life story regardless of its theoretical kind of, rooting, is the potential of this therapeutic alliance, whether that's an attachment relationship or whether that's something different. Now now for me the key thing here, is that, in kind of being engaged in whatever particular form of life story that people are working with, and with a 

with a team, showing someone you're interested in them and listening to them, in is itself be able to reflect and and help in some ways where we script or talk about different different ways 

of looking at life events, is in itself therapeutic.

There are lots of times kind of specialist workers go in and do a piece of therapeutic work with young person, and then they kind of, they connect to that young person's life, and again I understand reasons for that. I think for me one of the things I want to move to in in relation to kind of improving the access and quality and, um, standard of low intensity life story routines, is thinking about how we kind of come up still and equip carers with, with these, uh, forms of knowledge but also acknowledge and legitimise some amazing practices at carers who are, you know, with-in and around the young people every day, uh, can bring to party. 

So for, for me when we think about therapeutic alliances and what I've called here positive future expectations, it's the ability of this kind of narrative linguistic informed work, to help young people tell stories that are more more away from kind of oh, if only this hadn't happened to me, if only I hadn't have been in this birth family, or if only I hadn't been in these things that have happened to me. Kind of more resilient informed, kind of despite despite this, so, despite being in care or despite having this happen to me, I'm gonna go on and I'm gonna go and do this. 

And I think that for me is one of the key things about life story more broadly, the only idea of, kind of making um, limit narratives limitless and again that's kind of why the the project is called what it is. I think there's an awareness within and across the sector and beyond that, sometimes when a young person or a child has negative life experiences, their ways of narrating their ways of telling stories about themselves, um, can be limiting. Uh, they are limited by the sector potentially and limited by, kind of how that, relationship context does things and why the society stigmas. But for me one of the things that I'm keen to do is make sure that kind of young people with care experience realise they're limitless. And I think the power of narrative is really useful in that regard. 

 Hammond, S. P., Young, J., & Duddy, C. (2020). Life story work for children and young people with care experience: A scoping review. Developmental Child Welfare, 2(4), 293-315. https://doi.org/10.1177/2516103220985872.

• Watch: What is the LIMITLESS project? - YouTube

In terms of working with teens and adolescence is a time that matters particularly in kinda our culture. 

Now for me what that, what this does is invite the opportunity for work within this area to happen. So when we think about kind of life story work as a high intensity intervention, when I, when I, when I think about that I always think about life story work as a continuum. So on one side we have kinda, more low intensity everyday approaches with carers that some people might call kind of everyday identity work or, just memory boxy type stuff. 

We also have on the other side kinda high intensity intervention so, these will involve professional specialist input, perhaps over a number of sessions or months, and that can make it quite expensive and inaccessible. They could also contrive on waiting lists, and kind of people waiting for this sort of, um, intervention. The approach of most kinda high intensity approaches start in the present and return to past circumstances and then try to provide an age-appropriate explanation for why the child coming to live into social care. 

So like, kind of many high intensity and I'll call it mental health intervention for the moment, such work isn't always starting until certain parameters are achieved. So this could be for example, the child being stable in a particular placement or in particular relationships, um, which I think in, in the care it can itself be quite problematic and restrictive, and also because of its expense. You're on waiting times as I mentioned which means that adolescents in care, if we think about these as 12 to 18-year-olds for a moment, either perhaps never receive any life story work, or if they do, they perhaps miss out on the continued support of the age and revisit the information about their lives. 

Now for me the other end of this continuum, is kinda more low intensity interventions or low intensity life story work. So broadly, low intensity interventions vary according to whether their delivery involves perhaps support from a, uh, a specialist, so this could be in the form of guided self-help or indeed kind of not, so again, self-help or support from a carer. It could also depend upon the mode of delivery, so it could be face-to-face and or digital, in duration and the intensity of the services provided. So, if we think broadly for a moment and I'll, I'll bring, bring it to kind of life story work, lower interventions can improve outcomes, uh, for few people. They're also cheaper to deliver, and therefore more accessible so the challenge is therefore making sure they're as high quality as possible.

So for me, this is really important when we think about work with teens because you know, as you'll all be aware for a variety of different reasons, adolescents in care particularly in England, are the highest growing kind of group entering the care system. They're also most vulnerable in terms of mental health. Uh, there's high rates of mental health compared to their kind of non-care peers, but they're also kind of up to six times more likely to experience mental ill health, or four times more likely to commit suicide, or indeed attempt it.

So the National Institute for Care and Social Care of Excellence describes the need to support carers as a key mechanism, to improve the mental health outcomes of adolescents in care. Now when we bring this to bear on the life story context we also need to think about when working with teens, there are adolescent graduates and there are adolescent entrants. 

So an adolescent graduate is a, a young person who has entered the care system at an earlier age, and kind of continued within the care system as they enter adolescence. The are also adolescent entrants those people, those children, young people who haven't entered care perhaps until they are 12, 13, 14, and the different challenges and opportunities those two populations present. Now, I think it's a really good point there to think about within a birth family context, we'll have often have in a household someone who becomes the kind of the curator of a person's memory museum. And what I mean by this is, you know, a, a birth family member or a parent who perhaps is the one who takes the photos at family events. He's the one that's in the olden days, he says, would print off - you used to able to print photos off, it was a crazy time - uh, print off photos putting these things called photo albums and then write little anecdotes and stories and mementos underneath them.

Um, so I always think about when I think about life story with teenagers, just in trying to really keep in mind that, implications of, kind of care experience are lifelong and kind of life course trajectory. And that therefore may mean that you know, when a, a teen leaves care or indeed kind of, you know, starts to meet other people they're often called upon to kind of tell stories of places and people that they may not always remember, points in time that was kind of quite difficult for them. And again if we think couple that with the kind of potential memory implications of traumatic memories, or indeed complex traumatic memories and events, it's really challenging to tell a story about oneself in in the same manner.

And I think when I, when I talk of this, I often use kind of think about the carer's roles as, as being in the life story work kind of sense the word, helping the teen kind of create their own, curate, sorry, their own memory museum. The idea that there'll be certain exhibits on, on display at certain times, and there'll also kind of be like a, a backstage where there's perhaps more kind of sensitive things that aren't always, uh, appropriate for kind of displaying it in public.