Listening to Advice from Young People in Foster Care—From Participation to Belonging

Ensuring that young people in foster care receive the support they need at the right time, is a pressing issue across healthand social services. In this study, we aim to broaden the knowledge base on what constitutes appropriate help and support from the perspective of young people in long-term foster care in Norway. As part of a larger survey, young people in foster care (N1⁄4178) aged eleven to eighteenyears provided written accounts on the open-ended question: ‘What advice would you give adults who help young people living in foster care?’. We conducted a systematic content analysis to identify themes and categories across the data. Four main themes were identified: enable participation; build trusting relationships; ensure appropriate follow-up; and cultivate belonging. Participation served as a pivoting point across the themes, as a prerequisite for young people in care to receive the services they need and develop a positive self-relationship. Our findings indicate that services must be tailored to recognise how the strengths and needs of young people in foster care change over time and differ across individuals. Developing practice tools that enhance young people’s participation is therefore paramount, as social workers, foster parents and other adults are crucial to processes of well-being and belonging.


Introduction
Young people in foster care are often considered as particularly vulnerable group. Ensuring timely support and follow-up is therefore a pressing issue for service providers across health-and welfare services. A pitfall, however, is to lose sight of these young people's agency and competency. In this article, we analyse open-ended responses from young people asked to provide advice to the adults mandated to help them in their trajectory through care.
Foster care is the preferred option for long-term out-of-home care in Norway, as in the other Nordic countries (Skivenes and Søvig, 2016). Child welfare services (CWS) are responsible for the implementation of foster care and mandated to continually monitor and follow-up foster care placements (The Child Welfare Act, 1992). The term 'follow-up' refers to a range of different child welfare practices that aim to identify unmet needs and put appropriate measures into effect; for example, mediating conflicts in the foster home, referring the child and/or foster parents to counselling, initiating interagency collaboration and regulating contact with the child's birth family. Additionally, a supervision officer is assigned to independently assess the placement through regular visits to the foster home and conversations with the child.
Children's right to participate has been particularly high on the political agenda in Norway in the last decade. Social workers in the CWS are responsible for providing children in foster care with the information they need, giving children the opportunity to express their views freely and take the children's views and opinions into account in decision making (The Child Welfare Act, 1992, § 1-6). With regards to follow-up, there is a lack of guidance concerning what constitutes good practice; for example, when it comes to involving children in evaluation and decision making (Backe-Hansen et al., 2019). To guide service evaluation and development (Weldring and Smith, 2013;Wray et al., 2018), this study investigates how experienced young people in foster care envision appropriate help and support.

Literature review
In the last decades, how young people experience foster care and their relationships with adult helpers has gained increased research focus (see, e.g. Holland, 2009). Concerning relationships with social workers, young people's satisfaction tends to hinge on degrees of involvement (Vis et al., 2011;Kri z and Roundtree-Swain, 2017). Availability, trustworthiness and information sharing are emphasised across countries (Dillon et al., 2016;Paulsen and Thomas, 2018;Toros, 2021), as well as personal qualities such as humour, kindness and a non-judging attitude from the professional (van Bijleveld et al., 2015). However, many young people report that they struggle to be heard and taken seriously when encountering CWS (McLeod, 2007;Toros, 2021), thus they often participate in more subtle ways, such as by keeping silent/withdrawn or through rebellion (van Bijleveld et al., 2015;Fylkesnes et al., 2018). Furthermore, different views may be a barrier for children's voices being heard, as social workers see participation as a tool for cooperation, while children emphasise being heard, informed and taken seriously as core values (van Bijleveld et al., 2014).
When it comes to the relationship with foster parents, a number of studies have investigated how a bond develops over time and is linked to a sense of belonging (or lack thereof) to the foster family (see, e.g. Ellingsen et al., 2011;Bengtsson and Luckow, 2020). Young people emphasise a warm atmosphere and routines, and report that humour and doing things together are central to feelings of inclusion (Hedin et al., 2012). Also, contact with the birth family impacts foster children's wellbeing, emphasising the crucial role of cooperation among social workers, parents and foster parents (see, e.g. Boyle, 2017;Chateauneuf et al., 2018).
Concerning contact with health and social services, young people in foster care may find it troublesome to access the services they need, and outcomes depend on the quality and timeliness of the help provided (Tatlow-Golden and McElvaney, 2015;Smales et al., 2020). In Norway, most young people in foster care are in contact with several services, such as child welfare-, educational-and child and adolescent mental health services (Larsen et al., 2018).
Existing studies thus bring forth important aspects of the foster care experience and young people's perceptions of the support and help they receive. Reviewing the knowledgebase, we find that most studies tend to focus on specific and separate aspects of the foster care experience through in-depth small-scale qualitative approaches. Many of these studies also voice the opinions of young people who have transitioned out of foster care. Research with larger groups of children still living in foster care, and taking a wider, more open approach to map what these young people highlight as important, is scarce.

Study and aims
In this study, we analyse responses from young people, living in stable placements, who participated in the Norwegian survey study 'Young in foster care'. Previous publications from this study have highlighted that half of the participants showed evidence of mental health problems (Larsen et al., 2018), and that even though participants reported lower quality of life scores compared with their peers, the majority reported having good relations with their foster parents (Larsen et al., 2021). To identify those themes that were important to young people, but not detected by the standardised measures, we included an open-ended question where participants could formulate advice to the adult helpers, from which this paper reports its findings.
The aim was to examine young people's written accounts to identify what constitutes appropriate help and support from adults, from the perspectives of young people in foster care.

Procedures and recruitment
The study 'Young in Foster Care' investigates the mental health, service contact and quality of life for young people in foster care (Lehmann, 2016). Young people born between 1999 and 2005, who had lived in their current foster home for at least six months following a legally mandated placement, were invited to participate. All invitees were recruited through forty-three municipal CWS offices in the southern region of Norway. Young people were assessed for eligibility from regional records (n ¼ 573) and municipal CWS offices (n ¼ 279) in this region. Information about the participants' gender, age and number of years in the current foster home was retrieved from regional records and checked with the municipal CWS offices. Questions about country of origin, duration of stay in current foster home and type of foster care placement were included in the questionnaire to foster parents. Data collection was conducted between 1 October 2016 and 31 March 2017.
The invitees received letters describing the aims of the study and how to complete the questionnaires, either online or by telephone interview. Only one person chose to respond by telephone interview. In accordance with Norwegian legislation, invitations to young people aged eleven to fifteen years were included in invitation letters addressed to the foster parents. Young people aged sixteen years and older received information letters addressed to them. Reminders were given by post and subsequent telephone contact with the foster parents. Through this telephone contact, sixteen young people were identified as ineligible to participate. A total of 724 young people in foster cares were identified as eligible. Participants were compensated with a gift card of thirty BP.
The data used in this study are derived from the open-ended question: 'What advice would you like to give adults who help young people living in foster care (e.g. child welfare services, educational psychology service or adolescent mental health service)?'

Participants
Of the 303 young people participating in the study (41.9 per cent response rate), 209 participants answered the open-ended question in focus for this article. Answers that did not provide substantial information (e.g. 'no comment') were excluded from the analysis, yielding a final sample of 178 participants. Participants were eleven to eighteen years old and the majority of them were living in long-term placements. The sample consists of 51.1 per cent boys (n ¼ 91) and 24.4 per cent had an immigrant background (n ¼ 32). About 15.3 per cent were living in kinship care (n ¼ 20). The mean (SD) age was 14.9 years (2.1, range 11.3-18.0) and they had lived in their current foster home for a mean (SD) of 6.6 years (4.3, range 0.8-17.6). We compared the 178 young people included in our sample to the sample of young people who responded to the survey but did not answer the open-ended question, and found no differences with respect to gender, age, type of foster care, immigrant background, mental health problem scores or time in the current foster home.

Ethics
The Regional Committee for Medical and Health Research Ethics, Western Norway approved the study (2010/2367-1). The Norwegian Directorate for Children, Youth and Family Affairs provided exemptions from confidentiality for social workers and foster parents.

Analyses
We conducted descriptive analyses in IBM SPSS Statistics version 25. Information on country of origin and type of foster care placement was available for 131 of the young people. We categorised participants as immigrant when a young person or at least one biological parent was foreign born. To protect the identity of participants, no further distinctions were made, due to the small total number. Participants that were biologically related to their foster parents were classified as living in kinship care.
We chose content analyses as our approach to examine the data. The aim was to identify categories and themes, in line with Erlingsson and Brysiewicz's (2017) approach. The first author acquired an overview by first reading through the responses. Then a codebook was developed step by step, as two research team members first coded approximately 30 per cent of the data. Subsequently, all members coded a larger part of the data-set, paying attention to inconsistencies, overlapping and missing codes as well as more implicit themes. Based on team discussions, the codebook was finalised. To ensure validity, all responses were coded manually by two team members. The first author coded all responses, whereas the remaining team members coded one part each. The data-set was then uploaded to the NVivo 11 software program and coded based on the team members' notes. Discrepancies between coders were discussed, leading to consensual validation. Finally, the team collaborated to identify categories and overarching themes across the dataset, as presented in the findings below. No exact number of references was required to determine what constituted a theme or a category. In a final analytical stage, we identified excerpts that illustrated the identified themes and categories particularly well and translated these into English as the paper progressed.

Results
The responses varied in length, from 3 to 201 words, and young people aged sixteen to seventeen years old tended to provide the longest responses. The majority addressed services in general, for example, how adults can improve their communication with young people or offer the kinds of care/help that young people in foster care need. Others were more specific, describing critical events or specific services. Responses also varied with regards to the expression of critical views. Some wrote that they were thriving, whilst others communicated a feeling of powerlessness and hopelessness. Some themes and categories were significantly more prevalent than others. For example, categories coded within the overarching theme 'Enable participation' were frequently mentioned, in approximately one-fourth of the responses.
Four main themes and subsequent categories were identified from our thematic analysis: Overall, social workers and foster parents were most often referred to in the responses. A tendency was that themes 1 and 2 involved helpers across different services, while themes 3 and 4 primarily addressed foster parents, social workers and supervision officers in the CWS. We present the themes subsequently, while simultaneously illustrating how the themes were interrelated.

Enable participation
The most recurring main theme, 'Enable participation', refers to the value of enabling young people's participation in everyday life and decision-making processes. Interestingly, shorter responses often involved this theme: 'Listen to us' (Boy, eleven years), 'Always listen to the child' (Girl, seventeen years). Some participants explicitly mentioned social workers, psychiatrists, supervision officers and foster parents, but most often it was not made explicit which adult helpers the young person had in mind. Enabling participation thus served as generic advice to all adults involved with young people in foster care.
The category 'Take our perspective' prompts adults to take an interest in young people's views and actively engage to see the world from their perspective. Adults were urged to ask young people what they think and feel about their situation, as well as convey to the young person that his/ her views are important. However, questions should always be asked in a sensitive and skilful manner. Taking young people's perspective thus appeared as a fine balancing act, as illustrated in the following two quotes: 'Try to see things through "the young person's eyes", try to understand how the foster child sees things because that can be different from how you see things.' (Boy, seventeen years). 'If you see a young person feeling sad, always ask what is troubling [him/her]. If they do not want to tell you, continue asking but let them have some space first.' (Boy, fifteen years) The second category, 'Make our views matter', concerned taking young people's views into account in decision making; participants mentioned deciding on house rules, placement options, appropriate help measures and contact with birth family. One participant wrote: Child welfare services should listen when we say that we are unhappy in the foster home and want to change foster family. I also think that they should act when we say that we don't have friends and don't thrive in school (Girl, sixteen years).
Several participants urged adult helpers to acknowledge young people's competencies. Making young people's views matter therefore involves genuinely believing that the young person has something important to say and trusting that the young person tells the truth: 'See the The third category, 'Let us decide', refers to yet another level of participation, as adults are advised to sometimes allow young people decide for themselves. As pinpointed by the following quote: 'Let them do what they want. We are smarter than you think' (Girl, twelve years).
Responses highlighted how young people in foster care may experience that adult helpers do not recognise their resources and knowledge and therefore hinder their autonomy. However, several participants conveyed that allowing young people to decide is a fine balancing act, as adults are simultaneously expected to set boundaries and monitor the young person: 'To be controlling can be a good thing. But it is absolutely not necessary to be too controlling! Even if you have a foster child living with you who needs follow-up, it doesn't necessary mean that you need to know what the foster child is doing all the time' (Girl, sixteen years).
The three categories ('Take our perspective'; 'Make our views matter' and 'Let us decide') were mentioned simultaneously in some responses, and were also mutually interlinked: Imagine yourself in their situation, imagine that your life has been turned upside down, and everyone is deciding for you. Let them be independent and don't treat them as kids, give them respect. And think that they have 'a lot of luggage', and always be there for them. Those are the most important things (Girl, sixteen years).

Build trusting relationships
The second main theme concerned the value of laying the ground for a mutual trusting relationship. 'Be available' highlights how developing trust hinged on adults' availability, through regular meetings, timely responses to requests, ensuring continuity in relationships as well as accommodating meeting places where the young person could feel safe/encouraged to share information. Social workers were the primary addressee in responses concerning meetings, requests and continuity. In some responses it was unclear to the researchers whom the young person had in mind: 'Might be a good idea to take the young person out of the house to talk about things that are not so easy when you are at home in everyday life' (Girl, fourteen years).
However, there were also examples of participants requesting 'Less meetings and talking' (Boy, eleven years), thus reflecting that meetings with social workers and other professionals could be experienced as hazardous. These findings underscore how the subjective experience of adults' availability depends on whether the contact fits the needs and wishes of the individual child, a theme we will return to in relation to appropriate follow-up.
The importance of availability was further underscored by participants describing how unpredictability in contact and shifting relationships with social workers and supervision officers might lead to feelings of powerlessness and distrust: Child welfare services in [my municipality] is JUST LOUSY. I have had 15 social workers in 10 years, I have not seen my supervision officer in 1 year (and she hasn't even contacted me). My social workers and supervision officer have cancelled 70% of our meetings. I don't trust child welfare services at all (Girl, seventeen years).
In line with this, one participant gave the following advice: If you have any doubt whether you can meet, do not set a date. Young people you 'forget' by not showing up have been abandoned by adults many times before and the young person will end up distrusting child welfare and other health services (Girl, seventeen years). 'Be honest' described how building trust also was linked to adults' willingness to openly share information with the young person: Don't let them feel left out or get the feeling that things are hidden from them (Girl, seventeen years).
Show that you can be trusted, maybe by opening-up to the child first? Then it might be easier to open-up to you. . . in my experience (Boy, fifteen years).
The second quote highlights that young people's willingness to openup and participate in decision making may hinge on adults' opening-up to them first. A pattern across the responses thus appears, as building trust emerges as a mutual and complex process where the adult needs to be trustworthy but also place trust in the young person.
'Be kind and humorous' was the last category within the theme build trusting relationships, illustrating how adults could build trusting relationships through warmth and laughter, as this could make young people feel at ease in their presence: 'They should be friendly, not cranky, and they should show that they want to meet you.' (Girl, eleven years). 'Speak with them in a fun way, don't be so strict and serious' (Girl, eleven years).

Provide appropriate follow-up
This third main theme entailed the kinds of support young people in foster care may need from adults. The first category, 'Care for us', concerns providing young people with the love, understanding, emotional and practical support they need to thrive. Some participants emphasised that adults must consider how the adverse experiences of young people in Listening to Advice from Young People in Foster Care Page 9 of 18 foster care affect their feelings of self-worth, and thus provide the care they need accordingly. Regarding the types of help and support young people might need, participants mentioned school and homework, health issues, practical needs, economic help (allowance) as well as activities and relationships with friends.
'Fit follow-up to individual needs' concerns the need to identify and address the hardships and hassles the individual young person experiences. Young people have different needs and wishes and therefore need different kinds of help from adults. In line with this, one participant explicitly stated that it was difficult to give generalised advice: 'I have always said to child welfare services that I don't want to provide any advice. All people are different and need different kinds of help.' (Boy, fifteen years). Adults' ability to follow-up individual needs was therefore closely linked to engaging with young people, namely enabling participation and building trusting relationships.
Ensuring appropriate follow-up also depended on the adult having the competency s/he needed through experience and education. One quote illustrates how lack of knowledge can lead to poor follow-up and a sense of powerlessness: [I have lost count of] all the times that you haven't taken seriously all the challenges I face because I live my life within the autism-spectrum, which means that I actually struggle with both hearing and empathy. This is not something I make up, it is ALL OVER the internet. [. . .] But no, you don't care about doing any research or using what you learnt through your professional training (Boy, sixteen years).
'Monitor and follow-up the foster home', encompasses advice to CWS and supervision officers, to both monitor how the child is doing in the foster home and be observant of the possibility that the child might not get the care s/he needs in the foster home.
Child welfare services: Do not only focus on how the child was doing before [moving]. Check how they are doing in the foster home as well. If the child tells you something, you should not only talk to the foster parents [about the issue], because that will just go in one ear and out the other. Try to act and do something about it!!! (Girl, twelve years).
Furthermore, follow-up measures in the foster home should consider the individual needs of the young person and placement stability. For example, the number of home visitations could be reduced when things are going well for the young person, and foster parents could be trusted to make decisions on behalf of the child without always involving the CWS: 'I advise adults who help children and young people in foster care to consider the situation. For example, my supervision officer only visits me twice a year. It has been reduced because there is less need for it now.' (Boy, sixteen years). 'Concerning "stuff" foster parents need to ask your permission to do, I think that is kind of stupid. I think foster parents should be given the opportunity to control what they do with us but might get some advice' (Boy, sixteen years).
The last two responses indicate that appropriate follow-up also involves listening to and trusting the foster parents, thus placing the foster parents more clearly in the role as the primary carers for the young person.

Cultivate belonging
This fourth main theme emphasises the important role that adult helpers can play in cultivating a sense of belonging for the young person at different stages in the foster placement trajectory, and social workers, foster parents and supervision officers were the main addressees. The term 'cultivate' reflects the dynamic process we identified across responses; belonging is (re)negotiated throughout the foster care trajectory.
'Ensure a good match' pinpoints how belonging depends on finding a foster family that fits the needs and personality of the individual young person, as well as allows for continuity of relationships prior to placement (with peers, community, spaces of belonging): 'Give them a foster home with a lot of love and where you think the person will thrive' (Girl, fourteen years). 'ALWAYS ensure that children do NOT have to move away from the community. That might make things worse' (Girl, sixteen years).
'Support the difficult transition into the foster home' brings forth how social workers and foster parents can support young people in a particularly vulnerable phase of their life. One participant urged social workers to provide foster families with more information to ease the transition: 'Foster families should get more information about the foster children moving in.' (Boy, sixteen years). However, most importantly adults must acknowledge that it takes time to develop a sense of belonging in the foster home. Based on his/her own experience, one participant suggested the following: Give the person some space, then the child will approach you after some time. When I arrived where I live now, I was angry at the world, did not trust a soul, school was bad, suicidal thoughts and cutting. But I was given the space I needed. Everything calmed down. The foster family did not expect as much as everyone else because my foster mother knew what I needed. I became close to her little by little; it took a while. Now I participate in physical education (in school), something I had never done before. I have good grades. I am the clown of the class. I am in a place that I love (Girl, seventeen years).
'Treat the child as part of the family', underlines how belonging was dependent on foster families treating the young person as 'one of their own': 'That the foster family (aunt, uncle, grandfather and grandmother) must treat you like they treat your foster siblings. Not be treated differently' (Girl, thirteen years).
For one participant, being treated as part of the family involved being acknowledged by wider society as such. Being subject to research could therefore create a sense of alienation: I find it annoying to be reminded all the time that you are a foster child.
[. . .] My foster family is my family, but according to you they are my foster family. Even though we don't have the same blood that is not what defines who my family is. Family is whom you have been with most of your life, that you love, and you trust. I get sad, annoyed, and irritated when you send me letters about foster children (Boy, seventeen years).
The theme of belonging could also pertain to the young people's relation to the birth family. Hence, the fourth category 'Support relationship with the birth family' concerns helpers' role in facilitating a sustainable relationship with the birth family. One participant recommended that helpers discuss the birth family in a respectful manner. Others urged social workers to facilitate more contact with birth parents and siblings. One participant underscored the importance of assessing the individual need of every child with respect to the birth family, and how generalised knowledge about what is 'best' does not necessarily apply to all: My siblings mean everything to me, and I only get to see them a few times a year. This has made everything worse for me. Even though it has helped other foster children to not meet their family it does not mean that it has helped me (Boy, fifteen years).
This participant urged helpers to emphasise the young person's view when making best interest decisions. This is in line with a pattern we identified across the data-set, as participation served as a prerequisite for trusting relationships, appropriate follow-up and belonging. Lengthier responses provided examples of how themes were inter-linked: Take the time to listen to what we have to say, and do not use complicated words that we do not understand (because sometimes you do that). When you visit the foster home, for example, make sure that the foster parents do not speak on behalf of the child because often the foster child has a totally different opinion/view than the foster parents. Feel free to interrupt the foster parents and tell them that it was the foster child you had a question for, not them. [. . .] In this way you can, among other things, avoid that a child lives in a foster home where he/she does not thrive. The most important thing of all is that you take us seriously. (Girl, sixteen years)

Discussion
This study is based on responses from 178 young people living in foster care, who were asked to give their advice to adults. Our analyses brought forth four main themes: enable participation, build trusting relationships, ensure appropriate follow-up and cultivate belonging. Participation served as a pivoting point in our analysis, integral to trusting relationships as well as appropriate follow-up and belonging. Furthermore, enabling participation unfolded as a complex balancing act, as two contradictory requests were communicated; calls for more independence and voice (autonomy) on the one hand, and closer followup and monitoring (care) on the other.
At a thematic level, our analysis is supported by previous research emphasising that young people want to participate in matters that are important to them, a sense of belonging in the foster home and in the birth family, to access health care and be given opportunities for success in life (see, e.g. Sinclair and Wilson, 2009;Hö jer and Forkby, 2010). However, our analysis contributes to the current knowledgebase by mapping themes of importance to a larger group of young people. The themes and categories we identified serve as an overview, or holistic map, of aspects that are central to the well-being of young people in long-term care and illuminate how these aspects are interlinked. Moving forward, we focus our discussion on the pivotal role of participation.
To explain the role of participation in young people's responses, the age of our participants and the Norwegian context is central. Adolescence is a period of gradual individuation from caregivers and developing a sense of identity and independence is a key task for young people. At a societal level, children's participation has never been higher on the agenda in Norway (Skivenes, 2011). In both a developmental and socio-historical perspective, it is therefore not surprising that young people growing up today expect and request opportunities to participate.
However, our findings also illustrate how having a say might be particularly challenging for young people living in foster care, often surrounded by many more stakeholders in their life than their peers. Negotiating these relationships can be hazardous, as participants struggled to get in touch with helpers, access information they could rely on and be acknowledged as competent in matters concerning them. Our results thus highlight how young people's participation can be hindered by adults' attitudes, as adults fail to take their views seriously and how this impacts negatively on young people's well-being. The way forward, according to our young participants, is for adults to set their preconceptions aside and engage actively with young people to acknowledge their perspective through decision making. Social workers were most often mentioned when barriers to participation, building trust and powerlessness was described (unavailability, information sharing, emotional distance, etc.). Social workers play both a central and distanced role in young people's lives in foster care. They have the power to make lifechanging decisions on behalf of young people, but also limited influence over, and knowledge of, their everyday life. For young people, struggling to be heard by CWS might therefore be experienced as particularly challenging, due to the power imbalance (Warming, 2006).
Our analyses also illuminate the strong link between young people's opportunities to participate and their everyday well-being (Vis et al., 2011). The transition into the foster home is described as a particularly precarious period by our young participants. Helpers are urged to acknowledge that it takes time to develop a sense of safety and belonging and to be sensitive to the young person's process. Such sensitivity can only be achieved through listening to the subtleties of what young people say. Our analyses thus correspond with previous research emphasising support in this transition period (Mitchell et al., 2010) and adds nuances to how enabling participation can increase young people's well-being over time. Trusting relationships is also emphasised, as both a prerequisite for participation and a source of well-being. For trust to develop, kindness and humour from adults were emphasised, which is in line with Hedin et al. (2012), who found that gentle teasing and laughter builds emotional warmth between children and their foster parents.
These conclusions thus reveal that even though participation is embedded in policy, there is still an urgent need to better understand how participation can be facilitated through foster care practices. Developing theoretical frameworks and practice tools that consider and address context specific barriers to participation is paramount. These are joint tasks for research and practice.

Strengths and limitations
To our knowledge, no previous study has asked the advice of such a large group of young people living in foster care by letting young people define which themes to focus on. Our findings are unique in this respect. Compared with the general foster care population in Norway, placement stability was higher in our sample. This has implications for generalisability, because advice from our participants might differ from young people of less experience. Due to the varied content and length of responses, we did not find it suitable to explore thematic patterns across subgroups, such as gender, immigration or type of care arrangement. Our results thus do not provide knowledge about the challenges that different subgroups of children may experience. Furthermore, a substantial number of participants in the main study chose to not answer the openended question on advice to adults. Even though attrition analyses did not identify systematic differences between participants who answered the open-ended question, and those who did not, groups of young people may have refrained from responding to the survey; for example, disadvantaged or less literate young people.
The intention of our research design was to bring out those themes important to the young people themselves. This open approach is, however, also a limitation. For example, the term 'adult helpers' left room for participants' very different interpretations of whom they could address in their response. However, the design also provided an opportunity to investigate whom young people in foster care define as adult helpers in their life. We anticipated that professionals outside the foster home would be the primary addressees, but somewhat unexpectedly, many participants also included foster parents. This finding might reflect both the important role foster parents play, and how young people in foster care struggle to establish a true sense of belonging in the foster home (Christiansen et al., 2013).

Implications for practice and concluding remarks
By asking the advice of a large group of young people in foster care, this study has expanded the knowledgebase on what constitutes appropriate help and support, from their own perspectives. Our findings reflect that young people in foster care have differing needs and wishes, depending on their personal stories and preferences as well as at different stages of the foster care trajectory. Providing appropriate help and support therefore depends on the ability of foster parents, health-and social service professionals to identify and recognise individual young people's needs and resources, across time and changing contexts.
Our findings highlight the important role social workers may play when young people struggle in their new home and need different kinds of support. Making it safe for young people to continually express their feelings, needs and wishes and participate in decision making should be of high priority. Concurrently, it will provide child welfare workers with important information when tailoring services for young people, whose needs for autonomy and care change over time (Christiansen et al., 2013). An implication for CWS is to provide social workers with the time and resources they need to engage with young people, including tools for follow-up, involvement and assessment.
The holistic map derived from our analysis, can serve as a starting point for sensitising social workers, supervision officers and foster parents to issues that may be important to young people, and evaluate the support they receive at different points in their trajectory through care. Today there are few standardised instruments for measuring the users' experiences with services, especially for children and young people in child welfare. Our findings may therefore inform future work on developing and evaluating such measures, by providing insights into which themes that are perceived as relevant for young people.