Improving the Employability and Wellbeing of Care-Experienced Young People: Initial Findings from the I-CAN Project

Abstract

Background: Care-experienced young people face an elevated risk of experiencing disadvantages across manifold domains, including health, housing, education, and employment. There is a dearth of accessible interventions targeted at this population to help them navigate the ‘cliff-edge’ transition to adulthood and improve their life chances. The 8-week I-CAN programme was designed to address the provision gaps and support care-experienced young people’s learning, personal development, and progression. Methods: A mixed methods design was used as part of a pilot evaluation study. The participants were n = 11 care-experienced young adults (three males; eight females); aged 19–30 years, M = 22 (3.17). The data collection methods comprised programme statistics, well-validated, self-reported questionnaires, and a focus group with I-CAN programme recipients. Results: The integrated quantitative and qualitative findings showed tentative support for the effectiveness of the I-CAN programme, with the majority of care-experienced young adults transitioning to a confirmed progression route (training, education, or employment) after completing the programme. The findings cautiously suggest that alongside proposed learning outcomes, the recipients benefited in terms of their personal development (mental wellbeing and positive self-image and empowerment). Some candidate core ‘ingredients’ or factors that had facilitated positive programme outcomes were also identified. Conclusions: Future research should focus on integrating theoretical, outcome, and process issues, and refining the I-CAN theory of change.

1. Introduction

In the UK, the number of ‘care-experienced’ children and young people (CYP), those who have been in the care of their local authority at some point during their childhood, is growing (NSPCC 2024). In 2023, approximately one child in every 140 children in England was in the national care system, and a concerning societal trend is emerging (Children’s Commissioner 2023). This figure has steadily increased in recent years, with more than 83,000 cases reported in 2023, revealing a 2% increase from the previous year (Department for Education 2023). Care-experienced young people typically encounter a “more compressed, accelerated, and linear” transition to adulthood compared to their peers (Stein 2019, p. 400). In England and Wales, the statutory age for leaving care is 18 and, in 2023, around 13,000 young people left the care system on their 18th birthday (GOV.UK 2024). In comparison, the average age of a young person leaving their family home is 24 years old (Office for National Statistics 2024).

The process of transition is conceptualised as involving multiple and multi-dimensional components (Jindal-Snape 2023), and care-experienced young people face an elevated risk of experiencing disadvantages across manifold domains, including health, housing, education, and employment (Atkinson and Hyde 2019; Bakketeig et al. 2020). At 18, care-experienced young people are faced abruptly with major concurrent responsibilities associated with adulthood, such as the need to find accommodation and employment, managing their finances, and living independently. One survey of 474 young adults revealed that 20 per cent of those with care experience (aged 16–24) found it difficult to cope financially, more than twice the percentage (9 per cent) of their peers in the general population (Coram Voice 2020). A UK government report tracking the outcomes of vulnerable young people (GOV.UK 2023) discovered that eight years post-statutory education those with care experience were the subgroup least likely to have participated in higher education or gained employment and the most likely to be claiming state benefits. Strikingly, care-experienced young people are almost four times more likely to end up being NEET, not in education, training, or employment, than their non-care-experienced peers (Foulkes et al. 2023). Furthermore, being care experienced is a key differentiating variable in young people’s education and employment experiences, with evidence of marginalisation among this population that cannot be accounted for in terms of socio-economic status or educational attainment (Harrison et al. 2023). Worryingly, related research has shown that care-experienced adults are more likely to occupy a prison cell than a lecture theatre (Young and Lilley 2023).

Professionals working with care-experienced young people, and those with lived experience, have described the transition to young adulthood as a milestone akin to falling off a cliff edge (Barnardo’s 2024; Hughes 2024). Scoping review evidence (Feather et al. 2023) firmly suggests that the transition process could be better supported through targeted interventions for employment, education, and training (EET). However, certain gaps exist in regard to young people’s access to tailored information, advice, and guidance (IAG) and progression pathways (Foulkes et al. 2023). The I-CAN (Initiating and Supporting Care Leavers into Apprenticeships in Nursing) project was designed to help care-experienced young people in England (aged 18–30) to navigate the transitional ‘cliff edge’ into adulthood by offering a person-focussed pathway to training and employment, with dedicated support for their wellbeing. The current paper presents the preliminary findings from a pilot study involving the first cohort of I-CAN recipients. Although this research was conducted in England, the issues highlighted and the tentative findings will have wider resonance and international relevance.

1.1. Adversity and Barriers to Educational Progression

Care-experienced CYP do not comprise a homogeneous group and any links to poor educational or wellbeing outcomes are not deterministic. Nonetheless, they are often disadvantaged by their pre-care experiences, and these early exposures can inhibit the development of essential trusted relationships with adults (Home for Good 2021) and negatively impact on multiple outcomes across their lifespan (Sacker 2021; Young and Lilley 2023). For example, in England, care-experienced CYP are consistently less likely to do well academically than their peers, who have been brought up by their birth families, and international evidence supports the universality of poor educational outcomes in this population (Bakketeig et al. 2020; Jackson and Cameron 2011; Pecora 2012). In 2019, only 12% of pupils in England achieved Grade 5 or above in their GCSEs compared to 43% of their non-care-experienced counterparts (Ellis and Johnston 2024). To some degree, this pattern of low achievement can be explained by the disproportionate representation of care-experienced pupils with special educational needs and disabilities (SEND). Research by Meltzer et al. (2003) identified distinct SEND tendencies among this population, specifically, social, emotional, and mental health (SEMH) difficulties (in 40 per cent of cases) related to CYP’s unique experiences of trauma.

Although strong attention to the gap between the academic progress of care-experienced CYP and their peers is justified, it fails to consider how SEND (typically SEMH difficulties) and pre-care experiences have an impact on learning outcomes (Schooling 2017). Moreover, this oversight helps to generate a widely held misconception that being care experienced is inherently damaging and can exacerbate the stigma already felt by many CYP. Evidence has shown that care-experienced pupils perceived that they were being treated differently by their teachers compared to other children (Honey et al. 2011; Mannay et al. 2017). A lack of trust in adults and poor teacher–pupil relationships can lead to the underestimation of CYP’s abilities and hinder their access to education at the appropriate level (Ott and O’Higgins 2019). Researchers with lived experience of the care system have highlighted the prevalence of stigmatising narratives and negative stereotypes (Sprecher 2023). In a study involving 38 high-achieving young people who spent at least one year in the care system, one third believed that negative stereotypes and low expectations among professionals and care providers represented major obstacles that they had to overcome. Ultimately, academic support and encouragement from significant adults were seen as pivotal to their educational success, while one third of participants expressed a strong desire for a “guardian angel” to support and encourage them during their university career.

Concerningly, Foulkes et al. (2023) identified a recurrent, distrustful narrative amongst care-experienced young people towards some of the professionals whose remit was to support them. Rather than offer encouragement, some staff insinuated that due to their care experience, these young people should have narrow expectations for their future. Longitudinal labour market research from England revealed that many care-experienced young people were effectively “filtered into lower level options” post-16 (Harrison et al. 2023, p. 8), exposing persistent disadvantages and systemic failings in regard to inclusive education provision. Furthermore, care-experienced young people are less likely to have adult support when navigating job, college, or university applications and are more likely to encounter barriers during application processes, including in regard to transportation to open days, financial difficulties, and stigma (Sanders 2021). Cumulatively, these factors contribute to their over-representation in part-time, low-paid, and low-skilled employment (Furey and Harris-Evans 2021).

Official figures for England in 2023 showed that just 550 care-experienced individuals under the age of 19 (0.2 per cent of the total intake) enrolled in a university undergraduate course (Young and Lilley 2023). Applicants were three-quarters more likely to be aged 21, and twice as likely to be over 25, than those without care experience. In terms of programme choice, in 2022, compared to other applicants, those with care experience were 167 per cent more likely to apply for health and social care options, and 69 per cent more likely to apply for nursing or midwifery courses (UCAS 2022). Primary deterrents to university for care-experienced applicants were lower/non-standard entry qualifications (Stevenson et al. 2020), ongoing study costs, and a lack of support when navigating the application process (Office for Students 2022). One survey found that 60% of care-experienced respondents received no dedicated help relevant to their circumstances when deciding on their options (UCAS 2022). In the UK, bursaries and grants are available to support continuing education and independent living; however, these measures have been criticised as inadequate compensation for young people who have no familial safety net (Fortune and Smith 2021). Tellingly, the number one priority, applicants stated, when making their final choice of university, was the level of support available (Stand Alone and the Unite Foundation 2015).

Even if the many challenges associated with accessing higher education are surmounted, care-experienced students still face elevated risk of dropping out. One survey found that 68% of care-experienced university students had encountered difficulties and 51% considered leaving due to various factors, including financial worries, personal and family circumstances, health and socio-emotional issues, and concerns related to managing the workload (Ellis and Johnston 2019). Other evidence has shown that undergraduates with care experience are 10% less likely to progress from year one to year two, and are equally less likely to graduate with a good honours degree (Stevenson et al. 2020). Clearly, the transition to higher education (or other progression pathways) is a process that requires significant and ongoing personalised support for care-experienced young people, not only to make the transition, but also through and beyond. Pertinently, research by Foulkes et al. (2023) on the views of young people with care experience, found that although many respondents lacked definitive future career plans, they expressed a wide variety of aspirations and hopes. This led the authors to conclude that barriers to EET were not primarily motivational, but rather linked to capability, opportunity and support, factors that were outside of young people’s control and, moreover, that required systemic solutions.

1.2. A Pivotal Focus on Mental Wellbeing

Research on the inter-relationship between care experience and adversity has shown mental health difficulties, stemming from childhood trauma and instability (Sanders 2020), to be the root cause of other deep concerns, including educational inequality, unemployment, and social exclusion (Feather et al. 2023). Studies have consistently demonstrated the link between lived experience of the care system and poor mental (and physical) health outcomes (Sacker 2021; Young and Lilley 2023). Recent systematic review evidence revealed that care-experienced CYP demonstrate much higher rates of mental health difficulties and are more likely to develop a mental disorder than those CYP living with their birth families (Cummings and Shelton 2024). Strikingly, poor mental health was the most frequently identified barrier to EET (91.8 per cent of responses) in a survey of 112 organisations supporting care-experienced young people (Foulkes et al. 2023).

In terms of subjective wellbeing, research by the charity Coram Voice (2020) found that one in four (25 per cent) care-experienced young adults reported having low life satisfaction (compared to 3 per cent in the general population). In related research, isolation and loneliness were negative factors often identified during young adulthood; one in five care-experienced young people (aged 16–25) admitted to feeling lonely “always” or “most of the time” (compared to one in ten of those without care experience) (Baker 2019). Clearly, if young people’s mental health and wellbeing needs remain unmet, the risk of poorer outcomes increases, including fewer post-16 transition choices and reduced opportunities for progression across their lifespan (Sacker 2021).

In a study by the National Youth Advocacy Service (NYAS) (NYAS 2019), CYP articulated their experience of ‘care’ as a passive encounter, something that was done to them rather than actively constructed with them. Such prolonged lack of agency and subjugation to the decision-making of others can generate perceived abuses of trust which, in turn, creates a wariness about engaging with professionals. According to McCrory and Viding (2015), this reflects the neurocognitive system’s altered threat-processing response, which has adapted or altered its calibration due to early neglect or maltreatment. Crucially, while heightened neurocognitive vigilance to threat (manifested in distrust) can be functional in the short term, it is ultimately maladaptive, hindering CYP’s willingness to trust and engage with supportive adults, and there can be a reluctance or inconsistent engagement with interventions that are made available.

Conversely, Gilligan (2004) found that CYP who had a trusting relationship with an adult role model and long-term mentor were significantly more likely to be resilient in the face of difficulties. In related research, strong, positive, and safe relationships were flagged as universally central to the wellbeing and resilience of care-experienced young people (Eldridge et al. 2020). A focus on resilience has been credited with helping care-experienced young people to overcome some of the challenges associated with the complex transition to adulthood (Feather et al. 2023). Broader research on resilience (Zimmerman 2013) supports a major shift in focus from a deficit approach centring on an individual’s problems, towards an affirmative developmental lens that builds on personal strengths. Interventions that bolster resilience enable CYP to cope better with adversity, have more agency, and to think ahead and plan their lives (Gilligan 2019).

1.3. Tackling Poor Outcomes for Care-Experienced Young People

Clearly, the transition to young adulthood for those with care experience is de-stabilising. Understandably, young people may not prioritise their education or career when meeting their basic needs, such as securing stable accommodation and regular sustenance, is more pressing (Sanders 2021). Moreover, additional practical and psychosocial barriers may prevent care-experienced young people from accessing services for educational and career progression or support for their wellbeing needs. Feelings of stigma and bias by professionals and services were widely reported as deterrents to accessing healthcare and other support services (Who Cares? Scotland 2021). Evidently, practitioners need a greater awareness of the influence of care experiences on health factors and professional practice should be trauma informed (Braden et al. 2017; Sanders 2020). In particular, those working in education need a better understanding of how care experiences can affect a student’s learning and behaviour. Notably, young people themselves have called for all adults working with care-experienced CYP to receive mandatory mental health training on the negative effects of trauma (NSPCC Wales 2019). Feather et al. (2023) point out that the influence of education staff, employers, and training facilitators is negligible when a young person feels uncertain about the present and future; therefore, the relevance of understanding biographical narratives is imperative. Aligned with this personalised approach, EET provision should include a one-to-one component, ensuring that every young person feels prioritised (Foulkes et al. 2023), and educators, employers, and trainers must build relationships based on trust, understanding, and mutual respect (Arnau-Sabatés and Gilligan 2020).

It is universally understood that education is a key social determinant of health outcomes, personal development, and wellbeing (Bibby 2017; Hahn and Truman 2015). Therefore, schools, colleges, and universities should provide tailored support to address the holistic needs of care-experienced students, including appropriate interventions at key transition points to, through, and exiting different levels of education (Bibby 2017). Worryingly, evidence has shown that care-experienced young people typically lack knowledge about the available options and the application process, and often have low self-confidence in relation to EET (Foulkes et al. 2023). This is often compounded by the absence of a familial support network to provide practical help and encouragement. In line with a strong rationale for providing tailored assistance, UCAS (2022) recommended that all higher educational institutions (HEIs) should review their current practices and develop strategies that are student centred and student led, acknowledging the intersectionality of care experiences with other unique characteristics. Thus, recognising the importance of incorporating an understanding of power and difference in the provision of education. Moreover, ensuring that those involved in designing, delivering, and evaluating education programmes respect, assess, and respond to the uniqueness of each care-experienced young person and their individual circumstances (Hlungwani and van Breda 2022). The Initiating and Supporting Care Leavers into Apprenticeships in Nursing (I-CAN) project is underpinned by such an approach.

1.4. The I-CAN Project and Pilot Study

I-CAN is an innovative project funded by an Integrated Care Partnership and delivered through a HEI in England. It was developed in response to the raft of damming evidence highlighting the barriers that care-experienced individuals encounter in their transition to young adulthood and in regard to their EET progression. In particular, the project sought to tackle the lack of empathic support young people often encountered from key professionals and the inadequate practical and financial assistance available, which are known deterrents to engagement (Sanders 2021). Many training programmes offered to young people as a bridge into longer-term EET opportunities fail to provide sufficient renumeration to those without a financial safety net (Foulkes et al. 2023). Conversely, the I-CAN model was designed to be financially viable, offering a stipend and covering all learners’ expenses, including contact time, preparation hours, travel, and subsistence for campus-based sessions. In addition, a dedicated team of professionals provide proactive, tailored, and rolling transition support, with a focus on both academic skills and learners’ wellbeing. Recruits are likely to have experienced a fragmented educational and career journey to date, and the benefits of mentoring support in HEIs have been recognised (Clayden and Stein 2005). Moreover, a vital component of successful intervention models involves demystifying the notion of what a university is and who it is for, this involves welcoming care-experienced YP onto campus and nurturing a sense of belonging to a university community (Young and Lilley 2023). Youth empowerment has also been recognised as a central feature of effective interventions centred on EET (Nesmith and Christophersen 2014) and the design and delivery of the I-CAN programme promoted positive psychological wellbeing and empowerment.

The I-CAN intervention aims to provide care-experienced young adults with an opportunity to develop their skills and move into a nursing associate apprenticeship or an alternative progression pathway. The programme is delivered across eight consecutive sessions, one per week (3 h duration plus lunch), and broken down into ‘bitesize’ chunks (see

Table 1. Summary of the 8-week I-CAN programme.

Session	Topic	Overview and Learning Objectives
1	Welcome to the programme Introduction to health and social care careers Life as a student on a healthcare programme	To introduce the I-CAN programme; develop an awareness of the opportunities within health and social care; and gain insight into the life of a student
2	Introduction to the Wellbeing Team Wellbeing and learning	To introduce the Wellbeing Team and their service offer; develop an understanding of wellbeing and resilience and how wellbeing is linked to learning
3	The role of the healthcare student and person-centred care	To gain insight into the day-to-day life of a healthcare student, and to describe person-centred care and the importance of person-centred care
4	Infection control Delivering person–centred care	To define infection and understand the importance of infection control, and to describe how healthcare workers deliver person-entred care
5	Basic life support (BLS) Self-care and personal wellbeing	To understand the basic principles of BLS and practice the skills required in BLS; understand the importance of self-care and personal wellbeing; and introduce reflective practice
6	Working in healthcare–exploring healthcare roles Building your skills for work	To describe different health and social care roles and careers; build skills needed to gain employment in healthcare; and describe the responsibilities of working in healthcare
7	Communication skills for healthcare careers	To describe communication skills needed within healthcare; consider examples of good and bad communication; and interview preparation
8	Bringing it all together and scaffolding next steps	To celebrate completing the programme; review individual personal goals and progression plans; and signpost the next steps

for indicative content and Figure 1 for supporting activities). The group size is intentionally small (up to 15 learners) to enable the maximum level of personalised support and direct contact with the I-CAN delivery team.

The I-CAN theory of change (ToC) (Mills 2024) (see Figure 1) proposes that the recipients of the I-CAN intervention will achieve outcomes in learning and personal development domains and will successfully transition to a pathway in the healthcare sector (training, employment, or higher education), or otherwise, will transition to an alternative progression route, as the providers acknowledge that not all participants may decide to pursue a healthcare-related career. The current ToC is underpinned by a strengths-based approach, aligned with affirmative models (Gilligan 2019; Zimmerman 2013) and a positive psychology framework (Seligman and Csikszentmihalyi 2000). The I-CAN team adopts a trauma-informed pedagogy, acknowledging the importance of personal narratives (Hlungwani and van Breda 2022): teaching and learning is focused on building learner confidence and bolstering resilience to equip students with progression-ready skills and augment their wellbeing.

The target number of beneficiaries for the I-CAN project was 45 in total, divided across three cohorts. The first group of care-experienced young adults completed the programme in August 2024 and two subsequent cohorts will take part in the intervention in early 2025. The staggered delivery was designed to facilitate ongoing programme development, by building in preliminary feedback from the recipients involved in the first round. This approach permitted programme developments to arise organically and for them to be implemented for the benefit of subsequent cohorts. The current paper presents the findings from a pilot study involving the first iteration of the I-CAN programme, acknowledging that the potential value of any new interventions should be tentatively established first (Kabat-Zinn 2003).

The aims of the pilot study were to:

(1) Establish preliminary evidence for the effectiveness of the I-CAN programme in supporting the transition of care-experienced young adults into the health and social care sector through a progression route (i.e., training/employment/HE) or an alternative pathway;

(2) Test the suitability of selected measures and methods to demonstrate the effectiveness of the I-CAN programme; and

(3) Investigate the perceptions and experiences of I-CAN recipients to enhance programme development.

2. Materials and Methods

2.1. Design

The pilot research was an exploratory mixed methods, sequential quantitative→qualitative, equally weighted study design. This aligns with a pragmatic approach to research inquiries that encourages methodological triangulation and involves the use of complementary data collection methods to explore and explain complex human behaviour and provide a more balanced explanation of such behaviour (Mertens and Hesse-Biber 2012).

2.2. Participants

A purposive sampling method was used. Local authorities and relevant networks facilitated recruitment by disseminating information about the project. Professionals working with care-experienced young people referred candidate participants to the programme. A total of 25 young people expressed their initial interest by submitting an online request for further information. Screening interviews were conducted online by the I-CAN project manager to ascertain whether the candidates met the inclusion criteria (i.e., had lived care experience and an interest in pursuing a healthcare pathway). A taster event was held at the host university for young people who had expressed an interest in participating. From the 25 expressions of interest, 13 care-experienced young people subsequently accepted the invitation to take part in the I-CAN intervention; no candidates were declined, but one candidate failed to attend, and one later withdrew. The 11 young people who comprised the first cohort gave their consent to take part in the pilot research and were informed that if they declined, this would not preclude them from taking part in the intervention. The participants comprised: n = 3 males; n = 8 females; aged 19–30 years, M = 22 (3.17).

2.3. Measures and Methods

2.3.1. Quantitative Data Collection

The programme statistics and six well-validated, self-reported questionnaires were used to measure the proposed outcomes for young adults stated in the I-CAN ToC and were categorised according to two key domains: individual skills and knowledge acquisition; and personal development and wellbeing (see

Table 2. The outcomes proposed in the I-CAN ToC for young adults and the quantitative measures used.

Domain and ToC Outcome/s	Quantitative Measure/s
Individual skills and knowledge acquisition
Programme learning outcomes Gaining the right skills to enter health careers Perceptions and understanding of careers in the NHS	Programme completion and attendance data
Employment/training (progression route): Employment (financial independence)/other progression route (e.g., HE)	Progression data
Personal development and wellbeing
Mental wellbeing	The Subjective Happiness Scale (SHS) (Lyubomirsky and Lepper 1999); The Cantril Self-Anchoring Striving Scale/Ladder of Life (LOL) (Cantril 1965); Flourishing Scale (Diener et al. 2009)
Positive self-image and empowerment	The Rosenberg Self-Esteem Scale (Rosenberg 1965); The General Self-Efficacy Scale (Schwarzer and Jerusalem 1995); The Brief Resilience Scale (BRS) (Smith et al. 2008)

). The personal development and wellbeing measures were selected on the basis of their suitability for examining specific outcomes proposed in the I-CAN ToC (i.e., wellbeing and positive self-image and empowerment) and their robust psychometric properties (see Section 2.3.2). Furthermore, self-reported measures were deemed the most appropriate method to access the participants’ subjective experiences and internal states (Corneille and Gawronski 2024), while the brevity of each questionnaire mitigated the potential negative effects of participant fatigue (Ashley 2021).

2.3.2. Summary of Selected Validated Measures

The Subjective Happiness Scale (SHS) (Lyubomirsky and Lepper 1999) is a 4-item scale of global subjective happiness; scores for each item range from 1 to7, with a higher score indicating greater happiness. Two items ask respondents to characterize themselves using both absolute ratings and ratings relative to their peers, whereas the other two items offer brief descriptions of happy and unhappy individuals and ask respondents the extent to which each characterisation describes them. The SHS possesses good internal consistency (alphas ranging from 0.79 to 0.94) and good test–retest reliability (r = 0.55 to 0.90), and substantially correlates with other measures of happiness and wellbeing.

The Cantril Self-Anchoring Striving Scale (Ladder of Life) (Cantril 1965) measures an individual’s current level of happiness (experiencing self) and future (reflecting self) on a scale of 1–10, with a higher score indicating greater happiness. The general tendency is for respondents to provide more optimistic views of the future than the present. Three distinct (and independent) groups were devised for summary purposes: ‘Thriving’ describes wellbeing that is strong, consistent, and progressing with scores of 7+ (current) and 8+ (future); ‘Struggling’ describes wellbeing that is moderate or inconsistent; and ‘Suffering’ describes wellbeing that is at high risk, with scores of 4 and below (present and future).

The Flourishing Scale (Diener et al. 2009) is a brief 8-item summary measure of an individual’s self-perceived success in important areas of life, such as relationships, self-esteem, purpose, and optimism; scores for each item range from 1 to 7, with a higher score indicating greater wellbeing. The possible total range of scores is from 8 (lowest possible) to 56 (highest possible). A high score represents a person with many psychological resources and strengths. The scale provides a single psychological (eudaimonic) wellbeing score and has a Cronbach’s alpha of 0.87 and a temporal stability over one month of 0.71.

The Rosenberg Self-Esteem Scale (Rosenberg 1965) is designed to measure individual self-esteem and is the most widely used self-reported measure of its kind. It contains 10 statements that pertain to self-worth and self-acceptance, with a four-point response scale ranging from “strongly agree” to “strongly disagree”. A body of evidence supports the scale’s structural and predictive validity, as well as its good internal consistency and test–retest reliability (Schmitt and Allik 2005; Torrey et al. 2000).

The General Self-Efficacy Scale (GSE) (Schwarzer and Jerusalem 1995) was created to assess a person’s general sense of perceived self-efficacy, with the aim of predicting how they cope with daily hassles, as well as how they adapt after experiencing various stressful life events. The scale has 10 items, with a four-point response scale ranging from “not at all true” to “exactly true”, and is designed for the general adult population. The construct of perceived self-efficacy reflects an optimistic self-belief that one can perform novel or difficult tasks, or cope with adversity. The scale has demonstrated high internal consistency (alphas ranging from 0.75 to 0.91) with a test–retest reliability of r = 0.55 to r = 0.75 (Scholz et al. 2002).

The Brief Resilience Scale (BRS) (Smith et al. 2008) is a 6-item tool designed to measure resilience in regard to its original meaning (an individual’s ability to recover from stress), utilising a five-point response scale, ranging from “strongly agree” to “strongly disagree”. A lower score means a lower level of resilience. The scale has strong internal consistency (alphas ranging from 0.71 to 0.85) and test–retest reliability. The unidimensional nature of the BRS makes it ideal for specifically measuring resilience with minimal complexity (Rösner et al. 2024).

2.3.3. Qualitative Data Collection

An in-person focus group was chosen to explore the participants’ perceptions and experiences of the I-CAN intervention, namely to gauge the satisfaction levels, including the participants’ sense of personal achievement (see Figure 1 ToC), and identify potential areas for improvement. Employing a qualitative method enabled triangulation of the quantitative findings and a more comprehensive understanding of them in relation to the research aims (Patton 1999). Specifically, this approach enabled scrutiny of the quantitative findings regarding the programme and the personal development and wellbeing outcomes. In addition, the qualitative component enabled insight to be gained into underlying process issues and potential key ‘ingredients’ of the I-CAN intervention, which can be extrapolated to refine the current ToC.

A focus group method was selected as the most appropriate qualitative technique, as it was intended to be primarily led by participants and to centre on the issues most meaningful to them. A topic guide was designed to focus the discussion and questions were organised in key areas: expectations and motivations for joining the programme (example: why did you decide to join this programme?); barriers to participation (example: are there any barriers that young people with care experience face in regard to joining programmes like I-CAN?); perceptions and experience of the programme (example: how would you describe the I-CAN programme to a friend or another young person?); the difference the project made (example: do you think that you, personally, have more opportunities for work/study than before you completed the programme?); and recommendations for change (example: if we conducted a programme like this again, what, if anything, should we change?).

2.4. Procedure

Full ethical approval was granted by the University of Roehampton’s ethics committee. The data were collected in line with the standards set out in the Declaration of Helsinki (2013) and in accordance with the guidance from the British Psychological Society (BPS) (British Psychological Society 2021). Written consent was provided by the study participants for the quantitative and qualitative data collection. The baseline data on the six self-reported quantitative measures were collected manually at the start of the programme (Time 1 [T1]) by the researcher. Participant ID numbers were used on the questionnaires to protect participants’ anonymity. The 8-week I-CAN programme (one, 3 h session on consecutive weeks) was delivered at the host HEI. Weekly taught sessions (theory and practical) took place in the same location (designed for small classes) on the university campus to offer a comfortable and regular learning space. The majority of the teaching was delivered by the same lecturer from the school of nursing for consistency, and additional content was provided by healthcare practitioners. The small group size enabled participant understanding and engagement with the content to be formatively assessed on a rolling basis. If extra support was identified or requested (e.g., print copies of slides), this was supported on an individual basis. Additional activities included a site visit to a healthcare provider and careers talks (see Table 1). Ongoing support was available on request from the university wellbeing team. The I-CAN project manager and the project assistant provided one-to-one mentoring throughout the programme, so each young person received individual support and attention. The design and delivery features were intended to help foster a sense of belonging to the group and to promote engagement. Repeated quantitative measurements were collected at the end of the programme (Time 2 [T2]).

The qualitative data were collected after the final session. A focus group was facilitated by the researcher and was approximately 45 min in duration. All 11 young people who completed the programme participated in the final session. A question schedule was used to help guide the discussion (see Section 2.3.3. for example questions). The researcher regularly employed member checking (Lincoln and Guba 1985) to ensure that the respondents’ views were accurately interpreted. The session was audio recorded. The qualitative data were transcribed verbatim by the researcher. Attendance and progression data were collated. Independent analyses were undertaken, appropriate for the type of data collected (statistical analysis using SPSS v29 for the quantitative data and inductive–deductive thematic analysis (TA) (Fereday and Muir-Cochrane 2006) for the qualitative data). The findings were integrated into the discussion in line with a well-established approach (Stange et al. 2006).

2.5. Analysis of Focus Group Data

The inductive–deductive, hybrid TA comprised a deductive component, which was driven by the research aims and guided by the extant literature, specifically facilitators and barriers to care-experienced young people’s successful transition and progression in regard to EET. In tandem, the inductive component gave priority to the voices of focus group participants through open coding and ensured that the respondents’ meanings were accentuated. The analytical framework by Braun and Clarke (2006) was adopted, involving a six-stage process. Step 1 involved familiarisation. The transcript was read multiple times, and the audio recording was reviewed in order for the researcher to become highly familiar with the content, and initial notes were made. Step 2 involved the generation of initial codes. Preliminary codes were inserted alongside excerpt examples and comprised both “in vivo” and descriptive codes. Step 3 involved the search for candidate themes. Initial codes were actively combined or collapsed and organised into potential superordinate themes and subthemes. Step 4 involved the review of candidate themes. A recursive review of all the potential themes in relation to the coded extracts and across the complete dataset was undertaken to ensure that the participants’ voices were well represented and consistency was established, indicating that thematic saturation had been reached. Step 5 involved the final labelling of themes. The essence of each theme was captured clearly and concisely during the final labelling process, with some minor adjustments made to the names. Step 6 involved producing the report. An analytic narrative and selected data extracts were combined to produce a coherent, logical, and traceable account of the findings (Lincoln and Guba 1985).

3. Results

3.1. Quantitative Results

3.1.1. Individual Skills and Knowledge Acquisition

The proposed learning outcomes stated in the ToC, namely ‘gaining the right skills to enter a career’ and ‘perceptions and understanding of careers in the NHS’ were formatively assessed on a weekly basis by the session instructor. Achievement of the proposed learning outcomes was, therefore, indicated by all 11 participants that successfully completed the I-CAN programme and who demonstrated high overall attendance rates (see

Table 3. I-CAN programme: participant attendance data.

Participant n = (Total 11)	Attendance % (Total 8 Weeks)
4	100%
4	87.5%
2	75%
1	62.5%

Of the 11 participants, 10 had an attendance rate of 75% or above: M = 81.25 (16.14).

). Positive outcomes related to employment, training, or other routes towards financial independence (e.g., a HE course) were shown by the progression data (see

Table 4. I-CAN programme: participant progression routes.

Participant n = (Total 11)	Progression Route
3	Employment/training: Level 2 Healthcare assistant apprenticeship
1	Higher education course
2	Higher education deferral until 2025/6 academic year (applying for employment)
1	Further training (short course)
2	Actively seeking employment
2	Higher education application pending *

* To be confirmed.

).

Seven participants had a specified transition pathway at the end of the I-CAN programme (a further two were to be confirmed at the time of writing) and two were actively seeking employment.

3.1.2. Personal Development and Wellbeing Outcomes

The proposed participant outcomes stated in the ToC, namely ‘mental wellbeing’ and ‘positive self-image and empowerment,’ were mapped to well-validated self-reported measures (see Table 2). The Cronbach alpha coefficient (α) for the selected self-reported measures showed good internal consistency in line with the literature: The Flourishing Scale α was 0.83; the Rosenberg Self-Esteem Scale α was 0.92; the General Self-Efficacy Scale α was 0.92; and the Brief Resilience Scale α was 0.73. As the Subjective Happiness Scale has less than five items, reporting the α is not recommended, but rather the inter-item correlation, which was 0.26 and was deemed to be within the optimal range (Briggs and Cheek 1986). The descriptive statistics (mean and standard deviation) for the self-reported measures were calculated at the baseline (T1) and post-test (T2) (see

Table 5. Descriptive statistics for the Subjective Happiness Scale.

Item	Mean (SD) T1	Mean (SD) T2
1. In general, I consider myself…	5.09 (1.51)	5.73 (1.74)
2. Compared to most of my peers, I consider myself…	4.91 (1.30)	5.36 (1.63)
3. Some people are generally very happy… to what extent does this characterization describe you?	4.09 (2.02)	4.64 (1.86)
4. Some people are generally not very happy… to what extent does this characterisation describe you?	4.91 (1.64)	4.36 (2.01)
Total Subjective Happiness Score	4.75 (1.07)	5.02 (1.23)

,

Table 6. Descriptive statistics for the Cantril Self-Anchoring Striving Scale.

Item	Mean (SD) T1	Mean (SD) T2
Best possible life now	6.4 (2.01)	6.7 (1.33)
Best possible life future (5 years)	9.1 (1.52)	9.1 (1.20)

,

Table 7. Descriptive statistics for the Flourishing Scale.

Item	Mean (SD) T1	Mean (SD) T2
1. I lead a purposeful and meaningful life	5.45 (1.97)	5.54 (1.75)
2. My social relationships are supportive and rewarding	5.55 (1.51)	5.73 (0.90)
3. I am engaged and interested in my daily activities	5.55 (1.19)	5.82 (0.87)
4. I actively contribute to the happiness and wellbeing of others	5.45 (1.92)	5.45 (1.37)
5. I am competent and capable in the activities that are important to me	6.18 (1.25)	6.45 (0.52)
6. I am a good person and lead a good life	6.0 (1.41)	6.27 (1.19)
7. I am optimistic about my future	6.0 (1.55)	5.64 (1.36)
8. People respect me	5.0 (1.51)	5.36 (1.12)
Total score (8 lowest possible; 56 highest possible)	45.18 (8.40)	46.27 (5.71)

,

Table 8. Descriptive statistics for the Rosenberg Self-Esteem Scale.

Item	Mean (SD) T1	Mean (SD) T2
1. On the whole I am satisfied with my life	2.09 (0.70)	1.55 (1.13)
2. At times, I think I am no good	1.64 (1.03)	1.64 (1.03)
3.I feel that I have a number of good qualities	2.37 (0.81)	2.18 (0.75)
4. I am able to do things as well as most other people	2.18 (0.75)	1.90 (0.83)
5. I feel I do not have much to be proud of	2.0 (1.0)	2.18 (0.75)
6. I certainly feel useless at times	1.45 (0.93)	2.0 (1.10)
7. I feel that I’m a person of worth, at least on an equal plane with others	2.09 (1.04)	2.27 (0.90)
8. I wish I could have more respect for myself	1.64 (0.92)	1.55 (1.04)
9. All in all, I’m inclined to feel that I am a failure	2.09 (0.70)	2.55 (0.93)
10. I take a positive attitude toward myself	2.27 (0.79)	2.36 (1.03)
Total score (0 lowest possible; 30 highest possible)	19.82 (6.71)	20.18 (6.61)

,

Table 9. Descriptive statistics for the General Self-Efficacy Scale.

Item	Mean (SD) T1	Mean (SD) T2
1. I can always manage to solve difficult problems if I try hard enough	3.18 (1.09)	3.45 (0.69)
2. If someone opposes me, I can find the means and ways to get what I want	2.27 (0.79)	2.0 (1.0)
3. It is easy for me to stick to my aims and accomplish my goals	3.18 (0.87)	3.18 (0.60)
4. I am confident that I could deal efficiently with unexpected events	3.0 (1.18)	3.0 (0.89)
5. Thanks to my resourcefulness, I know how to handle unforeseen situations	3.45 (0.69)	2.91 (0.94)
6. I can solve most problems if I invest the necessary effort	3.45 (1.04)	3.18 (0.87)
7. I can remain calm when facing difficulties because I can rely on my coping abilities	3.18 (0.98)	3.0 (1.0)
8. When I am confronted with a problem, I can usually find several solutions	3.18 (1.08)	3.09 (1.04)
9. If I am in trouble, I can usually think of a solution	3.18 (1.25)	3.09 (1.04)
10. I can usually handle whatever comes my way	3.09 (0.94)	2.81 (0.87)
Total score (10 lowest possible; 40 highest possible)	31.18 (7.71)	29.72 (7.09)

and

Table 10. Descriptive statistics for the Brief Resilience Scale.

Item	Mean (SD) T1	Mean (SD) T2
1. I tend to bounce back quickly after hard times	3.81 (0.98)	4.0 (0.77)
2. I have a hard time making it through stressful events	3.0 (1.18)	3.09 (1.22)
3. It does not take me long to recover from a stressful event	3.36 (1.12)	3.82 (0.87)
4. It is hard for me to snap back when something bad happens	3.64 (1.03)	3.55 (1.13)
5. I usually come through difficult times with little trouble	3.45 (1.04)	3.0 (1.18)
6. I tend to take a long time to get through setbacks in my life	3.64 (0.92)	3.73 (1.10)
Total Brief Resilience Scale Score	3.48 (0.75)	3.53 (0.69)

).

Overall, the results showed a slight increase in the total mean subjective happiness scores from T1 to T2 (see Table 5). However, the Wilcoxin Signed Rank Test did not show a statistically significant increase in the subjective happiness scores over time: z = −0.893, p > 0.05.

Although there was little change in the scores on the Cantril Self-Anchoring Striving Scale from T1 to T2 (see Table 6), more participants were in the ‘thriving’ category at T2 (n = 6) than at T1 (n = 4), according to their ‘life now’ assessments (one participant did not respond). However, the Wilcoxin Signed Rank Test did not show a statistically significant difference in the levels of reported happiness for ‘now’ or the ‘future’ (in 5 years) prediction from T1 to T2. In line with the literature, at both time points, there was a statistically significant increase in the reported happiness ‘now’ and the ‘future’ predictions, T1 was z = 2.55, p < 0.05; T2 was z = 2.75, p < 0.01.

There was a slight increase in the total flourishing scores from T1 to T2 (see Table 7). The median T1 flourishing score remained stable at 48 at T2; however, the lowest individual score at T1 (34) had increased by 14 points at T2 (48). Nonetheless, the Wilcoxin Signed Rank Test did not show a statistically significant difference in the flourishing scores from T1 to T2: z = −0.26, p > 0.05.

Overall, there was a slight increase in the total self-esteem scores from T1 to T2 (see Table 8). In terms of score boundaries, more respondents were in the ‘high’ group at T2 (n = 8) than at T1 (n = 6). However, the Wilcoxin Signed Rank Test did not show a statistically significant difference in the self-esteem scores over time: z = −0.102, p > 0.05.

There was a slight decrease in the total general self-efficacy scores from T1 to T2 (see Table 9). However, the Wilcoxin Signed Rank Test did not show a statistically significant difference in the self-efficacy scores over time: z = −1.13, p > 0.05.

The total mean brief resilience score increased marginally from 3.48 to 3.53 (see Table 10) and remained in the ‘normal category’. However, in terms of individual categories, two respondents had shifted from the ‘low’ to the ‘normal’ band at T2 (n = 8), with only two participants in the ‘low’ band at T2 compared with four in the ‘low’ band at T1. However, the Wilcoxin Signed Rank Test did not show a statistically significant difference in the scores over time: z = 0, p > 0.05.

3.2. Qualitative Findings

A hybrid inductive–deductive thematic analysis (Fereday and Muir-Cochrane 2006) of the focus group data yielded five superordinate themes: the I-CAN learner; barriers to access/continuation; facilitators (core ‘ingredients’); the I-CAN graduate; I-CAN development (the learner’s voice) (see

Table 11. Table of themes: perceptions and experiences of I-CAN recipients.

Superordinate Theme	Subtheme	Illustrative Quotation
The I-CAN learner	Expectations	“To network and build relationships” (Charlotte)
	Commitment	“We attend because we want to be here and I think, everybody knows individually what they’re getting out of it for themselves” (Jasmine)
	Uniquely non-traditional	“It was never really something that I expected to do, so it was my sister who encouraged me” (Alison)
Barriers to access/ continuation	Practical	“I can say childcare [is a barrier]” (Sissy)
	Psychological	“Like you know, university/college, that was never really an option for me” (Alison)
Facilitators (core ‘ingredients’)	Learning environment	“We’ve learnt skills and feel very relaxed” (Blessing)
	Delivery agent(s)	“[They] made you feel comfortable and made you feel at home” (Charlotte)
	Delivery style	“The way they break things down” (Sarah)
	Content	“They took us to visit different places like a nursing home, and gave us opportunities to meet different people and hear about their professions” (Callum)
The I-CAN graduate	Knowledge acquisition and skills development	“[I’ve learnt] communication skills, people skills for social care” (Blessing)
	Personal development	“It’s been quite good for me personally, without even thinking about the options that come afterwards (Alison)
	Goal fulfilment	“I was thinking [at the start], I’m going to do this [I-CAN] and this will guide me - and I have done it!” (Sky)
I-CAN Development (the learner’s voice)	Messages to the next cohort	“You never know until you try” (Sky)
	Adaptation and evolution	“The number of weeks – it wasn’t enough, I would love [it] for three months” (Jasmine)

). Pseudonyms have been used to maintain participants’ anonymity.

Presentation of Themes

Theme 1: The I-CAN learner

The first superordinate theme, ‘The I-CAN learner,’ refers to the distinctive profile of the care-experienced young adults who attended the programme. ‘Expectations’ is one of three subthemes identified. Participants had begun the I-CAN programme with specific ideas of what they hoped to get out of it. For Richard, it was becoming better informed about working in the health sector, in line with the programme’s core focus, “I was hoping to find out more about healthcare”, while Charlotte was looking for guidance in terms of personal career planning: “To try and find an answer at the end of it in terms of what career path to go into”. The broader benefits of attending, including exposure to a range of future pathways, were recognised: “…even if it [my original idea] does change, then just having the guidance and just having different avenues of what you may do [is helpful]”. Similarly, for Jasmine, “This may take me to my new place or to an apprenticeship that I can get into properly”. Overall, participants’ expectations were linked to employability-oriented goals. As such, they were generally highly motivated to engage in the programme, seeing it as a valuable opportunity to access professional pathways, network, and build relationships. This perception of the I-CAN programme is manifest in the second subtheme, ‘Commitment’. Young people expressed how keen they were to make the most of the programme; they were prepared to adapt their daily routines and proactively try to mitigate any obstacles: “I put something in place so I could basically not miss out on the new [experience]; I knew it would be a good opportunity to definitely put my foot in [healthcare careers]” (Jasmine). Participants attended because “we want to be here”, and for Charlotte, commitment to the programme was embedded in a personal sense of wanting to see things through:

There were certain days and I just kind of felt like I don’t want to let myself down, I need to see it through today. And so, if I start something, I always try and finish it. So, I just kind of felt, you know, I was getting here late on some days, and I just thought, nope, I don’t care what time I get here, I’m still coming because I’ve told myself I’m coming.

The final subtheme, ‘Uniquely non-traditional’, encapsulates some of the shared legacy of being a care-experienced learner and a non-traditional student juxtaposed with individual influences. This subtheme highlights the heterogeneity of participants and some of their unique motivations for choosing to take part in the I-CAN programme. For example, for several young people, the notion of being a student and university life was not something that they had associated with their own prospects, and low expectations regarding post-compulsory educational options were voiced: “I was planning to finish school and then work” (Alison). However, individual circumstances prompted participants to re-evaluate their learning potential and progression pathways. For example, in the case of Alison, this was encouragement from a sibling. Whereas, having the guarantee of a secure destination at the end of the programme was particularly important for Sarah. Removing the risk of an uncertain future with the reassurance of a supported pathway enabled Sarah to embrace the learning opportunity: “When I started I was really scared that I might not end up applying [for a healthcare course], when I found out that I was able to I was really pleased, I’m so happy!” (Sarah).

Theme 2: Barriers to access/continuation

The second superordinate theme, ‘Barriers to access/continuation’, encompasses some of the significant obstacles that care-experienced young people often encounter in completing educational programmes, such as I-CAN, which are compounded by the absence of a familial safety net. The first subtheme, ‘Practical barriers’, includes shared and individual challenges that recipients have to deal with. For example, a minority of participants had young children and arranging childcare around attending the programme was a critical issue and a financial burden. This was aggravated by travel disruptions, which also affected others travelling longer distances. Another pressing concern was having to juggle existing work commitments with the demands of the programme: “[I worried about] balancing the [I-CAN] work and then doing my job” (Jasmine). In addition, not all participants were native English speakers, and this presented another type of difficulty: “For me, English is not my first language but after one lesson or two lessons I was able to understand” (Blessing). The second subtheme, ‘Psychological’ barriers’, is closely related to the non-traditional student profile of care-experienced learners. In particular, this related to young people’s perceptions of the physical learning space and student life and their own sense of belonging in relation to a university environment. Additional, inter-related psychological factors emerged, which potentially impede continuation and progression, such as low self-esteem and self-efficacy: “I was a bit doubtful, a bit lacking in confidence” (Sissy). This was exacerbated by genuine fears around the uncertainty of the next steps: “It was just something at the back of my mind… So it was just like, am I going to get a place at the end?” (Sarah).

Theme 3: Facilitators (core ‘ingredients’)

The next superordinate theme, ‘Facilitators (core ‘ingredients’)’, comprises the underlying components or facilitators specific to the I-CAN programme that contribute to its effectiveness. Four inter-related subthemes were identified. ‘Learning environment’ refers to both the physical space and the social milieu. Participants unanimously described a relaxed and comfortable environment. The intentionally small-sized cohort and high staff–student ratio helped to engender a sense of belonging to the new learning community: “I like that [class discussions/reflections at the end of each session] because it makes me feel like, OK, everyone is learning together” (Richard). Learning was described as a genuinely satisfying experience: “It was very enjoyable, if there was anything [I didn’t like], I would probably not come back every single week” (Jasmine). ‘Delivery agent(s)’ (DAs) were pivotal to the success of the programme and the primacy of the teacher–learner relationship was highlighted: “Thank you, [name of DA] just for coming with your fatherly energy that we had every Wednesday” (Charlotte). Key DA skills were elicited and included sensitivity to students’ unique needs and adopting a personalised approach to every learner: “[name of DA] has been able to access what we think’s working, what’s not? It’s always, ‘What would you like to do?’ ‘What is helping you?’ ‘What can work best for you?’” (Charlotte). In addition, the dedication and joined-up approach of the whole programme team was applauded: “I want to say a big thank you to the team and everyone involved who have really supported every one of us” (Sissy). And: The whole team—just how everyone is in sync with each other—I think overall, if it didn’t work like that, I think it would show, and I feel everyone’s together”.

‘Delivery style’ describes the pedagogical approach employed by the lead DA and other contributors to the programme. Teaching was not didactic, and an interactive and reflective learning environment was actively encouraged: “Like at the end of the lesson, we will talk about what we learned today” (Richard). This constructivist approach helped to foster young people’s confidence and independence: “They let you learn and interact, and also like find out what you want to do” (Sarah). In addition, “Nothing was ever forced upon us. If you wanted to do this course, you had the option to do it, and if you didn’t then we could just leave” (Charlotte). The final subtheme, ‘Content’, refers to the different elements of the taught programme and the balance of theory, practical skills, and field trips. Some participants were positively surprised by the practical component: “I didn’t expect as much practical work, and that was a good thing” (Callum). The opportunity to visit potential employment settings was seen as a real benefit: “Going to see the hospital and getting that first-hand experience” (Sky). For some participants this helped to affirm their career ideas:

I would say it gave me like the sense for what I wanted to do, talking to staff and just seeing, if this is the job I want to do. And when they [staff] described the job, yeah, I really liked that. It basically gave me, you know, like a sense of that’s what I’m going to be. So, not just the opportunity to see the place, but to speak to the people there when they’re actually doing the job as well (Alison).

Conversely, for others, the site visit to a hospital facility had the opposite effect: “[I know] I don’t want to do it! [work in a hospital environment]” (Sky). Nonetheless, regardless of the theoretical, practical, or field-based nature of the sessions, participants generally conferred that, “Every session we’ve had something [good] to take away from it” (Charlotte).

Theme 4: ‘The I-CAN graduate’

The next superordinate theme, ‘The I-CAN graduate’, encapsulates the learning and personal development experiences of the first I-CAN cohort. The subtheme, ‘Knowledge acquisition and skills development’ is linked to the intended learning outcomes. For some participants, their responses could be mapped directly to their expectations before joining the programme. For example, Richard reflected on the main skills and understanding he had acquired over the previous eight weeks: “Learning about the healthcare system and possibilities [for next steps] after we finish”. In addition, the acquisition of softer skills was reported including organisational, communication, and people skills. For example, “I can kind of plan around [things] and have structure” (Charlotte) and “[I’ve learnt] like the interview skills, the STAR method” (Sissy).

‘Personal development’ encompasses young people’s individual psychosocial development and subjective wellbeing. As Charlotte reflected:

I think that in the time frame we’ve done a lot and we’ve learned a lot. We’ve been able to identify quite a lot of things, even within ourselves. I think it’s made me have a lot more patience because little things like [travel disruptions] can just put a roadblock and you can just be like, ‘You know what? I’m late. I’m not going to go today or do that.

Another participant admitted, “I wasn’t actually going to go ahead and stay for the whole 8 weeks” (Sky). Nonetheless, Sky showed resilience and was able to complete the programme with “lots of encouragement from other people”. For Alison, her achievement gave her added joy as she felt this would instil pride in someone close to her (her sister), who had initially encouraged her to join the I-CAN programme: “I thought, ‘she’s going to be proud of you then,’ doing this now”.

The final subtheme, ‘Goal fulfilment’, relates to the participants’ sense of individual accomplishment, facilitating positive next steps. For Jasmine: “Finding what opportunity is the best thing for me was what I was going to investigate, you know, and so now I feel like my goal was achieved”. For Richard: “[I’ve achieved my goal] to complete the programme and be ready for next steps”. Other participants had been less certain at the start of the programme, but despite their initial scepticism, felt they had benefitted from attending the programme:

I didn’t really know whether to do this course or what mine [goal] was. I didn’t really believe it and just thought, ‘let’s see where it leads’ and well… but the opportunities to have good skills I think are brilliant (Alison).

Theme 5: ‘I-CAN development (the learner’s voice)’

The final superordinate theme, ‘I-CAN development (the learner’s voice)’, encapsulates the young people’s legacy. Firstly, the subtheme, ‘Messages to the next cohort’, refers to guidance passed on to future potential beneficiaries of the I-CAN programme. The participants were overwhelmingly positive about their experiences of the programme and encouraged other care-experienced young people to put aside any reservations and embrace the opportunity: “Just give it a try and see if you like it” (Sky) and “Take the risk” (Charlotte). Further recommendations were put forward that related to maximising the potential benefit: “I would say, the more questions you ask the better for you; be very active in the programme” (Jasmine) and “Take advantage of every opportunity they give you and like everyone was saying before, there’s really no risk in joining…The more you come, the more you learn and the more you want to come back” (Charlotte).

The second subtheme, ‘Adaptation and evolution’, refers to recipients’ views on how to improve the I-CAN intervention. The young people involved universally expressed a preference for the programme to be longer, with suggestions for extending it to three months, although, “It still works [with less time]” (Charlotte). For others, some minor tweaking of the schedule was proposed, for example, to dedicate more time to the non-theory components: “I would say even more practical work” (Richard) and “To see other work environments, like different things we’ll be dealing with, you know, like at the hospital” (Jasmine). In terms of ensuring an inclusive learning space, one participant advised that everyone should be mindful of students for whom “English is not [their] first language” (Sissy).

4. Discussion

Care-experienced young people are substantially more likely to become NEET than their non-care-experienced peers in the UK and internationally (Foulkes et al. 2023); moreover, care experience has been identified as a key differentiating variable in the education and labour market experiences of this population (Harrison et al. 2023). Cleary, there are gaps in support for care-experienced young people to navigate transition pathways, while access to information, advice, and guidance appears to be sorely lacking (Foulkes et al. 2023). Effective interventions are needed to provide targeted support and facilitate the successful transition to EET pathways. Such interventions should be well-designed to address the specific needs of care-experienced young people, while recognising intersectionality and the unique characteristics of individual learners. The I-CAN programme is a brief, 8-week intervention, specifically designed for care-experienced young people to achieve learning and personal development outcomes and facilitate their transition to EET in the healthcare sector or elsewhere. The aims of the current pilot evaluation were three-fold: to establish preliminary evidence for the effectiveness of the I-CAN programme; to investigate the perceptions and experiences of the I-CAN recipients; and to test the suitability of the selected measures and methods for future evaluation research.

The current exploratory pilot study used a mixed methods approach, informed by an understanding that methodological triangulation can increase the credibility and validity of research findings (Cohen et al. 2017). The sequential quantitative→qualitative design allowed qualitative insights to be gathered to help contextualize the quantitative findings and tentatively explore underlying process issues. The integration of the analyses in the discussion permits an enhanced presentation of cross-cutting findings that involve both quantitative and qualitative data (Stange et al. 2006). In the current study, the integrated findings showed that further to completing the brief, 8-week intervention, seven of the care-experienced young adults had transitioned to a confirmed progression route (EET), two were intending to apply for a HE course, and two were actively seeking employment. Therefore, support for the effectiveness of the I-CAN programme in facilitating recipients’ successful transition to EET was tentatively established. The specific programme outcomes stated in the I-CAN theory of change (ToC) (Mills 2024) are first discussed with respect to two key domains: individual skills and knowledge acquisition, and personal development and wellbeing. A discussion of the findings has been broadly organised under these domains to remain grounded in regard to the ToC framework, while also contextualised in regard to the wider literature. Potential barriers and core ‘ingredients’ of the I-CAN intervention are then considered to explore underlying process issues and potential developments, including future research.

4.1. Individual Skills and Knowledge Acquisition: Establishing Effectiveness

The completion, attendance, and progression data indicated that the first cohort of participants in the I-CAN intervention successfully achieved specified learning outcomes: gaining the right skills to enter healthcare-related careers, increasing their perception and understanding of careers within the NHS, and a positive progression pathway (EET) towards financial independence. Participants were formatively assessed on a weekly basis to monitor their knowledge and skills development and support their learning experience. Thus, participants’ attendance, completion, and progression rates comprised key outcome indicators. Moreover, 100% of the cohort completed the programme, with 10 out of the 11 participants achieving an attendance rate of 75% or above (mean attendance 81.25%). For comparison, attendance in regard to HE programmes is typically expected to be above 80%, with less than 70% considered a cause for concern (Think Student 2022).

The current findings suggest that the I-CAN programme had satisfied met the young people’s expectations and their personal learning goals were met. The design of the programme and the strength of the content provided participants with the skills and knowledge needed to proceed to the next transition stage (EET) that was personally appropriate for them. Beyond academic knowledge and understanding, the acquisition of softer skills was reported by participants, including organising, communication, and people skills, which are pivotal to health worker roles, but can also be applied across multiple professions and sectors. Collectively, these findings suggest that the social validity of the I-CAN intervention, namely recipients’ satisfaction with the goals, procedures, and outcomes of intervention programmes (Wolf 1978), has been tentatively established.

4.2. Personal Development and Wellbeing: Establishing Effectiveness

Alongside the predicted learning outcomes, participants of the I-CAN intervention benefited in terms of their personal development outcomes, specifically mental wellbeing and positive self-image and empowerment. Self-reported measures of subjective wellbeing (the Subjective Happiness Scale (Lyubomirsky and Lepper 1999), the Cantril Self-Anchoring Striving Scale (Cantril 1965), and in regard to eudemonic wellbeing (the Flourishing Scale (Diener et al. 2009)), showed slight increases in terms of the scores at the baseline (T1) to post-test (T2), although all three failed to demonstrate statistical significance (p > 0.05). Nonetheless, closer scrutiny of the individual changes revealed that in terms of subjective wellbeing, more young people had shifted into the currently ‘thriving’ category (over 50 per cent) after completing the I-CAN programme. In addition, in regard to eudemonic wellbeing, the median scores on the Flourishing Scale remained stable at 48 at T2; however, the lowest individual score at T1 (34) had increased by 14 points at T2 (48). Notably, all participants’ scores were over the mid-point (32) at both time points, suggesting a relatively high level of psychological resources and strengths among the cohort. The qualitative findings supported the individual gains in relation to personal development and wellbeing. For example, the young people involved reported greater self-awareness and emotional regulation and enhanced resilience (factors that support programme continuation and completion).

The quantitative measures examining the effects of the programme on participants’ positive self-image and empowerment showed mixed results. Overall, there was a slight increase in regard to the self-esteem measure (Rosenberg 1965) over time, although this was not statistically significant (p > 0.05). Again, further scrutiny of the individual changes indicated that more respondents were in the ‘high’ self-esteem group on the completion of the I-CAN intervention, with nearly three-quarters (72 per cent) of the group being in this category compared to before the intervention (54 per cent). Interestingly, in regard to the self-efficacy measure (Schwarzer and Jerusalem 1995), there was a slight decrease in the total general self-efficacy scores over time (but not statistically significant at the 0.05 level). Learning programmes are designed to provide participants with positive experiences in order to learn and increase their self-efficacy (Bandura 1977); however, they also involve recognising (or having to cope with) potential difficulties and uncertainties, which can have a negative influence on self-efficacy (Fretschner and Lampe 2019), at least in the short term. The qualitative findings encapsulate some of the shared legacy and uniqueness of being a care-experienced learner and support the notion of participants’ greater susceptibility to the threat of potential difficulties and uncertainties. Also, in line with the literature, several young people in the current study had not perceived university as a likely route for them growing up. More broadly, a lack of confidence and sense of belonging to a learning community can be exacerbated without the type of financial security and encouragement a familial safety net provides (Fortune and Smith 2021; Foulkes et al. 2023).

4.3. Barriers and Facilitators: Identifying Process Issues

Sanders (2021) identified a number of practical and psychological barriers that can impede care-experienced young people attending post-mandatory education, including transport and financial constraints, the absence of familial support, and stigma, which can significantly hinder their confidence and learner readiness. In addition, care-experienced young people are at higher risk of dropping out compared to their non-care-experienced peers (Ellis and Johnston 2019). According to Foulkes et al. (2023), societal systems and structures are designed around the notion of a parental/familial safety net; however, care-experienced young people are typically required to become independent much earlier than their non-care-experienced peers. These known risk factors have a potentially deleterious effect on both course recruitment and completion. Although the I-CAN programme was designed to address some of the financial constraints associated with education and training, this appears to be a primary consideration for care-experienced applicants with responsibility for their own financial security. Participants’ expectations of the programme were strongly linked to employability-oriented goals and having a guaranteed route to a professional pathway was highly valued. Security surrounding the next steps was an important concern for the young people involved who have experienced an accelerated transition to adulthood with associated housing and financial responsibilities and the worry of living independently (Atkinson and Hyde 2019; Bakketeig et al. 2020; Stein 2019). Participants were highly motivated and reported overcoming obstacles in order to regularly attend the programme, including arranging childcare and juggling work with the study demands, indicating their commitment to the successful completion of the programme and securing a progression pathway. Clearly, financial concerns are not unique to care-experienced young people in decision-making around EET; nonetheless, the current findings and the extant literature indicate that they are particularly pertinent for this population. Moreover, evidence suggests that barriers to EET for care-experienced young people are less likely to be motivational, as the current findings also show, but rather, relate to capability, opportunity, and available support, and, therefore, require structural-level solutions (Foulkes et al. 2023).

The I-CAN theory of change (Mills 2024) proposes a set of programme activities and resources that predict positive outcomes for intervention recipients. However, the underlying processes and mechanisms of change are currently unspecified. The qualitative findings from the current study have revealed some candidate core ‘ingredients’ that facilitated positive programme outcomes. Characteristics related to the learning environment, namely pedagogical practices, inter-personal relationships, and meaningful content, emerged as pivotal components. Care-experienced young people may share a history of finding themselves in multiple new learning settings in which they lack a sense of belonging (Young and Lilley 2023). Therefore, factors that contribute to a welcoming and nurturing environment, both in terms of the physical space and the social milieu, are core facilitators. For example, small-sized groups with a high staff–student ratio helped to foster a sense of belonging and a relaxed and comfortable learning environment. Care-experienced young adults may hold perceptions of receiving differential treatment from educators in the past (Honey et al. 2011; Mannay et al. 2017), while negative stereotypes and low expectations can create major obstacles to learning (Sprecher 2024). Such adverse prior experiences can inhibit the development of positive relationships with trusted adults (Home for Good 2021) and incite a wariness about engaging with professionals (McCrory and Viding 2015). To combat this, research supports embedding an individualised component in EET provision to ensure that each young person is made to feel like a priority (Foulkes et al. 2023). The current findings revealed the primacy of the teacher–learner relationship, as well as participants’ perceived support from the wider I-CAN team, who offered tailored assistance. This aligns with the wider literature, highlighting the importance of strong, positive, trusted, and safe relationships for the wellbeing and resilience of care-experienced young people (Eldridge et al. 2020), and the need for a trauma-informed approach to be adopted by professionals (Hlungwani and van Breda 2022; NSPCC Wales 2019).

The diversity of classroom-based and experiential learning appealed to participants who were highly positive overall about the programme. Furthermore, a non-didactic, interactive, and constructivist pedagogy helped to foster young people’s confidence and independence. Widely held misconceptions persist that being care experienced is inherently damaging, which can create perceived stigma associated with being care experienced (Munford 2021). Pertinently, the I-CAN intervention shifts away from a deficit model focussed on young people’s problems and is underpinned by an affirmative framework that builds on individual strengths, building learner confidence and bolstering their resilience. In addition to core healthcare topics, wellbeing and personal development were embedded across the programme to nurture participants’ understanding and positive psychological empowerment. This type of approach tackles psychological barriers, such as low self-esteem, and can help to boost subjective wellbeing, which has been identified as lower among care-experienced individuals compared to the general population (Coram Voice 2020). Likewise, care-experienced young people typically experience higher rates of mental health difficulty, often stemming from childhood trauma and instability. This reinforces the need for a trauma-informed approach that recognises the impact of personal biographical narratives and the significant value of nurturing positive, professional, helpful relationships (Mantovani et al. 2020).

4.4. Strengths and Limitations

The purposive sampling technique was considered to be a strength of the current study, as this facilitated a wider reach in regard to the target population. However, it must also be acknowledged that care-experienced young adults who do not engage with professional services (and may be in greatest need of EET support) were underrepresented. This is an important consideration for future recruitment strategies, which may benefit from more informal peer-to-peer, word-of-mouth approaches. Further consideration should also be given to converting expressions of interest into confirmed places, as several candidates did not proceed with their application. Those who provided a reason cited personal circumstances or a lack of sufficient interest in the health and care sector.

A key strength was the mixed methods approach adopted, which helped to balance the limitations of each method and enabled a richer research inquiry into both intervention effectiveness and process issues (McBride et al. 2019). Moreover, methodological triangulation gives more confidence to the research findings and can increase their credibility and validity (Cohen et al. 2017; Rothbauer 2008). A further aim of the current pilot study was to establish the suitability of both the quantitative and qualitative approaches in order to inform the design of a large-scale evaluation of the I-CAN intervention involving multiple cohorts. The quantity and duration of the questionnaire measures were deemed acceptable by the participants. The results from the validated questionnaires provided limited evidence of the effectiveness of the personal development and wellbeing outcomes, as the results were not statistically significant. However, the sample size was small and the time lag from T1 to T2 may not have been sufficient to demonstrate intervention effects. Social desirability effects may have also influenced participant responses (Gower et al. 2022). Follow-up (Time 3), repeated measures at five months post-test are proposed to examine any latent effects. A clear limitation of the quantitative component was the absence of a control group, this was due to the limited scope of the pilot study, practical recruitment difficulties, and ethical issues associated with implementing a wait-list control design with a vulnerable population (i.e., delaying access to a potentially beneficial intervention). Nonetheless, it was not the intention of this pilot study to provide generalisable findings, but instead to tentatively establish the potential value of a new intervention (Kabat-Zinn 2003).

The qualitative findings supported the programme outcomes data in relation to demonstrating successful learning outcomes, and tentative evidence of personal development and wellbeing outcomes emerged. Gaining insight into the perspectives and preferences of those directly impacted by an intervention is crucial for understanding what makes a successful programme (Kesherim 2023). This can determine the extent to which an intervention is considered meaningful, acceptable, and relevant (socially valid), as well as identifying factors that might enhance participation and intended outcomes (Leif et al. 2024). Enabling care-experienced young adults to shape the design and delivery of programmes can ensure HEIs meet the actual, and not the assumed needs, of students (Bayfield 2023).

In the current study, the first cohort of I-CAN recipients have contributed to its ongoing development. Suggestions for extending the practical components and providing extra support for students who may not be first-language English speakers can be fed into future iterations and help augment the programme. (For example, adapting the balance of different session types and supporting language comprehension by adding captions to presentation materials.) Notably, the majority of I-CAN graduates expressed their preference for a longer programme. The 8-week duration of the I-CAN programme is intentionally brief, as the expectation is that participants will be prepared for the next stage of EET on completion, and the quantitative findings on the progression outcomes support this proposition. However, the scope for extending the existing delivery model is a valid consideration for future iterations. Clearly, dosage, the quantity or amount of an intervention, is an important component of success (Bailey et al. 2016). Dosage levels can influence the impact of an intervention and, therefore, a minimum threshold is deemed desirable (Con and Chan 2016). Moreover, understanding and measuring dosage is important for the replication and scaling-up of effective interventions and is a pertinent consideration in future I-CAN evaluation research.

Limitations to the qualitative component, nonetheless, apply and include the potential for social desirability bias in focus group responses. Another limitation directed at the focus group technique is the group dynamic, which may inhibit some participants’ voices and prompt others to dominate (Smithson 2000). Alternative, anonymous data collection methods may yield fresh insights, as participants may be reluctant to express negative views, despite being encouraged to offer honest feedback.

To demonstrate the robustness of qualitative research, Koch (1994) recommended that researchers should include “markers” throughout, such as their rationale for theoretical, methodological, and analytical choices, and the current study has followed this guidance. Moreover, this approach aligns with the proposition by Lincoln and Guba (1985) that confirmability in qualitative inquiries is established when there is evidence of credibility (e.g., member checking), transferability (e.g., by providing “thick descriptions” of the research process for those who seek such transference to make an assessment), and dependability (e.g., ensuring a logical, traceable, and well-documented account).

5. Conclusions

It is well-evidenced that care-experienced young people are at greater risk of poor health and wellbeing and low social and education outcomes compared to the general population (Sacker 2021). They are also over-represented in socially excluded groups, including homeless and prison populations (Harding et al. 2011; Young and Lilley 2023). Strikingly, care-experienced young people are five times more likely to die earlier than those with no experience of care (Wilson 2021). According to Bibby (2017), access to quality education provides social connections, employment opportunities, learning and problem-solving skills, and, crucially, an improved sense of feeling valued and empowered. Sadly, care-experienced young people face multiple educational disadvantages across all levels of learning. However, given appropriate and ongoing support, post-mandatory education can be transformational, opening up routes to professional jobs or apprenticeships, and financial security (MacAlister 2022), which, in turn, helps to generate improved life chances.

The I-CAN intervention is underpinned by a commitment to reducing the challenges faced by care-experienced young adults transitioning to adulthood, acknowledging the relevance of personal, biographical narratives in an individual’s learning journey. It offers an accessible pathway for young adults to re-connect with learning and training, providing a financially viable option that is informed by a strengths-based and trauma-informed approach. The initial findings from this pilot study offer tentative support for the I-CAN intervention in terms of delivering proposed learning and personal development outcomes. In addition, underlying process issues were identified and recipient insights were gathered, which can inform further development of the I-CAN theory of change. The ethos of the I-CAN intervention aligns with the core principle that any intervention or recommendations for policy and practice focus on delivering what is important and meaningful to care-experienced individuals (Coram Voice 2020). Harnessing authentic voices can help address how researchers and developers might best target interventions and provide support for care-experienced young people (Mckeown and Hagell 2021). Finally, in accordance with the extant methodological guidance for intervention development and evaluation, future research should focus on integrating theoretical, outcome, and process issues, as well as an economic assessment, not included in the current study, to ensure a robust evidence base to underpin effective interventions with real-world implications (Evans et al. 2023).