“If I’m Here, It’s Because I Do Not Have Anyone”: Social Support for the Biological Family during the Foster Care Process

: Social support is a crucial element for families in vulnerable situations, especially for those with children in foster care processes. This support is key to the acceptance of the protection measure in the initial moments and to laying the foundations for collaboration towards reunification. However, the social support of these families is limited, and families’ use of support elements is strongly related to their attitude towards them. The aims of this article were to identify the types and characteristics of social support and to analyze what elements influence families’ attitudes towards these supports. The qualitative study research was carried out in Spain through focus groups and interviews with 135 participants: 63 professionals from child protection services, 42 parents, and 30 children and adolescents who had been in foster care measures. Results show the diversity of social support resources available to families and demonstrate that families make unequal use of such resources depending on factors such as their experiences in the process of formalization and communication of the protection measure or their predisposition to receive support, among others. The important role played by social support resources in the promotion of factors that allow for successful reception and reunification is highlighted.


Introduction
The Spanish Child Protection System understands its actions as being a consequence of a situation of helplessness that endangers the psychological, emotional, and/or physical well-being of children. The Organic Law for the Legal Protection of Minors (Ley Orgánica de Protección Jurídica del Menor) (Law 26/2015) includes various provisional separation measures, during which the child lives in foster care with extended family, foster care, or residential foster care, while his/her family is involved in a plan of a case that may allow family reunification and the child's return home. The decision that involves the separation of a family is of special relevance in the lives of children given the short and long-term effects it has on their lives (Farmer 2014). The initial moments in which the decision is made to apply a protection measure deserve detailed attention. In this situation, social support is a key element for families to promote their acceptance of the established measure and demonstrate a collaborative attitude.
Social support is defined as the process by which the social resources provided by informal and formal networks allow for personal and family instrumental and expressive needs to be satisfied, both in everyday situations and in crisis situations. (Lin and Ensel 1989). Such support is related to emotional, psychological, physical, informative, instrumental, and material support provided by others to maintain well-being or promote adaptations to difficult life events (Dunst et al. 1988). Moreover, social support comprises the networks of formal and informal support of social resources that help families cope with day-to-day life or in crisis situations (Lin and Ensel 1989).
In the case of families in the Child Protection System, research has indicated how the social support available to families to positively address the processes of foster care and reunification has been associated with a lower rate of return to the Protection System (Farmer and Wijedasa 2013). The family resilience model in cases of family reunification, developed by Lietz and Strength (2011), identifies social support as one of the strengths that helps in overcoming this initial moment of separation of children from their biological family. Additionally, Walsh (2002) notes the ability of families to generate positive relationships that help optimize their possibilities and resources as a mechanism of family resilience. In contrast, Kimberlin et al. (2009) show that the lack of social support could be considered as a risk factor for successful reunification. Other authors suggest that having or receiving this social support entails benefits that are associated with relapse prevention and strengthening the capabilities of the family system (Lee et al. 2010) and with maintaining and improving family functioning Ordoñez 2009).
Social support comprises formal and informal support. Informal support comes from those nonprofessional relationships established with family, friends, neighbors, etc. (Spilsbury and Korbin 2013). Various studies (Lietz and Strength 2011;Maluccio and Ainsworth 2003;Terling 1999;Maluccio et al. 2000;Lee et al. 2010) have indicated that this type of support plays a preeminent role in foster care and family reunification. According to Simard (2008), it is important to consolidate children's family networks when enacting protective measures to obtain positive results in reunification. However, despite the benefits of this type of support, the findings of different studies suggest that families at risk (Rodrigo et al. 2007) and those receiving attention from the Protection System (Fuentes-Peláez et al. 2016) often have an informal and poor support network to address their difficult situations and the changes to which they must respond.
Formal support comes from professionals, services, agencies, or institutions (Spilsbury and Korbin 2013). Among the studies on this type of support, one by Balsells et al. (2013) found that the families involved in the Protection System considered it essential to receive formal support from the institutions. More specifically, parents used support with various objectives, such as knowing what changes they had to make and in what way, expressing their emotions and feeling accompanied. In addition, Fuller et al. (2014) found that what helped most parents was the emotional support provided by professionals in child protection services. Such support was useful to normalize their feelings and their situation and to help them feel more secure in having someone to facilitate certain arrangements. Moreover, Barth et al. (2008) noted that some of the most successful formal support strategies in foster care and reunification are mentoring or socioeducational programs for parents.
Both formal and informal support are useful to address the acceptance of the protective measures in the initial phase of separation and foster care. Properly handling this phase is one of the most relevant issues to ensure that the family understands the situation and acquires a greater degree of awareness of the problem and commitment to change. Authors such as Amorós et al. (2003), Schofield et al. (2011) andEllingsen et al. (2011) emphasize the role of an adequate understanding of family difficulties; i.e., the importance of parents being aware of the situation and understanding the reasons for the separation. Balsells et al. (2014) found that the acquisition of this ability originates progressively and at different moments of the process of foster care and family reunification. They agree with the previous authors in mentioning that, at first, it is important to work on the understanding of the reason for the separation and the assimilation of that reason with the case plan. It is important that parents understand how to adapt, are open to change and remain flexible in the face of this situation. It is also crucial that they consider the measure of protection as positive and providing a personal gain for them and for their children, and at the same time, they must acquire confidence, security, and autonomy in themselves to overcome the situation (Schofield et al. 2011;Thomas et al. 2005). Balsells et al. (2011) also found that families placed great importance on their commitment and willingness to accept and carry out the necessary changes to regain the guardianship of their children, demonstrating a commitment and an unquestionable desire of the family to be reunited (Lietz and Strength 2011;Ordoñez 2009;Farmer 1996).
However, families' use of a support is strongly related to their attitude towards this support. It is known that, in this first phase, parents can demonstrate hostility towards the protection measure, towards the professionals who have made the decision to enact such measures, and, ultimately, towards all the formal support resources that have been involved in the separation. (Forrester et al. 2012) indicate five reasons why parents tend to show resistance and little collaboration in these circumstances: (1) the parents' social disadvantage, (2) the working context of the Protection System, (3) the resistance to change, (4) the denial or minimization of abuse, and (5) the behavior of the professionals themselves. Studies (Smithson and Gibson 2016) have also collected the voices of parents, indicating how they feel judged, self-conscious, not considered in decision-making, frustrated by waiting periods and changes in requirements for reunification, emotionally poorly understood, and stressed. Such studies call for more support from professionals and offer examples of good practices, such as comprehensive attention to families' problems, viewing the family as a family and not merely a case, and ensuring that parents are heard and informed in a timely manner, among other issues (Smithson and Gibson 2016). Parents tend to demonstrate less reluctance towards informal support because, for example, relationships with other families in the same situation or who have undergone a process similar to their own reduce the feelings of isolation and solitary experience that these families often suffer when separated from their children (Serbati and Milani 2012;Balsells et al. 2015).
In summary, social support is a fundamental element for the development of families who are in foster care processes, especially in the initial moments when the communication of the measure occurs. In this phase, families need more intense and specific support to lay the foundations for good collaboration, involvement, and participation throughout the process (Fernández-Simo and Cid-Fernandez 2018), which will mark the success of the possible reunification. However, these needs raise questions such as the following: What types of support are more relevant? What characteristics do these supports have? What attitudes do families have regarding social support?
To answer these questions, the present article aims to (a) identify social support and its characteristics in the initial stages of a foster care process and (b) analyze the elements that influence birth families' attitudes towards social support.

Methods
The present research is qualitative in nature, with a descriptive-explanatory purpose. The study included an exploratory design using discussion groups and semistructured interviews with multiple informants: professionals from the Child Protection Service, parents with children in protective measures, and children and adolescents involved in foster care processes. The perspective focused on these participants as experts in the reunification process (Stolz et al. 2013) and who are essential to its improvement. This methodological design was deemed necessary to deepen and better understand the role of social support in the processes experienced by families in the child protection system (Lin 2014). This multi-informant nature made it possible to find relevant aspects from different perspectives.

Participants
The research was conducted with a total of 135 participants from four different regions of Spain: Catalonia, Balearic Islands, Cantabria and Galicia. In total, 63 of them were professionals who worked in public agencies of the Child Protection Service, 42 were parents with reunification plans or had been recently reunified, and 30 were children and adolescents who had gone through a family or residential foster care process. The participants were families who went through the whole process in order to identify the protective factors that had an impact over time and which the families themselves valued as important strengths linked to social support and family resilience in the early stages of the process: foster care and reunification. Participants were selected according to different criteria. The selection criteria for professionals were the following: participants (1) worked in the Child Protection System; (2) had a minimum of two years of experience in residential or family foster care; and (3) represented the multidisciplinary nature of the professionals-that is, they had different roles, such as being social educators, pedagogues, psychologists, social workers, etc. Table 1 shows the characteristics of the participating professionals. The selection criteria for parents were as follows: (1) families that were already reunified or waiting to be reunited in one or two months; (2) families who had created or were carrying out a reunification plan; (3) families with a predisposition to and attitude of collaboration with professionals at the time of data collection; (4) families with different characteristics of age, family structure, etc.; and (5) families that did not have any physical, mental, or sensory disabilities. Table 2 shows the characteristics of the participating parents. The selection criteria for children or adolescents were the following: (1) over six years old, (2) already reunified or waiting to be reunited in one or two months; (3) different characteristics of age, family structure, etc.; and (4) no physical, mental, or sensory disabilities. Table 3 shows the characteristics of the participating parents. The recruitment of parents and children, as a participant in the study, was proposed by the reference professional of each family of the child protection agency, according to the cited criteria.

Instruments
Discussion groups and semistructured interviews were used to collect data. This technique has been considered appropriate for use with vulnerable population groups (Ayón and Villa 2013), particularly families in the child protection system (Balsells et al. 2011) as well as with professionals who work with families (Stolz et al. 2013). A guide was prepared that included several instruments: (1) an identification card to collect participants' basic data; (2) a script of questions for the development of discussion groups and semistructured interviews; and (3) a summary record, in which the researchers gathered aspects related to the development of the group, such as the date, duration and place of performance, participants' motivation, group cohesion, and dynamics.
The scripts were developed as a result of a review of the scientific literature on the subject, which revealed key elements to be investigated. The focus of the questions was intended to prompt participants to share their experiences about the process of foster care and reunification, including the initial stages of the protection measure: how it was produced, what feelings surfaced, what help was given, etc. The questions were formulated from the perspective of the different participants involved: parents, children, and professionals. Thus, different questions about formal and informal support were asked of each participant, adjusting aspects such as the technical vocabulary or type of information that professionals, parents or children could provide in each case.

Procedure and Data Analysis
A total of 22 discussion groups were conducted: nine with professionals (average of seven professionals per group), eight with parents (average of five parents per group) and five with children and adolescents (average of three children per group). Moreover, a total of 18 semistructured interviews with children and adolescents were carried out. All of them were audiorecorded and subsequently transcribed. Two researchers from the research team went to each Child Protection Service that collaborated in the project. One investigator was in charge of the group dynamics, while the other was in charge of recording and verifying that the criteria established in the instructions were followed.
The content analysis was performed following the bottom-up system and focused on two dimensions: (a) social support and its characteristics in the initial stages of a foster care process, and (b) elements that influence birth families' attitudes towards social support. Content analysis was used to analyze the information by the preparation of codes to be evaluated by seven judges. The first stage of analysis was textual, selecting paragraphs, fragments, and important quotes from the transcripts of the interviews and focus groups. The second stage was conceptual and identified the categories and subcategories that were potentially interrelated. Both stages were subjected to review by judges. The process of extracting codes and categories was evaluated through a validation process. The content analysis was reviewed to seek consensus and achieve maximum reliability of the extracted data. Categories and subcategories were defined when the data reached saturation. The categories were considered saturated when (1) no new data emerged in a category, (2) the category was well developed and showed variation and (3) the relationships between the categories were established and validated.
The software Atlas.ti 6.2 was used to process qualitative data. A Hermeneutic Unit Editor was created in which the literal transcriptions of the focus group and interviews (primary documents) were included. Each category was assigned a code (code), and textual notes were included (memos). A conceptual network (network) was created to analyze the data as a basis for the connections established between the codes of the hermeneutic unit.

Ethical Considerations
Numerous ethical considerations were involved in the development of the research. An informed consent document was developed for professionals and parents to ensure that they knew what they were involved in and could offer their consent. This document clearly explained the scientific purpose of the research, their rights as participants, and the confidential treatment of the data collected. Before interviews were conducted, participants were encouraged to ask any questions or request clarifications to support their understanding and willingness to participate. Similarly, the fact that participants had the right not to answer any question they did not wish to was emphasized. In the case of children, authorization and consent were requested from parents or from the Public Administration that had legal guardianship at that time. Before starting data collection, children were informed in detail about the purpose of the study, adjusting the vocabulary and language, and were also encouraged to state any doubts they had; furthermore, explicit assent was requested before beginning the data collection.

Results
The content analysis of the voices of the parents, children, and professionals made it possible to identify and answer two key questions related to formal and informal support: (a) What types of support are more relevant, and what are their characteristics? and (b) What are families' attitudes regarding social support?

What Types of Support are More Relevant, and What are Their Characteristics?
The results show a diverse range of formal support resources that families use when a separation and fostering measure is initiated: (a) the formal supports provided by the Protection System (the interdisciplinary team that runs the case plan, the reception center, or the service for foster families, among others) and other formal supports (doctors, teachers, etc.) or specialized support (psychologists, psychiatrists, specialists or therapists, etc.); and (b) the informal supports provided by community social services, extended family, friends, etc..
Regarding formal support, the results suggest that this type of resource is not always used to equal extents or in the same way by families. In this phase of foster care, there are families that make little use of the support provided by the Protection System and even reject it. Other families, in contrast, use these supports positively from the beginning, especially those who go to social services to voluntarily apply for the administrative guardianship of their children.
"At the beginning, I rejected it, I was blocked, I only received help from the director of the center where I was rehabilitating, but then, when I left, it is true that I was with some psychologists and educators who helped me, but maybe it was because by then, I listened to them more." (quote from a mother) Standardized or specialized formal supports are used selectively by families according to their needs; notably, their use might also be influenced by the type of relationship established between the family and professionals. In this sense, trust, mutual knowledge, and bonding are crucial aspects associated with this relationship.
"I arrived mid-year, the teacher took care of me very well, they gave me affection, they were very attentive to me, they treated me very well." (quote from an adolescent) The results indicate the formal supports that are most requested by parents are economic and psychological support. In the case of economic support, families, children, and interviewed professionals emphasized the need to increase this type of aid. In the case of psychological support, the results indicate that this is recognized as one of the most notable sources of formal support in this phase of foster care.
"You cannot tell a family with €400 to take good care of three children and that is it, because it is impossible...because sometimes things are sustained by something material." (quote from an adolescent) "Social workers bet a lot on me. In addition, then, the psychologists made me see the reason why they had taken the children away from me." (quote from a father) With regard to informal support, the results demonstrate that it has a low presence in the initial moments of the foster care process. Support from family, friends, or neighbors is often considered insufficient. Particularly in the case of the extended family, absence usually corresponds to deteriorating family relationships or distance from relatives. In spite of everything, some participants recognized that informal support is a fundamental element in the well-being of their children and for the stability of the family. In this sense, they stated that if they had had this type of support in the past, perhaps the situation of separation from their children could have been avoided.
"At first, I had my whole family against me, and it was very hard; I was alone and they had taken my daughter away from me. Then, I called social services to get my family together, we sat down, we talked, and from then on the thing began to be solved...now I think that if I had had the relationship I have now with my family, perhaps none of this would have happened to us." (quote from a mother) "When you ask some families -Do you have someone who...? The majority tell you -if I'm here, it's because I do not have anyone." (quote from a professional)

What are Families' Attitudes Regarding Social Support?
The results show that the attitude of families towards support depends on how the protection measure is formalized and how it is communicated to families. As this separation process takes place, a set of feelings are generated among the family members that determines their attitude towards support.
With regard to the attitude of families regarding formal support, families tend to be more collaborative and receptive towards formal support when they voluntarily request that the guardianship and custody of their children be exercised by the Administration. In contrast, when the decision is not made by families, and they do not accept the protection measures, two types of attitudes that lead to less collaboration are usually observed: anger and aggressiveness or passivity and indifference.
Although the results indicate that families who are angry and agitated at the beginning are most reluctant to collaborate in the early stages, they do suggest that this may be a reaction to regaining guardianship for children, which can lead to reunification, as it may indicate-in terms of involvement and participation-that there is genuine interest in the future of the children and the reestablishment of family and contextual conditions for optimal parenting. In contrast, those who accept separation and who do not show interest in understanding the elements that led to the separation may have lower expectations of reunification. However, the latter make up a minority of the families in foster care.
"I have met very few families who are 'abandoning'; if I think of the twenty years that I have been working on the team, I might have known one or two." (quote from a professional) The results also indicate that the acceptance of these formal supports is related to three elements: the acceptance of the foster care measure, the family's perception of professionals as a help resource, and the predisposition to receive support.
To promote acceptance of the measure, both an awareness of the problem that caused the separation and feeling responsible for the situation are considered key. In this sense, results suggest that awareness of the reasons for separation is acquired through a gradual process of understanding that is linked to the motivation for change. When parents understand the reasons for the separation, they begin to be motivated to make the necessary changes.
"I began to see them as useful after eight months or so, not before, because I saw that they wanted to help me get my children back and be well." (quote from a mother) For parents to accept formal support, it is necessary for them to consider professionals as an element of help and not as a controlling element. For this change in perspective and attitude to occur, a crucial aspect is trust, which is also acquired through a gradual and temporal process.
"First it sounds strange, then you start to listen. It is like a process, right? And then the time comes because they talk to you, and you start accepting a little bit, then you get used to it slightly more, until there comes a time when you get to trust them." (quote from a father) Another essential element associated with accepting support consists of the predisposition and openness of parents to receive help. In this regard, all participants believed that collaboration begins when parents are aware that the first step towards progress lies in a receptive attitude to be helped: "I personally was very negative about listening to anyone, I did not want anyone to help me, but when I realized everything I had lived, I understood, I opened my heart so that the teacher I had could help me. Then, I was open to all the corrections, to everything that was said to me." (quote from a mother) "You have a great team around, a great team that supports you, that guides you...but it is you who have to accept it and swallow your pride." (quote from a father) In addition to these elements, the results indicate that families' attitudes are also influenced by the feelings that are generated in the initial moments of the foster care experience. In general, families harbor intense, ambivalent, and even negative feelings due to the separation from their children. The results show that the most frequent feelings might be anxiety, loneliness, disorientation, shock, emotional blockage, pain, suffering, anger, helplessness, fear, tension, and depression. Some of these feelings seem to be generators or propellers of intentions for change in families.
"Families tend to be reactive, but behind this reaction, there are feelings of fear and helplessness, of anger...and these are the ones that end up 'clicking' before." (quote from a professional) "I felt I was a bad father, and since I felt a bad father because no one told me anything, well, I would leave the girl...So, when they took my daughter away, the world sank. I fell into a dark pit." (quote from a father) With regard to the attitude of families regarding informal support, the parents and professionals interviewed affirm that if foster care occurs in extended families, the situation is usually experienced in a less traumatic way, which might imply that the family's attitude towards informal support is also more positive.
"If it is in the family environment because it stays in the extended family, it is not so traumatic; it is within its scope." (quote from a professional) Finally, the results indicate that families' most frequent feelings towards informal support are shame, fear, and distrust, which makes them reject this type of support due to the fear of "what they will say" and the perception that asking for help is a symptom of weakness.
"When they return home, there are those who do not ask for help because they fear that they will take their children away from them again." (quote from a professional) "If they had been there, it would have been very different; a single person [family] is not capable without help from someone they trust." (quote from a mother)

Discussion and Implications for Practice
This study has analyzed two of the key elements linked to the social support of families in foster care processes: the type and characteristics of support and families' attitudes towards them. As has been observed in this study and those of different authors (Rodrigo et al. 2007;, social support is a key factor before (to prevent separation), during (to promote change during foster care) and after (to promote and strengthen family reunification and the children's return home) the process. These aspects are associated with the strengths of the stages of the process of family resilience (Lietz 2006;2009;Lietz and Strength 2011). Social support is a relevant key factor for family resilience during all of the foster and reunification process but is particularly important in the early days following placement where not only do families need to receive confident and trusted formal support, but they have to face different challenges to build an informal network progressively that will help them to succeed in fostering and reunification.
The research shows that formal support is especially important at the beginning of a protection measure. This type of support is demanded by some families but also rejected by others, who may initially harbor intense feelings and ambivalence, or even reject some support. This finding supports and extends the results of other studies that point to the relationship between professionals and the family as an element that favors the commitment of the family to reunification (Child Welfare Information Gateway 2011). When parents consider professionals to be help elements, the process of fostering and returning their children to their homes is favored (Bravo and Del Valle 2009). This view of the professional as a reference for help is obtained through a gradual process in which the acceptance of the foster care measure and the establishment of a relationship of trust and communication are crucial factors (Balsells et al. 2014).
Regarding informal support, the results underscore the important role played by family members, neighbors, or friends. According to Spilsbuy and Korbin (2013), this type of support can help reduce and mitigate the impact of certain vulnerability factors by providing emotional resources, protecting families from the stresses of daily life, and helping them cope with crisis situations. However, the results confirm the weak informal support network of these families, especially regarding the support received from the extended family, despite its importance as reflected in other studies ).
In addition, the voices of the participants confirm that the family's attitude towards support is linked to the family's other feelings, especially the reticence and fears that parents and their children may have regarding asking for help. In other studies, parents do not want to be vulnerable because "they might feel guilt, shame or anger" (Bravo and Del Valle 2009, p. 130), which makes it difficult for them to apply for and receive help.
The relevance of formal support to help families successfully face foster care and reunification leads professionals to adopt new forms of relationships and communication. Our results align with those indicated by the Child Welfare Information Gateway (2011) and Ward et al. (2012) in terms of the challenges that arise: working collaboratively with parents, helping them understand the changes they need to face, building on their strengths, showing sensitivity, explaining the consequences of breaking agreements, and explaining "bad news" where necessary. Similarly, the results confirm how certain skills and attitudes displayed by the professional help mitigate families' fears and build the necessary relationship for a quality placement, such as open and honest communication with parents (Yatchmenoff 2005) or a real commitment to the case (Cheng 2010).
Therefore, some orientations and implications for practice linked to social support in foster care processes emerge: a. Offer greater formal support based on understanding and emotional support, treating families with empathy and showing open, sincere, and constant communication to foster trust with professionals. b. Promote the informal network of friends, family, and groups of families who have been through the same situation such us family group conference as a strategy to begin to foster greater informal support during the early days following placement. c. Encourage the professionals of the Child Protection System to be a reference figure in whom families find a person who can provide them with support. d. Work with the whole family, including the extended family as much as possible; i.e., conduct comprehensive work with the family with the possible inclusion of informal support.