Out-of-home care - Lessons from research · Children in Out-of-Home Care 40,549 Australian children in out—of-home care (OOHC) as at 30 June 2013 Increased by 19% since June 2009

Out-of-home care: Lessons from Research

Presented by: Dr Daryl Higgins Deputy Director (Research), Australian Institute of Family Studies

Life Without Barriers – Communities of Practice Seminar

3 December 2014

Acknowledgement and disclaimers

Thanks to Dr Debbie Scott, Research Fellow – AIFS, for assistance with preparing this presentation.

This presentation is based on papers previously prepared by AIFS – available at http://www.aifs.gov.au andhttps://www3.aifs.gov.au/cfca/

Disclaimer: The Australian Institute of Family Studies (AIFS) is committed to the creation and dissemination of research-based information on family functioning and wellbeing. Views expressed here are those of the presenter and may not reflect those of the Australian Institute of Family Studies or the Australian Government.

http://www.aifs.gov.au

https://www3.aifs.gov.au/cfca/

Children in Out-of-Home Care

40,549 Australian children in out—of-homecare (OOHC) as at 30 June 2013 Increased by 19% since June 2009 Australia – 7.8 per 1,000 children Lowest rate in Victoria – 5.2 per 1,000 NSW – 10.4 per 1,000 Highest rate in NT – 11.7 per 1,000 Qld: rate per 1000 increased from 6.7 (in 2009)

to 7.3 (in 2013)Source: AIHW 2014. Child protection Australia: 2012-2013. Child Welfare series no. 58Cat. no. SWS 49. Canberra: AIHW.

Drivers of increased demand for OOHC

Growth in child protection concerns The proportion of Aboriginal and Torres

Strait Islander children assessed to be in need of protection

The increasing complexity of the needs and circumstances of children and families (particularly parental substance misuse, mental health, family violence, and their co-occurrence)

Add figure caption here

Australian child protection data trends over past two decades

Aboriginal and Torres Strait Islander children overrepresented in OOHC

4.7% of all children 0-17 yrs in Australia but 34% of children in OOHC

13,952 Aboriginal and Torres Strait Islander in OOHC 57.1 /1,000 Aboriginal and Torres Strait Islander children

compared to 5.4 /1,000 non-Indigenous children Varies from 22.2 /1,000 in NT to 85.5/1,000 in NSW Qld – 3,425 children:

43.6 /1,000 Aboriginal and Torres Strait Islander 4.7 /1,000 non-Indigenous

Source: AIHW 2014. Child protection Australia: 2012-2013. Child Welfare series no. 58Cat. no. SWS 49. Canberra: AIHW.

Cost of national child protection services

$3.2 billion on child protection and OOHC services in 2012-2013

Increase of 5.8% from 2010-2011

OOHC services = $2.1 billion (64.3%)

Source: Steering Committee for the Review of Government Service Provision. (2013). Report on government services 2014. Canberra: Productivity Commission.

What’s the right model of OOHC

Life Without Barriers: Pillars of Practice Framework: “Choose the model that works and gets better

results”

Range of OOHC support options

Receiving homes

• home based care by families on short notices for limited periods of time (not common in Australia butsimilar to emergency foster care)

Kinship care

• care for children by adults who have a kinship bondmost important for children where connection to culture is critical•

Conventional foster care

• provision of home-based care by unrelated non-kin adults for children removed for abuse or neglect

Treatment foster care

• home-based care by foster carers recruited and trained to care for children in a therapeutic, trauma informed way

• in North America common for children with special needs or juvenile defenders

from: S. McLean, R. Price-Robertson and E. Robinson (2011) therapeutic residential care in Australia: Taking stock and looking forward. NCPC. AIFS. Available at: https://www3.aifs.gov.au/cfca/node/10445


Family group care

• similar to foster care but workers supported on a shift basis• maybe owned by service provider with foster parents living in• uncommon in Australia

Congregatecare

• staffed group care or residential carecommunity-based residential homes where workers provide care on rostered basisin Australia not necessarily with multi-disciplinary teams/consultants and not therapeutic or treatment focus by design

•

•

Therapeutic residential care

• intensive care placement for young people in statutory care within a residential setting to address complex impacts of abuse, neglect and separation from familytime limited and transition to traditional foster carebecoming more common in Australia

••



Residential treatment care

• fully staffed group home or large campus under a common clinical supervisory structure, may included day homes, ‘on-site classrooms’not exclusive to children in OOHC, generally time limitedlikely to have well articulated theoretical framework (mental health,

••

education/training)

Psychiatric hospital

• similar to residential treatment centres but also able to medicate or certify/secure young people as requirednot exclusive to OOHCshort term care for children with acute needs

••

Secure care/correctional

facility

• locked facilities where children are sent by court order – usually for criminal misconduct and not exclusive to OOHCdon’t usually provide therapeutic inputin Australia can be enacted for children where Children’s court deems seriouconcerns for the safety and wellbeing of child (in some jurisdictions like Victoria)

•• s


Kinship care

Kinship care – is the type of care that has seen the most significant increase in Australia.

Advantages include: maintain family connections (a way of following

the Aboriginal Child Placement Principle) avoids problems in recruitment of foster carers cost-effective

Aboriginal Child Placement Principle Acknowledgement of problems in past practice Central principle underpinning placement Legislation in all jurisdictions Preferred order of placement for Indigenous children:

child’s extended family child’s Indigenous community other Indigenous people non-Indigenous families

Includes directives to expedite reunification and facilitate contact with birth family

From: N. Richardson, L. Bromfield, A. Osborn (2007) Cultural Considerations in out-of-home care. NCPC Resource Brief no. 8. AIFS. Melbourne. Available at: https://www3.aifs.gov.au/cfca/node/10430

https://www3.aifs.gov.au/cfca/node/10430


Placements of Children in Out-of-Home Care

93% live in home-based care in Australia: 43% in foster-care 48% in relative/kinship care 3% other forms of home-based care 0.6% family group homes

Other care types: 5.5% residential care 0.4% independent living 0.25% other/unknown

Source: AIHW 2014. Child protection Australia: 2012-2013. Child Welfare series no. 58 Cat. no. SWS 49. Canberra: AIHW.

Residential out-of-home care

Service provision exists along a continuum Residential care = last resort with children

‘failing’ their way into residential care Summary of continuum on next slide – not

all models exist in Australia some employed for purposes other than

children who have been removed for child protection concerns (e.g. juvenile justice, disability)


Residential Care – Australia and international models Solutions must fit in Australian context

Influenced by demographics, geography, culture and care needs

Comparisons difficult without clear definitions and conceptualisations Treatment or ‘therapeutic’ component rarely

articulated Differ in goals, nature, ‘restrictiveness’ of

intervention, staffing and support configurationsfrom: S. McLean, R. Price-Robertson and E. Robinson (2011). Therapeutic residential care in Australia: Taking stock and looking forward. NCPC. AIFS. Available at: https://www3.aifs.gov.au/cfca/node/10445

What do we know about the children in OOHC?

Much of Australian research is based on South Australian Longitudinal Study of children in OOHC (235 children over 12 months)

More research on this topic than many others associated with OOHC

From: L. Bromfield and A. Osborn (2007) ‘Getting the big picture’: A synopsis and critiques of Australian out-of home care research. NCPC. AIFS. Available at: https://www3.aifs.gov.au/cfca/publications/getting-big-picture

Well-being of children in OOHC

Physical health appears good and psychological health improved for most

Poorer mental health outcomes than for children who have not been in care

Many have complex psychological and behavioural problems, mental health issues, threatened suicide, physical and intellectual disability.


Well-being of children in OOHC

Adolescents more likely to have behavioural problems than young children – maybe because of trauma exposure in younger ages

Children with placement instability also had family history of significant trauma – suggesting it is the early trauma associated with subsequent placement instability

Urgent need for wider range of options for these children


Impacts of OOHC on the child’s birth family

Parents experience powerlessness, alienation, sadness, loss and despair

Often find working with child protection services threatening, confusing and experienced overt exclusion

Challenge for workers to maintain involvement of natural parents but not to compromise safety of children and placement stability


Working with birth families

Need ongoing care and support Methods that engage, encourage and

empower may assist in maintaining contact and working towards personal change and family reunification

Better support = better chance of reunification


Birth family: Contact and relationships

Positively associated with reunification (increased likelihood) and negatively associated with time in care (shorter)

Family contact less common for children in rural areas and Indigenous children

Evidence about outcomes of children who maintain birth family contact unclear


Views of Aboriginal children in care

Importance of safety vs. connection to family, community and culture…

Listening to the voices of children – one the LWB Pillars of Practice – might give us a different perspective.

“…get help for mum and dad with the alcohol stuff…”

Higgins, D. J., Bromfield, L. M. and Richardson, N. (2005). Enhancing out-of-home care for Aboriginal and Torres Strait Islander young people. A report to the Australian Council of Children and Parenting commissioned by the Australian Government Department of Family and Community Services. Melbourne, Australian Institute of Family Studies (31 October). Retrieved from: http://www.aifs.gov.au/nch/pubs/reports/empirical/empirical.pdf

Carers

Limited Australian research into recruitment, retention, support assessment and training

Most likely to be women 35-54 yrswho are not in the labour force

Most had planned to foster or had known a child in care


Carers – recruitment

Most common reason not to foster is disruption to own family circumstances

Recruitment is time consuming – few inquiries convert to actual foster-carers

Word-of-mouth from existing carers most effective method

Research has found recruitment campaigns are not particularly effective as they fail to reach the majority of the population


Carer satisfaction Most feel they have ‘adequate’ support from family,

friends, peers, NGOs but not by relevant state or territory government departments

Standard carer subsidy found to be inadequate Vulnerable to false/malicious allegations of abuse,

intimidation, threats, violence and property damage by children in their care – with little support or back-up from department


Training of foster-carers

Important that foster-carers feel adequately prepared for their role

Most want training to be practical and nationally accredited Carers of Indigenous children feel better supported with pre-

service training, including how to work with the department Non-Indigenous carers of Indigenous children want training in

Indigenous culture (may include some Indigenous carers of Stolen Generation)

From: A. Osborn et al. (2007) Foster families. NCPC Research Brief No. 4. AIFS. Melbourne. Available at: https://www3.aifs.gov.au/cfca/node/10432

Professionalisation of foster-carers Children in care demonstrating increasingly complex

needs and demands on carers are changing (e.g., involvement in therapeutic services, court hearings)

Varying opinions between carers – “most support professionalisation and a significant minority” do not

Some research has identified that foster carers would like to be seen as semi-professional

Need for further Australian researchFrom: A. Osborn et al. (2007) Foster families. NCPC Research Brief No. 4. AIFS. Melbourne. Available at: https://www3.aifs.gov.au/cfca/node/10432

Carer retention Most cease due to changed personal circumstances Some stop due to burn out, lack of support, effects on

families and ‘difficult’ foster children Retention improved through improved reimbursement,

increased recognition and involvement in decision making about their child, better information about the child, increased support (services and respite)

Particularly an issue for Indigenous carers and children


Research on foster-carers

Most research focuses on ‘enough’ training Need for research evaluating models of

recruitment, assessment, training and support

Do they access available training and support? What helps? What hinders?

Most research focuses on ‘enough’ training


Cultural considerations

Services delivered in context of poverty and extreme disadvantage

Force removal of Stolen Generations resulted in denial of heritage and culture and contributed to breakdown of culture and communities

Loss of parenting skills and knowledge plays major role in current context of disadvantage




Cultural considerations – child wellbeing Attachment and bonding to assess wellbeing are

inconsistent with Indigenous values of relatedness and childrearing values (e.g., mother may not be primary attachment figure)

Use of administrative indicators to measure wellbeing (i.e., reasons for coming into care, time in care) are not good indicators for wellbeing

Should include cultural and spiritual dimensions as well as physical, emotional and social status




Cultural considerations - wellbeing

Placement services for Aboriginal children do not include sufficient care planning

Children remain in OOHC for lengthy periods of time with no planning for permanency

Aboriginal OOHC services report inadequate services due to insufficient resources and time




Cultural Considerations - Carers There are too few carers to cope with demand Commitment to community is common incentive to become a

carer Community-based (word-of-mouth) most effective means of

recruiting carers Poverty, mental health issues, criminal records are a

hindrance Material disadvantage limits ability to become carers and

place additional financial demand on existing carers


Cultural Considerations - Carers Assessment techniques and requirements need to be

more culturally appropriate (communication style, previous criminal record, literacy requirements)

Financial and practical support critical – particularly important given issues of disadvantage

Mainstream training not suitable for all potential carers Caseworkers, carers and residential workers need

training in the value of connecting Indigenous children to their culture




Cultural considerations – carers Talk about need for:

Adequate/timely financial support, Respectful relationship with

department, and Practical and emotional support= LWP Pillars of Practice: Listen/Plan.

Ongoing support is crucial to prevent ‘burn-out’ and loss of carers


: Listen/Plan.



Child-safe environments: Overview1. Screening for known perpetrators

Preventing infiltration - national overview of working with children checks2. Managing situational risks

Overview of research on risk factors, and strategies for prevention3. Creating positive cultures

Clarifying unacceptable behaviour Encouraging disclosures Involving police and child protection authorities

1. Screening

Preventing known perpetrators:1. Police checks2. Working with Children Checks3. Mandatory reporting

2. Managing situational risks

Making organisations safer involves:1. Identifying organisational risk factors 2. Changing risky environments where possible3. Closer monitoring of inherent risks

3. Creating Positive Cultures

Safe environments = positive organisational cultures:1. Clarifying unacceptable behaviour2. Encouraging disclosure3. Involving police and child protection authorities

Key strategies for creating child-safe organisations • Induction programs – defining acceptable behaviour • Reinforce with ongoing professional development• Supervision, mentoring and accountability for staff• Understanding mandatory reporting obligations• Analyse risks• Develop (and regularly review and update) child

abuse policies, procedures, and standards

Resources for Creating Child-Safe Organisations • The Australian Council for Children and Youth Organisation’s

Safeguarding Children is an accreditation program run by the Australian Childhood Foundation www.safeguardingchildren.com.au/

• Childwise has published 12 Steps to Building Child Safe Organisations and conducts regular training, such as Choose with Care and cybersafety programs www.childwise.net

• Erooga, M. (ed). (2012). Creating safer organisations: Practical steps to prevent the abuse of children by those working with them. Wiley-Blackwell: Chichester, UK.

• AIFS help sheets on organisational issues: • www.aifs.gov.au/nch/pubs/newsletters/nl2005/winter.html#tr• www.aifs.gov.au/nch/pubs/newsletters/nl2006/summer.html#tr

http://www.safeguardingchildren.com.au/

http://www.childwise.net

http://www.aifs.gov.au/nch/pubs/newsletters/nl2005/winter.html#tr

http://www.aifs.gov.au/nch/pubs/newsletters/nl2006/summer.html#tr

Summary Many children are happy and do well in OOHC Contact with birth family and permanency planning are

important There are too few carers to meet demands Carers who are well trained and supported are more likely to

continue in their role Special consideration must be given for Indigenous

communities, families and children Additional research needed to provide an Australian

evidence base of ‘best practice’

Child Family Community Australia

<www3.aifs.gov.au/cfca>

Promising Practice Profiles Resources prepared in

collaboration with SNAICC relate to Indigenous carers,

families and children evidence based

Weblinks available next slide New topic ‘landing page’ at

CFCA relating to OOHC coming soon…

<www3.aifs.gov.au/cfca/topics/out-home-care>

Promising Practice Profiles http://web.archive.org/web/20080720120013/http://www.aifs.gov.au/nch/pubs/reports/promisingpractices/summarypapers/pap

er1.pdf http://web.archive.org/web/20080720115710/http://www.aifs.gov.au/nch/pubs/reports/promisingpractices/summarypapers/pap






er7.pdf http://web.archive.org/web/20071011082607/http://www.aifs.gov.au/nch/pubs/reports/promisingpractices/booklets/booklet1.pdf http://web.archive.org/web/20071011082646/http://www.aifs.gov.au/nch/pubs/reports/promisingpractices/booklets/booklet2.pdf http://web.archive.org/web/20071011082520/http://www.aifs.gov.au/nch/pubs/reports/promisingpractices/booklets/booklet3.pdf http://web.archive.org/web/20071011082433/http://www.aifs.gov.au/nch/pubs/reports/promisingpractices/booklets/booklet4.pdf

http://web.archive.org/web/20080720120013/http:/www.aifs.gov.au/nch/pubs/reports/promisingpractices/summarypapers/paper1.pdf














http://web.archive.org/web/20071011082607/http:/www.aifs.gov.au/nch/pubs/reports/promisingpractices/booklets/booklet1.pdf




AIFS research relating to OOHC Beyond 18: The Longitudinal Study on Leaving Care - about the

lives of young people in out-of-home-care (OOHC) and their experiences transitioning from care in Victoriahttp://www.aifs.gov.au/beyond18/

Pathways of Care Longitudinal Study of Children and Young People in Out-of-Home Care in NSW (FACS)http://www.community.nsw.gov.au/pathways/index.htm

Cradle to Kinder – evaluation of a prevention program: DHS (Vic) Grandparents who take primary responsibility for raising their

grandchildren – AIFS submission to Senate Standing Committee on Community Affairs, March 2014 www.aifs.gov.au/institute/pubs/submissions.html

http://www.aifs.gov.au/beyond18/

http://www.community.nsw.gov.au/pathways/index.htm

http://www.aifs.gov.au/institute/pubs/submissions.html

Documents

Out-of-home care - Lessons from research · Children in Out-of-Home Care 40,549 Australian children in out—of-home care (OOHC) as at 30 June 2013 Increased by 19% since June 2009