A Comparison of Out-of-home Care for Children and Young People in Australia and Sweden: Worlds Apart?

Abstract

In this paper we present a comparative analysis of out-of-home care in Australia and Sweden. We compare the age structure of the out-of-home care population and the types of out-of-home care services provided to children and young people in both countries. Our analysis reveals that in Australia the out-of-home care service system is focused mainly on children who are deemed to be abused or neglected within their families, while in Sweden the majority of the out-of-home care population are teenagers who cannot live with their families for emotional or behavioural reasons. These population differences intersect with variations in the forms of service provision in both countries, with a much greater reliance on home-based care in Australia than in Sweden, while there is more extensive use of residential care in Sweden. We envisage that this paper will demonstrate how the age structure of the out-of-home care population, though rarely considered in international comparative child welfare research, reveals much about the assumptions on which State intervention with children and young people is based. We intend that this analysis will assist social workers to better understand and address the gaps in the quality and comprehensiveness of out-of-home care service provision to children and young people in both countries.     

Cost effectiveness of a school readiness intervention for foster children

ObjectiveMany young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12 months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC).MethodRandomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n = 102) or FCC (n = 90). KITS includes school readiness groups and parent training over 4 months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness.ResultsKITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD.ConclusionsThe cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefit and improvement in school readiness for young children in foster care.     

“Adding Their Flavour to the Mix”: Involving Children and Young People in Care in Research Design

Abstract

Children and young people are often the subjects of research but are not usually thought of as codesigners of research projects contributing to the development of tools and resources so that research about them and their peers is more likely to be appropriate and effective. This paper describes and analyses the involvement of a group of 14 children and young people who have been in out-of-home care. They assisted in the design of a research project that sought their views on what makes a “good” foster carer. The impetus for this study arose from a desire to include children and young people as stakeholders in improving the foster care system and a long-held belief that they could and should be active partners in creating change. The study demonstrated how children and young people could be engaged creatively in individual and group conversations and activities in relation to potential research questions and research methods and tools. The paper concluded that capturing their views will ensure that research will be of benefit to other children and young people and to policy makers and practitioners working in the field.     

Australian Social Work Reviewers 2010

Abstract

Children placed in out-of-home care are a particularly disadvantaged group in society, who have often been exposed to trauma and socioeconomic disadvantage. As a result, they experience poorer health outcomes than children in the general population, especially mental health outcomes. One health outcome that has yet to be researched thoroughly is overweight and obesity of children placed in out-of-home care. Hence, the overall goal of this paper was to review the extant literature over the last decade on weight-related issues for children in out-of-home care, with particular emphasis on overweight and obesity. The findings of the review revealed that there is a lack of rigorous Australian research in relation to prevalence rates of overweight and obesity in children in out-of-home care; there is a lack of strategies or interventions designed specifically to combat overweight and obesity in children in out-of-home care; and one of the major limitations of Australian research to date is the use of self-report measures to assess the weight status of children in out-of-home care. It was concluded that prevention and intervention strategies are needed that target children as they enter out-of-home care.     

Participation in decision-making in out-of-home care in Australia: What do young people say?

Drawing on qualitative research with 28 young people in Australia, this article explores children and young people's views and experiences of participation in decision-making while in out-of-home care. It initially examines the value of participation, before focusing on two key questions. First, do young people feel they had the opportunity to participate in decisions made about their lives during their time in out-of-home care? Second, on which issues do children and young people in care want to have a say?     

Young People Transitioning from Out-of-Home Care: A Critical Analysis of Australian and International Policy and Practice

Abstract

Young people transitioning from out-of-home care comprise arguably one of the most vulnerable and disadvantaged groups in society. They experience multiple disadvantages resulting from their abuse or neglect prior to entering care, their often negative experiences in care, and the lack of support provided to them as they transition from care. Compared to most young people, they face particular difficulties in accessing educational, employment, housing, and other developmental and transitional opportunities. This paper critically analyses the pathways taken by care leavers, and the Australian and international policy and practice responses. We conclude by suggesting some policy and program reforms that are likely to lead to improved outcomes for care leavers.     

Young People Transitioning from Out-of-home Care in Victoria: Strengthening Support Services for Dual Clients of Child Protection and Youth Justice

Abstract

A significant proportion of young people leaving out-of-home care make their transition to independence via the youth justice system, exposing them to further risks and reducing their likelihood of full social and economic engagement in mainstream society. This article presents the initial findings of a research project based on a partnership between Monash University and seven nongovernment child and youth welfare agencies in Victoria, Australia. Seventy-seven key stakeholders participated in interviews and focus groups with a view to identifying practices and policies that could reduce the over-representation of young people leaving out-of-home care in the youth justice system. Factors that contributed to offending included varied responses by the child protection and youth justice systems, limited utility of leaving care plans, and the availability of a range of preventative and diversionary programs. The findings point to a need for more formalised interagency collaboration, and intensification of the interventions and supports offered both in custodial settings and post discharge from custody or care.     

Supporting families: Outcomes of placement in voluntary out-of-home care for children and young people with disabilities and their families

Parents caring for children and young people with disabilities typically have extensive additional demands on their time and resources. This added pressure can significantly impact well-being and mental health. In extreme circumstances, parents may seek an out-of-home placement for their child. Previous research has looked into factors that influence decisions for families to place their child into out-of-home care but little is known about outcomes for these young people and their families. The Supporting Families study aimed to explore the impact of a voluntary out-of-home placement on young people with disabilities, and consequences for their families. Fourteen parents/carers, twenty six case managers, six accommodation services' managers, and four young people with disabilities participated in face-to-face and telephone interviews and focus groups. Participants reported a range of outcomes for young people in care. Positive outcomes included increased levels of respect for themselves and others, an improvement in independent living skills, and reductions in challenging behaviours. Negative outcomes centred on their experiences of grief, loss and rejection, as well as behavioural problems. Positive and negative outcomes were also found for families. For many parents/carers there was a reduction in perceived stress and caring load, as well as improved mental health and wellbeing for them and the child's siblings. However, parents/carers often experienced ongoing feelings of guilt, grief and loss. The study adds to knowledge about outcomes of being in voluntary out-of-home care for this small but vulnerable group of young people in care and their families.     

Mental health outcomes among child welfare investigated children: In-home versus out-of-home care

BackgroundChild welfare has increasingly focused on alternatives to out-of-home (OOH) placement. In-home services, such as parent training, have increased and more maltreated children remain in-home. Yet, little is known about the effect on mental health of maintaining vulnerable children in-home vs placement in stable OOH care.ObjectiveTo evaluate and compare difference in mental health among children investigated by child welfare and who remained in-home vs. those who were placed in stable OOH care.Design/methodsWe examined a cohort of children (aged 1.5–18 years) from a nationally representative sample of children investigated by child welfare using the National Survey of Child and Adolescent Well-Being II (NSCAW II). We compared changes in mental health functioning over 18 months for children who remained in-home with parent training versus those placed in stable OOH care.ResultsAmong the 749 children in our sample, baseline characteristics of children who remained in-home with parent training and those placed in stable OOH care were similar. Among school-aged children placed in stable OOH care, mental health problems decreased from 26% to 13% (p = .003). This differed significantly from school-aged children who remained in home, for whom mental health problems increased (50% decrease stable OOH care vs. 23% increase in home; p = .007). Among pre-school aged children, mental health problems increased in both settings, particularly stable out-of-home care (p = .008).ConclusionsFor school aged children with a history of maltreatment, mental health outcomes improve following stable OOH placement, yet worsen when remaining in-home with parents. Pediatricians should be watchful for mental health problems among children who remain home after maltreatment and should advocate for high-quality stable OOH care when it is necessary. Child welfare may need to monitor the outcomes of children remaining at home more closely and provide more intensive preventive and treatment services to families.     

The Kids Say Project: Supporting Children to Talk about their Experiences and to Engage in Decision-making

Research and policy calls for hearing the voices of children and youth in out-of-home care and involving them in decisions about their own lives. The “Kids Say” cards were designed to facilitate this engagement, particularly with Indigenous children and youth. A feasibility study explored the extent to which the Kids Say cards were acceptable to young people, and prompted discussion about their lives and what is important to them. The study involved 47 participants, aged 7 to 18 years, from three cultural groups: Aboriginal n?=?20; culturally and linguistically diverse (CALD) n?=?10; non-Indigenous English-speaking n?=?17. The cards were found to be appealing to all three groups, and to facilitate child and youth voice. Findings also did not differ significantly according to gender or age. These preliminary findings indicate the potential value of appropriate practice tools to support children and youth to share their experiences and participate in decision-making.

IMPLICATIONS

• Engaging resources, such as the Kids Say resource, are potentially valuable in supporting practitioners to encourage children and young people to share their experiences and participate in decision-making about their own care and service needs.

• Training in creating safe sharing contexts for children and young people is essential. While emphasis is often given to gathering child voices, there is a need for at least equal emphasis on respectful adult listening.

     

Completing the Circle

Abstract

The four themes of the Circle of Courage, a Native American medicine wheel that focuses on child socialization, connect with and add to key ideas from Western theories of human development. These themes are belonging, mastery, independence, and generosity. The purpose of this paper is to present a framework developed from the integration of the Circle of Courage with theories of human development. A key feature of the framework is the role of adults in providing guidance, modeling, and affirmation. Assessment guidelines to promote the resilience of children and youth in out-of-home care are developed from the framework. The long term goal of the framework is to “complete the circle”; that is to foster the resilience of young people in care so that they can in turn provide to guidance, modeling, and affirmation.     

Improving the Archiving of Records in the Out-of-home Care Sector

Abstract

Senate Inquiries into the lives of people who grew up in care, highly critical Ombudsman reports, and advocacy groups for recent and past “care leavers” draw attention to the significance of the records for children growing up in out-of-home care. This article reports on a project in which an interdisciplinary team of social workers, archivists, and historians worked together with 12 community-sector (nongovernment) organisations to look at the question of how to improve the management of the records for people with experience of out-of-home care. A Self Assessment Tool was developed and deployed at two points in time to provide feedback to organisations about the quality of their record-keeping practices. Clear improvements could be documented over a 2-year period in all 12 of the organisations involved.     

Family Functioning as a Measure of Success in Intensive Family Preservation Services

ABSTRACT

An experimental research design was employed in evaluating intensive family preservation services to reunify families after out-of-home placement. There was a significant difference between the treatment group and control group in terms of family reunification, but there were mixed findings with regard to the difference between the two groups on measures of family functioning. Although more treatment parents than control parents felt their families were functioning better, there was no difference between scores for the two groups of parents on normed instruments designed to measure family functioning. The author describes the measures of family functioning employed in the evaluation and discusses the confusing findings along with implications for program evaluation.     

Foster parents exposed to political violence: The role of social support in addressing emotional and functional difficulties

BackgroundBeing a foster parent is stressful. It becomes even more stressful when foster parents face major threats to their own families and to the foster children in their care, such as during war situations. This study focuses on foster parents' reactions to the war with Gaza in southern Israel that took place in 2014. The first goal of this study was to describe posttraumatic symptoms (PTS) and problems in functioning among foster parents following their exposure to the war. The second goal was to identify background and social support predictors of PTS and functioning problems among these parents. The third goal was to examine the role of formal and informal support received by the parents as a moderator of the association between exposure to war events and PTS and problems in functioning.MethodsParticipants were 354 Israeli foster parents who were exposed to the war. Participants completed structured instruments of exposure to war events, PTS, functioning, and social support.ResultsExposure to war events was associated with PTS and related functioning problems. Education and religiosity were correlated with PTS and problems in functioning. Contrary to our hypothesis, more formal social support was associated with more PTS. Social support did not moderate the association between exposure to war events and PTS.DiscussionThe unexpected positive correlation between support and PTS was interpreted as either reflecting the fact that foster care agencies targeted foster parents who were most in need, or as a reflection of the inadequacy of the support they received. The findings indicate that foster parents need support during times of major stressful events such as natural disasters and wars, so that they will be able to help the children in their care. Specialized professional training for foster care workers needs to be implemented. Future longitudinal and mix-methods studies are suggested to help address the limitations of the present study.     

Evidence-based practice for youth in supervised out-of-home care: a framework for development, definition, and evaluation

Adolescents comprise more than half of the children in child welfare supervised out-of-home care. This article considers the evidence-base for an array of services to adolescents in out-of-home care and evaluates the existing research base for each program. This review advances a framework for considering the critical need to develop, define, and evaluate the essential elements of out-of-home care services for older foster youth. Policy, program, and evaluation recommendations are forwarded.     

Children in out-of-home care as young adults: A systematic review of outcomes in the Nordic countries

BackgroundInternationally, the Nordic countries occupy top positions in child well-being. We investigated literature on the overall outcomes of young adults from the most vulnerable backgrounds in the Nordic countries, namely young adults who were placed in statutory out-of-home care (OoHC, i.e. foster care) during childhood in the Nordic countries for the protection of their safety and welfare.MethodsWe followed PRISMA guidelines and conducted literature searches manually, as well as electronically, via EBSCO's Psychology/Sociology databases and ProQuest's Social and Behavioral Sciences databases in February 2016 for quantitative studies that compared outcomes at age 18 or later between young adults placed in OoHC as children and those never placed in OoHC. Because of the heterogeneity and small number of eligible studies on each outcome, we conducted no meta-analysis but did formulate a narrative synthesis.ResultsOf 333 studies identified, 20 met the inclusion criteria. All of these studies were cohort studies that employed social and health register data. OoHC placement was studied with nine outcome categories: self-supporting problems, educational challenges, mental health problems, criminality, teenage parenthood, mortality, suicidal behavior, alcohol and drug use, and disability pension. In each of these categories, young adults with a history in OoHC faced higher risks compared with the general population, even after adjusting for various birth parents' socio-economic, demographic, and mental health–related factors.ConclusionAlthough the Nordic countries are among the world's leading nations in promoting child well-being, the Nordic welfare model has partly failed in preventing the inequality of families with children. As young adults, children placed in OoHC in the Nordic countries face an elevated risk of experiencing adversity.     

Profile of children placed in out-of-home care: Association with permanency outcomes

The goals of this study were to explore characteristics and profiles of children who received out-of-home care services and to examine the relationship between their profiles and permanency outcomes. Results of latent class analysis suggest that there are three distinct subgroups of children served in out-of-home care (N = 33,092): Children with Complex Needs (6%), Children in Families with Complex Needs (64%), and Older Abused Children (30%). Of the three identified subgroups Children with Complex Needs consisted of youth who were at greater risk for adverse outcomes. These children were less likely to experience timely adoption, had the longest length of stay in out-of-home care, and were least likely to experience timely reunification. Although permanency outcomes for Older Abused Children are somewhat better than for Children with Complex Needs, they represent a vulnerable population of youth in out-of-home care who have a very low chance of being adopted. Overall, this study suggests that service provision by itself may not improve permanency outcomes for children unless both prevention and intervention efforts address co-occurring family needs and are tailored to specific characteristics of the children being served.     

The early home environment and developmental outcomes for young children in the child welfare system

The quality of the early home environment is predictive of young children's subsequent cognitive, academic, and behavioral functioning. Limited research has focused on the effects of the early caregiving environment on the functioning of young children involved with the child welfare system. This study investigated the influence of children's home environments (i.e., number of children in the home, number of moves the child experienced, level of cognitive stimulation, and level of emotional support) during the first 2 years of life on their preschool developmental outcomes (i.e., cognition, language, social skills, and behavior problems).As anticipated, a high-quality early home environment promoted the well-being of preschool children who had entered the child welfare system as infants. Children who lived with greater numbers of children incurred more compromised cognitive, language, behavioral, and social outcomes. No significant associations emerged between the total number of placements and developmental outcomes; children who remained in the same home during infancy (typically the birth family home) had more compromised developmental outcomes in every domain except behavioral problems.Both cognitive stimulation and emotional support in the home predicted higher cognitive and language scores, decreased behavioral problems, and increased social skills. Early out-of-home placement and lack of emotional support interacted to predict children's behavioral problems. These findings are considered in the context of extant research and policy relevant to young children in the child welfare system.     

‘Who do I turn to if something really bad happens?’ Key working and relationship-based practice in residential child care

ABSTRACT

This article explores the psychodynamics of relationship-based practice from the perspective of young people in residential care. This research involved qualitative semi-structured interviews with 10 care leavers, aged 18–24 years, who had been in residential care in Ireland. Drawing selectively from that research, this article reports their views and experiences of key-working and how relationship-based practice acted as a reparative method within their experiences of care and aftercare. Similar to previous research, this study underscores the necessity to ensure that children in care are cared for and supported by a trusted adult. In addition, based on this study, the role of a key worker appears capable of providing this ideal type of supportive relationship. It also highlights the importance of the care system working to provide consistency and support for the young people and confirms the importance of relationships with trusted adults, such as key workers.