Characteristics of effective, harm-free environments for children in out-of-home care.

The history of out-of-home care is replete with documented examples of abusive and neglectful practices. Some scholars express concern that out-of-home care is de facto abusive. Certain elements, however, can foster effective and harm-free out-of-home care, such as caregiver support, a model of care, a focus on positive behavior, a consumer orientation, training, program evaluation, and an internal program audit. These elements work together to increase program effectiveness and reduce negative outcomes such as staff burnout. Furthermore, programs that use these elements can be cost efficient.     

Ready or not: assessing youths' preparedness for independent living

This article discusses the utility of the Ansell-Casey Life Skills Assessment (ACLSA) in assessing life skills necessary for living successfully in the community upon emancipation from out-of-home care. ACLSA, completed by youths and their caregivers, identifies skills that have been mastered and those yet to be learned. Assessment information can be used for goal setting, strength identification, and relationship building, as well as to direct program planning and training in self-sufficiency services.     

Evaluation of the Neurodegenerative Conditions Coordinated Care Program (NCCCP) in Western Australia: barriers to better service provision

This paper details a 2009-2010 evaluation of the Neurodegenerative Conditions Coordinated Care Program (NCCCP) commissioned by the Disability Services Commission (DSC) in Western Australia (WA). The program, run by the Multiple Sclerosis Society of WA (Inc.) provides in-home care and supports and respite for people who are under the age of sixty-five and diagnosed with a rapidly degenerative neurological condition. In 2009, the identified barriers to the better provision of services included: shortage of quality out-of-home respite providers, and convoluted paperwork requirements to qualify for the program. Some service providers were unaware of the program and so were not referring them into the NCCCP, a number of service providers were unwilling to refer their clients into the program, neurologists were unwilling to give a final diagnosis for a client, that would enable them to qualify for the service, there was a general lack of knowledge about what services were available in the general community, and existing equipment pools were under-resourced. In 2010, the study found that most of the issues had been addressed however, out-of-home respite services were still very limited especially in rural areas, and the eligibility criteria for entry to the program is confined to those 65 years and under. This paper discusses the issues that still remain with the program as examples of barriers to better provision of services.     

The role of licensing in child placement and protection

Regulation of child residential care facilities requires licensors who have professional experience in child welfare. Licensing requirements must be applied within a context of professional knowledge and experience, particularly in regard to child placement and child protective services. The licensing of facilities for out-of-home care of vulnerable children generally has not been viewed as a mainstream social service or child welfare function. Although licensing differs from placement services and protective services in that licensing is basically a nonservice approach to protection each of the three elements forms a triangle of comprehensive protection for vulnerable children. Recognition of both the similarities and the distinguishing characteristics of the three elements reduces individual and organizational role conflict and, furthermore, holds promise for mature and effective coalitions in achieving the common goal of protection for vulnerable children in out-of-home care. The strength of a statewide licensing program is founded in centralized organizational and supervisory structure. Licensing must fulfill its partnership role in coordination with child placement and child protective services to achieve genuine community protection for vulnerable children.     

Health care policies for children in out-of-home care

Placement in out-of-home care is one intervention used to protect children from abuse and neglect. While children are in such care, it is the child welfare agency's responsibility to ensure that their health needs are met. The study reported here examined health care policies and services for children in 46 state child welfare agencies. Virtually all states had some sort of written policies regarding health care for children in out-of-home care. Half, however, reported having no information management system to record health care data, and only six of the 23 had computerized systems. Most states fell short of meeting the standards set by the Child Welfare League of America for the health care of children in out-of-home care.     

Housing problems experienced by recipients of child welfare services

This study uses data on the experiences of families involved with child welfare services to examine the nature of housing problems and needs among these families and whether housing status affects case outcomes. First, the article describes the housing difficulties faced by two distinct child welfare service populations: families receiving voluntary in-home services and families with children in court-ordered out-of-home care. Second, the study demonstrates the relationship between housing problems and the likelihood of family reunification for children in out-of-home care. The findings have implications for the delivery of child welfare services and the provision of housing assistance to low-income families with children.     

Evolve Therapeutic Services: A 5-year outcome study of children and young people in out-of-home care with complex and extreme behavioural and mental health problems

BackgroundLittle evaluation research has been conducted on the effectiveness of services and intervention provided to children in out-of-home care. This study evaluated an innovative Queensland, Australia program employing a collaborative wrap-round model of care in combination with a flexible intervention approach, individually tailored to children and young people in out-of-home care presenting with complex and extreme behavioural and mental health problems.MethodThe sample consisted of 664 children and young people. Two clinician-rated measures, the CGAS and HoNOSCA, were used to assess young people's functioning via a pre-post-treatment design.ResultsResults revealed significant improvements across a range of problems areas: general functioning and adjustment; disruptive, antisocial and aggressive behaviour; overactivity, poor attention and concentration; non-accidental self-injury; problems with scholastic and language skills; non-organic somatic symptoms; emotional symptoms; peer and family relationships; self-care and independence; and school attendance.ConclusionFindings provide good evidence for the effectiveness of the therapeutic intervention program. Implications for future research are explored.     

Do youth in out-of-home care receive recommended mental health and educational services following screening evaluations?

For children in out-of-home care, a significant gap exists between those who need services and those who receive them. Screening all children in out-of-home care is recommended to reduce this gap. This study was designed to determine if recommendations from mental health and educational screening evaluations were related to service implementation for youth in out-of-home care. Screening evaluations were completed with 171 maltreated youth (ages 9 to 11) who had been placed in out-of-home care within the prior year. Written reports summarizing the findings were provided to children's caseworkers. Service utilization was assessed at baseline (T1; before screening reports were completed) and follow-up (T2; 9–12 months later) interviews. For children not already receiving services at T1, logistic regression analyses tested the association between T1 recommendations for services and new service implementation by T2. Mental health (youth-report) and educational (teacher-report) outcomes were analyzed separately. Screening evaluations identified 22% of children with unmet mental health needs and 36% with unmet educational needs at T1. Children who received a recommendation for new services (i.e., all of those with unmet needs) were more likely to receive mental health (OR = 2.50, p = .06) and/or educational (OR = 3.54, p = .04) services by T2 than children who did not receive recommendations for services. While recommendations increased the odds of receiving services, almost half of the children with unmet mental health needs did not receive services, and 84% of children with unmet educational needs did not receive services by T2. Much work remains to ensure youth receive needed services.     

Measuring contract agency performance with administrative data

This article uses administrative data to analyze the relative performance of contract agencies-those organizations under contract with a city child welfare agency to provide out-of-home care services to children placed in the custody of the public agency-by examining how long it took children placed in out-of-home care to return home to their families. The objective was to determine whether credible empirical evidence could show a relationship between length of stay and the agency providing care. Agency level reunification rates are widely distributed around the mean, indicating that contract agency performance differs and that "agency effects" leave an independent imprint on a child's out-of-home care experience.     

Are children safer with kin? A comparison of maltreatment risk in out-of-home care

Safety, or the absence of maltreatment, is the primary mandate of the child protection services (CPS) system, both for children living at home and those living away from home. Yet, few research studies have examined maltreatment in out-of-home care due to the low incidence rate and data limitations. This study used statewide administrative data to estimate the association between placement type and experiencing a maltreatment investigation or substantiation in out-of-home care. Over 6% of informal TANF-funded kinship placements experienced an investigation alleging maltreatment by an out-of-home caregiver, compared with just over 3% for formal kinship care and non-relative foster care. However, the monthly risk of maltreatment was lowest in informal kinship care because these placements tended to endure longer before maltreatment occurred. Substantiated maltreatment during an out-of-home placement was rare across all placement types. For both investigated and substantiated maltreatment, risk was highest in the first 3 months.     

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.     

Genetic services for foster children: an unmet need?

The genetics revolution has significant ramifications for child welfare. An overview of genetic disorders and of the expanding array of genetic services is given. Findings of an exploratory study of the proportion of children in out-of-home care in two cities who had diagnosed genetic disorders and who met criteria for referral to genetic services, and utilization of genetic services are presented. The findings suggest that genetic services that might be beneficial to foster children and their biological families are not being offered. Implications for foster care are discussed.     

Services for maltreated children: variations by maltreatment characteristics

Mental health services were the most frequently recommended service for maltreated children known to a child protective service agency, but more than one-fourth of the children with serious behavioral problems did not receive referrals for such services. Children with long histories of maltreatment were more likely to be referred for some services, especially out-of-home care. Gaps in services remain, underscoring a need for research focused on the need for interventions targeted to maltreated children involved with child protective service agencies.     

Establishing a mental health service for young children in out-of-home care: The Gumnut Clinic for 0 to 5 year olds in Western Sydney

Objective

Children aged 0 to 5 years in out-of-home care represent a vulnerable population at high risk of social, emotional and developmental problems, yet there are few services specifically addressing their psychological needs. This paper is the first of two concerning the establishment of The Gumnut Clinic, a specialist mental health assessment clinic in Western Sydney for this population. The current paper provides the rationale for the development of the clinic and detail of the referral and assessment processes.

Method

The paper describes the establishment of The Gumnut Clinic at Redbank House in Sydney, Australia, the approach to assessment of these young children and their carers, and the challenges encountered.

Conclusions

Young children are overrepresented in child protection and out-of-home care services. Their social, emotional and developmental needs are under-recognized. Development of a specialist mental health service is a step towards improving health outcomes for these children.     

Mental health service utilization and time to care: A comparison of children in traditional foster care and children in kinship care

Existing research indicates that children who are involved with the child welfare system and placed in various forms of out-of-home care experience emotional and behavioral problems. It is also suggested that children placed in kinship care are less likely to receive mental health services than children placed in non-kinship foster homes. This study sought to compare children in non-kinship foster homes to children in kinship care to determine their receipt of mental health services and the time it took for children in kinship care to receive mental health services compared to children in non-kinship foster homes. Using a Cox regression, researchers determined that children in kinship care had a 14% lower likelihood of receipt of mental health services compared to their counterparts in non-kinship foster placements.     

Junior life skills: an innovation for latency-age children in out-of-home care.

Children age seven to 13 in out-of-home care should be given instruction in basic life skills, just as their older counterparts are prepared for independent living. One program that provides such instruction is detailed here.     

Recent changes in the child welfare system: One state's experience

Nationwide over the past 5 years there has been a substantial reduction in the number of children involved with the child welfare system entering out-of-home care as well as a reduction in the lengths of stay among those who do enter the system. This article compares national data on children entering out-of-home care and the length of stay with data from Florida over a 7-year period (2005–2011). Findings are shared on the strategies and services that stakeholders in one state reported as contributing to preventing out-of-home placements and reducing lengths of stay in residential settings. Federal policies such as IV-E Waivers that support this reduction also are discussed. The article concludes with policy and research recommendations regarding how to sustain this reduction while ensuring that child safety and well-being are preserved.     

Fostering homeless children and their parents too: the emergence of whole-family foster care.

Children should not be placed in out-of-home care simply because their families lack the means to provide for their basic needs, yet this practice continues nationwide. A new program based in St. Paul, MN, gives county social service departments the placement option of whole-family foster care. The target population is adult parents and minor children without stable residences, where the children are at risk of placement in out-of-home care. Although the parents and children may have special needs, there are no safety risks that would necessitate separating children and parents. The program's design is described and policy questions discussed.     

Making parents pay: The unintended consequences of charging parents for foster care

Most families in the child protective services system also interact with the child support enforcement system. This study exploits a natural experiment in Wisconsin, created by the state's large regional variation in child support referral policy, to estimate a potentially important effect of child support enforcement on the duration of out-of-home foster care placement. The effect we examine is whether requiring parents to pay support to offset the costs of foster care delays children's reunification with a parent or other permanent placement. We find evidence of this unintended effect, which is important not only because longer foster care spells are expensive for taxpayers, but also because extended placements in foster care may have consequences for child well-being. Our results highlight the potential importance of cross-systems analysis and the potential consequences when the policies and fundamental objectives of public systems are inconsistently coordinated. We discuss the implications of our findings for child support and child protective services policy.     

How different are their experiences and outcomes? Comparing aged out and other child welfare involved youth

This paper adds to the growing body of research examining the experiences of youth aging out of the child welfare system. Through a comparison of youth aging out with two other groups of child welfare-involved youth—those whose families received child welfare services but were never placed out of home and those who were in out-of-home placement but did not age out—it presents a profile of their care careers and other system involvement (e.g., mental health, justice system). Analyses indicate that young people aging out of care have experienced significant amounts of time in out-of-home placement, a great deal of placement instability, and high levels of other system involvement. In general, their involvement is more extensive than that of the two comparison groups. However, the justice system involvement of youth who experienced out-of-home placement but did not age out is just as high as that of youth who have aged out. This finding highlights the importance of devoting resources not only to youth aging out of care but also to similarly-aged young people with prior child welfare involvement.