Improving outcomes for children in out‐of‐home care: the role of therapeutic foster care

How best to support children and young people in foster care remains a challenge for child welfare. There has been little Australian research on the outcomes for children and young people placed in therapeutic foster care (TFC). This article aims to address this knowledge gap, presenting the evaluation of a state‐wide model of TFC known as the Circle Program operating in Victoria, Australia. Data sources for the study were case assessment analysis; surveys of foster carers, program workers and other stakeholders in the sector; and both focus groups and individual interviews with foster care workers. The evaluation found that the Circle Program lessened the number of unplanned exits of children from foster placements compared with generalist foster care. Another important finding was that the Circle Program positively influenced foster carers' decisions to stay in the carer role. Key components perceived as contributing to outcomes of the Circle Program included enhanced training of foster carers, intensive carer support, specialist therapeutic support to the child and carer, therapeutic service to family members and a network of services to provide support to the child.     

FAMILY CARERS: SOME IMPEDIMENTS TO EFFECTIVE POLICY AND SERVICE DEVELOPMENT

The shift to community care for people with disabilities in Australia has given rise to some recognition and acknowledgment, in both academic research and policy development, of the importance of their carers. However, information about government policy and services for carers is fragmented and limited. Our knowledge about the prevalence of caregiving and the socio-demographic characteristics of carers and their service needs, is inadequate. Studies in relation to carer use of and satisfaction with services tend to be small scale and focussed on a specific service or carer group. Carer views on broader mainstream service provision have received little attention. This paper identifies gaps in our knowledge as well as the practical and conceptual difficulties in documenting the range of services available and the relevant social policy. These difficulties are likely to reflect barriers to broad and effective policy and service development.     

In their Own Right: Translating the Policy of Carer Assessment into Practice

Successive legislation has underscored the importance of assessmentsthat are sensitive to the needs of carers and take into accounttheir ability and willingness to continue caring. This papersynthesizes qualitative and quantitative findings from a continuingprogramme of carer-related research that began in 1993 and hascontinued in parallel with legislative changes. It considersthe process and characteristics of carer assessment from theperspectives of carers for individuals with a range of healthand social care needs, and practitioners. This paper exploresthe assessment of carer need over time and highlights the considerableand enduring gap between policy and practice. It considers practitioners’reluctance to offer separate carer assessments, identifies confusionrelating to the interpretation of eligibility criteria and documentsthe limited contribution of health service staff. The need foran evidence-based framework for good practice, that distinguishesbetween carer needs, service provision and carer outcomes, ishighlighted. The paper concludes by identifying key changesthat are necessary to promote future good practice, such asstaff training and information strategies and the need for practitionersto engage with carers as partners in the care process.     

The nature and prevalence of kinship care: Focus on young kinship carers

Young kinship carers tend to be overlooked in kinship care policy and practice. This Australian research project explored the prevalence of kinship care households in Australia, with a particular focus on households headed by young kinship carers. Census data were utilized to explore the number of kinship care households across the carer age spectrum and some of their characteristics, including households with Indigenous carers and carers with a culturally and linguistically diverse (CALD) identity. Characteristics of households headed by carers aged 16–30 years were explored in some detail, and comparisons made with young parents. The data pointed to particular challenges for young kinship carers in relation to post‐secondary education, employment and income security. Implications for policy and practice are discussed.     

‘Replacement Care’ for Working Carers? A Longitudinal Study in England, 2013–15

In the context of rising need for long‐term care, reconciling unpaid care and carers’ employment is becoming an important social issue. In England, there is increasing policy emphasis on paid services for the person cared for, sometimes known as ‘replacement care’, to support working carers. Previous research has found an association between ‘replacement care’ and carers’ employment. However, more information is needed on potential causal connections between services and carers’ employment. This mixed methods study draws on new longitudinal data to examine service receipt and carers’ employment in England. Data were collected from carers who were employed in the public sector, using self‐completion questionnaires in 2013 and 2015, and qualitative interviews were conducted with a sub‐sample of respondents to the 2015 questionnaire. We find that, where the person cared for did not receive at least one ‘key service’ (home care, personal assistant, day care, meals, short‐term breaks), the carer was subsequently more likely to leave employment because of caring, suggesting that the absence of services contributed to the carer leaving work. In the interviews, carers identified specific ways in which services helped them to remain in employment. We conclude that, if a policy objective is to reduce the number of carers leaving employment because of caring, there needs to be greater access to publicly‐funded services for disabled and older people who are looked after by unpaid carers.     

Carer Break or Carer‐blind? Policies for Informal Carers in the UK

This article examines three policy statements on informal carers published in the UK in 1999—the National Strategy for Carers, the report of the Royal Commission on Long Term Care and the note of dissent by two members of the Royal Commission. These three documents contain two rather different approaches to policy for carers. On the one hand, the National Strategy and note of dissent emphasize respite care or short-term breaks for carers, and are concerned with sustaining the well-being of carers as well as ensuring the continuation of caring itself. The Royal Commission, on the other hand, emphasizes support for the older or disabled person who is being cared for, as a means of supporting the carer, and advocates "carer-blind" services. It is argued that this policy contains within it the potential to substitute for or replace the carer and that this represents a radical new departure for social policy for carers in the UK. The advantages and disadvantages of the two policy approaches are explored. It is argued that policies for carers should include both services specifically for carers, like breaks from caring, and services provided for the cared-for person, like domestic and personal care services. Wider issues about the proper boundary between family and state care are explored.     

'Your friends don't understand': Invisibility and unmet need in the lives of 'young carers'

This paper is based on a study of the experiences of people identified as ‘young carers’, commissioned by the National Assembly for Wales as part of a wider review of carers’ needs and services. Following a brief review of some of the previous research in this area, the paper reports key findings of the research, using the words of children and young people as much as possible. It then goes on to explore some of the wider implications of this and other research for the identification and support of ‘young carers’ and their families, and for the understanding of the needs and wishes of children and young people so defined. The paper concludes with an alternative definition of a ‘young carer’ and with some recommendations for professional practice, suggesting that the role of social work is crucial in this area of service.     

Nonfamilial kinship carers—Who are they and what support do they need to nurture children?

There is a growing body of literature about kinship care in the Western world; however, much of it focuses on grandparent care. A lesser known aspect of kinship care is the care of children by nonrelatives known to the child or their family. What little research exists about this group suggests that such placements are less stable than familial kinship care. This article reports a research study in Victoria, Australia, that explored nonfamilial kinship care through analysis of administrative data, interviews with young people and carers, and focus groups with kinship care support workers. It emerged that current administrative databases are not yet able to reliably identify the carer relationship, and thus the extent of such care arrangements cannot accurately be determined. Interviews and focus groups revealed that nonfamilial kinship care is diverse and qualitatively different from familial kinship care, bearing some similarities to foster care yet managed very differently. It is suggested that policymakers need to pay more attention to conceptualizing nonfamilial kinship care within kinship care policy frameworks and that greater attention is needed to the individual support needs of children in such placements and their carers.     

Making a connection: school engagement of young people in care

Intervention to improve educational attainment for children in out‐of‐home care is increasingly being recognized as important for their well‐being and future opportunities. This paper reports on a mixed method study of the school engagement or connectedness of young people in care. The study comprised a survey of 202 young people in care in Queensland, Australia, and a matched comparison group of young people not in care, plus interviews with a subset of 65 young people in care who were surveyed. Both the school environment and the perceived levels of support influenced school engagement, with those who were assisted by carers and caseworkers more likely to be positively connected with school. These young people perceived education as a pathway to achieving work and life goals. The findings suggest that active and focused attention on young people's school engagement should be part of case planning and monitoring as it offers an additional strategy for improving their educational experience.     

Short Term Care for the Elderly in Residential Homes: A Research Note

Please address requests for reprints to Dr. D. Boldy, Division of Health Sciences, Centre for Advanced Studies, Western Australian Institute of Technology, Kent Street, Bentley WA 6102, Australia. Summary Short term care for the elderly has expanded rapidly in thelast five years. The study evaluates short stay care in fourresidential homes using interviews with 42 clients, their main‘carers’, officers-in-charge of the homes and socialworkers. Whilst the service worked reasonably smoothly and provideda break for family carers there remains further potential forimproving the quality of service in the context of a full rangeof services for elderly people.     

An investigation of the needs of grandparents who are raising grandchildren

Evidence suggests that children in out‐of‐home care function better when placed in kinship compared with foster care. Less is known about the functioning of children in the unique form of kinship care where grandparents are caring full‐time for their grandchildren in informal care arrangements. As grandparent carers are increasingly taking on this role, it is timely to investigate the functioning of the children in this form of care and the characteristics of the grandparents themselves. We compared the functioning of children in the two types of care. We also investigated carer characteristics, including the relationship between child functioning, social support and daily hassles on carer stress. One hundred fourteen cares and 180 children were assessed on a range of demographic and clinical measures. Children in grandparent care were displaying better behavioural and adaptive functioning than children living with foster carers. Grandparent carers reported higher levels of distress in the carer role. Predictors of carer stress included severity of child behaviour problems and daily hassles. Both group of carers and the children in their care would benefit from increased support from treatment services.     

Strengthening kinship families: scoping the provision of respite care in Australia

Kinship care is the fastest growing form of out‐of‐home care in Australia, as it is in many other countries. The Victorian Government's response has been to establish 18 programmes across the state to provide support to kinship families. The scoping project described here, based on interviews with key programme staff, explores the experiences of the new programmes in providing support, specifically respite care, to kinship families. It has produced a picture, based on qualitative and quantitative data, of how respite care is understood, the perceived respite needs of kinship families, how services are organized and provided, identified barriers to families accessing support, the effect of respite provision and what constitutes optimal practice. The findings establish a basis for a best practice model of service provision for this increasingly significant family type.     

Renewing the Social Vision of Care

Care is a fundamental condition of human existence, an inherently social activity. Yet surprisingly, care has only recently begun to receive serious attention from social researchers and the public. Despite the fact that care has become a public issue over the past twenty‐five years or so, current thinking in policy and advocacy for carers has developed an overtly narrow and self‐limiting focus with a strong emphasis on the plight of primary or sole carers, with care being seen predominantly as a burden. From looking at Australian policy on carers, it may be concluded that care is essentially understood as a private, individual concern, a one‐way activity in which the active agent, the carer, does something to the other, passive, recipient. The challenge posed in this paper is to move beyond this approach to that of a more social conception of care. Following a review of the uses of the terms ‘care’ and ‘carers’ in the current Australian policy context, a discussion of the meaning of the term ‘care’ is presented and an alternative understanding of the term, with the potential of recognising and promoting care as a complex, social outcome is advanced.     

The role of carers in supporting the progress of care leavers in the world of work

The aim of this component of a preliminary cross‐national study (Ireland and Catalonia) of care leavers' experience in the world of work is to explore how carers may influence the entry of young people in care into the world of work and how they may also influence the young people's progress in that world. A total of 22 care leavers, aged 23–33 years, were recruited on the basis of their having substantial employment experience since leaving care. Evidence from the interviews reveals the importance of the role of carers in the work‐related progression of the young care leavers, especially in relation to gaining work experience while they were still in care. The qualitative analysis shows that carers were influential in promoting (and sometimes hindering) progress in work and education. Carers were often reported to play an important role in opening up opportunities, giving support (modelling skill development, giving practical help, etc.), being role models and cultivating the young person's agency. On the basis of these findings, we propose an initial conceptualization of carer roles in positive work support.     

Is cash allowance a way to ease child care burden? Views of carers in Hong Kong

Caring for the carers is not only a policy challenge for the government but also a global concern to achieve gender equality by restructuring welfare for care. Paying informal carers is one of the measures that address their needs, which is being practiced in Western countries for more than 10 years now. Financial support for care does not only value the contribution of carers but also compensate for the loss of carers caused by unpaid care duties. However, cash for care is a complex issue because it is located within a number of different policy domains that may be considered controversial. This study discusses the views of carers on cash allowance and identifies issues affecting the support provided to the informal care system in Hong Kong. The discussion is based on the findings from the focus group interviews with 11 groups of carers with different socioeconomic backgrounds.     

Exploring Social Care: Applying a New Construct to Young Carers and Grandparent Carers

Mainstream literature on paid care for children, frail elderly people and people with chronic illness or disability, and unpaid care provided usually by family members within households and kin networks tends to establish dichotomies: formal/informal, commodified/non‐commodified. Recent feminist literature rejects these dichotomies, developing models of social care in which the interconnections of paid and unpaid care are mapped within policy frameworks. This paper uses theoretical frameworks of ‘social care‘: care as labour; care as a relationship embedded in obligation; care incurring a range of costs; to explore two case‐studies: young carers aged up to 24 years who are most often caring for a co‐resident parent; and grandparents who are the primary carers of their grandchildren. The latter may occur under the aegis of child protection authorities, or Family Court orders, or in informal arrangements, not licensed by state authorities. This analysis of the international literature and Australian research data affirms the power of the social care framework, and also shows the influence of social policy settings on informal care provision.     

Young people leaving care in Sweden

The transition from a placement in care to an independent life can be a problematic phase for young people. In Sweden, special care‐leaving services are almost non‐existent. What then happens to young people when they leave a placement in out‐of‐home care? This paper draws on the results of a study in which 16 young care leavers between the ages of 18 and 22 years were interviewed. Telephone interviews were also performed with the young care leavers' parents, social workers, foster carers and institutional staff. The aim of the study was to investigate how young care leavers perceive the transition from care to an independent life. The Swedish welfare model, the prolonged transition to adulthood and the family‐oriented welfare discourse have been used as analytical perspectives. The results show that young care leavers have a pronounced need for social, emotional, practical and financial support. Whilst such support is occasionally provided by foster carers and residential staff, it is seldom given by social services or biological parents. This group is at risk of facing severe problems in the transitional phase from care to independent life, a fact that is not acknowledged by the Swedish welfare system.     

Supporting foster and kinship carers to promote the mental health of children

The majority of children and young people removed from the care of their parents by the state of Victoria, Australia, reside in foster or kinship care. These children have experienced a broad range of adverse conditions and are up to 4 times more likely to experience problems with mental health than their mainstream peers. This paper draws on the perspectives of foster and kinship carers, describing the disconnection between their role as mental health advocates and their interest in early intervention in a field which is dominated by crisis and the historic marginalisation of foster and kinship carers. Thirty‐one foster and kinship carers across greater metropolitan Melbourne, Australia, contributed to this study through interviews and focus groups. Participants demonstrated a practical understanding of mental health and an ability to identify a range of conditions that have an adverse impact on the mental health of children and young people in their care. The paper concludes that there is a lack of systemic support and even a range of barriers that affect the capacity of foster and kinship carers to promote the mental health and well‐being of the children and young people in their care.     

Compulsory intergenerational family solidarity shaping choices between work and care: Perceptions of informal female carers and local policymakers in Estonia

Estonians are obliged by law to provide maintenance for family members who are unable to cope by themselves. As a result, 80% of fragile older people receive informal care. Whether this is because the carers themselves feel solidarity and choose informal caring or because they lack alternatives is the question. We applied the cultural approach for explaining the construction of compulsory family solidarity in care provision to older people through the perceptions of informal carers and policy actors. Our interest is in how filial norms framed by individual responsibilities of care provision required by law can influence (i) informal carers’ perceptions concerning their choices between work and care and (ii) impact policy actors’ perceptions concerning eldercare service provision. Analysing the empirical data produced during focus groups with female carers and interviews with policy actors, we demonstrate the triple‐fold pressure to informal caregiving as an expression of compulsory family solidarity. Key Practitioner Message: ? The article demonstrates how the national Family Law Act constitutes a compulsory requirement of family solidarity in society; ? The compulsory family solidarity norm influences local‐level policymaking and inhibits the development of formal care services for older people; ? Informal carers’ choices between work and care are shaped by their personal filial norms, familialistic policymaking, and pressure exerted by older people.     

Providing a secure base for LGBTQ young people in foster care: The role of foster carers

The experiences and needs of lesbian, gay, bisexual, trans and queer/questioning (LGBTQ) young people in care have been overlooked in England, in both policy and research. This paper reports on findings from the first study of LGBTQ young people in care in England and focuses on the nature of foster carers' experiences and perspectives on caring for LGBTQ young people. Qualitative interviews regarding the fostering role in caring for LGBTQ young people were conducted with a sample of foster carers (n = 26) and analysed thematically. Foster carers described the importance of offering LGBTQ young people not only the nurturing relationships that all children in care need but also availability, sensitivity and acceptance to help young people manage stigma and other challenges associated with minority sexual orientation and gender identity. The Secure Base caregiving model provided a framework for analysing the different dimensions of these relationships. Understanding caregiving roles and relationships for LGBTQ young people in care has important implications for recruiting, training, matching and supporting foster carers to care for LGBTQ young people effectively.