Making Records Meaningful: Creating an Identity Resource for Young People in Care

Abstract

The Who Am I? research was an interdisciplinary, action research project focused on the past and present record-keeping practices for people growing up in out-of-home care in Australia. This paper reports on two of the nested projects directed at current record-keeping practices. For the 100+ Points of Identity study, a tool was developed (the Document Accessibility Exercise or “Daesy”) to determine the number of personal records critical to identity that could be accessed by practitioners prior to a young person leaving a placement. The Backpack of Identity project developed a further iteration of the action research cycle, as the first project identified the vulnerability of the record when placements for the young person changed. A number of implications for practice arose, including the need for greater attention to the development of personal records (as against an administrative record) and the need for practitioners to understand their responsibilities for the story “of the record” as well as the story “in the record”.     

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.     

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.     

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.     

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.     

Letters

Abstract

Approximately 500,000 children were institutionalised in Australian orphanages and other forms of children's Homes over the course of the 20th century. However, growing up in care is not just a part of childhood; it can have ongoing impact across a person's life. Access to records can be a very important way in which people who grew up in institutional care construct the story of their lives, contributing to their self-identity, and also find out practical information, such as their exact date of birth and medical history. The present article takes as its starting point a recommendation of the third of the Australian Government reports concerned with the institutionalisation of Australian children—Forgotten Australians—and draws on interviews with former residents of children's Homes aged between 42 and 76 years to examine their access to records in Australia. We discuss a case study, the unique Heritage Information Service at MacKillop Family Services, which supports former residents to access their records, and consider the implications for good practice of agencies working in this area.     

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.     

Australia's leading social work authors: the devil in the detail

Abstract

Many care leavers with disabilities face difficulties as they transition from out-of-home care (OoHC), and suffer multiple, ongoing forms of disadvantage after they leave care. This paper is drawn from a study comprising six focus groups, involving 21 participants employed in disability and OoHC services in Victoria, Australia. The findings suggest that care leavers with disabilities do not receive the transitional and postcare support and housing they need. Many are transitioned into housing options that are unsuitable for their needs, or unsafe. The argument of this paper is that care leavers with disabilities may benefit from adult guardianship legislation. When appropriate an application for a guardianship order should be made prior to the young person exiting care, to enable a smooth transition between the child and adult systems. Adult protection services with an advocacy function should be given the opportunity to advocate for care leavers with disabilities.     

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.     

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.     

Downward spiral: The impact of out-of-home placement on paternal welfare dependency

In this article, we test how out-of-home placement affects men's labor market attachment, and in so doing we provide a novel parallel to existing research on how fatherhood affects men, which focuses almost exclusively on a child's arrival. Using population panel data from Denmark that include all first time fathers whose children were placed in out-of-home care from 1995 to 2005, we find that having a child placed in care is associated with up to a 4 percentage point increase in welfare dependency. Having a child placed in out-of-home care appear to aggravate conditions that likely necessitated the out-of-home placement to begin with, thereby likely necessitating longer duration of out-of-home placements. Thus, out-of-home placements have substantial secondary costs for parents and society.     

The Education of Children in Out-of-home Care

Abstract

In spite of a high investment in out-of-home care services across Australia, the educational attainment of children in care remains an issue of concern. This paper discusses findings from a study designed to identify the factors that promoted educational attainment of children in care based on 18 university-educated women with a care background. The narratives of these women from primary schooling through to graduating from a university were collected and analysed using narrative inquiry. The women's narratives strongly suggested that the educational needs of children in care vary according to individual care circumstances and individual characteristics, and can be identified in five groups: Destined, Decision, Determined, Denied, and Delayed. It was concluded that the promotion of educational attainment for children in care requires carefully tailored support and resources following assessment based on this information.     

The transition from in-home services to out-of-home care: A Danish register-based study

Objective

This register-based study describes the transition from in home-based care to placements in out-of-home care. It also describes whether children who enter care directly differ from children who enter care after episodes of in home-based care.

Method

The study includes all children who entered the child protection system of a larger regional social service system in Denmark from 1993 to 2006 (N = 9961). Graphs of cumulative incidences were used to describe transitions into out-of-home care within two years after in home-based care started. Cox regression models are used to estimate the impacts of child and parental characteristics. In addition, Chi² tests are used to identify differences between children who enter care directly and children who receive in home-based care.

Results

Results indicate that the majority of children do not enter out-of-home care but that risks differ among age groups. Covariates did not predict transitions into out-of-home care for those who entered in-home care after becoming teenagers. Especially for those who entered in-home care before entering their teens, the psychiatric histories of the mothers and the children predicted the transitions into out-of-home care. Immigration background was a protective factor for those who entered in-home care as pre-scholars. Depending on the age group, low birth weight, children's fathers' and mothers' psychiatric histories, and single parentship were all characteristics more likely to be associated with children who entered care directly. Children who entered care directly differed from children who entered care within two years after an in home-based service had been initiated on covariates that described psychiatric history.     

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.     

“We Live and Breathe Through Culture”: Conceptualising Cultural Connection for Indigenous Australian Children in Out-of-home Care

Indigenous Australian children are overrepresented in the out-of-home care (OOHC) system, with numbers and rates on an upward trajectory. There is now serious concern that this overrepresentation is creating a second Stolen Generations in Australia, noted within policy campaigns such as Family Matters—Kids Safe in Culture, not in Care, and Grandmothers Against Removals. While placement in OOHC is designed to protect children’s long-term safety and wellbeing, it threatens cultural connection, which is fundamental to Indigenous identity and wellbeing. Some government policies that aim to foster cultural connection have not been effective, while others, such as the 2014 permanency legislation in Victoria, arguably threaten cultural connection. This article highlights the vital importance of cultural connection for Indigenous child development, arguing that for Indigenous children, family connection strengthens cultural connection. We argue that family needs to be recognised as a critical component of cultural connection that is equally as important as placement stability in OOHC. Consequently, statutory and community organisations responsible for Indigenous children in OOHC must focus on facilitating and strengthening family relationships, not only to foster cultural connection, but also to explore reunification possibilities.

IMPLICATIONS

• Cultural connection is fundamental to Indigenous identity and wellbeing, but requires family connection if it is to be fostered and strengthened.

• When Indigenous children live in out-of-home care, social workers in child and family welfare need to ensure that children are connected to culture.

     

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.     

Remaining home: Well-being outcomes and co-occurring parental substance use following a maltreatment investigation in middle childhood

PurposeThe purpose of the study is to understand differences in child well-being related to parental substance use among children ages 6–12 who were investigated for maltreatment but not removed from their homes. Children with a substance-using parent in the home are compared to those without a substance-using parent in the home.MethodsLongitudinal data from waves 1 and 3 of the second National Study of Child and Adolescent Well-Being (NSCAW II) are used. NSCAW II is a national sample of families with children and youth aged birth to 17.5 investigated by child protective services (CPS). A subset of the data (analyzed with domain analysis methods) is used for this study (n = 575). Eight well-being outcomes from four domains (cognitive development, physical health, psychological/behavioral development and social/emotional competence) are analyzed.FindingsWe hypothesized that (among children investigated for maltreatment and not removed from home) children whose parents used substances would exhibit lower mean levels of well-being at thirty-six months follow-up compared to those whose parents did not use. Unexpectedly, we found no significant differences in well-being levels between children with parents in the home using substances and those without.ConclusionsChildren with substance-using parents may be able to remain at home over an extended period after investigation, while maintaining well-being levels similar to children at home with parents not using substances. If an effective safety plan can be put in place, this option may provide a path to maintaining safety, permanency and well-being for such children without placement in out-of-home care.     

Kinship Care: Analysis of the Health and Well-Being of Grandfathers Raising Grandchildren Using the Grandparent Assessment Tool and the Medical Outcomes Trust SF-36 TM Health Survey

ABSTRACT

As more and more children are being separated from their biological parents because of AIDS, substance abuse, mental and physical illness, incarceration, and child abuse and neglect, child welfare agencies are relying more often on kinship care as a viable option for out-of-home placements. In many cases, kinship care falls on the grandparents. While keeping children within their families is generally viewed as preferable by child welfare agencies, it can be a burden on grandparent caregivers, who often exist on severely limited incomes and without much assistance or support from social service agencies. A research project was conducted which used both quantitative and qualitative data from research conducted by Jones and Gibbons (2000) on grandparent care, but this study focuses on the experiences of grandfathers who participated in the project and examines their outcomes in several different areas.     

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.     

Understanding corruption

Abstract

Like many governments across the globe, the Australian Government has embarked on major healthcare reforms. Part of this reform agenda included the establishment of sixty-two primary healthcare organisations (PHOs) originally called Medicare Locals (MLs), currently to be re-structured as primary healthcare networks. Primary health organisations were tasked with the coordination of primary health care delivery and with tackling local healthcare needs and service gaps. They were to drive improvements in primary healthcare and ensure that services are better tailored and integrated to meet the needs of local communities. This article puts forward the argument that new primary healthcare organisations have the potential and the ethical aspects of healthcare organisations are largely overlooked in the literature. To address this gap we outline two complementary frameworks: a theory of ethical communities and an emancipatory method. We conclude that these frameworks could be used as potential guides for new healthcare organisations to become transformative organisations.