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Placement disruption and its Placement disruption and its psychological consequencespsychological consequences
Implications of the 3-year South Australian longitudinal study
Presenter: Dr. Paul Delfabbro
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Project teamProject team
Professor Jim Barber, Flinders UniversityDr. Paul Delfabbro, Adelaide UniversityDr. Robyn Gilberton, Flinders UniversityMs. Janey McAveney, DHS, Adelaide
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Purpose of presentationPurpose of presentation
Brief overview of the South Australian foster care system and its status during the time of the project
Summary of the principal policy and practice directions in Australia
Summary of the key findings of the South Australian longitudinal study
Implications for policy and practice
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The South Australian foster The South Australian foster care systemcare system
Heavy reliance on family-based foster careVery little residential or group-careShortage of families willing to look after
adolescentsHigh-rates of ‘placement drift’Foster care placements are outsourced
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Policy context prevailing in Policy context prevailing in South AustraliaSouth Australia
Strong emphasis on keeping families together (‘family preservation’)
It is assumed that the attachment between children and their biological families cannot be truly replicated by relationships established with other adults
Foster care is a necessary evilLittle emphasis on adoption
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But can we generalise from But can we generalise from S.A. to other Australian S.A. to other Australian
States?States?
The trends and problems identified in South Australia appear to be shared by many other States
The research, practice and policy trends identified nationally appear very relevant to S.A.
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National priorities 1: EvidenceNational priorities 1: Evidence
Recent edition of Children AustraliaEmphasis on evidence-based practiceThis includes a need to monitor children’s
well-being as they progress through the care system
Possibility of using the LAC system (Sarah Wise’s paper)
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National priorities 2: National priorities 2: OutcomesOutcomes
Achieving more stable outcomes for children in care
Better matching of services with needsDeveloping appropriate standards for foster
care servicesMaintaining family connections (Thomson
and Thorpe paper)
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International contextInternational context
Where might we be headed?In the U.S., much greater emphasis is
placed on permanency planningThe best interests of the childThe Adoption and Safe Families Act of
1997
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The U.S. Adoption and Safe The U.S. Adoption and Safe Families Act (1997)Families Act (1997)
Child safety and well-being are now the primary imperatives
Emphasis on ‘permanency planning’ Stable and safe arrangements are the 1st priority
rather than family preservation In many States, concurrent arrangements for
adoption are made at inake Limits are placed on how long children are
allowed to drift in care
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Practice implications of U.S. Practice implications of U.S. policiespolicies
Permanent solutions (Adoption, relative care, or reunification) must be achieved quickly (usually within 15 months)
There are fewer rewards for trying to resolve problems in the family of origin
If parents are apathetic or unresponsive to goals that are set, they can lose custody of the children within 15 months
Financial penalties apply to agencies and/or States that fail to adhere to these guidelines
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Is this sort of solution Is this sort of solution appropriate for Australia? appropriate for Australia?
Some similar trends are emergingHighly publicised cases of child abuse
either in the care system or uninvestigated allegations of abuse in biological families
Strong emphasis on child protection (e.g., Layton report in South Australia)
Increasing interest in permanency planning (e.g., in Qld)
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What would make this What would make this approach justifiable?approach justifiable?
Children doing very badly in careHigh levels of placement ‘drift’Drift linked to poorer outcomes for childrenLow rates of family reunificationFamily preservation not working
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South Australian evidence: South Australian evidence: What happens when children What happens when children
progress through the care progress through the care system?system?
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Objectives of studyObjectives of study
Profile the characteristics and needs of children coming into care
Placement patterns, breakdown rates and causes of breakdowns
Psychosocial effects of placement instability
Identify children most ‘at risk’
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Design considerationsDesign considerations
Longitudinal design to address concerns about cross-sectional analyses
Cohort approach: all children includedFrequent follow-upsShort and efficiently administered measuresInformation from multiple sourcesMixed methodology
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Mixed methodologyMixed methodology
Multivariate analysis of child outcomes
Analysis of case profiles / child groups
Qualitative review of case histories
Interviews with children in care
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Sampling strategySampling strategy
All new emergency, short-term and long-term referrals (1 week+) between April 1998 and April 1999
Both metropolitan and regional areasAge 4-17 yearsExclusions: family reunification cases,
remand cases
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Measurement pointsMeasurement points
Intake1st 12 months (every 4 months)Thereafter (every 6 months)Interviews with case workers, and a subset
of foster carers and children to assess the reliability of measures
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Sample characteristicsSample characteristics
235 children (121 boys, 114 girls)73% from metropolitan area40 Indigenous/ 195 non-indigenous90 (38.%) were teenagers195 (83%) had a previous placement history40 (17%) had never been placed in care
before
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MeasuresMeasures
Abbreviated CBCL, health, substance abuse, sexualised behaviours, educational and social adjustment, offending behaviour
Placement movements: duration, location, nature, reason for termination
Family contactCase worker involvement
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Two identifiable baseline Two identifiable baseline clustersclusters
CLUSTER 1 N=132 More girls Mean age =13.35 yrs. Behavioural problems
CLUSTER 2 N=103 More boys Mean Age = 7.44 yrs. Parental problems Neglect
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Placement historiesPlacement histories
0
5
10
15
20
25
1 to 2 3 to 5 6 to 9 10+
Placement numbers
Previous placement history at intake (%)
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Placement destinationsPlacement destinations
Gone
Home
Stable in care
Unstable in care Other
At 4 months 59 (25%) 72 (31%) 92 (39%) 12 (5%)
At 8 months 85 (36%) 90 (38%) 49 (21%) 11 (5%)
At 12 months 92 (39%) 83 (35%) 43 (18%) 17 (7%)
At 2 years 95 (40%) 59 (25%) 50 (21%) 31 (13%)
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Placement rates over 2 yearsPlacement rates over 2 years
0
0.5
1
1.5
2
2.5
3
4 mths 8 mths 12 mths 2 yrs.
Follow-up points
Mean changes per 4 months
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Why do placements end?Why do placements end?
Take the 4-month (most unstable period)49% of placements only intended to be
short-term18% Broke-down due to child’s behaviour14% Family reunification7% Other arrangements secured
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Problematic examplesProblematic examples
4 mths 8 mths 12 mths 2 yrs
1 FFFFFFFFFFRFFFFFFFFFFF
F FFFFFFFFFF
FFFFFFFFFF
2 FFFFFFFFFFFFFC
CY Y YSYSMSYSSSYSYM
3 F F FCFFHFFH
FYSISYSYSYSY
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Identifying challenging Identifying challenging childrenchildren
Which children are struggling in care?What predicted the case profiles just
shown?ANSWER: 2 or more breakdowns due to
behaviour in 2 years
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Comparative placement Comparative placement destinationsdestinations
Gone
home
Stable
in care
Unstable in care Other
Total sample
(n=185)
88 (48%) 55 (30%) 20 (11%) 23 (12%)
Challenging
Group (n=50)
7 (19%) 4 (8%) 30 (60%) 9 (18%)
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Psychological outcomes in Psychological outcomes in South Australian foster careSouth Australian foster care
Analyses involved 3 groups
Group 1: Stable throughout
Group 2: Moderately unstable
Group 3: Very unstable
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Conduct disorderConduct disorder
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Intake 1 year 2 years
Stable
Very unstable
Mod unstable
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HyperactivityHyperactivity
0.70.80.9
11.11.2
1.31.41.51.61.7
Intake 1 year 2 years
Stable
Very unstable
Moderatelyunstable
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Social adjustmentSocial adjustment
2.5
2.6
2.7
2.8
2.9
3
3.1
3.2
3.3
Intake 1 year 2 years
Stable
Very unstable
Moderatelyunstable
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General trendsGeneral trends
Children stable in care generally improve or remain unaffected by foster care
The most unstable children show improvements in the short-term, but then experience deteriorations in functioning after 12 months
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Results for the most Results for the most challenging children (n=50)challenging children (n=50)
All adjustment measures poorer at baseline and after 2 years
Some improvement in conductNo improvement in hyperactivity and
emotionalityDecrease in social adjustment
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Summary of placement Summary of placement findingsfindings
Placement instability is NOT as severe as indicated by cross-sectional designs
Most placement changes are planned Most children are doing well in foster care Approximately 15-20% of children are
experiencing severe disruption Placement disruption is not problematic unless it
is sustained
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Thresholds and early Thresholds and early detectiondetection
It is possible to detect problematic cases very early and using system data
If At intake: Age = 15 + Conduct disorder items all in ‘frequent’ or ‘often’ range THEN p (breakdown) = 80% in 1st 4 months
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Further examplesFurther examples
If N (breakdowns due to behaviour) > = 2 within 2 years, then P(stability within 2 years) = 8%
If the child is not stable by 12 months, psychosocial functioning will deteriorate
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Significance: Supports the Significance: Supports the role of indicators to monitor role of indicators to monitor
progressprogressNeed systematic inake assessmentCase terminations need to be monitoredCritical thresholds and indicators can be
used to ‘flag’ or identify cases at riskProblematic cases could be targeted for
early intervention
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Evidence in support of Evidence in support of American model?American model?
Placement instability appears harmful beyond 12 months
Monitoring outcomes is feasible and worthwhile
Interventions with families should occur sooner rather than later
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Is foster a ‘necessary evil’?Is foster a ‘necessary evil’?
Children’s viewsInterviews were conducted with 100
children (50 in the current study and 50 in existing long-term placements)
In both groups, 95% believed they were well treated by their carers, and felt safe and accepted
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Further conclusionsFurther conclusions
Foster care is a good option for many children and most carers are doing an excellent job
Foster care should be seen as a realistic option that can benefit children; not simply a last resort
We strongly endorse the need for monitoring and early detection of children for whom foster care is not working
We believe that this monitoring and early detection process is very feasible
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Continued….Continued….
Prescriptive foster care (one rule for all) ignores the fact that there are different clusters of children in care
Certain children are not suitable for family-based care. Other options should be sought for them
We endorse permanency planning, but believe that this can be achieved without severing family ties
Alternatives to foster care should only be considered when there is evidence for genuine disruption and instability
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Continued…Continued…
The same rules should not be applied to children who seem to be doing well in care
Foster care should not be a one system fits all
The focus should be on what works rather than rigid inflexible policies that are not adaptive to differences within the care system, e.g., carer classifications
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Other issues examinedOther issues examined
Predictors of family reunificationNature and effects of family contactGeographical distribution of placementsCost-analysis of special loadingsChildren and foster carers’ perceptions
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Follow-up informationFollow-up information
[email protected] home-page for reference list (
www.psychology.adelaide.edu.au)Australian Centre for Community Services
Research (ACCSR)Contact: [email protected]