A national profile and review of services and interventions for children and young people with high support needs in Australian out-of-home care

One of the major challenges currently being faced by out-of-home care services is the issue of placement breakdown and multiple placements, and the psychological effects of these experiences. Previous longitudinal research by Barber and Delfabbro (2004) indicates that approximately 15-20% of young people in Australian out-of-home care have significant emotional and behavioural problems or 'high support needs' that often condemns them to a life of repeated placement instability and further psychosocial harm. This thesis reports the findings of Australia's first national comparative study of 364 children with this placement profile in four Australian States (Queensland, South Australia, Victoria and Western Australia). Based on detailed interviews with case-workers, case-file reading, and comprehensive analysis of objective placement data, this study provides a detailed analysis of the social and family background of this population of children, their psychosocial profile, service history, and their placement experiences. It was found almost all of the children with high support needs in Australian out-of-home care had been subjected to traumatic, abusive, and highly unstable family backgrounds. A proportion of young people had experienced over 30 placement changes and approximately 70% scored in the clinical range of emotional and behavioural disturbance. The young people in the sample were generally very similar in their characteristics. Children within this population appear to form one single cluster based upon very common family experiences; namely, the combined effects of domestic violence, substance abuse, physical violence and neglect. Such findings suggest very strongly that out-of- home care policy cannot, and should not, be considered in isolation from other important areas of social policy and public health. Following the review of the characteristics of the children, the thesis examined the range of therapeutic interventions and placement options that might be suitable to address their needs. This section involved a literature review, an extensive internet search of care and service options and a review of program information wherever this was available. It is clear from the review that it is very difficult to maintain this population of children and young people in stable family-based foster care arrangements within the existing out-of-home care system. This thesis highlights the need for a greater integration of services and a greater focus on ensuring an ongoing commitment to addressing the entrenched psychological and social difficulties contributing to placement instability. There is also a great need for a re-structuring and re-thinking of the continuum of care services available to children in out-of-home care, including the possible development of professional foster care services and an increased use and availability of treatment group residential care options. Most importantly, a re-structuring of the way child protective services and family, social and mental health services are provided and coordinated by State governments is felt to be desperately needed.Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2006