placement disruption and its psychological consequences implications of the 3-year south australian...

Placement disruption and its Placement disruption and its psychological consequencespsychological consequences

Implications of the 3-year South Australian longitudinal study

Presenter: Dr. Paul Delfabbro

Project teamProject team

Professor Jim Barber, Flinders UniversityDr. Paul Delfabbro, Adelaide UniversityDr. Robyn Gilberton, Flinders UniversityMs. Janey McAveney, DHS, Adelaide

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

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

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

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.

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)

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)

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

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

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

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)

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

South Australian evidence: South Australian evidence: What happens when children What happens when children

progress through the care progress through the care system?system?

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’

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

Mixed methodologyMixed methodology

Multivariate analysis of child outcomes

Analysis of case profiles / child groups

Qualitative review of case histories

Interviews with children in care

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

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

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

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

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

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 (%)

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%)

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

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

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

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

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%)

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

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

HyperactivityHyperactivity

0.70.80.9

11.11.2

1.31.41.51.61.7

Intake 1 year 2 years

Stable

Very unstable

Moderatelyunstable

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

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

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

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

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

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

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

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

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

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

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

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

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

Follow-up informationFollow-up information

paul.delfabbro@adelaide.edu.auPersonal home-page for reference list (

www.psychology.adelaide.edu.au)Australian Centre for Community Services

Research (ACCSR)Contact: priscilla.binks@flinders.edu.au