Placement disruption and its psychological consequences

1. Placement disruption and its psychological consequences Implications of the 3-year South Australian longitudinal study Presenter: Dr. Paul Delfabbro

2. Project team • Professor Jim Barber, Flinders University • Dr. Paul Delfabbro, Adelaide University • Dr. Robyn Gilberton, Flinders University • Ms. Janey McAveney, DHS, Adelaide

3. Purpose 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

4. The South Australian foster care system • Heavy reliance on family-based foster care • Very little residential or group-care • Shortage of families willing to look after adolescents • High-rates of ‘placement drift’ • Foster care placements are outsourced

5. Policy context prevailing in South 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 evil • Little emphasis on adoption

6. But can we generalise from S.A. to other Australian 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.

7. National priorities 1: Evidence • Recent edition of Children Australia • Emphasis on evidence-based practice • This 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)

8. National priorities 2: Outcomes • Achieving more stable outcomes for children in care • Better matching of services with needs • Developing appropriate standards for foster care services • Maintaining family connections (Thomson and Thorpe paper)

9. International context • Where might we be headed? • In the U.S., much greater emphasis is placed on permanency planning • The best interests of the child • The Adoption and Safe Families Act of 1997

10. The U.S. Adoption and Safe 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

11. Practice implications of U.S. policies • 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

12. Is this sort of solution appropriate for Australia? • Some similar trends are emerging • Highly 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)

13. What would make this approach justifiable? • Children doing very badly in care • High levels of placement ‘drift’ • Drift linked to poorer outcomes for children • Low rates of family reunification • Family preservation not working

14. South Australian evidence: What happens when children progress through the care system?

15. Objectives 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’

16. Design considerations • Longitudinal design to address concerns about cross-sectional analyses • Cohort approach: all children included • Frequent follow-ups • Short and efficiently administered measures • Information from multiple sources • Mixed methodology

17. Mixed methodology Multivariate analysis of child outcomes Analysis of case profiles / child groups Qualitative review of case histories Interviews with children in care

18. Sampling strategy • All new emergency, short-term and long-term referrals (1 week+) between April 1998 and April 1999 • Both metropolitan and regional areas • Age 4-17 years • Exclusions: family reunification cases, remand cases

19. Measurement points • Intake • 1st 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

20. Sample characteristics • 235 children (121 boys, 114 girls) • 73% from metropolitan area • 40 Indigenous/ 195 non-indigenous • 90 (38.%) were teenagers • 195 (83%) had a previous placement history • 40 (17%) had never been placed in care before

21. Measures • Abbreviated CBCL, health, substance abuse, sexualised behaviours, educational and social adjustment, offending behaviour • Placement movements: duration, location, nature, reason for termination • Family contact • Case worker involvement

22. 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 Two identifiable baseline clusters

23. Placement histories

24. Placement destinations

25. Placement rates over 2 years

26. Why do placements end? • Take the 4-month (most unstable period) • 49% of placements only intended to be short-term • 18% Broke-down due to child’s behaviour • 14% Family reunification • 7% Other arrangements secured

27. Problematic examples

28. Identifying challenging children • Which children are struggling in care? • What predicted the case profiles just shown? • ANSWER: 2 or more breakdowns due to behaviour in 2 years

29. Comparative placement destinations

30. Psychological outcomes in South Australian foster care Analyses involved 3 groups Group 1: Stable throughout Group 2: Moderately unstable Group 3: Very unstable

31. Conduct disorder

32. Hyperactivity

33. Social adjustment

34. General 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

35. Results for the most challenging children (n=50) • All adjustment measures poorer at baseline and after 2 years • Some improvement in conduct • No improvement in hyperactivity and emotionality • Decrease in social adjustment

36. Summary of placement findings • 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

37. Thresholds and early detection • 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

38. Further 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

39. Significance: Supports the role of indicators to monitor progress • Need systematic inake assessment • Case terminations need to be monitored • Critical thresholds and indicators can be used to ‘flag’ or identify cases at risk • Problematic cases could be targeted for early intervention

40. Evidence in support of American model? • Placement instability appears harmful beyond 12 months • Monitoring outcomes is feasible and worthwhile • Interventions with families should occur sooner rather than later

41. Is foster a ‘necessary evil’? • Children’s views • Interviews 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

42. Further 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

43. 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

44. 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

45. Other issues examined • Predictors of family reunification • Nature and effects of family contact • Geographical distribution of placements • Cost-analysis of special loadings • Children and foster carers’ perceptions

46. Follow-up information • paul.delfabbro@adelaide.edu.au • Personal home-page for reference list (www.psychology.adelaide.edu.au) • Australian Centre for Community Services Research (ACCSR) • Contact: priscilla.binks@flinders.edu.au