Paper
Enhancing placement stability via a continuum of care approach: reflections from the Australian context
abstract
Background
The care and welfare of looked after children (LAC) in Australia is a State responsibility, in the same way as it is a Local Authority responsibility in the United Kingdom. In New South Wales, the Department of Community Services (DoCS) has the responsibility for the care and protection of children as well as statutory responsibility for Looked After Children. As of 30 June, 2006, up to 10,623 children in NSW were recorded as being in out of home care (OOHC) which includes residential care, foster care, and kinship care. Of these, 40.1% were Indigenous (Aboriginal or Torres Strait Islander) who are significantly over represented in the LAC population.
In December 2002, the NSW Government announced additional funding of $1.2 billion over six years to strengthen the child protection and care system. A significant proportion of the funding enhancement - over $600 million over the six-year period to 2007/08 - was allocated for consolidating and extending OOHC services in NSW to improve outcomes for children and young people.
A significant part of that OOHC initiative was directed at a subset (about 200) of young people in care known as "High Needs Kids" (HNKs) who were seen to have significant and complex needs and for whom "traditional" residential and foster care options had failed. Many of this group of mainly adolescents have some form of intellectual disability, and most have seriously challenging behaviours that mean they are a risk to themselves or to the people who care for them. Most have some symptoms of mental illness, and many have been diagnosed with one or more psychiatric disorders, most commonly conduct disorder, oppositional defiant disorder, or attention deficit hyperactivity disorder. Most have some involvement with the criminal justice system but have not received custodial sentences. Most HNKs have very stressful relationships and/or are poorly engaged with parents and other family members. Most also have chronic school problems including learning difficulties, behavioural problems and truancy.
These children usually fail to meet the particular thresholds for intensive intervention by any particular service system (disability, mental health, the criminal justice system) yet still have complex child protection needs. In the USA, the UK, and Canada, such children may end up in secure welfare services, e.g., accommodation in secure units. In Australia these only exist in Victoria although they are being explored in Western Australia. In NSW, no such secure provision exists, and HNKs are placed in residential and foster placements in community settings run by Non-Government Agencies such as Centacare Broken Bay.
Purpose
The present study used a retrospective file audit methodology aimed at determining the factors underpinning placement stability in community settings for High Needs Kids with high and complex needs.
Key findings
Despite the inherent difficulties associated with placing young people with such high and complex needs in community placements placement stability was high. Factors associated with placement stability were consistent with a continuum of care approach:
· Staged entry and transitional arrangements
· Movement of staff with the young person in residential care placements
· A risk minimisation rather than a matching approach to co-placement
· The exposure of young people to staff from future placements prior to placement through recreational activities
· A comprehensive individualised intervention plan that sets out an integrated approach to the young person's needs
· A close relationship between the statutory case management agency (DoCS) and the Non-Government Agency
Implications for policy and practice
A continuum of care approach leads to enhanced placement stability which in turn offers the possibility of consistent, targeted therapeutic interventions that address trauma, lead to the establishment of better attachments and social functioning, and in turn stabilise behaviours contributing to placement breakdowns. Placement stability can be enhanced if government funding and resources allow for young people to transition within agencies and care providers have the flexibility to adjust programs, staffing, and resources to meet a young person's changing needs whilst still maintaining continuity for the young person in the relationships developed within their placements.
Key references
Ainsworth, F. (2007) 'Residential programs for children and young people: What we need and what we don't need.' Children Australia 32, 1, 32-36.
Anglin, J.P. (2002) Pain, normality and the struggle for congruence: Reinterpreting residential care for children and youth. New York: The Haworth Press.
Clough, R., Bullock, R., and Ward, A. (2006). What works in residential care: A review of research evidence and the practical considerations. London: National Centre for Excellence in Residential Care, National Children's Bureau.
Contact details
Deirdre Cheers, Executive Director, Centacare Broken Bay, 29 Yardley Ave Waitara NSW 2077
Post: PO Box 636, Hornsby NSW 1630
Tel: 61 2 9488 2400 Fax: 61 2 9488 2510
Email: dcheers@brokenbay.catholic.org.au
Dr Stephen Mondy, Senior Manager Program Development and Research, Centacare Broken Bay NSW Australia.
Address as above.