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Paper

Evaluation of the circle therapeutic foster care program in Victoria, Australia: Outcomes and implications

abstract

Background. Children and young people requiring out-of-home (OoHC) care have experienced severe abuse and/or neglect and trauma. Services for these children should be developmentally appropriate, focusing on the best interests of the child; they must also be culturally supportive and needs driven. The Circle Program aims to offer such a service. It is a therapeutic foster care program, introduced in 2007 by the Victorian State Department of Human Services in Australia. The overarching conceptual frame of reference for The Circle Program is ecological-developmental (Bronfenbrenner 1997), informed by a knowledge of trauma and attachment (Perry 2009) and application of social network theory (Pecora 2010); it is guided by the Best Interests of the Child framework (DHS 2010). The Circle Program aims to improve outcomes for children and young people (0-15 years) who have experienced abuse and/or neglect and been placed in out of home care. A program evaluation was undertaken by a research team from La Trobe University's Melbourne campus in 2011-2012 (Frederico et al., 2012 http://www.cfecfw.asn.au). There were 97 Circle program placements available within the Victorian foster care system at the time of the evaluation; this constituted 7% of foster placements across Victoria. This paper focuses on key findings and considers implications for practice, policy planning and further research.

Aims. The evaluation aims were to explore effectiveness, review outcomes for children and young people, carers and families and to make recommendations for further program development.

Methods. Data collection included review of the literature and program documentation, interviews with Therapeutic Specialists and selected key informants, on-line surveys completed by 38 Carers in The Circle Program, 43 Generalist Foster Carers and 56 professionals, including Child Protection Practitioners. Focus groups for Circle Carers and service providers were conducted, along with analysis of assessment, review and closure documents and case studies. The researchers also utilised a sample of approximately 180 children and young people who have experienced The Circle Program matched with the same number from General Foster Care. The children were matched by age, date of entry into foster care, and local government area. The Project Brief stipulated that there be no direct contact with children and young people or their biological families, so those important perspectives were not included.

Findings. The following key themes emerge from data analysis related to the seven areas targeted for investigation in the Evaluation Brief:

1. Theoretical underpinnings: Overall, The Circle Program implementation appears to have been consistent with the program design and has remained true to its conceptual underpinnings. This was evident from analysis of training, review of documentation, the data from the focus groups held with carers and professional foster care workers and discussions with key informants.

2. Program content/processes: The program appears to have followed guidelines closely and consistently.

Professional survey respondents in particular cited the importance of a whole organisation commitment to the delivery of The Circle Program, and this commitment to content and guidelines influenced the maintenance of program integrity.

3. Child outcomes: In summary: real gains in children's and young people's stability; the attainment, and in some instances exceeding, of developmental milestones where there had been marked delay; the capacity to offer continuity of care to children and young people who were experiencing ongoing instability as a result of their legal status; and successful reunification with the children and young people's families. These outcomes are consistent with international research evidence of the effectiveness of therapeutic approaches to foster care (Fisher, Kim and Pears 2009; Westermark, Hanssen and Vinnerljung 2008).

Characteristics of children and young people. The initial Circle Program targets were met or exceeded. Where targets were not met, recruitment of suitable carers was identified as the main difficulty. The age range for children and young people in the program was 0 years to 15 years. The median age was two years, and the mean 3.8 years.

Outcomes for Aboriginal and Torres Strait Islander children and young people. The high percentage of Aboriginal and Torres Strait Islander children and young people participating in The Circle Program is consistent with the over-representation of these children and young people in OoHC in Victoria and other Australian states and territories. Relatively few of the children and young people included in this evaluation had Cultural Support Plans in place; it was of concern that carers were not receiving cultural support.

Enhanced stability. There was enhanced stability and continuity of care for children and young people in The Circle Program compared to those in generalist foster care and significantly fewer unplanned exits from The Circle Program. Stability in placement is clearly an important factor in the outcomes of care for children and young people (Fisher, Kim and Pears 2009; Westermark, Hanssen and Vinnerljung 2008).

Significant developmental gains. Children and young people in The Circle Program made gains in their capacity to form relationships, regulate their emotions and participate in community activities. They also demonstrated stronger cultural identity and enhanced relationships with their families. The latter has been found to correlate positively to potential family reunification or ongoing positive family relationships (Pecora 2010).

4. Foster carer outcomes: The Circle Program carers are clearly well trained and supported and as a result better placed to provide a healing environment for children and young people who have experienced trauma. Carers positively highlighted their experience of support, training and ongoing education and access to flexible «brokerage» funds. Carers in The Circle Program were significantly less likely to withdraw from foster care than those in generalist foster care. A key factor contributing to carers' success in The Circle Program was that of feeling «listened to», that their opinions were «valued». Carer wellbeing was also described as a constant point of focus in Care Team meetings.

5. Family outcomes: A key message from the focus groups was that The Circle Program has been more successful in engaging families than the generalist foster care model. This appears to have been assisted by the process of regular Care Team meetings in which the child's family is included. Care Team meetings provided an opportunity for families to engage and develop relationships with other Team members. They ensured that the family remained involved and informed about their child's or children's situation and gave them the opportunity to participate in discussion and decision-making. Qualitative data are supported by a trend in the quantitative data where more children and young people in The Circle Program reunify with their family or go to kinship care than children and young people in a generalist foster care placement.

6. Cost comparison: A comparison of Circle Program and generalist foster care benefits and costs suggests that The Circle Program shows up strongly in comparison with generalist foster care when outcomes for children and the care system are taken into account. Significant un-costed benefits include the development of a training model now in use in generalist foster care and the development of effective approaches to working therapeutically with vulnerable children throughout the service system.

7. Program improvements: It was suggested that the important role of Child Protection Practitioners should be further emphasised in implementation of The Circle Program Guidelines. It was suggested that the Guidelines could highlight the role undertaken by the Therapeutic Specialist in facilitating educational stability for the child and young person through their work with teachers and the school. Development of an evidence based outcomes model, enhanced carer recruitment for The Circle Program, «refresher» training for Circle Carers, greater attention to culture and access to respite with consistent therapeutically trained carers were recommended (McNamara et al. 2011).

Conclusions. This evaluation suggests that most Victorian children and young people in foster care can potentially benefit from engagement in The Circle Program. The Circle Program would appear to achieve excellent early intervention results; it can also achieve very good results where children in out-of-home care experience complex and entrenched difficulties. There are, however, some constraints to achieving these outcomes. They include recruitment of carers, experience of high caseloads by Therapeutic Specialists and demands on Child Protection workers, limiting their engagement. The Circle is also still a finite resource in Victoria, currently only experienced by a small percentage of children in foster care. However, the Victorian State Government committed funds to improve the delivery of Therapeutic Foster Care to Aboriginal and Torres Strait Islander children in 2012 and in 2013 has allocated substantial funding to the overall expansion of therapeutic foster care. Neighbouring New South Wales has also seemingly been influenced by The Circle in developing its own therapeutic foster care program. These signs are encouraging for the future of a program that seems to make an important difference for vulnerable children and young people.

Key references

Bronfenbrenner, U. (1997). The Ecology of Human Development Experiments by Nature and Design, Cambridge: Harvard University Press.

Department of Human Services (2010). Cumulative Harm: Best Interests Practice Model, Specialist Practice Resource, Melbourne: Government of Victoria.

Fisher, P., Kim, H. and Pears, K. (2009). Effects of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) on reducing permanent placement failures among children with placement instability. Child and Youth Services Review, 31, 541-555.

Frederico, M., Long, M., McNamara, P., McPherson, L. and Gilbert, K. (2012). Latrobe University Department of Social Work and Social Policy for The Centre for Excellence in Child and Family Welfare, Melbourne, Victoria, Australia The Circle Program: An evaluation of a therapeutic approach to foster care http://www.cfecfw.asn.au.

Pecora, P. (2010). What works best in foster care: Results of the Northwest Alumni Study. New York: Oxford University Press.

Perry, B.D. (2009). Examining child maltreatment through a neurodevelopmental lens. Journal of Loss and Trauma,14, 240-255.

Westermark, P., Hannsson, K. and Vinnerljung, B. (2008). Does MTFC reduce placement breakdown in fostercare? International Journal of Child and Family Welfare, 4, 155-171.

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