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A National Profile and Review of Services and Interventions for Children and Young People with High Support Needs in Australian Out-of-Home Care Alexandra L. Osborn B.HSc.(Hons) Submitted for the award of Doctor of Philosophy in the School of Psychology University of Adelaide June 2006 The thesis contains no material which has been accepted for the award of any other degree or diploma in any University, and, to the best of the candidate’s knowledge and belief, the thesis contains no material previously published or written by another person, except where due reference is made in the text of the thesis. I give written consent to this copy of my thesis, when deposited in the University Library, being available for loan and photocopying. Signed: Dated: 9th June 2006 v Abstract 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 vi 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. vii Acknowledgements “Perhaps the greatest social service that can be rendered by anybody to this country and to mankind is to bring up a family”. George Bernard Shaw First, I would especially like to thank Dr. Paul Delfabbro, my supervisor, for all of his support, assistance, encouragement, guidance and expertise. I would not have been able to complete my thesis otherwise. I would like to thank him for all of the travel and work opportunities and all of the funding he has offered and provided for me during my candidature. I would also like to thank Associate Professor Helen Winefield, my co-supervisor, for all of her help and guidance with editing my thesis and offering invaluable advice and guidance. I would like to acknowledge and thank all of the wonderful people that worked on this research project with me, including Ms Mignon Borgas, Professor Jim Barber, Ms Tara Black and all of the researchers involved in the project from around the country. I also need to acknowledge and thank the case-workers for the time they took out of their hectic and stressful work lives to participate in my interview. I greatly appreciate their time, effort and recommendations. I would also particularly like to thank my mum (for reading my thesis) and dad and my two sisters, Cathy (for formatting my thesis) and Leah, for all of their encouragement, support and love. I would like to especially thank Stacey Panozzo for all of her support, encouragement and coffee breaks – without her I would have gone crazy. I am also grateful of the support provided to me from Caroline, Jadynne and Sara – they all deserve a big thank you! Most importantly, the children and young people, on whom much of the research in this thesis is based, I hope that one day the best possible service can be provided to you. Last, but certainly not least, I would like to thank my husband Paul for being the best husband, friend, confidante, cook, and most supportive person in the world. ix Table of Contents General Introduction........................................................................................................ 1 SECTION A....................................................................................................................... 7 Chapter 1 ........................................................................................................................... 7 Literature review .............................................................................................................. 7 1.1 The need for out-of-home care in Australia ............................................................. 7 1.2 How children come into care in Australia.............................................................. 11 1.3 The principal forms of out-of-home care in Australia .......................................... 12 1.4 Out-of-Home Policy: Then and Now....................................................................... 17 1.4.1 A Brief History of Australian Out-of-Home Care ............................................... 17 1.4.2 The modern policy environment.......................................................................... 20 1.5 Foster Care ‘Drift’ or Placement Instability.......................................................... 23 1.6 Psychosocial issues in foster care research: An overview ..................................... 26 1.6.1 The effects of early trauma on child well-being .................................................. 26 1.6.2 Attachment theory and out-of-home care placement........................................... 34 1.7 Family contact and disconnection in foster care.................................................... 38 1.8 Problems left untreated in care ............................................................................... 43 1.9 General psychosocial consequences in adulthood of out-of-home care ............... 44 SECTION B..................................................................................................................... 49 Chapter 2 ......................................................................................................................... 49 National Comparative Study of Children with High Support Needs ........................ 49 2.1 The Problem of Foster Care Drift or Placement Instability................................. 49 2.1.1 The need for further research into placement instability ..................................... 50 2.1.2 Aims of the National Comparative Study............................................................ 51 2.2 Overview of method and presentation of results .................................................... 53 2.2.1 Selection criteria .................................................................................................. 53 2.2.2 Sample characteristics.......................................................................................... 54 2.2.3 State differences in sample characteristics .......................................................... 55 2.2.4 Method of data collection .................................................................................... 56 2.2.5 General survey design.......................................................................................... 57 2.2.6 Frequency of case-worker contact with child and foster carers/staff .................. 58 2.3 Measures.................................................................................................................... 59 2.3.1 Case-file Audit..................................................................................................... 59 x 2.3.2 Psychosocial assessment - Interview

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