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featureHealth needs and outcomes for children in out-ofbyMelinda Clarke and Kylie Gwynne | Life Without BarriersMost Australian children have thechance to grow up safe and well infamilies where they are cared for,supported and enabled to growinto contributing members of thecommunity. Some children, however,grow up in out-of-home care. For thesechildren growing up safe and well is afar less certain outcome.Out-of-home care is provided acrossAustralia for children and youngpeople who are unable to live withtheir families. Out-of-home care cantake the form of foster care (living witha family), residential care (living in astaffed house with other children), orkinship care (living with a relative).Children enter out-of-home carefollowing an assessment by the statebasedcommunity services governmentdepartment, usually because achild abuse or neglect matter issubstantiated, or their family is unableto care for them. In NSW this is theresponsibility of Community Services,part of the Department of HumanServices. Children may be placed intemporary or short term out-of-homecare by the Department and then theChildren’s Court can determine if achild will be placed in the care of theMinister and in out-of-home care in thelonger term.Health is one of the most basicindicators of wellbeing in children andyoung people, including social andemotional wellbeing, which in turnis related to quality of life. Childrenand young people in out-of-homecare are a particularly vulnerablepopulation and are more likely to havephysical and mental health problemscompared to the general population ofchildren. There is a myriad of researchdemonstrating that children in out-ofhomecare have higher rates of health,dental, developmental, behavioural andemotional problems and a significantnumber also have a physical and/orintellectual disability. For example,Nathanson and Tzioumi 1 (2007)found that, compared to the generalpopulation, children seen at the SydneyChildren’s Hospital out-of-home clinicwere:n Four times more likely to haveproblems with vision;n Eight times more likely to haveproblems with hearing;n Two to three times more likelyto have speech and languagedifficulties; andn Much less likely to be fullyimmunised.There are a range of risk factors inthe early life of children and youngpeople who enter care that increasetheir risk for developing healthproblems including:n Poor diet;n Inadequate healthcare;n Increased risk of accidental injuryassociated with poor parentalsupervision;n Physical and emotional traumaassociated with various forms ofmaltreatment;n Exposure to parental drug abuse(pre- and post-birth);n Exposure to high levels of conflictand family violence; andn Attachment disruption.Some children and young peopleare further disadvantaged by multipleplacement changes, leading to pooremotional and social adjustment.Placement changes can sometimestranslate into poor communicationabout health history leading to delaysin accessing the right healthcare andsupport services. Although there isa large body of research evidencepointing to the poor state of healthof children in out-of-home care, andthis evidence has been accepted bygovernments across Australia, furtherwork is required in order to alter thecourse of the trend.The National Standards for Outof-HomeCare 2 will be implementedthis year and were developed viaan extensive national consultation.The KPMG Final Report – NationalStandards for Out-of-Home Care 3 –identifies physical and mental health asone of the six key areas of overall childwellbeing. Standard 5 requires thatchildren and young people have theirphysical, developmental, psychosocialand mental health needs assessed andattended to in a timely way.The standard goes on to state that:Children and young people enteringcare are to have their health needsassessed and receive specialisedservices to respond to their healthchallenges so that their chances foroptimum health are maximised. The16 I THE NSW DOCTOR I march 2011
home care in Australiachild or young person’s physical,developmental and psychosocialand mental health needs are to beidentified in a preliminary healthcheck. This will provide advice on thespecialist services required and thetiming of a comprehensive health anddevelopmental assessment. Childrenand young people are to have their ownwritten health record which moves withthem if they change placements.Effective implementation of thisnew National Standard will go someconsiderable way to ensuring that thehealth needs of children in out-of-homecare are met in a more consistent way,leading to more positive outcomes.This will require substantial effortand commitment on the part of stategovernments – both communityservices and health portfolios and themany non-government organisationsthat provide out-of-home care services.Children in out-of-home care are partof our community and experience pooroutcomes through no fault of their own.It is incumbent on all of us to work toensure that they have a better chanceto grow up safe and well.Life Without Barriers is the largest nongovernmentprovider of out-of-home careacross Australia1 Nathanson, D., & Tzioumi, D. (2007). Health needs ofAustralian children living in out-of-home care. Journal ofPaediatrics and Child Health, 43, 695-699.2 http://www.fahcsia.gov.au/sa/families/pubs/nat_std_4_outofhomecare/Pages/default.aspx3 http://www.fahcsia.gov.au/sa/families/pubs/kpmg_final_report_nsfohc/Pages/default.aspx4 Report on Government Services 2010 http://www.pc.gov.au/__data/assets/pdf_file/0006/93966/61-chapter15.pdfp 15.125 Report on Government Services 2010 http://www.pc.gov.au/__data/assets/pdf_file/0006/93966/61-chapter15.pdfTable 15A.166 http://www.community.nsw.gov.au/docswr/_assets/main/documents/bcg_report.pdf p A. 60.7 Harden, B. (2004) Safety and Stability for Foster Children:A Developmental Perspective in Children, Families andFoster Care Vol.14, No.1, p 39.8 Northern California Training Academy (2008) PlacementStability in Child Welfare Services: Issues, Concerns,Outcomes and Future Directions Literature Review. p 4.9 http://www.lboro.ac.uk/research/ccfr/Publications/placementstabilitylitreview.pdf p.2.10 Report on Government Services 2010 http://www.pc.gov.au/__data/assets/pdf_file/0006/93966/61-chapter15.pdfTable 15A.2411 Life Without Barriers 2008/09 data for NSW OOHCservices12 http://www.create.org.au/news-and-events/kids-in-carewithout-a-road-mapOut-of-home in AustraliaThere are about 34 000 children in out-of-home care in Australia, including15,211 in NSW 4 . The rate of children in out-of-home care Australia-wide is6.7 per 1,000 children. This rate is 44.8 per 1,000 for indigenous children, and4.9 per 1,000 for non-indigenous children.The rate for children in out-of-home care in NSW is 9.4 per 1,000 children(71.3 indigenous; 6.6 non-indigenous). Victoria is 4.3 per 1,000 children (48.7indigenous; 3.8 non-indigenous), Queensland 6.7 per 1,000 children (36.0indigenous; 4.6 non-indigenous) and Western Australia 5.1 per 1,000 children(38.8 indigenous; 3 non-indigenous). 5In NSW, Community Services directly provides out-of-home care forapproximately 85 per cent of children in out-of-home care with the remaindercared for by non-government agencies. Non-government agencies haveresponsibility for 84 per cent of high needs children. 6Placement stability for children in out-of-home care is often used as aproxy indicator of quality. 7,8,9 In NSW, 43.5 per cent of children in out-of-homecare have moved three or more times per year. 10 Australia-wide this statisticis 50.3 per cent. For non-government agency Life Without Barriers in NSW,the proportion of children moved three or more times per year is 2.3 percent 11 ). The higher the number of moves the greater the impact on schooling,healthcare and social networks.Outcomes for children in out-of-home care are very poor. A survey by theCREATE Foundation found that:“They are at higher risk of developing recognised characteristics ofyouth who have left care such as being more likely to be undereducated,unemployed, to earn less, become a parent at a younger age, be involvedin the juvenile justice system, become homeless, be dependent on socialassistance, have mental health issues, attempt suicide and be at a higher riskof substance abuse”.The CREATE report noted that:n 64 per cent of young people do not have a leaving care plan (a strategy forlife after being in the care system).n 35 per cent of young people in out-of-home care are homeless in the firstyear after leaving care.n 46 per cent of boys in out-of-home care are involved in the juvenile justicesystem.n 35 per cent of young people in out-of-home care completed Year 12.n 29 per cent are unemployed (compared to the national average of9.7 per cent).n 28 per cent were already parents themselves. 12 www.amansw.com.au I 17
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