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Re-thinking out-of-home care

by PeakCare Qld. on 9th August 2012

Home -> Articles -> 2012 -> August -> Re-thinking out-of-home care

Media attention has again been placed on residential care. This is likely to continue, if not significantly increase as the current Child Protection Commission of Inquiry proceeds. Whilst residential care appears to be the focus of attention at the moment, this could and is likely to extend very quickly to other forms of out-of-home care.

We can choose to respond to this attention in a defensive manner or embrace it as an opportunity to re-think the role to be played by residential care as well as other forms of out-of-home care in a re-shaped child protection system and what is needed to ensure that this role is performed well.

What do we already know?

We already know that, wherever and as far as possible, parents and families should be supported - practically, financially and emotionally - to care safely for their children in the family home. In-home and intensive family support services can be used both to assist the preservation of children’s care within their own families and, where children have been removed from the care of their parent/s, their reunification with family.

We also know however that whilst effective prevention and early intervention services reduce the demand for tertiary intervention and the removal of children from the care of their families, there will always be some children and young people where a tertiary response and placement in out-of-home care, at least for a period of time, is needed and this should never be denied to a child or young person where it is necessary.

Our current knowledge base also says that where children and young people require placement in out-of-home care, the matching of their needs to care environments and maintaining their connections to family, community and culture are paramount.

This means that smooth transitions into out-of-home care, between placements, back to family and to independence necessitate planning and individualised attention to the range of needs held by children and young people.

How the system is currently constructed

Despite what we already know, the current ‘categorisation’ of children and young people as residing within either ‘in-home’ or ‘out-of-home’ care does not represent the reality of many children and young people’s lives where, in a much more fluid way, their primary care is shared by their immediate family and alternative care providers. Nor does it adequately reflect or cater for the trend towards most young people, on their own volition, returning to the care of their families either prior to or when they ‘age out of care’.

In many instances, this ‘categorisation’ serves as an obstruction to the successful and safe reunification of children and young people with their families in a timely and successful manner or, where it may not be possible for parents to resume their role as the ‘primary caregiver’, their capacity to remain involved in the parenting of their children to the extent to which this is possible.

Even where the ongoing involvement of parents in the care of their children is negligible or ceases, there is nevertheless a need to support children in reconciling themselves with this estrangement from their parents that is preferably undertaken with the cooperation of family members in conveying information to children in ways that assist them in not assuming the ‘blame’ for these decisions and facilitating the permanence of their care arrangements and the stability of their relationships with trustworthy and caring adults.

Broadly, services are currently funded to provide either ‘in-home’ support or ‘out-of-home’ care in a discrete and distinct manner. These arrangements mitigate against organisations having the capacity to integrate strategies that facilitate a continuity of service to children and young people and support them in their complex transitions from receiving in-home support to being placed in out-of-home care, during the process of moving from one out-of-home care environment to another or when they are reunified with family or proceed to independence.

For example, the cessation of involvement by an organisation charged with the responsibility of providing for the out-of-home care of a child when the child returns to the care of their family significantly disrupts the involvement of known and trusted workers who are often the best placed to support families throughout and following the challenging process of being reunified.

Of even greater concern are situations where an out-of-home care placement is disrupted by a child or young person leaving the placement on their volition to ‘self-place’ with their family or other persons who may be known to them or simply become ‘homeless’. In these circumstances, the organisation previously charged with the responsibility for the out-of-home care of the child or young person is too often prevented by the terms of their funding and service agreements from continuing to provide an ‘outreach service’ to them for purposes of facilitating a return to their former placement or assisting their transition to another safe, alternative placement whilst also ensuring their safety and supporting them during these often tumultuous periods within their lives.

Given the emotional turmoil often displayed by children and young people due to the trauma of abuse or neglect and their removal from the care of their families, it should be anticipated that many will understandably experience great difficulty in forming and maintaining trusting relationships with adults who enter their lives as carers – be they foster carers or residential service staff. Put simply, given that many children and young people have experienced adults as people who are not trustworthy, who inflict harm and/or have abandoned them, it would not be ‘sane’ of these children and young people to readily and easily engage in trusting relationships with ‘strangers’ whose caring roles have largely been imposed upon them.

Whilst always seeking to prevent placement disruptions by having a wide range of flexible and adaptable placement options available to children and young people and through well-considered matching of their needs to suitable care environments, it should nevertheless be anticipated and accepted that some placements will be disrupted by children and young people choosing to leave. In most instances, this should not entail ‘blame’ for the disruption being ascribed to either those who have been responsible for the child’s or young person’s care or, most importantly, to the child or young person. For many children and young people, the disruption should be simply and properly viewed as symptomatic of their histories of trauma and broken attachments to family members and other people who have been of significance to them and being ‘not yet ready’ to expose themselves to the seemingly high risks of engaging in new relationships with other adults.

The child protection system is not well equipped in the ways in which it is currently constructed to respond to these types of complexities in meeting the care requirements of children and young people. It is, in fact, likely that the system by responding in ways that are reactive, chaotic and piecemeal exacerbates the difficulties being experienced by some children, young people and families.

Funding frameworks as they are currently applied in Queensland generally encourage the ‘placement’ of children and young people to be perceived as an ‘end in itself’ rather than as a ‘means to an end’ – this being the creation of a safe haven for their healing and recovery from abuse or neglect, the establishment of trusting relationships with caring adults and the flexible delivery of individualised therapeutic interventions that are ‘tailor-made’ to meet the needs of each child and their family.

The conceptualisation of out-of-home care service models which are then prescribed in service agreements between the Department of Communities, Child Safety and Disability Services and non-government service providers is usually far too narrowly focussed on the services to be provided to children whilst, and only when, they are ‘residents’ of the service. The performance of services is reported and judged on the basis of ‘outputs’ such as the number of ‘bed-nights’ provided, with inadequate emphasis placed on assessing the ‘outcomes’ being achieved for children, young people and their families.

Subsequently, there are wide variations in the extent to which service providers incorporate either the reunification of children with their families or the facilitation of ‘shared care’ arrangements as express purposes of their service models. Nor is sufficient capacity built into their service models to deliver the kinds of ‘outreach’ services needed to support children and young people during either planned or unplanned changes in their living arrangements.

What should we be doing to re-think the role played by out-of-home care services?

A re-conceptualisation of out-of-home care and the ways in which it is funded and administered is urgently required. This includes, in particular:

  • a re-conceptualisation of ‘kinship care’ and ‘shared care’ (ie. service models where a child’s care is shared by carers and family members)
  • enhanced use of ‘respite care’ (including in particular, respite care provided by extended family or family friends known to the child or young person) provided on either an emergent basis or in a planned and regular manner, for purposes of assisting parents to either maintain or resume their role as the ‘primary carers’ of their children
  • improved models of foster care that build on developments in relation to current ‘intensive foster care schemes’ to establish programs where small networks of highly trained and properly remunerated carers work within multi-disciplinary teams to provide specialised therapeutic care of cohorts of children and young people as a cost-effective and suitable alternative to congregate care models of residential care
  • more creative and innovative models of residential care that better support the preservation or re-commencement of the primary carer role played by parents (by, for example, having scope to accommodate family members with their children in some circumstances) and/or the transition of children and young people to independent living or other longer-term alternative care arrangements that include provision for delivering ‘after-care’ services, and
  • out-of-home care models that better reflect the cultural needs of, and forms in which care should be provided to, Aboriginal and Torres Strait Islander children and young people as well as other children and young people who have culturally and linguistically diverse backgrounds.

In respect of all ‘types’ of out-of-home care services ranging from foster and kinship care through to residential care and supported independent living programs, there is an urgent need for the development of clear and shared understandings by Departmental officers, service providers, children and families about the role and intended outcomes being sought from different service models.

We now have an invaluable opportunity to research and say what out-of-home care services should look like in the future. Join in the discussions and debates about this – it is too good an opportunity to miss!

Lindsay Wegener
Executive Director

Click on this Blog post title to enter your comments – anonymously if you prefer – about what you would like to see out-of-home care services look like in the future. Alternatively, you may like to encourage your organisation to complete the questionnaires attached to the Issues Papers posted in the Members Only section of our website and/or submit some ‘case examples’ to illustrate your point of view.