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PREDICTING OUTCOMES FOUR YEARS ON: YOUNG PEOPLE LEAVING CARE . Judy Cashmore CFWAA Symposium When Care is Not Enough Canberra Sep 2003. Outline. Importance of stability and critical value of a sense of security A focus on positive outcomes, not just adverse

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predicting outcomes four years on young people leaving care

PREDICTING OUTCOMES FOUR YEARS ON: YOUNG PEOPLELEAVING CARE

Judy Cashmore

CFWAA Symposium

When Care is Not Enough

Canberra Sep 2003

outline
Outline
  • Importance of stability and critical value of a sense of security
  • A focus on positive outcomes, not just adverse
  • Predicting / Working out what makes the difference between good and adverse outcomes – NSW Wards study
    • Direct and indirect effects
    • Multiple pathways, multiple influences
    • Cumulative effect of risk and adverse experiences
what outcomes
What Outcomes?

Aims of out-of-home care:

  • Child safety – prevent further abuse / neglect
  • Permanence and sense of security – having a ‘home’
  • Child(and family)health and well-being
    • maintain connections and connectedness
    • improve or stabilise emotional, social cognitive development and physical and mental health

But how long-lasting,

and how much repair expected?

problems in out of home care
‘PROBLEMS’ in OUT-OF-HOME CARE
  • Multiple ‘placements’ – ‘drift in care’
  • Low expectations of education and other achievement – lack of shared responsibility
  • Lack of mental health treatment
  • Minimal contact with parents, siblings, relatives
  • Lack of options, choices
  • Little involvement of children and families
  • Inadequate support for carers, care leavers
problem atic outcomes
‘PROBLEMATIC’ OUTCOMES
  • Difficulty with trusting relationships
  • Poor educational achievement
  • Unemployment and dependence on income support
  • Criminal justice involvement
  • Homelessness, mobility
  • Poor self-esteem
  • Early / teenage parenting
focus on positive outcomes
FOCUS ON POSITIVE OUTCOMES
  • Aiming for well-being rather than safety and welfare?(Poertner, McDonald & Murray, 2000)
  • More positive view of foster care?
  • What is measure of success?
    • Child returning (safely) home
    • Or remaining secure in LT placement?
    • Child as productive adult and member of community?
  • Stability and security
    • Stability as a means to an end: security
outcomes of out of home care
OUTCOMES of OUT-OF-HOME CARE
  • Depends on comparison group
    • If compare with general population, usually negative
    • If compare with children at risk returning or remaining at home, generally positive findings
  • Need to take account of:
    • characteristics, problems at entry into care
    • alternatives
      • remaining at home, returning home, adoption
      • different forms of care
children b etter off in care
CHILDREN “BETTER OFF”IN CARE”
  • Improved adjustment(T1 and T2)
    • Fanshel & Shinn (1978)
    • Horwitz (2002)
  • In care vs ‘reunified’ or ‘remain’ at home
    • Wald et al. (1988) – (4 -10 yr-olds, 2 yr follow-up)
    • Gibbons et al (1995) – 11 yr follow-up of <5 yr-olds
    • Taussig, Clyman & Landsverk (2001) – (7-12 yr-olds, 6 years on)
    • Davison-Arad et al. (2003) – (3-13 yr-olds, 6 months on)
children b etter off in care9
CHILDREN “BETTER OFF”IN CARE”

Children’s views

  • Kufeldt, Armstrong & Dorosh (1996)
      • 89% of children and
      • 79% of parents said that going into care was ‘best solution’
  • Festinger (1983) – most satisfied
  • Wald et al (1988)
  • Cashmore & Paxman (1996) – 78% “better off” in care
    • I wasprotected from Mum with drugs and violent boyfriend. But I also thought I was getting punished because I didn't get much help from DOCS. I thought I was to blame for my mother's problems - no one explained anything to me.
wards leaving care study cashmore and paxman 1996
WARDS LEAVING CARE STUDYCashmore and Paxman, 1996

WARDS discharged over 12 mth period:

  • Interview group: n = 47/ 45 (4 not discharged)
  • Non-interview: n = 44 (10 not discharged)
  • Four interviews: (1) Before discharge

(2) 3 mths after (n =47)

(3) 12 mths after (n =45)

(4) 4 - 5 years (n = 41)

actual stability
ACTUAL STABILITY

Long-term placement for > 75 % time in care

→ fewer schools

→ more years of schooling

→ report better school progress

→ get on better with peers

→ fewer workers

→ more willing to ask for financial, emotional support esp from foster carers

Cashmore and Paxman, 1996 WARDS LEAVING CARE STUDY

actual stability12
ACTUAL STABILITY

Long-term placement for > 75 % time in care → 82 % say needs met cf 39 % not LT

→ 18 % say miss out on affection cf 70 %

→ 24 % attempt / think re suicide cf 50 %

→ happier after discharge

→closer to ‘at home’ comparison group

* Cause or effect? Or bi-directional?

actual stability13
ACTUAL STABILITY

Long-term placement for > 75 % time

in care

  • Other effects continue well beyond care
  • Link between stability and sense of security
  • Child’s perception of security

– directand indirect effect (mediator)

permanency stability
PERMANENCY?STABILITY?
  • Stability (or continuity) is means to an end

 sense of security and identity

    • Capacity to form relationships
    • Positive outcomes and adaptive adulthood
  • Not just continuity of placement
    • Contact with parents and quality of contact
    • Siblings and extended family
    • School and friendships
    • Known and trusted workers
sense of security
SENSE OF SECURITY

Coded as positive, negative, medium:

  • Was there ever anyone feel loved you?
  • Anyone ever feel secure with?
  • Feel as if listened to?
  • Miss out on things other kids had?
  • Miss out on affection?
  • Grow up too fast – bad thing?
predicting stability in c are
PREDICTING STABILITY IN CARE
  • More problems noted in care→more places

r= .56, n = 47, p <. 001

  • Children ‘rejected’ by family →more places

r= .43, n = 42, p <. 004

Also →more problems in care

r= .56, n = 47, p <. 001

  • Age of entry to care not significant associated with no of placements /stability in care

BUT “Delayed” entry to care →more places

r = .37, n = 47, p <. 01

domains of resilience
DOMAINS OF RESILIENCE *
  • Employment*(ever employed?)
  • Living arrangements – never homeless*
  • Education (completed high school?)*
  • No drug and alcohol (ab)use *
  • Mental health – depression, suicide ideation *
  • Criminal behaviour *
  • Relationships
    • Contact, unresolved family issues *
    • Partner, domestic violence
    • Social activity * (McGloin & Spatz Widom, 2001)
predicting outcomes
PREDICTING OUTCOMES
  • Continuing effect? Mediated by?:
  • More problems in care

 higher risk after leave care

r = .58, n = 40, p < .001

  • Rejected  higher risk after leave care

p < .002

delayed entry to wardship
Delayed entry to wardship
  • Greater “delay” in entry to wardship
    • Higher no of placements in care

r = .37, n = 47, p <. 01

    • More moves after leaving care

r = .47, n = 40, p <. 004

    • Higher risk scores 4-5 years after leaving care

Case studies of 4 highest risk young people

– “delays” of 89 -153 months (eg Daven, Terry)

sense of security with foster family after care
Sense of security with foster family after care
  • 60% Continuing contact with foster carers
  • Can manage contact with birth family
  • Feel that can ask for support
    • Emotional and financial
    • See as place can call home – celebrations.

use as secure base etc

    • Would ask for support eg pregnancy etc
contact with foster carers
Contact with foster carers *
  • No, I’m happy with the way things are. We just live around the corner from them and I’m treated as part of the family – birthday and Christmas presents like all the other kids and if I’m not there for something, I’m missed.
  • I’m happy … I’ll be in contact with them for the rest of my life.
  • We’ve always been in close contact, they are family.
contact with foster carers after care
Contact with foster carersafter care
  • I’d like to see them more often but they both work – and they live about an hour and half’s drive away.
  • It’s up to me – the door is open.
  • I’d like them to make more effort so it wasn’t up to me to initiate it all the time. I get the feeling that now that we have moved out that we’ve gone back to being foster children.
  • It’s just little things – like they just don’t make an effort for my birthday and I turned up there at Easter and they were having a BBQ with foster siblings but hadn’t invited me.
contact with family 4 5 years after care
Contact with family4-5 years after care
  • 93% have some contact with family but quality of contact and support varied
    • 48% in contact with parents at least monthly
    • 63% in contact with some sibs
    • 29% with grandparents
    • 24% with aunts / uncles etc
  • 56% have unresolved issues to sort out
contact with family
Contact with family *

The other exciting thing … I have contact with my mother now. When her husband sexually abused me, she didn’t believe me but she rang me recently after she had split up with him. Now I see her all the time but we don’t really know each other as mother and daughter and are having to start from day one. She feels guilt and shame because she never believed me – but as I say to her, I don’t hold any bitterness because I can’t afford to.

contact with family37
Contact with family

I might see her (mother) five times in 3 months and then I won’t see her for 6 months. I got back in contact last year after not seeing her for about 6 years. She rang me up; she was in a refuge with no money and her boyfriend had beaten her up.

I haven’t had anything to do with her for 12 years and until she grows up, I’m not prepared to.

cluster faring well
CLUSTER FARING WELL
  • All employed or parents
  • Usually make ends meet and doing better than others of same age
  • Significant “mentor” or belonging to community (eg church, armed forces) and/or ability to turn to others for help
  • Felt secure in care and most in stable care
jo doing well
JO: DOING WELL
  • No drugs, no criminal involvement, never been homeless, never run away, never attempted or thought about suicide, no children
  • Ward at 14 – sexual abuse by father, rejected by mother and sisters
  • One stable placement in children’s home (rural)
    • positive relationship with one LT worker
    • involved departmental worker
  • Listened to re not going into foster care
  • Exchange trip to US, transition house on return
  • Experience as nanny, live in cook on rural property, planning to do child care course
  • Support network – church, worker now friend, no family
cluster of difficulty n 10
CLUSTER OF DIFFICULTYn = 10
  • All either unemployed or parents
  • All lacked stability in care
  • None said felt secure, loved in care
  • Having to ‘cut back on’ or ‘go without’ number of necessities / services
  • Turbulent relationships, few long-term
  • Lack of supportive networks
  • Unresolved family issues (60% overall)
ben high risk
BEN: High risk
  • Drugs, crime, attempted suicide, not complete year 9, unemployed, no stable network
  • Placed with aunt at 3 – assessed as difficult
  • Broke down at 12 - behaviour problems
  • Series of temporary respite, restoration attempts
  • Wardship - residential care, detention
  • Very hurt by parents’ rejection
  • Very mobile, casual employment
  • Relationship difficulties – no supportive network
predictors
PREDICTORS?
  • Rejection and understanding why in care
  • Stability in care
  • Perceived emotional security in care **
  • Timing of transition/s – incl. delayed entry to care
  • Duration and timing of positive and negative events
  • Accumulation of adverse events, risks
  • Perceived control – voice in process
  • Emotional support / social networks
    • Role of trusted worker, carer, family member
  • Contact with family? Identity issues
  • Combinations? Direct and indirect effects
research
RESEARCH
  • Long-term outcomes of being in care

– beyond care, beyond childhood

  • When is it too late to restore children?
  • Understanding attachment and social support
  • What works in improving outcomes?
    • esp re Identity issues and emotional security
  • What intervention / treatment works?
impact of early experience but later change still possible
Impact of early experiencebut later change still possible

The individual is the product of all of his or her experiences, not early experiences alone (Sroufe et al, 1999, p. 2)

Change remains possible at numerous points in development, although both theory and data suggest that such change is more readily accomplished early in the process or at least when there is a foundation of early support (Sroufe et al, 1999, p. 11)