1. PREDICTING OUTCOMES FOUR YEARS ON: YOUNG PEOPLE LEAVING CARE Judy Cashmore CFWAA Symposium When Care is Not Enough Canberra Sep 2003

2. 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

3. 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?

4. ‘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

5. ‘ 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

6. 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

7. 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

8. 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)

9. 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 was protected 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.

10. WARDS LEAVING CARE STUDY Cashmore 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)

11. 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

12. 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?

13. 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 – direct and indirect effect (mediator)

14. 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

15. 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?

17. 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

21. SUICIDE Stability in care Stable Not stable Tot % Suicide Attempt 4 13 17 (41) Thoughts 4 7 11 (27) Never 8 5 13 (32) Total 16 17 41 Likelihood ratio = 5.00, 2 df, p <.08

22. SUICIDE Perceived security in care Negative Moderate Positive Tot % Suicide Attempt 9 6 2 17 (41) Thoughts 2 8 1 11 (27) Never 1 3 9 13 (32) Total 12 17 13 41 Likelihood ratio = 19.1, 4 df, p <.001

25. 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)

26. 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

29. 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)

34. 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

35. 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.

36. Contact with foster carers after 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.

37. Contact with family 4-5 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

38. 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.

39. 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.

40. 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

41. 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

42. CLUSTER OF DIFFICULTY n = 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)

43. 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

44. 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

45. 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?

46. Impact of early experience but 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)