Various studies report that placement into care does not necessarily ameliorate health problems. Children in out-of-home-care are less likely to access continuous medical care, as a consequence of multiple placements, or alternating periods of placement at home and out-of-home-care. Data suggests that children in care have ongoing unmet health needs such as poor uptake of immunisations, inadequate oral health care and developmental disabilities remain prevalent as do chronic medical conditions.57
Currently across Australia, evaluation of children in care is generally performed on an as needs basis and by a range of health professionals. Assessment tends to be in response to an acute episode of ill health and relies on identification by the carer or caseworker rather than being undertaken as part of a health screening assessment or early intervention process. There is evidence that carers or caseworkers tend to under-report health concerns/needs and reliance on this practice identifies only about 30% of children with developmental delay and 33% with psychological problems.58, 59
For children in care there are also inherent problems in either locating medical histories for some children or in recording or transferring information from one practitioner to the next. This can occur for a variety of reasons (e.g. medical histories are non-existent or records are not transferred upon change of placement) but can result in inconsistent or lack of appropriate health care for the child.60, 61, 62
Studies report that if there is no provision for permanent and accessible health records, and no overall coordination of a health care plan, access to services, particularly scarce developmental and mental health resources, is likely to be problematic.63
Key Learning: The availability of health information and continuity of care are essential elements to improve health outcomes of children in OOHC.
Longer-term outcomes for children and young people in out-of-home careThe Create Foundation Report Card: Transitioning from Care (March 2008) highlights specific inadequacies in the existing arrangements for children and young people transitioning from OOHC. The report identifies the need for a more coordinated approach to the provision of services to those transitioning from care.
The longer term outcomes for those leaving of out-of-home-care show that this group of children and young people experience significant health, social and educational deficits, including homelessness, disproportionate involvement in juvenile crime and prostitution, poor social supports and early parenthood.64 Children who have been in care are over represented in the juvenile justice system and in prisons. A NSW inmate health survey reported that 23% of women and 21% of men had been in care before they were 16 years old.65 This group of children is also at increased risk of unemployment, poverty and financial stress, drug and alcohol use/abuse, and poor physical and mental health issues.66
Research highlights that the vast majority of care leavers suffer from, or are at a greater risk of, negative outcomes in their social and psychological functioning, financial status, educational and vocational pursuits.67
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Young people leaving care were found to be at great risk of experiencing negative life outcomes,68 including periods of homelessness and involvement in committing offences since leaving care.69 Each of these studies identify that the young people needed to develop more employment and independent living skills and more social and emotional skills before they could successfully live independently.
This is supported by further analysis of the ONS Survey results in the UK which found that unresolved mental health problems in childhood can cause ongoing problems for children, in adult life such as homelessness, poor educational outcomes and employment prospects, unsatisfactory personal relationships and even contact with the criminal justice system.70
The UK Statutory Guidance on Promoting the Health and Well-being of Looked After Children notes that preparing to leave care is critically important for all young people in OOHC. The Children (Leaving Care) Act 2000 requires all eligible, relevant and former relevant children to have a Pathway Plan which will focus on arrangements for the young person’s successful transition to independence. The Pathway Plan will take account of the assessed health needs of the young person and set out clearly how these are to be met. Particular attention must be given to the young person’s need for support in taking responsibility for his/her own health and in accessing appropriate services, including information and advice.
Care leavers consistently take a holistic view of health when asked about their views on what helps them to be healthy and what impacts adversely.71 A sense of security, stability, continuity and social support were strong predictors of better outcomes for young people’s long-term outcomes after leaving care.72
Research highlights the need for children to have stable and secure placements, whether that be with their natural parents or in out-of-home care. The quality of relationships with carers is also critical. Care leavers can be better supported if they are equipped with improved employment and independent living skills and more social and emotional skills while in care. 73
Key Learning: Whilst the focus of the Framework is on health assessments for children and young people in OOHC, addressing the health needs of children transitioning from care is a key area for attention for an improvement in longer term outcomes to be achieved.
54 Mason, J., Falloon, J., Gibbons, L., Spence, N., & Scott, E. (2002). Understanding kinship care. Haymarket, NSW: Association of Children’s Welfare Agencies and University of Western Sydney.
55 Baldock, E., & Petit, C. (2006). Grandparents raising grandchildren because of alcohol and other drugs. Curtin, ACT: Canberra Mothercraft Society.
56 Bromfield, L and Osborn, A (2007) ‘Getting the big picture’: A synopsis and critique of Australian out of-home care research. Child Abuse Prevention Issues No 26 2007 Australian Institute of Family Studies.
57 Royal Australasian College of Physicians (2006) Health of Children in “Out-Of-Home” Care - Paediatric Policy
58 Royal Australasian College of Physicians (2006) Health of Children in “Out-Of-Home” Care - Paediatric Policy
59 Nathanson, D & Tzioumi, (2007), Health need of Australian children in out-of -home care. Journal of Paediatrics and Child Health 43 695-9
60 Submission to the Special Commission of Inquiry into Child Protection Services in NSW (2008) NSW Commission for Children and Young People
61 Nathanson, D & Tzioumi, (2007), Health need of Australian children in out-of -home care. Journal of Paediatrics and Child Health 43 695-9
62 Royal Australasian College of Physicians (2006) Health of Children in “Out-Of-Home” Care - Paediatric Policy
63 Crawford, M, (2006), Health of Children in out-of-home care: Can we do better? Journal of Paediatrics and Child Health 42 77-78
64 P Mendes, B Moslehuddin (2004) Graduating from the child welfare system: a comparison of the UK and Australian leaving care debates. International Journal of Social Welfare,
65 Royal Australasian College of Physicians (2006) Health of Children in “Out-Of-Home” Care - Paediatric Policy
66 Halfon N, Berkowitz G, (1995). Health status of children in foster care: The experience of the centre for the vulnerable child. Archive of Paediatric and Adolescent medicine; 149: 386-392.
67 Bromfield, L and Osborn, A (2007) ‘Getting the big picture’: A synopsis and critique of Australian out of-home care research. Child Abuse Prevention Issues No 26 2007 Australian Institute of Family Studies.
68 Cashmore, J. A., & Paxman, M. (1996). Wards leaving care: A longitudinal study. Sydney: Department of Community Services.
69 Maunders, D., Liddell, M., Liddell, M., & Green, S. (1999). Young people leaving care and protection. Hobart: National Youth Affairs Research Scheme.
70 Ford, T. et al. (2007) Psychiatric disorder among British children looked after by local authorities: comparison with children living in private households. British Journal of Psychiatry, 190; 319-325.
71 Saunders L and Broad B (1997) The Health Needs of Young People Leaving Care. De Montfort University
72 Cashmore, J. A., & Paxman, M. (2006). Predicting after-care outcomes: The importance of “felt” security. Child and Family Social Work, 11, 232–241.
73 Cashmore, J. & Paxman, M. (1996), Wards Leaving Care: A Longitudinal Study, Department of Community Services, Sydney