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Infants have the highest rate of admission into out‐of‐home care in Australia, with rising rates of entry to care occurring around the world. Our previous research identified children who entered care as infants as having high levels of developmental vulnerability. The objective of this study was to determine the child protection and developmental trajectories of children who entered care as infants and whether meeting developmental needs through service provision improves trajectories and outcomes for these children. This is a prospective cohort study using three waves (2011–2016) of survey data from the New South Wales Pathways of Care Longitudinal Study which includes standardised assessments (Age and Stages Questionnaire, Brief Infant Toddler Social Emotional Assessment and the Child Behaviour Checklist), as well as linked administrative child protection and health data. Our findings suggest that children who entered care as infants predominantly remained in the care system and had a high level of developmental vulnerability as infants. A large group had positive physical and cognitive developmental trajectories with service provision increasing over time; however, early service provision is needed. Another group was identified as having early social–emotional concerns and displaying worsening social–emotional trajectories. Intervention for this group is an important priority to reduce risk of ongoing poor mental health outcomes. [ABSTRACT FROM AUTHOR]

Child sexual exploitation (CSE) is a problem for children and young people living in out‐of‐home care (looked after children). As part of a broader action research project aiming to prevent both harmful sexual behaviour carried out by children and young people and CSE in out‐of‐home care, four focus groups were undertaken with 17 workers at three Victorian residential houses in 2017. The findings reported in this paper were generated through the research question: What do workers perceive as the key challenges in caring for children and young people vulnerable to CSE in out‐of‐home care? Three major themes were identified: (i) children and young people going missing from home; (ii) children and young people not identifying as victims; and (iii) frontline police response unhelpful when children and young people missing. The design of prevention and response strategies to combat CSE must take into account the challenges identified by workers to ensure the best possible sexual abuse prevention outcomes for children and young people living in residential care. 'What do workers perceive as the key challenges in caring for children and young people vulnerable to CSE in out‐of‐home care?' Key Practitioner Messages: Children and young people need to be educated about the tactics used by perpetrators so that they can recognise if they are being groomed or exploited.Residential staff need to be upskilled about how to respond to children and young people at the point that they are leaving the house for the purpose of CSE.Workers need to be empowered to make decisions about the day‐to‐day welfare of the children and young people in their care.Multiagency collaboration is vital in preventing and responding to CSE, and efforts should be upscaled across all local government areas. [ABSTRACT FROM AUTHOR]

Internationally, there are few studies that have trialled structured intervention programmes designed to prevent excessive weight gain or combat existing overweight/obesity for young people living in out-of-home care. The Healthy Eating, Active Living (HEAL) programme was designed to address this limitation and is, to our knowledge, the first programme that simultaneously encourages young people and their carers to engage in a healthy lifestyle. This is the second of two papers presenting the HEAL evaluation. The aim of this study was twofold: first, to explore the experiences and opinions of key stakeholders regarding the intervention programme; and second, to understand the key enablers and barriers to successful implementation of the HEAL programme in residential care. Seventeen carers and ten programme coordinators participated in semi-structured interviews. Findings demonstrated that HEAL was considered a valuable adjunct to the residential care programme, and was successful in raising awareness about the importance of leading a healthy lifestyle. Positive behaviour change among the young people and carers' dietary, physical activity and sleeping habits, and the development of independent living skills were described. Barriers to implementation included leadership support and professional development of carers. Recommendations are made to improve implementation, particularly around the importance of increasing stakeholder 'buy-in'. [ABSTRACT FROM AUTHOR]

Internationally, there are few interventions that promote healthy lifestyles in the out-of-home care (OOHC) sector. The aim of this quantitative study was to measure the efficacy of the Healthy Eating, Active Living (HEAL) programme for young people who live in residential OOHC and their carers. Seventy young people and 177 carers were recruited between August 2012 and October 2014 from 48 residential care units across metropolitan Melbourne and regional Victoria, Australia. The HEAL programme included educational sessions for young people, and professional development for carers to foster healthy eating and physical activity. Young people and carers completed questionnaires measuring behavioural, psychosocial and motivational outcomes. Objective measures of height and weight were collected for young people and self-reported by carers. The findings revealed no evidence for the efficacy of the HEAL intervention for either young people or carers. The most likely explanation for the null result was difficulties associated with: (1) collecting quantitative data for evaluative purposes in vulnerable populations (particularly the impact of attrition on statistical power); and (2) implementing interventions in complex environments. We conclude with a summary of lessons learnt and recommendations for future research in this unique setting. Copyright © 2017 John Wiley & Sons, Ltd. Key Practitioner Messages There are a number of challenges inherent to collecting longitudinal data and/or employing a randomised trial design in this setting. Researchers working in this area need to acknowledge the critical need for this type of research but also consider alternative approaches to data collection., It is integral that organisational practices and/or policies are in place so that a HEAL philosophy is embedded in the residential OOHC culture; in other words, HEAL becomes a part of each organisation's values, goals and shared expectations. [ABSTRACT FROM AUTHOR]

We systematically reviewed quantitative research that compared developmental health or wellbeing outcomes for maltreated children placed in out-of-home care (OoHC) with those cared for in their home. Randomised, quasi-randomised and cohort studies that met detailed criteria were eligible. Study results and bias risk information were extracted by two authors using predefined data fields. Narrative synthesis was used because of the diversity of studies. No randomised studies were found. Thirty-one papers from 11 cohort studies were included. The studies covered 15 developmental health or wellbeing outcomes (63 distinct comparisons). Of 40 significance-tested comparisons, 29 were consistent with no evidence of benefit or harm of OoHC, seven were consistent with harm and four with benefit. Three studies with low risk of selection bias showed no evidence of significant differences, or found worse outcomes for OoHC. Overall, evidence from cohort studies shows limited evidence of improved outcomes, and some evidence of worse outcomes associated with OoHC. These results may be explained by selection bias favouring placement of children likely to have worse outcomes in OoHC rather than in-home care. Further research, including randomised controlled trials and carefully matched data-sets, is needed to determine the effectiveness of OoHC. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Messages Most research has high bias risk, as children who enter OoHC have more disadvantaged backgrounds and higher risk for poor outcomes than other maltreated children., Even allowing for significant bias risk in the studies, there are mixed results for children entering OoHC, and the three highest-quality studies showed no difference or worse outcomes for OoHC. [ABSTRACT FROM AUTHOR]