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Young people who are currently or were previously in state care have consistently been found to have much higher rates of mental health and neurodevelopmental difficulties than the general youth population. While a number of high-quality reviews highlight what research has been undertaken in relation to the mental health of young people with care experience and the gaps in our knowledge and understanding, there is, until now, no consensus, so far as we aware, as to where our collective research efforts should be directed with this important group. Through a series of UK wide workshops, we undertook a consultative process to identify an agreed research agenda between those with lived experience of being in care (n = 15), practitioners, policy makers and researchers (n = 59), for future research regarding the mental health of young people with care experience, including those who are neurodiverse/have a neurodevelopmental difficulty. This consensus statement identified 21 foci within four broad categories: how we conceptualize mental health; under-studied populations; under-studied topics; and underused methodologies. We hope that those who commission, fund and undertake research will engage in this discussion about the future agenda for research regarding the mental health of young people with care experience.

Licensing is a public instrument used to control welfare services. One such service is residential care for children, which is targeted at children who experience maltreatment in their home environment and/or have behavioural problems and have been separated from their parents by the authorities. In Sweden, Finland, Norway and Denmark, residential care may be provided by public or private (not-for-profit or for-profit) providers. The aim of this article is to explore and compare how public authorities in Sweden, Finland, Norway, and Denmark, license residential care for children. The data consist of application forms and instructions for how to apply for a licence as well as interviews with key staff responsible for licensing. The findings show differences in how national agencies license residential care providers. Licensing models may be centralised/general (Sweden, Finland) or regionalised/specialised towards residential care (Norway, Denmark). The process can be more investigative (Sweden, Norway) or consultative (Finland, Denmark), and the review of standards formality-oriented (Sweden, Finland, Norway) or content-oriented (Denmark). Finally, the models of supervision post-licence vary in terms of being non-intervening (Finland), semi-intervening (Sweden, Norway) or intervening (Denmark). The discussion centres on the possible contribution of the different models to the regulation of the residential care markets.

With growing overrepresentation of Aboriginal and Torres Strait Islander children and young people in out-of-home care (OOHC), cultural disconnection is an omnipresent threat. Despite research and inquiries that have highlighted the risk of cultural disconnection for Aboriginal and Torres Strait Islander children living in OOHC, limited research has explored Indigenous children and young people's experiences of cultural connection in the Australian context. Informed by Indigenous Standpoint Theory, this Aboriginal-led qualitative study sought to understand 10 OOHC-experienced Aboriginal young people's experiences of cultural connection over time, including after exit from OOHC, through retrospective interviews that employed a phenomenological lens. It was found that Aboriginal young people experienced cultural connection as a heterogenous process involving identity formation and the practice of culture, enacted as a choice over time. The complexity of Aboriginal young people's experiences of cultural connection over time gives rise to a new understanding of cultural connection as a journey of culturally connecting, wherein the risk of cultural disconnection is complicated by intergenerational child removals, dominant discourse about what constitutes Aboriginal culture, and removal from an Aboriginal cultural milieu. Refereed/Peer-reviewed

Trauma knowledge and skills are needed to support relational safety for children in out-of-home care and birth family contact is a particular area where trauma-informed approaches are critical. Mixed methods were used to understand the application of trauma-informed approaches to contact in New South Wales, Australia. A total of 118 caseworkers and 15 organisational leaders took part in an anonymous survey or semi-structured interview. Descriptive statistics and thematic analysis were completed. Results indicated that caseworkers were confident in their knowledge of trauma and ability to protect children at contact but not to explain trauma to carers or manage conflict between carers and birth relatives. Confusion about how to deliver trauma-informed practice hampered knowledge-to-practice translation. Staff training and supervision were used to build workforce skills but were not evaluated and no strategies to reduce vicarious trauma were identified. Strategies to promote psychological safety and improve cultural safety for Aboriginal children and families were in their infancy. The study demonstrates that the out-of-home-care sector needs a community of practice where it can test, implement and share promising strategies for improving relational safety and where adult and child trauma survivors are empowered to inform and lead new approaches to contact.

A systematic review of longitudinal studies relating to young people leaving care and how they acquire independent living skills

This is the protocol for a scoping review synthesizing evidence regarding the levels, correlates, outcomes and intervention prospects of callous-unemotional traits (and the related construct of psychopathy) within an out-of-home/institutional care population. It is anticipated that the review will inform a new research agenda based on potential gaps in the existing literature.

Findings from youth research have shown that, due to the development of the transitional phase of “emerging adulthood”, the family has become increasingly significant for young adults as a source of support and as a safety net. In contrast, care leavers are confronted with a relatively abrupt transition to independent living. However, international studies have shown that the family also plays a significant role during the status passage of leaving care — as an arena of concrete social relationships, as a normative model and ideal, as a biographical experience and memory, as a connection to family traditions and practices, and as an important contextual factor for resilience and identity formation. The first section of this paper describes the various links between care leavers and their families based on a literature review. In the second section, the biographical relevance of the family is highlighted based on the example of a qualitative interview study about the educational pathways of 20- to 27-year-old care leavers. The study shows the various influences of family links on the educational careers of young people during and after out-of-home care. From the findings, we derive some consequences for professional work with families in out-of-home care and for professional support and guidance during the status passage of leaving care.

Residential caregivers are the central figures responsible for the children in their charge. Their work is physically and emotionally taxing, and carried out under pressure: they are prone to burnout. In addition, their status is lower than that of other staff. This study aimed to identify the strategies to improve caregiver functioning that have been adopted in Israel’s residential social-service facilities, and to examine the extent of their implementation. A two-stage, mixed-methods study design was employed. In the qualitative stage, six successful care facilities were identified; their directors were interviewed in depth using the Learning from Success method. In the quantitative stage, a survey was administered to 95 directors, using open and closed questions. Six best-practice strategies for working with caregivers were identified: careful screening, training, ongoing supervision, personal and professional support mechanisms, flexible schedules, and a clear work plan and procedures. While these strategies were applied to some extent in most facilities, they varied in scope and implementation. Using a regression model, we found a connection between the implementation of these strategies and the directors’ satisfaction with the caregivers’ work. We discuss recommendations that can help directors incorporate the six strategies in residential homes and meet the challenges directors face in their work with caregivers.

To date, no theory of bullying in residential care for youth has been proposed. By drawing on the results of the existing research on bullying and peer violence in youth residential care and adapting the Multifactor Model of Bullying in Secure Settings (MMBSS), this paper proposes the first integrative theory of bullying in residential care-the Multifactor Model of Bullying in Residential Settings (MMB-RS). The paper first summarises the existing empirical findings on bullying and peer violence in residential care for youth and describes the MMBSS. It then moves on to proposing and describing the MMB-RS. In a nutshell, the MMB-RS assumes that bullying in residential care is shaped by a dynamic interaction between a complex set of individual and contextual factors. The model also takes into account the interaction between bullies and victims, thus explicitly considering the social interactional components of bullying and victimisation and offering possible explanations of the sizable overlap between bullying and victimisation in residential care, including the possible contributions of residential peer cultures. The paper concludes by noting the importance of empirically testing the MMB-RS and proposing a programme of research that may be helpful in testing it.

Previous research suggests that young adults from out-of-home care (OHC) are at high risk of low education and unemployment. However, there are no studies on their risk of long-term NEET (Not in Employment, Education or Training). This study compared the risk of NEET at age 21-23 among OHC youth across Denmark, Finland and Sweden, using register data for an entire birth cohort born in 1987. The Nordic countries share many features, but there are differences in the provision of after-care support and in the linkage between the educational system and the labour market. The results show that about a fourth in Denmark and Sweden and a third in Finland were NEET, suggesting that the welfare systems were not able to compensate for the OHC youth's childhood disadvantages. To a significant extent, the excess risk of NEET was attributed to poor school performance. Implications for research, policy and practice are discussed.

Children in care (CiC) experience poorer health outcomes than their same-aged peers without an experience of care. Despite growing recognition of the importance of listening to the voices of children and young people (YP), to date, the voices of CiC are not well represented in research examining their health. This study aimed to explore the experiences and perceptions of health among YP who have previously lived in care. A co-design approach was used to inform the research methodology by engaging YP with a lived experience in cooperative discussions. Ten YP participated in one-on-one semi-structured interviews and thematic analysis was used to analyse the data. The current findings highlight that YP consistently felt their health needs were not adequately met while in care, nor did they feel listened to, understood, or educated about health-related matters. This unique insight into the challenges they experienced in care offers realistic guidance for change.

[While many children living in out-of-home care aspire to complete higher education, research from the Australian Census Longitudinal Dataset suggests that very few are likely to achieve this goal compared to children living at home. These findings suggest (1) children from out-of-home care residing with a carer (i.e. children in foster care) are one-third as likely than their peers to progress to higher education, (2) transitioning to university is associated with parental education and employment, however, children from foster care are less likely to be living in homes with characteristics associated with transitioning to university, (3) post-school education for foster care children may be improved by placement with parents who have achieved a Year 12 equivalent or higher education status.

Evidence from Swedish and international studies show that a high proportion of children from out-of-home care (OHC) have poor school performance and that this is strongly associated with their substantial risk of adverse development in future life. However, risk factors for poor school performance and adverse development are difficult to disentangle since they are often interrelated and enforce each other over the life course. This study examines premature mortality in relation to early school failure (drop-out from compulsory school) and OHC experience in childhood (0–17 years of age) among clients who were in treatment for substance misuse in the early 1980s (N = 1,036). The analyses were based on record linkages between interview data collected during treatment and national register data covering approximately 30 years of follow-up, from exit from treatment until 2013. Our results showed that 54 per cent had been placed in OHC as children, half before their teens and half as teenagers. The OHC population had a higher prevalence of school failure compared with clients who had not been exposed to childhood OHC. OHC was associated with an excess mortality, although this was only significant for females who had entered OHC before their teens. Adjusting results for school failure reduced their excess mortality by half, and additional life course factors associated with mortality among people with substance misuse adjusted for most of the remaining excess mortality. School failure was strongly associated with the excess mortality of females, but not with the excess mortality of males.

Although we know there are high rates of mental health difficulties amongst young people in out-of-home care (i.e. social welfare-involved children), there is limited evidence on the longitudinal development of these problems, particularly from when they enter the care system. Using the routinely collected carer-reported strengths and difficulties questionnaire, we explored internalising (emotional and peer) and externalising (conduct and hyperactivity) difficulties for 672 young people across their first 3 years in the UK care system (2–16 yrs, 51% boys, 76% Caucasian). In all cases stable profiles (resilient or chronic) were most common, while changing profiles (recovery or delayed) were less common. Findings showed that entry into the care system is not enough of an intervention to expect natural recovery from mental health difficulties. Number of placements and being separated from siblings were associated with greater difficulties. Implications for child welfare and mental health systems are discussed.

Reducing the rate of over-representation of Aboriginal and Torres Strait Islander children in out-of- home care (OOHC) is a key Closing the Gap target committed to by all Australian governments. Current strategies are failing. The ���gap��� is widening, with the rate of Aboriginal and Torres Strait Islander children in OOHC at 30 June 2020 being 11 times that of non- Indigenous children. Approximately, one in five Aboriginal and Torres Strait Islander children entering OOHC each year are younger than one year. These figures represent compound-ing intergenerational trauma and institutional harm to Aboriginal and Torres Strait Islander families and communities. This article outlines systemic failures to address the needs of Aboriginal and Torres Strait Islander parents during pregnancy and following birth, causing cumulative harm and trauma to families, communities and cultures. Major reform to child and family notification and service systems, and significant investment to address this crisis, is urgently needed. The Family Matters Building Blocks and five elements of the Aboriginal and Torres Strait Islander Child Placement Principle (Prevention, Participation, Partnership, Placement and Connection) provide a trans-formative foundation to address historical, institutional, well- being and socioeconomic drivers of current catastrophic trajectories. The time for action is now.

In recent years, social network analysis has had its own distinctive theoretical and methodological underpinnings. This article proposes a novel method for the application of a fused mixed-methods approach and social network analyses that incorporates the critical aspects of numerous characteristics of children’s social development in a statutory care setting. We collected data from children involved in the Mockingbird Family out-of-home care model, following its implementation in Australia. Our approach involves three steps: social-developmental network indicators, relational dynamics, and social-developmental network narrative. We contend that this approach has the potential to provide powerful data representation that facilitates the understanding of the complexities of children’s social development, the links between different positions and roles of children, and their social network in the Mockingbird family. Using exemplars, we show the potential of the research method to unearth rich data for seeking to understand the system change important for strengthening children’s safe and protective environments. Refereed/Peer-reviewed

The aim of this study was to explore and better understand the enablers and barriers of implementation and how these impact on the organisational successes and challenges of adopting The Sanctuary Model, as perceived by residential care staff. Following ethics approval, three semi-structured interviews and six focus groups were conducted with residential care staff between February and July, 2020. Participants identified a number of enablers, presented in the subthemes: (a) social support systems and resources; (b) shared trauma-informed knowledge and understanding; and (c) leadership and champions. These enablers influenced organisational successes in adopting: (a) the Sanctuary Commitments; (b) the S.E.L.F Framework; (c) Reflective Practice and Supervision; and (d) Trauma Theory. A number of barriers hindering implementation were identified. These were reflected in the subthemes: (a) informal practice; (b) lack of practice-based training; (c) poor introduction to young people; and (d) resources. These barriers impacted on organisational challenges faced in residential out-of-home care including: (a) The Sanctuary Model Toolkit and (b) young people’s behaviour and engagement. Comparisons from this study and previous findings identified by executive and upper management staff (decision makers) are discussed. Key findings indicate that when implementing, sustaining and embedding The Sanctuary Model, organisations need to become trauma-informed rather than ‘do’ trauma-informed care and organisations need to “live and breathe” The Sanctuary Model Commitments, be connected and inclusive of one another, use trauma-informed language and feel safe.

Young people living in out-of-home care (OoHC) are widely considered to be one of the most vulnerable groups in the community. This article describes the evaluation and implementation study protocol of a healthy lifestyle programme developed to improve the eating and physical activity habits of young people living in residential OoHC. The study will employ a longitudinal multi-group pre-post process evaluation to assess our implementation strategy in the dissemination of HEALing Matters at the: 1) system-level; 2) organizational-level; 3) residential home-level; and 4) individual-level (N = approximately 60 residential homes [approximately 400–500 staff and 240 young people]). Implementation- and program-related outcomes will be assessed using self-report surveys, semi-structured interviews and focus groups, house audits and website usage data collected prior, during and after implementation. Results are expected to inform and help guide the further development and training of residential care staff’s understanding and application of health literacy.

Young people taken into custody and lacking the support of their families suffer from social and health problems more often than their peers, and the likelihood of their marginalization in later life can be significantly higher. The aim of this study is to discover how the different factors documented at the time of the custody decision or the placement in out-of-home care are associated with the coping abilities of young adults once aftercare services come to an end. The original dataset consisted of 428 measured variables taken from 600 young Finnish adults who have participated in aftercare services. The data were collected at the end of the aftercare period in 2015 from electronic customer/patient record systems. Original free-text documents were read and data extracted and collected on a structured electronic worksheet. All of the factors that had influenced the custody decisions were included in the dataset. Thus, the data consisted both of the baseline and follow-up data. The data were analyzed with BayesiaLab 7.0 tool. Altogether, 18.5% of examined persons had no remarkable coping problems, 74.5% had some challenges and 7% experienced serious difficulties. A child's own problems, such as substance use, running away from home or truancy, were associated with a poorer prognosis compared to children whose custody decisions stemmed from their parents´ urgent life situations, e.g. substance use, violence or serious mental health issues. Children and adolescents who may be in need of child protection services require effective preventive care activities. If a child does enter out-of-home care, s/he will need more influential social support and personal follow-up to enhance his or her long-term wellbeing as early as possible.

Long‐term foster carers in New South Wales, Australia, are being encouraged to consider open adoption of the child in their care. This includes an agreement to facilitate direct or face‐to‐face birth family contact without agency support. There is little Australian research on the factors that influence decisions to adopt children from out‐of‐home care. A mixed methods study was conducted to address this gap. An online survey (n = 76) and four focus groups (n = 30) were conducted with foster carers across New South Wales. Descriptive and thematic analysis was undertaken. Results related to birth family contact are reported. Birth family contact was an area of widespread concern among foster carers. The theme of Relationships with birth family included four subordinate themes: (a) disputed purpose, (b) supervision versus independence, (c) ambivalence about agencies, and (d) establishing boundaries. Foster carers viewed birth family contact as extremely challenging due to its effects on children and interactions with agency staff. For open adoption or guardianship to become the preferred permanency option for children over long‐term foster care, carers will need ongoing and appropriate professional support with contact.

PURPOSE: To compare experiences for adverse events, especially sexual abuse, and mental health in a group of high school students in out-of-home care with a representative sample of peers of the same age and similar educational attainment living with their parents. MATERIALS AND METHODS: A sample of 5839 students in the third year of Swedish high school, corresponding to a response rate of 59.7%, answered a study specific questionnaire. Data from 41 students living in out-of-home care were compared with data from peers not in out-of-home care in a cross-sectional analyze. RESULTS: Students in out-of-home care had more often an immigrant background and a non-heterosexual orientation, had more often experienced physical and penetrative sexual abuse, and more often sought healthcare for mental problems. Disclosure of sexual abuse was less common, and acts of persuasion or adults' use of their social position was more common among students in out-of-home care. CONCLUSIONS: Even where the protective factor 'senior educational attainment' is present, risks for abuse and poor mental health are evident for adolescents in out-of-home care. Disclosure of adversity, when it has occurred, ought to be higher among these adolescents with regular contact with social services, but our findings indicate tendencies for the opposite. We therefore suggest routines to be established to screen for adverse life events and mental health actively, along with general and systematic assessments of adversity and mental health during care.

Sociālā antropoloģija Socioloģija, politoloģija un antropoloģija Social Anthropology Sociology, Politics and Anthropology Maģistra darbs “Nevērtīgs, nenovērtējams, svēts. Ārpusģimenes aprūpētāju prakses īstenojot valsti kā supervecāku” ir institucionalizēto bērnu un tur strādājošo valsts īstenošanas pieredzes un prakses analīze un teorētiskā interpretācija. Izmantojot Agambena kailās dzīvības un Edelmana iedomāto bērnu, darbā tiek konstruēts un dekonstruēts bērna jēdziens, kas pamatojotes uz empirisko materiālu norāda, ka valsts īstenotā biopoitiku ‘bērna labākajās interesēs’ tiek radīta un īstenota neesošam tēlam. Valsts birokrātiskie mehānismi regulē, definē un leģitimē dažādus radniecības aktus un attiecības. To darot, valsts kā aparāts sevi ierindo supervecāka (Rockhill 2010, 157) lomā visiem bērniem, jo īpaši tiem, kam nepieciešama aizstāvība, pareizā aprūpe. Šīs supervecāka lomas īstenošana tiek deleģēta institūcijām, tur strādājošajiem, kas savā saskarmē ar bērnu to īsteno balstoties uz savu izpratni, uz savu iemiesoto dzīves pieredzi. Valsts politikas virzītāji plāno un paļaujas uz cilvēku radniecību kaut vai demogrāfiskā līmenī (Žabicka 2018). Tādējādi izlemjot, kurš ar ko ir likumīgi saistīts, kā arī virza un veido arī pašas šīs attiecības. Bērnam noņem visu, atstājot kailo dzīvību, lai to normalizētu jau citā, pareizā radniecībā. Biopolitika (Bianco, Giuseppe; Miguel, de Beistegui 2015), kas novienkāršojot nozīmē regulētu dzimstību, kontrolētu mirstību, ar atļauto izvēles brīvībi, kas ir definēta pastāvošās iekārtas akceptētajā normalizācijas rāmī un pasniegta indivīdam kā nepieciešamība virzītai ekonomiskai labbūtībai un drošumspējai . Realitātē īstenotā biopolitika bērna labākajās interesēs, sabiedrībā pašu bērnu atspoguļo kā pasīvu kultūras saņēmēju, kurš “lineārā līknē dodas savā ceļā uz pilngadību” (Abella 2017, 23). Bērniem līdz pilngadības sasniegšanai nav savu politisko tiesību: “Bērni nav balsotāji, bērni par mums nebalsos” (Kalnozols 2018). Morālu un likumisku motīvu vadīti par bērniem bērna labākajās interesēs rūpējas pieaugušie. Šie aprūpes apsvērumi nekad nav tikai morāli, tie vienmēr ir apzināti/ neapzināti politiski un ekonomiski virzīti. Bērnam ir tikai kailā dzīvība (Agamben 1998), ķermenis, kas tiek pārvietots, pakļauts un veidots pēc aprūpē iesaistīto ieskatiem. Bērnība, kā kultūras projekts ar mērķiem un nozīmēm, ir pastāvīga pielāgošanās un cīņa (Weisner 2015). Lauka darba etnogrāfiskie dati ieskicē vecāku, bērnu un aprūpētāju attiecībām ar valsts iekārtā noteikto pre-institucionālajā, institucionālajā un post – institucionālajā (Rockhill 2010, 3-5) posmā, kurus interpretējot teorijā, pastiprinot ar pētījumiem un analizējot īstenotās prakses, pierādu, ka valsts kā supervecāka politika ar likumos definēto rīcības vadmotīvu “bērna [labākajās] interesēs” (Saeima 1998), tiek īstenota uz neesošu, iedomātu (Edelman 1998) bērnu. Master's thesis “Worthless, priceless, sacred. Performing state as superparent by out-of-family caregivers” is an analysis and theoretical interpretation of the experience and practice of state performing by institutionalized children and those working there. Using Agamben's bare life and Edelman's imagined child, the work constructs and deconstructs the concept of the child, which, based on empirical material, indicates that the state-implemented biopolitics in the 'best interests of the child' is created and implemented for a non-existent image in child. State bureaucratic mechanisms regulates, define and legitimize various acts and kinship relationships. In doing so, the state as an apparatus, places itself in the role of a superparent (Rockhill 2010, 157) for all children, especially for those in need of protection, proper care. The implementation of this role of superparent is delegated to institutions, to those who work there, who in their contact with the child performe this role, based on their understanding, on their embodied life experience. Public policy makers plan and rely on kinship, even more at the demographic level (Žabicka 2018). Thus, in deciding on legal terams, to whom parental relationships are allowed to perform and to whom it’s not. Everything is removed from the child, leaving it’s bare life to be normalized in another, correct kinship. Biopolitics (Bianco, Giuseppe; Miguel, de Beistegui 2015), which in simple means regulated birth, controlled mortality, with defined in the accepted normalization framework allowed freedom of choice, and presented to the individual as a necessity for directed economic well-being and security. The reality-based biopolitics in the best interests of the child, in society, portrays the child himself as a passive recipient of culture, who “goes on a linear curve on his way to adulthood” (Abella 2017, 23). Children do not have their political rights until they reach their adulthood: “Children are not voters, children do not vote for us” (Kalnozols 2018). Driven by moral and legal motives, children are cared for by adults in ‘the best interests of the child’. These care considerations are never just moral, they are always consciously / unconsciously politically and economically driven. The child has only a bare life (Agamben 1998), a body that is moved, exposed and shaped at the discretion of the caregivers. Childhood, as a cultural project with goals and meanings, is a constant adaptation and struggle (Weisner 2015). The ethnographic data of the field work outline the relations of parents, children and caregivers with the pre-institutional, institutional and post-institutional (Rockhill 2010, 3-5) stages of the state system, which, when interpreted in theory, reinforced by research and analysis, show that the state as a superparental policy with the guiding principle of action “in the best interests of the child” defined by law (Saeima 1998), is performed to a non-existent, imaginary child (Ed

The obligation to ensure children’s right to express themselves freely and to give due weight to their views in policy decision making is described in Article 12 of the United Nations Convention on the Rights of the Child (UNCRC). Despite findings that direct engagement and dialogue are critical for meaningful participation, little is known about what happens when policy actors listen and consider their views in out-of-home care (OOHC) policy-making in Australia. The dearth of evidence risks overlooking the lived experience expertise of children and young people whose lives are affected by child protection, OOHC, and other policy systems. This study used a critical-participatory methodology informed by practice theory, children’s rights and relational accountability. It aimed to identify practices associated with giving due weight in policy-making, arrangements enabling and constraining practice, and young people’s ideas about improving practice., The study sought to extend participatory research practice by involving co-researchers in each research phase, including design of research methods, data collection, data analysis, knowledge co-creation and dissemination. Five young co-researchers with first hand experience in OOHC were engaged in observing over 100 policy actors in six national and state policy-making sites and interviewing 12 senior policy practitioners in Phase 1. In Phase 2, an eBook practice resource was co-created with co-researchers and shared with over 700 readers. Findings uncovered 14 policy-making practices, including four directly associated with giving due weight: listening and giving serious consideration, feedback and reporting back, amplifying their views and including children and young people as policy actors. Participatory analysis uncovered complex cultural-discursive, material-economic, and socio-political arrangements that enabled contracting out consultation and engaging caseworkers as experts on children and young people’s lives. Arrangements also constrained direct engagement, listening and including children and young people as policy actors., Improving the practice of giving due weight in participating Australian policy organisations relies on valuing the lived experience of children and young people and engaging in direct and ongoing dialogue with them. Such a dialogue is an opportunity to mobilise trust and relational accountability between policy actors. Beyond participation, giving due weight is an opportunity to activate ethical responsiveness in the organisations that serve children and young people’s welfare, wellbeing and safety for a more child-centred approach to policy practice.

Children growing up in families experiencing socioeconomic disadvantage (SED) are at greater risk for deficits in attachment and stress regulation as compared to peers in families with more socioeconomic resources. The present study hypothesized that care providers in out-of-home care might help these children to compensate. We therefore investigated 60 children (n = 30 from SED, n = 30 matched counterparts from middle class) and assessed children's Attachment Q-Sort (AQS) toward the mother and the primary care provider in childcare centers. Moreover, children's diurnal cortisol rhythm was measured based on 12 saliva samples taken across three days a week. The disadvantaged children showed lower AQS scores with their mothers than their care providers. Compared to their counterparts, disadvantaged children also displayed heightened cortisol release and flatter cortisol profiles reflecting overall high hypothalamic-pituitary-adrenocortical activities and lower capacities to regulate stress. Most notably however, multilevel path modeling linked higher care provider AQS scores to decreasing cortisol release throughout the week.Los niños que crecen en familias que experimentan desventajas socioeconómicas (SED) se encuentran bajo mayor riesgo de déficits en la afectividad y regulación del estrés, comparados con compañeros de familias con más recursos socioeconómicos. EL presente estudio presenta la hipótesis de que quienes cuidan a estos niños dentro del sistema público de guarderías pudieran ayudarles a compensar. Nosotros, por tanto, investigamos a 60 niños (n = 30 de SED, n = 30 niños de clase media pareados como contraparte) y evaluamos la afectividad de los niños (AQS) hacia las madres y quienes les proveían el cuidado primario en guarderías infantiles públicas. Es más, se midió el ritmo diurno de cortisol de los niños con base en 12 muestras de saliva tomadas a lo largo de tres días a la semana. Los niños con desventajas mostraron más bajos puntajes de AQS con sus madres que con quienes les prestaban el cuidado. Comparados con su contraparte, los niños con desventajas también mostraron un elevado nivel de emisión de cortisol y perfiles de cortisol más planos lo cual refleja en general un alto nivel de actividades HPA y más bajas capacidades para regular el estrés. Aún más notable, sin embargo, el modelo de trayectoria a múltiples niveles relacionó los más altos puntajes AQS del cuidador con una baja en la emisión de cortisol a lo largo de la semana.Les enfants grandissant dans des familles faisant l'expérience d'un désavantage socioéconomique (abrégé ici DSE) sont à plus grand risque de déficits dans l'attachement et la régulation du stress comparés aux enfants grandissant dans des familles dotées de plus de ressources socioéconomiques. Cette étude a pris pour hypothèse que les personnes s'occupant des enfants dans les crèches publiques pourraient aider ces enfants à compenser. Nous avons donc étudié 60 enfants (n = 30 de SED, n = 30 homologues issus de la classe moyenne) et évalué l'attachement (AQS) des enfants envers leur mère et envers les personnes prenant soin d'eux dans les crèches publiques. De plus le rythme de cortisol diurne a été mesuré basé sur des échantillons de salive pris au cours de trois jours par semaine. Les enfants de milieu désavantagé ont fait preuve de scores AQS plus bas avec leurs mères qu'avec les personnes prenant soin d'eux dans les crèches. Comparés à leurs homologues, les enfants désavantagés ont aussi fait preuve de sécrétion de cortisol plus élevée et des profils de cortisol plus plats reflétaient des activités HPA dans l'ensemble hautes et des capacités plus basses à réguler le stress. Plus particulièrement cependant une modélisation à plusieurs niveaux a établi un lien entre des scores AQS plus élevés des modes de soin à la crèche à des sécrétions de cortisol décroissantes tout au long de la semaine.Bindung und Stressregulierung bei sozioökonomisch benachteiligten Kindern: Kann die öffentliche Kinderbetreuung kompensieren? Kinder aus Familien, die sozioökonomisch benachteiligten sind (socioeconomic disadvantage; SED), haben im Vergleich zu Gleichaltrigen aus Familien mit mehr sozioökonomischen Ressourcen ein höheres Risiko für Defizite bezüglich Bindung und Stressregulierung. Die Hypothese der vorliegenden Studie ist, dass Erzieher_innen in der öffentlichen Kinderbetreuung diesen Kindern helfen können, dies zu kompensieren. Wir untersuchten 60 Kinder (n = 30 aus SED Familien, n = 30 gleichaltrige Kontrollproband_innen aus der Mittelklasse) und beurteilten deren Bindung zur Mutter sowie zur primären Bezugsperson in der öffentlichen Kindertagesstätte (AQS). Darüber hinaus wurde der tägliche Cortisolrhythmus der Kinder anhand von 12 Speichelproben gemessen, die an drei Tagen in der Woche entnommen wurden. Die sozioökonomisch benachteiligten Kinder erzielten bei ihren Müttern niedrigere AQS-Werte als bei ihren Erzieher_innen. Im Vergleich zur Kontrollgruppe wiesen die sozioökonomisch benachteiligten Kinder auch eine erhöhte Cortisolfreisetzung und flachere Cortisolprofile auf, was auf insgesamt hohe HPA-Aktivitäten und geringere Kapazitäten zur Stressregulierung zurückgeführt werden kann. Insbesondere aber zeigte sich durch eine Multilevel-Pfadmodellierung ein Zusammenhang zwischen höheren AQS-Werten bei den Erzieher_innen und geringerer wöchentlicher Cortisolfreisetzung.社会経済的に貧しい子どもたちのアタッチメントとストレス制御 abstract: 抄録 社会経済的に貧しい(SED)家族のもとで育っている子どもたちは、社会経済的な 資源のある家族のもので育っている子どもたちに比べ、アタッチメントとストレ ス制御に関して欠損しているリスクが高い。本研究では、公の保育現場の保育者 らがこのこどもたちを支援し、それを補償するのではないかと仮定した。そのた め、60人の子ども(SED:n = 30 、中産階級の同等の子ども:n = 30)を調査し、 母親と公の保育園の主な保育者に対する子どもの(AQS)アタッチメントについて 評価した。さらに、子どもの日中のコルチゾールリズムを週3日にわたり、12の 唾液サンプルを採取し、測定した。 社会経済的に貧しい子どもたちは、保育者より母親に対してより低いAQS値を示 した。中産階級の子どもたちと比較して、社会経済的に貧しい子どもたちはまた、 全体的に高いHPA活動とストレスを制御するための低能力を反映して、高いコル チゾール放出とより横ばいのコルチゾールプロファイルを示していた。しかし、 特に重要なことは、多層経路モデルが、週を通じてより高い保育者のAQS値がコ ルチゾール放出を減少させることに関係している事であった。.摘 要:与拥有更多社会经济资源的家庭中的同龄儿童相比, 处于社会经济劣势(SED)的家庭中长大的儿童, 在依恋和压力调节方面存在缺陷的风险更大。本研究假设公共看护机构的看护者们可能会帮助这些儿童弥补这方面的缺陷。基于此, 我们调查了60名儿童 (来自SED的儿童n = 30, 来自中产阶级的相匹配的同龄儿童n = 30) , 并评估 (AQS) 了每位儿童对他们的母亲以及公共看护机构中最初那位看护者的依恋程度。此外, 我们还根据每周中三天采集的12份唾液样本来测量这些儿童的皮质醇昼夜节律。结果显示, 社会经济劣势的儿童与其母亲的AQS得分低于他们与看护者们的得分。与其他相匹配的同龄儿童相比, 这些儿童的皮质醇释放量更高, 皮质醇分布曲线更平坦, 这反映出整体较高的HPA活动和较低的压力调节能力。但是, 值得注意的是, 多层次路径模型显示出, 在儿童与看护者AQS得分较高的整个星期中, 皮质醇释放量却在逐步下降。.التعلق وتنظيم الإجهاد عند الأطفال المحرومين اجتماعيا ً واقتصادياً: هل تقدم رعاية الأطفال العامة التعويض المطلوب؟ ملخص الأطفال الذين ينشأون في أسر تعاني من الحرمان الاجتماعي والاقتصادي (SED) هم أكثر عرضة للعجز في التعلق وتنظيم الإجهاد مقارنة بأقرانهم في الأسر ذات الموارد الاجتماعية والاقتصادية الأكثر. افترضت هذه الدراسة أن مقدمي الرعاية في الرعاية العامة للأطفال قد يساعدون هؤلاء الأطفال على التعويض. ولذلك قمنا بالتحقيق مع 60 طفلاً (30 طفل من الفئات المحرومة اجتماعيا واقتصاديا و30 طفل من الطبقة المتوسطة) وقيمنا تعلق الأطفال(AQS) بالأم ومقدم الرعاية الأولية في مراكز رعاية الطفل العامة. وعلاوة على ذلك، تم قياس إيقاع الكورتيزول اليومي للأطفال على أساس 12 عينة من اللعاب تؤخذ عبر ثلاثة أيام في الأسبوع. وأظهر الأطفال المحرومون درجات أقل على مقياسAQS مع أمهاتهم مقارنة بمقدمي الرعاية. بالمقارنة مع نظرائهم، أظهر الأطفال المحرومون أيضًا إفراز كورتيزول متزايد وملامح الكورتيزول التملقية التي تعكس أنشطةHPA العالية بشكل عام وقدرات أقل لتنظيم الإجهاد. وأبرزها ومع ذلك، ربط نمذجة المسار متعدد المستويات أعلى مستوى الرعايةAQS عشرات لخفض الإفراج الكورتيزول على مدار الأسبوع.

This study examines the relationship that occurs between birth parents and foster carers of children in out-of-home care. It has long been argued that the relational climate between parents and carers is a factor contributing to outcomes for placements and the wellbeing of children, including their sense of belonging. While a positive relationship between birth parents and foster carers is desirable, previous studies have found that birth parent interactions are a significant stressor for many foster carers. Yet attention to this relationship is frequently lacking in practice and there is virtually no research to guide how this relationship can be supported to become more collaborative. This mixed-methods study captured the perspectives of birth parents, foster carers and caseworkers in online surveys (n = 195) and semi-structured interviews (n = 30). It asked how the relationship between parents and carers is understood and experienced in the Australian context, what barriers exist, and what implications are associated with the way parents and carers relate to each other. It identified indicators of a positive working relationship and factors that assist in promoting a positive relational climate. Engaging with symbolic interactionist theory and theories of collaboration and partnership from other fields in analysing the study data, a conceptual framework to guide out-of-home care practitioners in supporting the relationship between parents and carers emerged. While the study found that this working relationship is frequently neglected in practice, a relationship of sorts is common between parents and carers, with factors that are promotive or inhibitive of partnership occurring in non-linear patterns. These factors were organised into a schema of three intersecting dimensions forming a framework for practice. The dimensions identify three phases of the relationship, four domains of influence over the relationship, and four attribute categories which determine the tenor of the relationship. When partnership is realised, experiences and outcomes related to the placement tend to improve for the benefit of children, including their sense of identity and belonging. Conversely, neglect of this working relationship can introduce conflict and negative experiences for participants and inhibit the achievement of outcomes in out-of-home placements.

Au Québec, sur le terrain des centres de réadaptation pour jeunes en difficulté d’adaptation, des « écoles de site » sont dédiées à la scolarisation des jeunes qui y sont hébergé.e.s. Ces derniers, placé.e.s sous la Loi de la protection de la jeunesse (LPJ) ou de la Loi sur le système de justice pénale pour les adolescents (LSJPA), ont moins tendance à avoir terminé ou d’être en voie de terminer leurs études secondaires avant l’âge de 18 ans. Cet article a pour objectif d’identifier les facteurs organisationnels qui peuvent avoir une incidence sur les parcours scolaires de ces jeunes. Pour ce faire, 25 professionnel.le.s responsables de la scolarisation de ces jeunes ont été interrogé.e.s sur leur expérience de collaboration intersectorielle et les répercussions de celle-ci sur le parcours des jeunes. Les résultats de cette collecte de données qualitatives offrent un nouvel éclairage sur le rôle potentiel des écoles de site dans le processus de réadaptation des jeunes qui fréquentent ces établissements., In Quebec, schools called “écoles de site” offer education to at-risk youth placed in readaptation centres. These young people, under the Youth Protection Act or the Youth Criminal Justice Act, are less likely to have obtained or be in the process of obtaining their high school diploma before the age of 18. This article aims to explore the organizational factors that can affect their education trajectory by interviewing 25 professionals in charge of the schooling of youth placed in these readaptation centres. They have shared their experience of intersectoral collaboration and its impact on the trajectory of these young people. The results of this study shed light on the potential role of on-campus schools in the social rehabilitation process of young people who attend these establishments.

Adoption is one of a range of options that can provide children in out-of-home care with permanency when they are unable to be reunified with their birth parents. This paper reports on how the adoption of children from out-of-home care is understood by professionals involved in making decisions about the permanent placement of children in out-of-home care in Victoria, Australia, where adoption is rarely used. Data were collected through a single, face-to-face semi-structured interview with 21 professionals; eight child welfare specialists, eight adoption and permanent care specialists and five judicial officers. The adoption of children from out-of-home care was primarily understood as a child-centered practice that can afford children stability and a sense of belonging. Adoption was largely viewed as a voluntary process dependent upon the consent of a child's birth parents. Adoption and permanent care specialists were the only group to refer to the dispensation of parental consent as a means of obtaining an adoption order. Most decision makers understood that contact between children and their birth parents is possible following adoption, but this was not understood by all judicial officers or all child welfare specialists. Children's connection to their cultural heritage was viewed as important to the consideration of adoption for children in out-of-home care. This research provides insight into the foundations upon which decision makers may appraise adoption, within a hierarchy of options, as a potential outcome for children in need of permanency. Refereed/Peer-reviewed

Background The terms affective dysregulation (AD) and irritability describe transdiagnostic dimensions and are characterized by an excessive reactivity to negative emotional stimuli with an affective (anger) and a behavioral component (aggression). Due to early onset, high prevalence and persistence, as well as developmental comorbidity, AD in childhood is one of the most psychosocially impairing and cost-intensive mental health conditions. AD is especially prevalent in children in the youth welfare service. Despite continuous research, there remains a substantial need for diagnostic approaches and optimization of individualized treatment strategies in order to improve outcomes and reduce the subjective and economic burden. Methods The ADOPT (Affective Dysregulation – Optimizing Prevention and Treatment) Consortium integrates internationally established, highly experienced and interdisciplinary research groups. The work program encompasses (a) epidemiology, including prevalence of symptoms and disorders, (b) development and evaluation of screening and assessment tools, (c) stepped care approaches for clinically useful personalized medicine, (d) evaluation of an easily accessible and cost-effective online intervention as indicated prevention (treatment effects, moderation/mediation analysis), and (e) evaluation of an intensive personalized modular outpatient treatment in a cohort of children with AD who live with their parents and in a cohort of children with AD who live in out-of-home care (treatment effects, moderation/mediation analysis). Discussion The results will lead to significant recommendations for improving treatment within routine clinical care in two cohorts of children with AD and coexisting conditions, especially oppositional-defiant disorder, conduct disorder and disruptive mood dysregulation disorder. Trial registration Trial registration ADOPT Online: German Clinical Trials Register (DRKS) DRKS00014963. Registered 27 June 2018. Trial registration ADOPT Treatment: German Clinical Trials Register (DRKS) DRKS00013317. Registered 27 September 2018. Trial registration ADOPT Institution: German Clinical Trials Register (DRKS) DRKS00014581. Registered 04 July 2018. Electronic supplementary material The online version of this article (10.1186/s12888-019-2239-8) contains supplementary material, which is available to authorized users.

Background Past research has shown that individuals who have had experiences of out-of-home care (OHC) in childhood have increased risks of premature mortality. Prior studies also suggest that these individuals are more likely to follow long-term trajectories that are characterised by economic, work-, and health-related disadvantages, compared to majority population peers. Yet, we do not know the extent to which such trajectories may explain their elevated mortality risks. The aim of this study is therefore to examine whether trajectories of economic, work-, and health-related disadvantages in midlife mediate the association between OHC experience in childhood and subsequent all-cause mortality. Methods Utilising longitudinal Swedish data from a 1953 cohort (n = 14,294), followed from birth up until 2008 (age 55), this study applies gender-specific logistic regression analysis to analyse the association between OHC experience in childhood (ages 0–19; 1953–1972) and all-cause mortality (ages 47–55; 2000–2008). A decomposition method developed for non-linear regression models is used to estimate mediation by trajectories of economic, work-, and health-related disadvantages (ages 39–46; 1992–1999), as indicated by social welfare receipt, unemployment, and mental health problems. To account for selection processes underlying placement in OHC, an alternative comparison group of children who were investigated by the child welfare committee but not placed, is included. Results The results confirm that individuals with experience of OHC have more than a two-fold increased risk of all-cause mortality, for men (OR: 2.10, 95% CI: 1.42–3.11) and women (OR: 2.23, 95% CI: 1.39–3.59) alike. Approximately one-third (31.1%) of the association among men, and one-fourth (27.4%) of the association among women, is mediated by the long-term trajectories of economic, work-, and health-related disadvantages. The group who were investigated but not placed shows similar, yet overall weaker, associations. Conclusions Individuals who come to the attention of the child welfare services, regardless of whether they are placed in out-of-home care or not, continue to be at risk of adverse outcomes across the life course. Preventing them from following trajectories of economic, work-, and health-related disadvantages could potentially reduce their risk of premature death.

Cumulative incidence provides a more accurate indicator than annual incidence rates of the number of children who experience out-of-home care during childhood. The study utilises a cohort of all children born in Western Australia (WA) 1994-2005 and Manitoba 1998-2008 using de -identified linked data. Life tables were used to calculate the age-specific cumulative incidence over time and for at-risk groups. Cox regression was used to compare risk factors for entry to care. Manitoba had a larger proportion of children entering care compared to WA (9.4% vs 1.5% by age 12). Over time children entered care at a younger age in both WA (HR= 1.5, CI:1.4-1.5) and Manitoba (HR= 1.5, CI:1.5-1.6). Similar factors were associated with earlier age care entries in both countries including: socioeconomic disadvantage, young maternal age, maternal hospital admissions for mental health issues, substance misuse and assault. Supplementary analysis for WA showed a time trend with young children (

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. 'Studies covered 15 developmental health or wellbeing outcomes' 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. Language: en

There is currently limited understanding of biological children of foster carers and their experiences of foster care placements. This article presents findings from focus groups with biological children that shed light on their perspectives and experiences. Findings indicate biological children are competent social actors who contribute to, and seek to influence, the care environment in their homes. However, due to a lack of recognition, information, and support, biological children’s agency is constrained and their challenges exacerbated. This article argues for increased recognition, information and support for biological children, advocating for a “whole-of-family” approach to foster care practice and policy.

Youth residing in out‐of‐home care settings have often been exposed to childhood trauma, and commonly report experiencing adverse outcomes after transitioning from care. This meta‐analysis appraised internationally published literature investigating the impact of transitional programme participation (among youth with a baseline age of 15–24 years) on post‐transition outcomes of housing, education, employment, mental health and substance use. A comprehensive search of sociology (e.g. ProQuest Sociology), psychology (e.g. PsycInfo) and health (e.g. ProQuest Family Health) electronic abstraction databases was conducted for the period 1990–2014. Search terms included ‘out‐of‐home care’, ‘transition’, ‘housing’, ‘education’, ‘employment’, ‘mental health’ and ‘substance use’. Nineteen studies, all from the United States, met the inclusion criteria and were included in the meta‐analysis. Living independently and homelessness were the most commonly described housing outcomes. Rates of post‐transition employment varied, while rates of post‐secondary education were low. Depression and alcohol use were commonly reported among transitioning youth. Findings of the meta‐analysis showed that attention should be given to the potential benefit of transitional programme participation on outcomes such as housing, employment and education. Moderator analyses showed that these benefits may differ based on study design, sample size and sampling unit, but not for mean age or gender. Detailed and rigorous research is needed internationally to examine the characteristics of transitional programmes resulting in more successful outcomes for youth, and whether these outcomes are sustained longitudinally.

The negative impact of childhood maltreatment, which can often extend well into adulthood, consistently appears to be ameliorated if victimized children possess several resiliencies or strengths. However, little is known about how vulnerable children's outcomes are affected by different levels of strengths across different out-of-home placement settings. Hence, this study examined the association of two factors — children's strengths and placement type, with outcomes at two time-points during out-of-home care. The Child and Adolescent Needs and Strengths (CANS) tool was used to assess the outcomes of 285 children placed in residential homes or foster care in Singapore. Multiple regressions were conducted on CANS domain scores to evaluate whether level of baseline strengths and placement type predicted outcomes at two time-points after controlling for race, prior placements, age, gender, interpersonal trauma, and baseline needs scores. Results indicate that relative to residential care, foster care children are reported to be younger, with lower baseline needs, more prior placements, fewer baseline strengths and suffered fewer types of interpersonal trauma. After controlling for covariates, higher baseline strengths significantly predicted lower baseline needs of children across 3 of 4 CANS domains, regardless of placement settings. However, at reassessment 1 year later, there were significant interactions between strengths and placement type, whereby baseline strengths significantly predicted lower life functioning needs only in foster care. To conclude, in both residential and foster care, the protective effects of high strengths against child maltreatment were similarly apparent at baseline, despite clear differences in children's profiles across placement types. Over time, these initial benefits appeared to persist somewhat for children in foster care but seemed to diminish in more restrictive, residential settings and this warrants further investigation on children with more similar profiles. Nonetheless, it is clear that the continual development of children's strengths should be prioritized in case planning.

Policies and thresholds vary for placing children into out-of-home care (OHC) at different ages. Evidence is lacking that quantifies the risk of entering OHC by age, and how this varies over time and between countries. We determined the age-specific cumulative incidence of ever entering OHC during childhood in Denmark and in eight local authorities in England. We used administrative data for any form of OHC (except respite care) provided by children's social services in Denmark and England from 1992 to 2008. Using life tables and national population estimates, we calculated the cumulative incidence of entry into OHC by year of age for cohorts born in 1992–1994 through to 2006–2008. The cumulative incidence of entry into OHC decreased over time in Denmark and increased in England at all ages. Cumulative incidence of OHC in the first year of life was similar in Denmark and England for infants born in 1992–1994 (Denmark 2.83/1,000, England 2.89/1,000), but infants born in 2007–2008 were nearly three times as likely to enter OHC before their first birthday in England (4.50/1,000) than in Denmark (1.61/1,000). Entry into OHC during adolescence was more common in Denmark than in England so that by 16 years old the cumulative incidence of ever entering OHC during childhood was twice as high in Denmark (33.83/1,000) as in England (15.62/1,000). Diverging trends over time in the use of OHC in Denmark and England are likely to reflect changing policies in the two countries.

Background: Children without disabilities in out-of-home care have a higher risk of child sexual abuse [CSA (Euser et al. 2013)]. In this study, we examined the year prevalence of CSA in out-of-home care for children with a mild intellectual disability, and compared it with the prevalence in out-of-home care for non-disabled children and children in the general population. Materials and Methods: Professionals (N = 104) from out-of-home care facilities reported cases of CSA that occurred in 2010 for the children they worked with (N = 1650). Results: In out-of-home care for children with a mild intellectual disability, 9.8 per 1000 children were victims of CSA. This prevalence was significantly higher than in regular out-of-home care and in the general population. Conclusion: Children with a mild intellectual disability in out-of-home care have an increased risk of CSA. Adequate education and support for both children and caregivers is necessary to recognize and prevent further sexual abuse. Copyright

We evaluate the association between foster care placement during childhood and adult criminality. In contrast to previous studies, we allow associations to vary by gender and age at initial placement. We find that foster care predicts higher adult criminality for males first placed during adolescence (ages 13–18). We find no significant association for boys who were placed in foster care before age 13 and no significant association on the adult criminality of girls. These null findings stand in stark contrast to the poor outcomes reported in earlier work concerning the long-run effects of foster care.

Young people in out-of-home care are more likely to experience poorer mental and physical health outcomes related to their peers. Stable care environments are essential for ameliorating impacts of disruptive early childhood experiences, including exposure to psychological trauma, abuse and neglect. At present there are very few high quality data regarding the placement stability history of young people in out-of-home care in Australia or other countries.To undertake the first systematic census of background, care type and placement stability characteristics of young people living in the out-of-home care sector in Australia.Data was collected from four non-government child and adolescent community service organisations located across metropolitan Melbourne in 2014. The sample comprised 322 young people (females 52.8%), aged between 12 - 17 years (mean age=14.86Most young people (64.3%) were in home-based care settings (i.e., foster care, therapeutic foster care, adolescent care program, kinship care, and lead tenant care), relative to residential care (35.7%). However, the proportion in residential care is very high in this age group when compared with all children in out-of-home care (5%). Mean age of first removal was 9 yearsPlacement instability is common in the out-of-home care sector. Given stable care environments are required to ameliorate psychological trauma and health impacts associated with childhood maltreatment, well-designed intervention-based research is required to enable greater placement stability, including strengthening the therapeutic capacities of out-of-home carers of young people.收容机构中的儿童青少年和同龄人相比可能存 在较差的心身健康水平。稳定的机构照料环境对改善 早期童年经历所致破坏性影响是非常重要的，童年经 历包括心理创伤、虐待和忽视。目前，澳大利亚或其 他国家很少有关收容机构中儿童青少年的安置稳定性 高质量研究的数据。.首次针对澳大利亚在收容机构生活中的儿童青 少年进行系统的背景、照料类型、和安置稳定性特征 的调查。.2014 年收集了墨尔本市区的四家民间儿童青 少年社区服务机构的数据。样本包括322 名年轻人 （女性占52.8%），年龄在12 – 17 岁之间[ 平均年龄= 14.86，（SD = 1.63）年]。.在收容机构中，相对于社区收容照料类型 （35.7%），大多数年轻人（64.3%）是基于家庭养育 照料模式（即寄养、治疗型寄养照料、青少年照料模 式、亲属照料、以及认领照料）。然而，与所有收容 照料的孩子相比，这个年龄组被社区收容比例是较高 的（5%）。第一次被社区收容的平均年龄为9 岁（SD = 4.54）。不同的照料类型均无性别差异。其中有248 人（76.9%）曾在收容照料系统中有一个以上的安置场 所，有117 人（36.5%）经历了超过5 个安置场所。相 对于家庭养育照料者，社区收容的儿童青少年经历了 更显著的安置不稳定性（χ2=63.018, p0.001）。.安置不稳定性在收容照料机构是常见的现象。 需要一个稳定的照料环境来改善被虐待儿童所导致的 心理创伤和健康影响。精心设计并以干预为基础的研 究能够增加安置稳定性，包括强化对儿童青少年收容 照料者的治疗能力。.

Foster carers frequently report receiving insufficient or inadequate support for the challenging behaviour of the children they look after. There is a need to understand the support that foster carers require. This study explores foster carers' perspectives in order to inform the development of a more effective support service. Refereed/Peer-reviewed

Parents caring for children and young people with disabilities typically have extensive additional demands on their time and resources. This added pressure can significantly impact well-being and mental health. In extreme circumstances, parents may seek an out-of-home placement for their child. Previous research has looked into factors that influence decisions for families to place their child into out-of-home care but little is known about outcomes for these young people and their families. The Supporting Families study aimed to explore the impact of a voluntary out-of-home placement on young people with disabilities, and consequences for their families. Fourteen parents/carers, twenty six case managers, six accommodation services' managers, and four young people with disabilities participated in face-to-face and telephone interviews and focus groups. Participants reported a range of outcomes for young people in care. Positive outcomes included increased levels of respect for themselves and others, an improvement in independent living skills, and reductions in challenging behaviours. Negative outcomes centred on their experiences of grief, loss and rejection, as well as behavioural problems. Positive and negative outcomes were also found for families. For many parents/carers there was a reduction in perceived stress and caring load, as well as improved mental health and wellbeing for them and the child's siblings. However, parents/carers often experienced ongoing feelings of guilt, grief and loss. The study adds to knowledge about outcomes of being in voluntary out-of-home care for this small but vulnerable group of young people in care and their families.

Background: Children placed in care because of abuse or neglect can display a range of challenging behaviours that can be difficult for foster carers to manage. While much is known about the prevalence of behavioural disorders among children in care, little quantitative information exists about which behaviours are problematic for carers. Conclusions: Four discrete profiles of problem behaviours were identified. These distinct groups of behaviour serve as a focus for targeting supports that may ultimately help enhance foster placement stability. Method: Two hundred and one foster carers of children aged 4-12 were asked to rate a range of potentially problematic behaviours via online survey. Items were drawn from existing clinical measures, a review of the practice literature, and focus group consultation. Results: Principal component analysis yielded four distinct profiles of behaviours that carers identified as problematic. The first component reflected cognitive difficulties (e.g., executive functioning, language, and memory problems). Component 2 comprised sexual or otherwise risky behaviours (e.g., drug or alcohol use). Component 3 contained behaviours of an aggressive, controlling, and violent nature (e.g., enjoying upsetting others). Component 4 contained anxiety-based behaviours (e.g., obsessive compulsive behaviour). Collectively, these four factors accounted for almost 60% of the variance. Conclusions: Four discrete profiles of problem behaviours were identified. These distinct groups of behaviour serve as a focus for targeting supports that may ultimately help enhance foster placement stability. Refereed/Peer-reviewed

aStudies generally show children who have entered out-of-home care have worse educational outcomes than the general population, although recent research suggests maltreatment and other adversities are major contributing factors. Children's out-of-home care experiences vary and may affect their outcomes. This study examined the influence of placement stability, reunification, type of care, time in care and age at entry to care on children's educational outcomes. We conducted a population-based record-linkage study of children born in Western Australia between 1990 and 2010 who sat State or national Year 3 reading achievement tests (N = 235,045 children, including 2160 children with a history of out-of-home care). Children's educational outcomes varied with many aspects of their care experience. Children placed in residential care were particularly likely to have low scores, with an unadjusted OR 6.81, 95% CI[4.94, 9.39] for low reading scores, which was partially attenuated after adjusting for background risk factors but remained significant (OR = 1.50, 95% CIs [1.08, 2.08]). Reading scores were also lower for children who had experienced changes in care arrangements in the year of the test. A dose response effect for multiple placements was expected but not found. Older age at entering care was also associated with worse reading scores. Different characteristics of a child's care history were interwoven with each other as well as child, family and neighbourhood characteristics, highlighting a need for caution in attributing causality. Although the level of educational difficulties varied, the findings suggest a widespread need for additional educational support for children who have entered care, including after reunification. Refereed/Peer-reviewed

The paper begins by suggesting that child welfare systems in North America and selected European and Scandinavian countries have converged functionally over the last two decades from a focus on child protection or family service to a more comprehensive child development orientation. The overview of the US in-care system covers the topics of mandatory reporting of child maltreatment, permanency planning, foster care funding, and decentralized service provision. It also portrays the current US foster care population and describes recent research on efforts to reduce the number of children in care, differential response, practice and policy reform, subsidized guardianship, Casey Family Programs, transitions to adulthood, and racial disparities in placements in out-of-home care. The overview of the Canadian in-care system notes the responsibility of the 10 provinces and three northern territories for child welfare and the concomitant lack of national data on child protection or out-of-home care. Estimates of the number of children in care are presented, and a review of research describes the following topics: rates and types of maltreatment, over-representation of Aboriginal children in care, prevention of the recurrence of neglect and physical abuse, effects of placement into care, differential response, resilience, educational achievement, and transitions from care. The paper concludes by noting certain differences and similarities between the US and Canadian in-care systems.

This article closes the special issue of this journal about an international review of out-of-home child care, principally family foster care and residential care, tough several aspects related to adoption were included as well. Although a comparison on some data about residential and foster care, or kinship and non-kinship care, is carried out, the article tries above all to make a reflection on the implications of several themes that have emerged as more interesting or important. Matters such as the use of residential care and its role in the current child care system, the overrepresentation of ethnic minorities in foster care in several countries, the situation of unaccompanied young people asylum seeking, the use of adoption as a permanent solution, the challenges of the transition to the adulthood from care, the relevance of the professionalization and models based on social pedagogy, the evaluation and planning based on data, and the current financial crisis and its impact on child care systems are some of the remarkable topics that will be reviewed.

Abstact While there is a large difference in the number of young inhabitants in the Netherlands and Germany, their child protection frameworks are quite similar. In both countries, child protection services are mainly focused on youth aged 0 to 18 and regulations are aimed at clients' responsibility and their active involvement during care. Youth care services consist of community-based services, day treatment and out-of-home care services, which include foster care and residential care. The history of out-of-home care services in both countries is characterized by similar developments. Over the last four decades, similar trends in residential care, towards more small-scale forms of residential care, smaller residential group sizes, and increasing professionalization of staff have emerged. Over the last two decades, a comparable trend towards increasing professionalization can be seen in the context of foster care in both countries. In addition, the number of youths in out-of-home care increased in both countries over the last decade, specifically in foster care. Over the last decade, more studies have been conducted in residential care than in foster care in both countries. Despite similar trends and developments in out-of-home care practice, research mainly shows differences in applied topics and methods between Germany and the Netherlands.

Objective Placing a child in out-of-home care is one of the most radical measures a child protection system can decide to take. There is an essential interest in understanding the probability of entering care and what circumstances are related to the decision to place a child in out-of-home care. This study investigates the temporal stability of rates and predictors for entry into care. Method Data were obtained by linking several registration systems. The study population was defined as all children entering care before their third birthday from birth cohorts 1981–2008 (N = 11,034). Furthermore, a control population consisting of a randomly assigned quarter of the Danish child population from the same birth cohorts was used (N = 515,773). Rates of entry and Cox regression models from six periods from 1981 to 2008 were used to model co-variates associated with entry into out-of-home care. Results The overall likelihood for entering care is found to be decreasing over time. Furthermore, results reveal two trends: relative rates of entry are significantly decreasing for children whose mother has a psychiatric history prior to the child's birth; relative rates are significantly increasing for children whose mother or father was unemployed in the year prior to the child's birth.

Introduction: This presentation describes the progress of the "Children and Young People in Out-of-Home Care Innovation Fund Integrated Care " project currently being undertaken by Children's Health Queensland.Children and young people in out-of-home care (OOHC) are subject to many levels of disadvantage including socio-economic disadvantage and trauma. In comparison to the general population, they experience poorer mental and physical health outcomes in childhood and adolescence, which continue into adulthood. There are more than 8000 children and young people in OOHC in Queensland. There is a recognised lack of coordination in their health care. The young people, their carers and the Child Safety workers negotiate a fragmented system - primary versus specialist care, and public versus private services - without clear roles and responsibilities among providers, and lacking oversight of each young person's health management. Paediatricians have historically taken a lead role in advocating for this vulnerable group of young people, however, the health needs of this group are diverse and primary care is positioned to be the first site of comprehensive assessment in a tiered approach, supported by the expertise of paediatricians and other staff within Hospital and Health Service child protection units. Practice Change: This project is developing an integrated system of health assessment and management for children and young people in OOHC that maximises the input of the primary sector, while allowing efficient digital communication between primary and tertiary care providers. The specific innovative elements of this project are: Pioneering collaboration between primary health care and Queensland Health settings at a level of engagement that has not been attempted or achieved previously. Development of a secure, shared digital platform for the documentation of the young person’s health status, with integrated multi-user management planning capability. Scalability of the piloted system to other groups of paediatric patients and across the State. Aim and Theory of Change: The aim of this project is to create an infrastructure and clinical tools to support the co-ordinated health assessment and management of children and young people in out-of-home care. Targeted Population: Children and Young people in out-of-home care residing in the Brisbane region are being targeted for this study. Stakeholders: Key Stakeholders include Department of Communities, Child Safety and Disability Services; Aboriginal & Torres Strait Islander Community Health Service; participating general practices and individual practitioners; and hospital Child Protection Units and Paediatricians. Timeline: the project commenced January 2017 and has a projected end date of June 2019. Sustainability: After initial set-up costs, efficiencies in health service utilisation and worker capacity will be immediate, and sustainable over the long term. Transferability: The platform will be built with the view to scaling the project across the state. Furthermore, the integrated information technology system will be scalable to many different groups of clients across the health system. Conclusions: Project progress will be discussed including the successful collaboration between the stakeholders and early development of the clinical tools. Delays include the complexities involved in building the integrated information technology system. A successful parallel project will also be highlighted.

Navigate Your Health is a place-based, co-designed model that will improve the health and wellbeing of children in out-of-home care (OOHC) in the Brisbane Region. The model defines the process and pathways for initial health screening, subsequent comprehensive health and developmental assessments, the provision of ongoing healthcare needs, and will be supported by the creation of four individual Health Navigator positions. Research consistently shows that children and young people in care are likely to have poorer health and wellbeing outcomes than those who are not in care, including poorer physical, developmental, behavioural and mental/emotional health. The Queensland Child Protection Commission of Inquiry report highlighted that children and young people in the care system also have higher rates of earlier onset of sexual activity, higher rates of sexually transmitted infections and higher rates of earlier pregnancy and parenting. Since late 2016, Children’s Health Queensland (CHQ), Department of Communities, Child Safety and Disability Services’ Brisbane Region, and Brisbane Aboriginal and Torres Strait Islander Community Health Service (Brisbane ATSICHS) have jointly led a co-design process with partners – including non-government agencies, Primary Health Networks (PHNs), children and young people and foster carers. Stakeholders contributed their vast experience and expertise to assist in the development of a best practice model. The proposed elements of the model include: Health Screening: Children and young people will receive a preliminary health check, followed by a comprehensive health and developmental assessment covering the domains of physical, developmental and mental/emotional health. Referral coordination: The most appropriate pathways for the child/young person will be determined - dependent on the outcome of the preliminary and comprehensive assessments, age, cultural status, disability status, care and health history. Referrals to required services or additional assessments are progressed and will be monitored to ensure the timeliness of follow up and the development of a Health Management Plan. Health care coordination: Children and young peoples’ healthcare will continue to progress in an integrated way, and in line with the recommendations of their Health Management Plan. A higher emphasis and priority for meeting their healthcare needs is in place and Child Safety Officers (CSOs) are provided with support in healthcare coordination. Change to be implemented: The trial implementation of a place-based, co-designed response in Brisbane that will deliver improved health outcomes for children and young people in OOHC Funding for four Health Navigator roles to support the trial The use of the Navigate Your Healthmodel as outlined above The Health Navigators will have capacity to be co-located between existing CHQ facilities and Child Safety Service Centres on an as needs basis to assist in development of relationships with Health and Child Safety staff, and to establish professional linkages. Fostering partnerships with PHNs and Brisbane ATSICHS will also enable flexibility for Health Navigators to co-locate with these services, as required. Evaluation of Navigate Your Healthwill encompass three outcome categories: implementation, clinical and economic outcomes.

Little evaluation research has been conducted on the effectiveness of services and intervention provided to Indigenous children in out-of-home care. This study evaluated Evolve Therapeutic Services, an innovative Queensland, Australia program employing a collaborative wrap-round model of care in combination with a flexible intervention approach, individually tailored to children and young people in out-of-home care presenting with complex and extreme behavioural and mental health problems. The sample consisted of 768 children and young people, of which 36% were Indigenous. Two clinician-rated measures, the Children’s Global Assessment Scale (CGAS) and Health of the Nation Outcome Scales for Children and Adolsecents (HoNOSCA), were used to assess young people’s functioning via a pre-post treatment design. Differences in outcomes between Indigenous and non-Indigenous consumers were assessed by comparing pre and post treatment CGAS and HoNOSCA mean scores using repeated-measures t-tests. For estimates of differences in the proportion of clients in the clinical range between pre and post-treatment the McNemar test was used. Results provide a demographic profile, clinical profile, and pre and post treatment comparisons for Indigenous and non-Indigenous consumers. Results will be outlined across a range of problems areas: general functioning and adjustment; disruptive, antisocial and aggressive behaviour; overactivity, poor attention and concentration; problems with scholastic and language skills; emotional symptoms; peer and family relationships; self-care and independence; and school attendance. Practical implications of the findings will be discussed.

Objectives: The Quebec Youth Protection Act was amended in 2007. The main goal of this reform was to improve placement stability for children who are removed from their home for their protection. Among several legal provisions introduced was the establishment of maximum age-specific durations of out-of-home care, after which a plan must be established to provide stability for children placed in substitute care by finding permanent homes for them. The purpose of this study is (1) to examine trends in placement use and placement stability since the reform and (2) to document the current frequency of each type of placement setting, the cumulative time in care before the exit to permanency, and the sustainability of the permanency outcome. Methods: The study relies on 3 entry cohorts of all children investigated who received protection measures in the province of Quebec during 3 specific time frames before and after the reform (n = 9620, 8676, 8425). Cohorts were observed for a period varying from 3 to 4 years. Administrative data from all 16 child protection agencies were used to track placement trajectory indicators and to compare cohorts. Results: There has been a decrease in the proportion of children receiving protection measures who were placed in care since the reform, and placement in kinship care has become more frequent among children placed. Placement stability improved slightly after the reform. Overall, for infants, the most frequent type of permanency attained is adoption, while reunification is the option most often indicated for older children. Some children are at a greater risk of experiencing unstable placement trajectories: young children have a high rate of reunification breakdown, some wait a long time to be adopted, and adolescents are frequently removed from the substitute care setting where they were supposed to stay until the age of 18. Conclusions: The results suggest interesting avenues for policy makers and service providers to improve the stability of placement trajectories. Advantages and disadvantages of administrative data are discussed.