Search

Background: Studies have shown an association between parental problematic substance use (PSU) and children's out-of-home care (OHC). But there is little researech on the kind of urban neighbourhoods in which such associations typically show up. This study aims to shed light on the associations between neighbourhood characteristics, parental PSU and children's OHC. Using register data, we explore the spatial concentration of parental PSU and children's OHC in urban areas. Methods: Register data of all children born in Finland in 2002 and their biological parents living in 14 Finnish cities were used to follow the children from birth until their 18th birthday or first OHC episode. The study looks at parental PSU andother individual-level indicators as well-as the sociodemographic neighbourhood characteristics. Cox proportional hazards modelling was used as the analysis method. Results: Parental PSU increased the probability of children's OHC regardless of neighbourhood type. The probabilty was highest if both parents had PSU (hazard ratio [HR] = 8.05, 95% confidence interval [Cl] 6.38-10.16), but this outcome did not look the same for all neighbourhoods. The risk of children's OHC placements was higher in suburbs compared to city centres (HR = 1.76, 95% Cl 1.38-2.25). Conclusion: As parental substance use is a complex problem that is often intertwined with other life challenges, such as financial difficulties and mental health problems, it is insufficient to treat caregiver conditions, such as problematic substance use in isolation. Services that increase positive, pro-social connections may be lacking in the neighbourhoods with the most challenges., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Objective: To identify additional mental and neurodevelopmental health needs of Aboriginal children born in Western Australia, who are placed in out-of-home care (OOHC), relative to Aboriginal children born in Western Australia who were not placed., Methods: Data-linkage of hospitalisations, health registries and child protective services data for all Aboriginal children born in WA between 2000 and 2013 was used. Children placed in out-of-home care between 2000 and 2019 were matched to children never placed and prevalence and cumulative incidence estimates of mental and neurodevelopmental health conditions were compared., Results: Children placed in out-of-home care had a three times greater prevalence of mental and neurodevelopmental health conditions generally. The prevalence of foetal alcohol spectrum disorder was ten times higher, and post-traumatic stress disorder was seven times higher for those placed in out-of-home care. Cumulative incidence plots highlighted for different conditions the ages at which the rate of diagnosis diverges between the two groups., Conclusions: Children placed in out-of-home care had greater mental and neurodevelopmental health needs generally when compared to children never placed in out-of-home care ., Implications for Public Health: Child protective services must ensure culturally safe, comprehensive, wrap-around services for Aboriginal children and their families are provided. Approaches should build on the strength of children, families and culture and avoid stigmatising children and their parents., Competing Interests: Conflicts of interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Sandra Eades reports financial support was provided by National Health and Medical Research Council. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Individuals who have experienced child protection system involvement are over-represented in criminal justice systems. This group faces greater risks of serious offending and justice system entrenchment relative to their peers without child protection system contact. Understanding the pathways from child protection to adult criminal justice system contact is critical for informing crime prevention policy and practice, yet most research on the maltreatment-offending relationship solely focuses on children's pathways from child protection to youth justice systems. This scoping review identified and synthesized evidence from studies examining adult justice system contact among individuals who have experienced child protection system involvement (including placement in out-of-home care [OOHC]). A search of six databases identified 7,599 publications, of which 37 met the inclusion criteria. These primary studies included adult participants with a history of child protection system involvement and adult criminal justice system contact (defined by administrative records or self-reported arrest, conviction, or incarceration). The review identified that many factors associated with increased likelihood of adult criminal justice system contact reflect those identified for youth justice involvement (e.g., male gender, racial minority or Indigenous status, a history of substantiated maltreatment, particularly physical abuse, placement in OOHC, particularly placement in residential care, placement for reasons of problem behavior, initial placement in early adolescence, and placement instability). While youth justice system contact is associated with increased risk, engagement in education or employment (for males), and becoming a parent appear to be associated with decreased risk of criminal justice system contact among adults previously involved in child protection systems., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Female child welfare-involved youths who are removed from the home are at risk of commercial sexual exploitation of children (CSEC). The aim of this study was to develop a prediction model to identify those at greatest risk of trafficking. Methods: Data were from the Florida Department of Children and Families' Florida Safe Families Network Database. A Cox proportional hazard regression of 60 cases and 3857 controls generated the proposed risk model. Results: Factors found to be associated with a higher risk of trafficking were quantified into point scores, generating the Welfare-Involved Female Sexual Exploitation Risk Assessment (WISER) tool with a cutoff of 20 points: first out-of-home placement at ≥15 years of age (11 points); run away from home in past year and age <15 years (40 points) or ≥15 years (16 points); English spoken as other language (14 points); on a psychotropic drug (17 points); congregate first placement (14 points); runaway/abducted status first "placement" (16 points); psychiatric facility experience (9 points); residential facility experience (7 points); and no time in temporary shelter (9 points). Of those who experienced CSEC, 92% had a WISER score above 20. Discussion: The WISER tool achieved good discrimination and calibration ability with a receiver operating characteristic for the validation data set of 0.923. The WISER tool can (1) inform risk assessment for CSEC among child welfare-involved females and (2) identify youths at greatest risk before they are harmed by trafficking.

Introduction: Despite the increasing overrepresentation of Aboriginal and Torres Strait Islander (hereafter respectfully referred to as First Nations) children living in out-of-home care (OOHC) in Australia, little is known about their wellbeing needs. This comprehensive literature review aimed to identify these needs and the features of care required to meet them., Methods: MEDLINE, CINAHL, Scopus, Informit, PsycINFO, and Embase databases and relevant grey literature were searched from inception to December 2023 for articles presenting qualitative accounts and perspectives relevant to the wellbeing needs of First Nations children in OOHC. These included reports from First Nations children in OOHC; First Nations adults with lived experience of OOHC; carers, caseworkers, and organizational stakeholders; and First Nations community members with relevant lived and/or professional experience. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Braun and Clarke's reflexive thematic analysis method for data analysis., Results: Thirty-five articles (19 peer-reviewed, 16 grey literature) met the inclusion criteria. Our analysis revealed six wellbeing needs of First Nations children in OOHC: Being seen, being heard; a sense of stability; holistic health support; social and cultural connections; culturally safe OOHC providers; and preparedness for transitioning out of care . A range of features of OOHC were also identified as critical for supporting these needs., Conclusions: Our findings suggest that First Nations children in OOHC have unique wellbeing needs in addition to safety, security, and health. Attention to the development and maintenance of social and cultural connections is an important concern that must be addressed by OOHC providers (caseworkers and organizations) and carers and supported by OOHC policy and the associated systems in Australia as part of providing culturally safe and supportive care.

Background: Across Canada, Child Protection Services (CPS) disrupt Indigenous families by apprehending their children at alarmingly high rates. The harms borne by children in out-of-home care (OoHC) have been extensively documented. We examined the impact of OoHC on Manitoba children's health and legal system outcomes to provide rigorous evidence on how discretionary decision-making by CPS agencies can affect these outcomes., Methods: In partnership with First Nations researchers, we used linked administrative data to identify Manitoba children (born 2007-2018) served by First Nations and other Manitoba CPS agencies. We compared those taken into OoHC (n = 19,324) with those never in care but with an open CPS file due to child protection concerns (n = 27,290). We used instrumental variable analysis (CPS agency rates of OoHC as the instrument) to obtain odds ratios (aOR) and 95% confidence intervals adjusted for child, maternal, and family factors., Findings: Mean age (yrs ± standard deviation) at first CPS contact for children taken into OoHC was 2.8 ± 3.7 (First Nations) and 3.0 ± 3.8 (other), and for children never in care was 4.5 ± 4.5 (First Nations) and 5.1 ± 4.7 (other). Among children served by a First Nations agency, males made up 50.6% (n = 5496) in OoHC and 51.0% (n = 6579) never in care. Among children served by other agencies, males made up 51.0% (n = 4324) in OoHC and 51.0% (n = 7428) never in care. Odds of teen pregnancy (First Nations aOR 3.69, 1.40-9.77; other aOR 5.10, 1.83-14.25), teen birth (First Nations aOR 3.23, 1.10-9.49; other aOR 5.06, 1.70-15.03), and sexually transmitted infections (other aOR 7.21, 3.63-14.32) were higher for children in care than children never in care, as were odds of being accused (other aOR 2.71, 1.27-5.75), a victim (other aOR 1.68, 1.10-2.56), charged with a crime (other aOR 2.68, 1.21-5.96), or incarcerated (First Nations aOR 3.64, 1.95-6.80; other aOR 1.19, 1.19-8.04)., Interpretation: Being in OoHC worsened children's health and legal system outcomes. The importance of reducing the number of children taken into care was emphasized in briefings to provincial and First Nations governments. The government response will be monitored., Funding: Social Sciences and Humanities Research Council (no. 890-2018-0029)., Competing Interests: The authors declare no competing interests., (© 2024 The Author(s).)

Background: Children have a right to participate in decisions about their lives. They also have the right to family and cultural connection, including when they are removed due to child protection concerns. However, the literature highlights barriers children in out-of-home care experience connecting to family-of-origin and culture. Moreover, this literature is predominantly from the perspective of practitioners and carers, with children's perspectives notably absent., Objective: This qualitative study addresses this gap by exploring Aboriginal and/or Torres Strait Islander and non-Indigenous Australian children's perspectives and experiences of family and cultural connection while in out-of-home care. It seeks to uphold children's right to express their views on matters that impact their lives., Participants and Setting: The participants were 62 children aged 4-15 years (x̄=9 years), who were in out-of-home care in Queensland (Australia). Forty-two of the children were non-Indigenous and 20 identified as Aboriginal and/or Torres Strait Islander children., Methods: Lundy's (2007) model of participation guided the data collection approach. Art-based graphic-elicitation interviews were conducted. Verbatim transcripts were analysed thematically., Results: Children had differing levels of understanding as to why they could not reside with their family. Most children referred to a family-of-origin member not living with them as important in their lives, but it was not always their parent/s. Siblings were mentioned frequently. Barriers to connections with family included distance and cost of travel, parents not attending visits and being uncontactable, incarcerated or deceased. Whilst most children desired increased connection with family, a few wished for reduction or cessation. Aboriginal and/or Torres Strait Islander children showed varying levels of connection to culture with both siblings and carers playing key roles in enabling greater connection., Conclusions: Graphic-elicitation interviews provided an important opportunity for children to voice their experiences of and preferences regarding family and cultural connection. The inclusion of children's voices is needed to inform responsive policies and practices that safely support their rights to family and culture when in out-of-home care., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Between 2012 and 2017, N = 2814 youth between the ages of 4 and 20 were in child protective services (CPS) custody in Hamilton County, Ohio, and placed in out-of-home care. Child welfare administrative records were extracted and linked to electronic health records for all encounters at Cincinnati Children's Hospital Medical Center, with n = 2787 (99.1%) of records successfully linked prior to de-identifying the data for research purposes. Child welfare administrative data fields in the dataset include demographics, dates of entry into and exit from protective custody and out-of-home care, reasons for entry into custody, dates of placement changes, reasons for placement changes, and types of placement (e.g., foster home, kinship home, group home, residential treatment, independent living). Electronic health records (EHR) data fields include demographics, all inpatient and outpatient encounters with medications, diagnoses, screening results, laboratory test results, flowsheet data, and problem list entries. Data have been coded to capture broader categories of health needs and encounter details, medications, and other health concerns. Due to the high representation of children in CPS custody and out-of-home care who are also represented in the EHR data, this dataset provides a comprehensive view of the medical needs and health concerns for school-aged children in CPS custody in an entire county. As a result, these data can be useful for understanding the emergence of global and specific health concerns, frequency of healthcare use, and placement stability for all youth in CPS custody in this community, accounting for variation due to other health and child welfare factors. These data are likely generalizable to other mid-sized urban communities where academic medical centers provide healthcare for children in CPS custody. De-identified data may be made available to other researchers with approved data transfer agreements between academic institutions in place.

Previous research has indicated that youth in care are at a disproportionally high risk of being suspended from school. Yet, research on this topic is scarce despite the detrimental effects such disciplinary actions can have on the educational development of this vulnerable group. Therefore, the goal of this study was to explore a longitudinal path model of factors associated with the risk of being suspended from secondary school among a national cohort of 3699 children placed in care in England. Using data from the National Pupil Database and the Children Looked after Database, children were tracked from School Year 2 through School Year 9 in order to test the direct and mediated effects of individual factors (i.e., gender, eligibility for free school meals, special educational needs, and belonging to an ethnic minority background), care factors (i.e., age of entry into care, reason for out-of-home placement, placement type and length of time in care) and educational factors (i.e., school type, achievements, absences and suspensions in Year 6 and school type in Year 9) on the risk of suspension in Year 9. Results indicated that approximately 1 in 5 children in care in England (19.4%) are suspended at least once during their secondary School Year 9; these proportions markedly exceed those previously found among their general population peers. Children found to be most at risk for out-of-school suspensions were (a) males; (b) late entrants into care; (c) children who had behavioral, emotional, or social difficulties; and (d) children with a history of suspensions. Surprisingly, being eligible for free school meals and having lower academic achievement was related to a decreased risk of being suspended. These findings are discussed in consideration of the interrelationships among variables and the mediating pathways found. Implications for schools and educators catering for youth in care are also discussed. [ABSTRACT FROM AUTHOR]

Care‐experienced young people demonstrate significantly poor physical, social and mental health outcomes during and beyond their time in care, yet they have rarely been consulted or included in research examining their health needs to date. This qualitative paper explores care‐experienced young people's perceptions of health in care, including accessing healthcare and interacting with health professionals. The research methodology was informed by a co‐design approach through consultation with care‐experienced young people. Semi‐structured interviews were conducted with 10 young people. The findings revealed that: (1) the care system does not nurture young people's health; (2) young people in care experience difficulty accessing and navigating a complex health system; and (3) young people are not given a voice when it comes to their health. The findings provide key recommendations for practice, including the empowerment of young people through positive, responsive and trusting relationships to prioritise the health of young people in care. [ABSTRACT FROM AUTHOR]

Previous research has demonstrated a graded relationship between cumulative childhood adversity and adverse later outcomes. Individuals with out-of-home care (OHC) experience constitute a population characterised by both childhood and educational disadvantages. Based on a fifty-year follow-up of a Stockholm cohort born in 1953, the purpose of this study was to examine the associations between cumulative childhood adversity and long-term educational outcomes in this group. The cumulative disadvantage perspective suggests that there would be a negative association, while the disadvantage saturation perspective implies that cumulative adversity would be less consequential for disadvantaged individuals. By means of multigroup path analysis, we furthermore asked whether this association may differ in relation to individuals with child welfare contact (CWC) and to the general population (GP). Adjusting for socioeconomic conditions and cognitive ability, cumulative childhood adversity had a negative influence on midlife educational attainment in the GP. However, it did not seem to influence the educational outcomes of neither OHC experienced individuals nor individuals with other types of CWC. The results of this study thus lend support to the disadvantage saturation perspective. Further studies are needed to explore this relationship. [ABSTRACT FROM AUTHOR]

Providing recreational activities is an important aspect of the intervention at residential care. We explore adolescents' experience of outdoor recreational activities organized by the care workers in the context of friluftsliv (literally: free-air-life). Giorgi's descriptive phenomenological method is used to analyze eight interviews with adolescents from residential care homes. Our analysis reveals that their experience of friluftsliv is made up of three constituents, described as Departure from everyday life, Shared experience, and Facing a different existence. Our discussion investigates the qualities and challenges related to friluftsliv as recreational activities at residential care and relates to the literature on nature-based interventions in child and youth care. [ABSTRACT FROM AUTHOR]

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 compounding 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 transformative foundation to address historical, institutional, well‐being and socioeconomic drivers of current catastrophic trajectories. The time for action is now. [ABSTRACT FROM AUTHOR]

The number of Australian children living in out-of-home care (O0HC) is significant: 46,000 children, with 30,600 living in OoHC for more than two years (AIHW 2021). Aboriginal and Torres Strait Islander children are over-represented in both the 00HC and Child Protection systems. In Victoria, Indigenous children are 16 times more likely to be removed from their family than non-Indigenous children. The health issue most commonly affecting children in 00HC, after behavioural/emotional health, is speech, language, communication needs (SLCN), with 45% of those under five years showing delays of concern (Nathanson & Tzioumi, 2007; Sylvestre et al., 2015). Speech-language pathologists (SLPs) are thus in a unique position to positively impact the lives of infants, children, and youth in the OoHC system. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract Background Relative to their counterparts in the general population, young people who leave, or transition out of, out-of-home (OOHC) arrangements commonly experience poorer outcomes across a range of indicators, including higher rates of homelessness, unemployment, reliance on public assistance, physical and mental health problems and contact with the criminal justice system. The age at which young people transition from OOHC varies between and within some countries, but for most, formal support ceases between the ages of 18 and 21. Programs designed to support transitions are generally available to young people toward the end of their OOHC placement, although some can extend beyond. They often encourage the development of skills required for continued engagement in education, obtaining employment, maintaining housing and general life skills. Little is known about the effectiveness of these programs or of extended care policies that raise the age at which support remains available to young people after leaving OOHC. This systematic review will seek to identify programs and/or interventions that improve outcomes for youth transitioning from the OOHC system into adult living arrangements. Methods This review will identify programs, interventions and policies that seek to improve health and wellbeing of this population that have been tested using robust controlled methods. Primary outcomes of interest are homelessness, health, education, employment, exposure to violence and risky behaviour. Secondary outcomes are relationships and life skills. We will search, from January 1990 onwards, MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, Cochrane CENTRAL, SocINDEX, Sociological Abstracts, Social Services Abstracts, NHS Economic Evaluation Database and Health Technology Assessment. Grey literature will be identified through searching websites and databases, e.g. clearing houses, government agencies and organisations known to be undertaking or consolidating research on this topic area. Two reviewers will independently screen all title and abstracts and full text articles with conflicts to be resolved by a third reviewer. Data extraction will be undertaken by pairs of review authors, with one reviewer checking the results of the other. If more than one study with suitable data can be identified, we plan to undertake both fixed-effects and random-effects meta-analyses and intend to present the random-effects result if there is no indication of funnel plot asymmetry. Risk of bias will be assessed using tools appropriate to the study methodology. Quality of evidence across studies will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Discussion Previous reviews were unable to identify any programs or interventions, backed by methodologically rigorous research, that improve outcomes for this population. This review seeks to update this previous work, taking into account changes in the provision of extended care, which is now available in some jurisdictions. Systematic review registration PROSPERO CRD42020146999

Previous studies have shown that mental health disorders (MHD) among parents might be an important mechanism in the intergenerational transmission of out-of-home care (OHC). The current study aimed to further study this interplay by investigating the associations between OHC and MHD within and across generations. We used prospective data from the Stockholm Birth Cohort Multigenerational Study (SBC Multigen) on 9033 cohort members (Generation 1; G1) and their 15,305 sons and daughters (Generation 2; G2). By odds ratios of generalised structural equation modelling, we investigated the intergenerational transmission of OHC and MHD, respectively, as well as the association between OHC and MHD within each generation. Second, we examined the associations between OHC and MHD across the two generations. In order to explore possible sex differences, we performed the analyses stratified by the sex of G2. The results showed an intergenerational transmission of OHC, irrespective of sex. Regarding the intergenerational transmission of MHD, it was shown for both sexes although only statistically significant among G2 males. OHC was associated with MHD within both generations; in G2, this association was stronger among the males. While we found no direct association between OHC in G1 and MHD in G2, there was a significant association between MHD in G1 and OHC in G2. The latter was more evident among G2 females than G2 males. We conclude that OHC and MHD seem to be processes intertwined both within and across generations, with some variation according to sex. Although there did not seem to be any direct influences of OHC in one generation on MHD in the next generation, there was some indication of indirect paths going via parental MHD and child OHC.

Abstract Background Randomised controlled trials (RCTs) are comparatively rare in UK social work, but can offer distinct advantages. Confidence in Care (CiC) is an RCT with embedded process evaluation evaluating Fostering Changes (FC), a 12-week training programme for foster and kinship carers to increase skills and coping strategies. In order to mitigate challenges in participant recruitment, an engagement strategy was designed to maximise this. Our aim is to explore experiences of key study stakeholders towards trial recruitment and identify broader messages about recruitment to social care trials. Methods Three focus groups were conducted, two with field-based recruiting staff (n = 7) and one with carers who attended the FC programme (n = 8). Five interviews were conducted with trainers who delivered FC, eight with foster carers who attended the programme, 18 with Foster Carers who elected not to take part in the programme, and 12 with social workers from participating trial sites. In addition, an away day for FC trainers was observed and discussions related to recruitment were noted. Transcribed audio-recorded data were inductively coded, double-coded by a second researcher, and thematically analysed. Results Six themes were identified. The first addressed pragmatic aspects of the intervention affecting recruitment (e.g. committing to a 12-week programme). A second focussed on accuracy of communication about the trial between provider agencies and carers. A third concerned the ability of recruiting staff to contact carers, a particular challenge in group-based recruitment. A fourth addressed trial methods and their communication (e.g. relationship between trial team and recruiting staff). A fifth explored lack of differentiation by carers between the roles of the various professionals (e.g. FC facilitators and provider agencies). The sixth addressed perceived differences between recruitment into social care and health studies. Conclusions Recruitment challenges in this social care setting were similar to those in healthcare. Some (e.g. gatekeeping by professional staff) may be rooted in randomisation anxiety, or unfamiliarity with research methods. Researchers more familiar with healthcare recruitment were however encouraged about the experience of working in this care setting. The original recruitment strategy and adaptations form the basis of further recommendations for research practice. Trial registration ISRCTN19090228 . Registered on 11 January 2017.

LGBTQ+ youth in out-of-home care experience multiple stressors due to being a minority group, in out-of-home care, and rejected by their families. Therefore, they tend to be vulnerable. The purpose of this study is to explore the sources of the resilience of homeless LGBTQ+ youth in out-of-home care in the Israeli context. The research question was: What are the experiences, perceptions, and constructions of "resilience" among LGBTQ+ youth who aged out of out-of-home care for homeless LGBTQ+ youth in Israel? The study employed a critical constructivist grounded theory approach. Thirty-one in-depth semi-structured interviews were conducted with LGBTQ+ youth aged 16 to 32 (average age of 21.5) and analyzed. The data analysis presents the sources of resilience according to four levels. (1) The individual level refers to self-acceptance, faith and hope, and creativity and productiveness. (2) The interpersonal level refers to friends and peer groups, educational institutions, employment environments, professionals, and LGBTQ+ out-of-home care services. (3) The macro level refers to public visibility of the LGBTQ+ community and financial support. (4) Finally, the chrono level refers to the development of rights and recognition over time. An ecological model was implemented to conceptualize resilience among LGBTQ+ youth in out-of-home care in Israel. This multidimensional model was used to construct resilience sources that could assist in overcoming adversities among these youth. Implications for practice and future research are discussed. [ABSTRACT FROM AUTHOR]

Infant placements into out-of-home care have garnered increased research and societal attention, yet the long-term outcomes of this vulnerable group are virtually unknown. This study aims to examine the association between infant placement and criminal offences across the life course, contrasting with general population peers and children placed at later developmental periods. The study includes 622,940 individuals born in Sweden between 1975 and 1981, among whom around 0.2 % (n = 1524) were taken into care during infancy (<12 months). Utilizing Swedish longitudinal population-based register data, sex-stratified hurdle regression analyses, adjusted for individual and family background characteristics, were conducted to investigate the risk and rates of criminal offences ages 15–38. Infants placed in care exhibited higher risks of any criminal offence compared to the general population (men: RR = 1.32, p < 0.001, women RR = 1.47, p < 0.001), but lower risks compared to children placed at later ages. Incidence-adjusted rates of offences were also higher among infants compared to their general population peers (men: IRR = 2.54, p < 0.001, women: IRR = 2.77, p < 0.001), with differences to other care groups being less pronounced. Infant placement in care is associated with an increased risk of criminal activity over the life course. [ABSTRACT FROM AUTHOR]

• Low academic performance was correlated to poorer scores on the Child Behavior Checklist, particularly anxiety, depression, and somatic symptoms. • Academic performance was not correlated to maltreatment type or multiple maltreatment exposure. • Internalizing clinical symptoms between carer and self-report were significantly different. Self-report demonstrated higher sensitivity to internalizing symptoms than carer-report. Compared to their non-Indigenous peers in out-of-home care (OOHC), children who are Aboriginal are at an increased risk of low academic achievement, mental health problems, and emotional and behavioral symptoms. This study aimed to profile the clinical symptoms experienced and examine the relationships among these clinical symptoms, academic achievement, and early life environmental characteristics, such as maltreatment and placement instability. Data were accessed through a collaborating OOHC clinical service providing support for children who are Aboriginal. Analyses indicated that low academic performance was correlated to clinical symptoms, including anxiety, depression, and somatic issues. Neither academic performance nor clinical symptoms were associated with maltreatment type or exposures. Internalizing clinical symptoms between carers (Child Behavior Checklist, CBCL) and self-report (Youth Self Report, YSR) differed significantly for children 11–18 years. Self-report demonstrated higher levels of internalizing symptoms than the carers reported. The results highlight the importance of capturing the child person's voice. Future research should investigate the impact of internalizing symptoms on academic performance across education and the impact of informant under-reporting of internalizing symptoms on health, well-being, and diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Children who experience out-of-home care (OOHC) often have low academic achievement which subsequently negatively affects their adult life outcomes, yet a smaller proportion succeed in spite of adversity. Scant research has examined the trajectories of children who achieve well in school and factors associated with positive educational outcomes. (1) Describe the reading trajectories from Year 3 to Year 7 of school of children who experienced OOHC, with a focus on higher achievement and improving trajectories. (2) Identify child, carer and placement characteristics plus supports and services associated with positive reading trajectories among children who have experienced OOHC. The study included 325 children from the Pathways of Care Longitudinal Study (POCLS) in New South Wales, Australia. The POCLS is a prospective cohort study including linked survey data and administrative child protection and education data. Group based trajectory modeling (GBTM) was used to identify and describe common trajectories of reading achievement. Multinomial logistic regression was used to identify factors associated with different reading trajectories. GBTM revealed three reading trajectories among non-Aboriginal children, and two among Aboriginal children. A high achieving group (12% of non-Aboriginal children) were the only trajectory group to maintain their level of achievement across the study. Improving achievement was rare, while falling behind over time was common across achievement levels. Results point to the need for early intervention supporting school readiness and catch-up growth, with ongoing interventions for children who experience OOHC to prevent declining student outcomes across achievement levels and extend talented students. [ABSTRACT FROM AUTHOR]

Few studies examined child abuse and neglect and its consequences in the context of a complex socio-political reality such as East Jerusalem. Additionally, research typically addresses trauma resulting of child maltreatment from the perspective of the children. Yet, little is known about the perceptions of the parents whose children were removed from their home by court order. This study explored the perceptions of families in East Jerusalem whose young children were removed from their home by an Israeli court order. Specifically, the parents' perceptions of the trauma experienced by their children and of the responses of their children to the removal from home. Semi-structured interviews with 22 caregivers (13 mothers, 8 fathers, and one aunt) of children at risk from East Jerusalem. The qualitative analysis was based on the principles of grounded theory. The analysis of the data revealed five risk factors attributed by the parents to their children's situation: Their young age, the abuse and neglect, the secondary victimization, the removal from home, and living in a conflict zone such as East Jerusalem. These risk factors of the children who are at the center of this study result in a cumulative trauma which intensifies their vulnerability. The lack of early childhood educational services in East Jerusalem places these children under the radar of the social service. Therefore, it is essential for policymakers to provide the necessary resources to these families. [ABSTRACT FROM AUTHOR]

The research protocol described aims to examine and establish the health outcomes of children and young people living in Out-of-Home Care (OOHC) in Perth, Western Australia (WA) from the perspective of the care recipients and service providers. A Study Advisory Panel (SAP) will be established comprised of Aboriginal Elders (because of the over-representation of Aboriginal children in OOHC), health professionals and other relevant stakeholders to help co-design all phases of the study. Mixed methods will be used in data collection and analysis. In the quantitative phase, it is proposed to collect retrospective data from three WA Department of Communities (DOC) districts. The data proposed to be collected includes: the number of children who received initial and annual health assessments, the health needs identified, and interventions put in place to address these needs. The qualitative phase will consist of interviews with service recipients (young people who have exited OOHC and Carers), health service providers (Community Health Nurses, School Nurses, General Practitioners and Paediatricians) and OOHC Case Workers. The research will provide an overview of the current health needs of children and young people in OOHC in WA and the perspectives of these young people, their Carers and service providers on current processes for accessing healthcare. It is anticipated that the study will provide valuable evidence for quality improvement in health service delivery to better meet the health needs of children and young people in OOHC.

This article reports the results of the first study in Serbia on factors (child, family and case) for different exit types for children admitted to out‐of‐home care. Case files of 154 children admitted to the Shelter for Urgent Protection of Children from Abuse and Neglect over a 5‐year period were analysed. After the shelter, less than a third of the children returned to their biological parents. The findings revealed that different constellations of child, family and case characteristics predict reunification and placement in a relative or foster family or in a group home. No significant predictors were noted for inadequate accommodation. The results of this study showed that although the patterns of reunification were very similar to those in other countries, there were differences that reflected the specifics of child welfare policy in Serbia. [ABSTRACT FROM AUTHOR]

Summary: In this cross-sectional study, we examined differences between 351 adolescents allocated to secure residential youth care and the non-residential alternative educational facility School2Care (12–18 years old, 63% boys). Data were collected by means of the official school registration system and standardized questionnaires. Findings: Results showed that adolescents in both settings had severe problems. Emergency situations, problems in daily functioning in all life domains, and previous out-of-home placements were found to be associated with allocation to secure residential youth care instead of non-residential alternative education. These three factors may be considered risk factors for secure residential placement of adolescents with complex needs. Applications: This study provides input for the prevention of secure residential youth care, because the two dynamic (changeable) risk factors for residential out-of-home placement (i.e., emergency situations and adolescent's daily life functioning) should be considered as intervention targets in non-residential care, while static factors (i.e., history of out-of-home placement) can be used to improve risk assessment of residential out-of-home placement, with higher risk requiring more intensive treatment according to the risk-need-responsivity model for effective mandated treatment. [ABSTRACT FROM AUTHOR]

Background: A review of the scientific literature showed few valid tools for assessing reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED), two diagnostic entities traditionally grouped under "attachment disorders." The Early TRAuma-related Disorders Questionnaire (ETRADQ), a caregiver report, was developed to assess attachment disorders in school-age children based on the Diagnostic and Statistical Manual of Mental Disorders–Fifth edition criteria. This study sought to validate this instrument. Method: Caregivers of school-age children from the community (n = 578) and caregivers of at-risk children adopted or in out-of-home care (n = 245) completed a sociodemographic questionnaire, the ETRADQ, the Relationship Problem Questionnaire, the RADA (RAD and DSED Assessment) interview, and the Barkley Functional Impairment Scale for Children and Adolescents. Results: Confirmatory factor analysis of the ETRADQ items supported the expected organization of the measure, that is, two second-order factors and five subfactors: (1) RAD scale (three subscales: Low selective attachment, Low social and emotional responsiveness, Emotional unpredictability) and (2) DSED scale (two subscales: Interactions with unfamiliar adults, Social disinhibition). All scales showed excellent internal consistency, test–retest reliability, convergent validity, and known-group validity. Conclusions: Results support the reliability and validity of the ETRADQ. [ABSTRACT FROM AUTHOR]

Research on the lives of lesbian, gay, bisexual, transgender, queer, intersex, asexual and other forms of sexual identities and orientations (LGBTQIA+) youth in care has mainly examined their experiences from a risk‐based approach, while few studies have explored their resilience experiences. Using in‐depth interviews, the present study aims to illuminate the resilience experiences of 13 LGBTQIA+ young people in out‐of‐home care in the Netherlands. Four themes emerged from their narratives: relationships that support and empower; construction of a positive identity around their sexual orientation and gender identity and expression (SOGIE); community involvement and self‐relying strategies. Our findings support the view of resilience as a complex process that shows at an individual, interpersonal and social level. [ABSTRACT FROM AUTHOR]

This article draws on the lived experiences and perspectives of young people and practitioners in therapeutic residential care to examine what constitutes relationship-based practice. Eight young people and twenty-six practitioners across three residential care services in Australia participated in this qualitative study. Framework analysis identifies that personalised engagement, a delicate balance between care and control, and perseverance through turbulent times are conducive to relationship-based practice in therapeutic residential care. Relationship-based practice is also found to be employed in a unique historical and relational context that demands mindful navigation through three specific professional boundary issues including self-disclosure, over-identification and physical contact. Against this context, relationship-based practice in therapeutic residential care is considered a 'double-edged sword', offering practitioners copious opportunities to build connections with young people in informal environments whilst needing to mitigate multiple ethical ambiguities. Implications for practice include the need to safeguard the 'do no harm' priority whilst resisting defensive or detached practice. Contextualising relationship-based practice within an ethical practice framework to embed ethics work in day-to-day practice becomes paramount. [ABSTRACT FROM AUTHOR]

Background: Children in out-of-home care (OOHC) experience poor mental health. With the number of Australian children in OOHC rising, accessible and effective interventions are needed to address this escalating predicament. South Western Sydney Child & Adolescent Mental Health Service (CAMHS) collaborated with the local statutory child protection agency, developing a specialized assertive mental health team supporting children in OOHC (OOHC MHT). This study outlines the characteristics of the first cohort of children referred to the OOHC MHT and the impact of intervention in improving outcomes, warranting ongoing provision of this service. Methodology: A two-part study was used to compare the psychosocial and emotional wellbeing of children referred to the OOHC MHT (OOHC group) against CAMHS-referred children who had not experienced OOHC (Control group). Evaluation of the OOHC MHT's intervention was conducted by measuring Health of the Nation Outcome Scale-Child and Adolescent (HoNOSCA) and Child Global Assessment Scale (CGAS) scores over the first year of treatment. Results: The OOHC group demonstrated significantly higher levels of emotional, behavioural and social problems compared to the control group through their HoNOSCA score on admission (OOHC Group: M = 24.9; SD = 5.3, Control Group: M = 16.7; SD = 5.7; p =.001) and CGAS (OOHC Group: M = 40.5; SD = 7.9, Control Group: M = 50.3; SD = 7.9; p =.001). Significant improvements in the OOHC group's HoNOSCA (T1 = 24.9, T3 = 17.0) and CGAS (T1 = 40.5, T3 = 52.8) measures were observed over the first year of treatment. Conclusion: Children in OOHC referred to CAMHS present with poorer mental health and psychosocial functioning than referred children who have not experienced OOHC. Assertive intervention was associated with improvement in social, emotional and behavioural problems and reduction in psychosocial impairment, suggesting the benefit of such an intervention both state-wide, and nationally. [ABSTRACT FROM AUTHOR]

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.

Whilst advancing outcomes for young people transitioning from out-of-home care is a national priority, no synthesis of Australian interventions that support their transition from care and into independence currently exists. The aim of this systematic scoping review was to examine the characteristics of such interventions delivered in Australia and to evaluate their impact. Papers were included if they assessed the extent to which transitional support interventions, delivered in Australia, improved housing, employment, education, financial, health, or social functioning outcomes. Eleven studies were included. Interventions primarily adopted a case management approach to support care-leavers’ transition. Interventions facilitated improvements in care-leavers’ independent living outcomes (e.g., housing, education, and financial stability), but less so in health outcomes. This synthesis provides guidance for how research organizations in partnership with community service organizations and statutory services should develop and deliver interventions to support young Australians transitioning from care.

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.

Limited evaluation research has been conducted on the effectiveness of mental health services and intervention provided to Indigenous children and young people (C&YP) in care. The primary objective of the study was to examine the difference in functioning and mental health outcomes of C&YP in care at a specialist mental health service for Indigenous and non-Indigenous C&YP. Of the total 259 C&YP included in this study, 38.2% (N = 99) were Indigenous. Two measures were used to examine C&YP's mental health and functioning. Indigenous consumers showed a significantly greater improvement in antisocial behaviour, emotional symptoms, and peer relationships compared to non-Indigenous consumers at discharge from the program. The findings of this study provide support for the program's therapeutic intent to be a culturally supportive tertiary level mental health service for vulnerable C&YP in care. IMPLICATIONS Equivalent outcomes for Indigenous and non-Indigenous consumers provide support for the program's intent to be a culturally supportive and safe tertiary level mental health service for vulnerable children and young people in care. Further research is needed to determine the key components of cultural consultation that are advantageous for consumers, care providers, and their families. [ABSTRACT FROM AUTHOR]

Contact between children in care and family members is complex and often emotionally difficult for all concerned. In the context of a wider Australian cross-jurisdictional intervention trial, focusing on contact between children in long-term care and their parents, a snapshot survey of 901 children in Victorian foster care and kinship care placements was undertaken. The aim was to determine which children had seen parents, siblings or extended family members within a 12-month period, and how practitioners explained lack of contact between children and their parents. The study found that most children had had contact with parents or other family members, though children in long-term care were less likely to have seen their parents than those where reunification was still a possibility. Practitioners' views on why parental contact had not occurred for 18% of the sample illustrate the complexity of the issues involved in contact. IMPLICATIONS To support children's best interests, professionals should be clear about the purpose of family contact and provide support appropriate to that purpose. With children in long-term care less likely to see their parents, professionals have a role in helping these parents adjust to a new role. Developing strategies to maintain meaningful connections between children in long-term care and their parents may be more effective for children's best interests than the current emphasis on actual visits. [ABSTRACT FROM AUTHOR]

Young people in residential out-of-home care often exhibit health and psychosocial challenges, which can emerge from childhood trauma. A body of research has examined the wellbeing of these young people; however, the ways in which interventions and practice models can improve the health and psychosocial wellbeing of young people in out-of-home care remains unclear. A systematic review was conducted to examine the effectiveness of interventions and practice models for improving health and psychosocial outcomes of young people in residential care and to identify relevant knowledge gaps. After a worldwide search, only four studies, from Australia (n = 2), USA (n = 1), and Canada (n = 1) were found. These studies evaluated Cognitive Behaviour Treatment, Healthy Eating Active Living, Power Through Choices and the Alternate Care Clinic. These studies aimed to improve numerous health and psychosocial outcomes including mental health, behaviour, obesity, pregnancy and sex. Despite limited evidence, the review suggests that contemporary interventions and practice models do have the potential to have positive impacts on the health and psychosocial outcomes of young people in residential care. Rigorous assessment of promising evidence-based interventions is urgently needed to advance best practice and improve outcomes. IMPLICATIONS Therapeutic and psychosocial approaches have significant impacts on the health and psychosocial wellbeing of young people in residential out-of-home care. Interventions and practice models within residential out-of-home care should incorporate trauma-informed care and psychoeducation. Findings from this review may guide the design and implementation of interventions and practice models in out-of-home care as well highlighting knowledge gaps for future research in this field. [ABSTRACT FROM AUTHOR]

From 2012 to 2014, we developed and subsequently evaluated the Healthy Eating, Active Living (HEAL) intervention—an obesity prevention and healthy lifestyle program designed for young people living in residential out-of-home care (OoHC). Based on quantitative (i.e., a randomised trial) and qualitative (i.e., semi-structured interviews) data and an iterative process of redevelopment, the program has evolved from taking a behavioural obesity prevention approach to now being underpinned by a trauma-informed care approach at a systems level. In this paper we outline the theoretical and empirical foundations of the HEALing Matters intervention that is currently being implemented at scale. In addition, we outline how our knowledge translation framework informed the iterative improvement of our intervention with a focus on stakeholder and end-user engagement, partnership, and codesign along the way. IMPLICATIONS There is a strong need for trauma-responsive health-focused programs and interventions within OoHC contexts. HEALing Matters addresses the need for trauma-informed approaches that encourage health behaviour change in young people living in OoHC. Policy, standards, and recommendations must not only acknowledge, but prioritise, the impact of trauma on health-related lifestyle behaviours in order to identify strategies to help address this impact. [ABSTRACT FROM AUTHOR]

For children and young people living in residential care, recent Victorian and national inquiries have found that harmful sexual behaviour carried out by children and young people, and child sexual exploitation perpetrated by adults, are significant problems. Efforts to address harmful sexual behaviour and child sexual exploitation in Victoria include the establishment of sexually abusive behaviour treatment services and the Sexual Exploitation Protocol. Applying the public health model of prevention, these programs of work are tertiary prevention interventions that respond after the abuse has occurred. A gap exists in secondary prevention efforts for children and young people living in residential care that target this vulnerable group and intervene early when warning signs emerge. This paper describes a secondary prevention program, Respecting Sexual Safety, that may provide an early intervention response to harmful sexual behaviour and child sexual exploitation for children and young people living in residential care. The program has been designed, and is being trialled and evaluated, through an action research collaboration. IMPLICATIONS Multi-agency collaboration to intervene earlier to address harmful sexual behaviour and child sexual exploitation for children and young people living in residential care requires strengthening. Residential carers require upskilling and support to respond to children and young people going missing from the home to keep them at home. Residential carers require upskilling and support to identify problematic sexual behaviour and ensure appropriate intervention. [ABSTRACT FROM AUTHOR]

When young people are harmed in extra-familial settings children's services may place them into care at a distance from their home authority to remove them from contexts in which they are considered 'at risk'. Guidance and regulation suggest such intervention be used as a last resort and only in a child's best interests. Using survey and interview data, this article examines how relocations are used in response to extra-familial harm (EFH) in thirteen children's services departments inEngland and Wales—exploring the extent to which they are intended to mitigate risk, or build safety, for young people. Findings demonstrate that rates at which relocations were used varied across participating services. Interview data suggest that variation may be informed by the strategic position a service takes on the use of relocation, the goal(s) of interventions used in cases of EFH, and the target of these interventions. In considering each of these factors, the authors recommend further study into the national (varying) rates of relocation and the role of those who review care plans for relocated young people; both intending to create conditions in which young people can safely return to their communities should they choose to do so. [ABSTRACT FROM AUTHOR]

Internationally, there is an increasing trend toward placing children in kinship vs. foster care. Prior research suggests that children in kinship care fare better compared to children in foster care; however, the reasons for this remain unclear. We conducted a systematic review and meta-analysis to examine the hypothesis that kinship care better preserves children's connectedness to caregiver, birth family, culture, and community; which, in turn, is associated with more optimal child outcomes. Thirty-one studies were reviewed that compared children aged 0–18 years in kinship care vs. foster care on levels of connectedness, three of which had outcomes that permitted meta-analysis. Findings indicated that children in kinship vs. foster care were more likely to feel connected to family in general; however, there was not a clear advantage for kinship vs. foster care for caregiver, birth parent, cultural, and community connectedness. While levels of connectedness were generally associated with more adaptive child outcomes for children in both kinship and foster care, no reviewed studies examined the hypothesis that children's connectedness may mediate the relationship between placement type and child well-being and placement outcomes. Results are discussed with respect to limitations and policy implications of the current evidence-base and the need for more rigorous research to help identify how to improve child well-being in home-based care. [ABSTRACT FROM AUTHOR]

Adolescents in out-of-home care generally have poor prospects for reunification with their birth families. However, for some adolescents in care, with deliberate support and intervention, there may opportunities for successful reunification. The Adolescent Reunification Program (ARP) is an Australian program designed to assist young people aged 12–17 years return home to their families. The program focuses on supporting families, mentoring young people so as to meet their developmental and educational needs, and providing a safe home environment. It also included an innovative therapeutic component which focused on addressing the consequences of intergenerational trauma in order to help repair relationships between parents and children. The purpose of this paper is to describe the therapeutic component of the program and to examine the potential value of therapy in a family reunification context with a particular focus on client receptivity and preliminary evidence on outcomes. Using case illustrations, this paper describes the therapeutic component of the ARP and provides a preliminary evaluation of these components using a mixed methods approach, including standardised psychological assessments, qualitative interviews with parents and young people, and reflections from the program workers. The therapeutic component of the ARP may have helped to break the cycle of intergenerational trauma by bringing focus to the interrelationships between how people feel and how they act. This was done through the work of therapists attempting to combine non-judgmental exploration and positive therapeutic framing with practical support within the context of the environment where the family reunification occurred. Therapy in conjunction with practical supports within a multidisciplinary collaborative approach may help to facilitate better outcomes for reunification when working with complex families. [ABSTRACT FROM AUTHOR]

Childhood maltreatment is a major risk factor for emotional problems in adolescence and adulthood and has deleterious effects on cognitive functions such as working memory. A key aspect in the study of the cognitive and affective consequences of maltreatment is autobiographical memory, especially regarding the difficulty retrieving specific memories, known as overgeneral memory. In this study, autobiographical memory tests, working memory, and a depressive symptom assessment were administered to 48 adolescents in care with a history of maltreatment (22 abused and 26 neglected) without mental disorder, who had been removed from their family and were living in residential child care, and to 61 adolescents nonmaltreated who had never been placed in care. The results show that adolescents with a history of maltreatment remember fewer specific events (Cohen d = 1.1–1.3) and that both working memory and depressive symptoms are involved in overgeneral memory (R 2 =.13–.26). Directions for future research include neuropsychological assessment and implementation of a training program to increase specific memory recall in this population. [ABSTRACT FROM AUTHOR]

Previous research has highlighted the poor educational attainment of children in out-of-home care, until relatively recently seen as a potential failure of the care system itself. However, the relationship between care and education outcomes is complex. It is important to disentangle the impact of the care system from that of adverse circumstances leading to admission to care. In this study, educational outcomes for 68 children (aged 3–9 years) in foster-care due to concerns about abuse or neglect were compared to those for 166 children with current or past child welfare involvement living at home. Data from teacher assessments of communication and literacy, and a standardized measure of receptive vocabulary were analysed. Accounting for key differences between the two groups, there was little evidence that educational attainment of children in care was significantly worse than that of children living at home. The findings suggest that being in care is unlikely to be the direct cause of poor educational achievement amongst children in care relative to the wider population of children. The study has implications for the ways in which schools and other services, both across the UK and internationally, work with children in and on the margins of care. [ABSTRACT FROM AUTHOR]

Abstract Background Italian laws allow the protection of a child who is suspected to be a victim of abuse through a procedure that can be put in motion by the attending physician in any Emergency Department (article nr. 403 Civil Code) with a temporarily suspension of parental authority. This study aims at evaluating both the appropriateness of the activation of the protection procedure by ED doctors in cases of suspected child abuse in terms of judicial confirmation and how it impacts children in the long-term. Methods We selected cases in which the procedure was activated due to suspected child abuse. The children were admitted to the ED of a tertiary children hospital from 2006 to 2018. We then reviewed the medical charts and collected data from the social services through a questionnaire concerning the long-term outcomes . Results Twenty-eight patients were included (75% females, mean age 13.8 years). In 90% of cases the activation of the procedure in the ED was followed by a Court confirmation. Evaluation of long term outcome was possible in 22 cases. Among them, a positive social outcome was achieved in 15 cases (68.2%). The remaining abandoned the program or had critical reintegration in the family. Eighteen percent of patients developed major issues such as aberrant behaviours, substance abuse or psychiatric disorders. Conclusions This report identifies a good ability of ED doctors in the activation of an emergency procedure to protect the child. Overall, the social outcome was good for nearly 70% of the patients, highlighting the importance of activation of social support programs for child abuse.

Background: Children in care and care leavers have worse health outcomes than their peers without care experience. This study addresses an evidence gap in exploring care-experienced young people's views and experiences of accessing general practice and dental services and attending health reviews in England., Methods: We conducted a qualitative study using podcasting as a creative medium. We recruited young people from two sites: one in South England (A) and one in greater London (B). We held two paired discussions in site A and two focus groups in site B, with 14 participants in total. Participants were aged between 13 and 22 years and were diverse in gender, ethnicity, and care experiences. Data were analysed thematically using candidacy theory as a theoretical framework., Results: Mental health was a prevailing concern for participants, but general practice was not considered a place to discuss it. Most participants reported distant relationships with primary healthcare professionals and considered opening-up to a professional to be risky, for example, it could result in an unknown/unwanted outcome. A lack of time and personal connection in appointments, and experiences of feeling judged, dismissed, or misunderstood, hindered young people's ability to disclose mental health or relationship concerns. Participants reported variation in the timeliness and location of services, with salient examples of extensive waiting periods for braces. Participants perceived annual health reviews to be largely inconsequential., Conclusions: Any primary care presentation by a care-experienced young person should trigger additional professional curiosity. To build rapport and trust, professionals should not underestimate the power of active listening, being reliable and honest, and small acts of thoughtfulness, for example, ensuring medical letters are provided promptly. Carers and other trusted professionals should help care-experienced young people to understand the role of primary care and support them with access. Health reviews may not be of value to all young people in care. Further research is needed to examine primary healthcare access for care-experienced young people with significant safeguarding and healthcare needs., (© 2024. The Author(s).)

Background: While individuals who were separated from their biological family and placed into the care of the state during childhood (out-of-home care) are more prone to developing selected adverse health problems in adulthood, their risk of cardiovascular disease is uncertain. Our aim was to explore this association by pooling published and unpublished results from prospective cohort studies., Methods: We used two approaches to identifying relevant data on childhood care and adult cardiovascular disease (PROSPERO registration CRD42021254665). First, to locate published studies, we searched PubMed (Medline) until November 2023. Second, with the objective of identifying unpublished studies with the potential to address the present research question, we scrutinised retrieved reviews on childhood out-of-home care and other adult health outcomes. Included studies were required to satisfy three criteria: a cohort study in which the assessment of care was made prospectively pre-adulthood (in the avoidance of recall bias); data on an unexposed comparator group were available (for the computation of relative risk); and a diagnosis of adult cardiovascular disease events (coronary heart disease, stroke, or their combination) had been made (as opposed to risk factors only). Collaborating investigators provided study-specific estimates which were aggregated using random-effects meta-analysis. The Newcastle-Ottawa Scale was used to assess individual study quality., Findings: Twelve studies (2 published, 10 unpublished) met the inclusion criteria, and investigators from nine provided viable results, including updated analyses of the published studies. Studies comprised 611,601 individuals (301,129 women) from the US, UK, Sweden, Finland, and Australia. Five of the nine studies were judged to be of higher methodological quality. Relative to the unexposed, individuals with a care placement during childhood had a 51% greater risk of cardiovascular disease in adulthood (summary rate ratio after age- and sex-adjustment [95% confidence interval]: 1.51 [1.22, 1.86]; range of study-specific estimates: 1.07 to 2.06; I 2  = 69%, p = 0.001). This association was attenuated but persisted after adjustment for socioeconomic status in childhood (8 studies; 1.41 [1.15, 1.72]) and adulthood (9 studies, 1.29 [1.11, 1.51])., Interpretation: Our findings show that individuals with experience of out-of-home care in childhood have a moderately raised risk of cardiovascular disease in adulthood., Funding: Medical Research Council; National Institute on Aging; Wellcome Trust., Competing Interests: None., (© 2024 The Author(s).)

Introduction: Western Australia has one of the highest rates of Aboriginal children entering out-of-home care in Australia. Kinship care is the preferred culturally safe out-of-home care option for Aboriginal children, yet all jurisdictions, including Western Australia, are far from meeting best-practice national standards. Intersectoral collaboration is a key primary healthcare principle and internationally recognized for improving health systems and outcomes. This paper presents findings from a qualitative research project investigating Aboriginal primary healthcare workers' experiences of intersectoral collaboration challenges and strengthening opportunities., Methods: Constructivist grounded theory guided this research involving 55 semi-structured interviews and four focus group discussions with Aboriginal primary healthcare workers. The research was guided by Indigenous methodologies and led by Indigenous researchers Participants were recruited from seven Aboriginal Community Controlled Health Organisations located across Perth metro, Pilbara, Midwest/Gascoyne and Southwest regions in Western Australia., Results: Key themes identified around intersectoral collaboration challenges were communication, including information sharing and interagency meetings, and the relationship with the government sector, including trust and the importance of the perception of Aboriginal health service independence. Key themes around strengthening areas to improve intersectoral collaboration included strengthening service resourcing and coverage, including the availability of services, and addressing high program turnover. The need for a shift in approach, including more emphasis on Aboriginal-led care and aligning approaches between sectors, was another area for strengthening., Discussion: This study addresses a significant research gap concerning out-of-home care, kinship care, and intersectoral collaboration in an Australian Aboriginal context. Findings highlighted the need to review the out-of-home and kinship models of care to strengthen the system, including creating more formal and structured modes of collaborating and better resourcing family support and kinship care., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Moodie, Jones, Chenhall, Williams, Garlett, Gibberd, O’Donnell, McAullay, McNamara and Eades.)