Placement disruption and its
psychological consequences
Implications of the 3-year South
Australian longitudinal study
Presenter: Dr. Paul Delfabbro
Project team

Professor Jim Barber, Flinders University
 Dr. Paul Delfabbro, Adelaide University
 Dr. Robyn Gilberton, Flinders University
 Ms. Janey McAveney, DHS, Adelaide
Purpose of presentation

Brief overview of the South Australian
foster care system and its status during the
time of the project
 Summary of the principal policy and
practice directions in Australia
 Summary of the key findings of the South
Australian longitudinal study
 Implications for policy and practice
The South Australian foster
care system

Heavy reliance on family-based foster care
 Very little residential or group-care
 Shortage of families willing to look after
adolescents
 High-rates of ‘placement drift’
 Foster care placements are outsourced
Policy context prevailing in
South Australia

Strong emphasis on keeping families
together (‘family preservation’)
 It is assumed that the attachment between
children and their biological families cannot
be truly replicated by relationships
established with other adults
 Foster care is a necessary evil
 Little emphasis on adoption
But can we generalise from
S.A. to other Australian
States?

The trends and problems identified in South
Australia appear to be shared by many other
States
 The research, practice and policy trends
identified nationally appear very relevant to
S.A.
National priorities 1: Evidence

Recent edition of Children Australia
 Emphasis on evidence-based practice
 This includes a need to monitor children’s
well-being as they progress through the care
system
 Possibility of using the LAC system (Sarah
Wise’s paper)
National priorities 2:
Outcomes

Achieving more stable outcomes for
children in care
 Better matching of services with needs
 Developing appropriate standards for foster
care services
 Maintaining family connections (Thomson
and Thorpe paper)
International context

Where might we be headed?
 In the U.S., much greater emphasis is
placed on permanency planning
 The best interests of the child
 The Adoption and Safe Families Act of
1997
The U.S. Adoption and Safe
Families Act (1997)





Child safety and well-being are now the primary
imperatives
Emphasis on ‘permanency planning’
Stable and safe arrangements are the 1st priority
rather than family preservation
In many States, concurrent arrangements for
adoption are made at inake
Limits are placed on how long children are
allowed to drift in care
Practice implications of U.S.
policies

Permanent solutions (Adoption, relative care, or
reunification) must be achieved quickly (usually
within 15 months)
 There are fewer rewards for trying to resolve
problems in the family of origin
 If parents are apathetic or unresponsive to goals
that are set, they can lose custody of the children
within 15 months
 Financial penalties apply to agencies and/or States
that fail to adhere to these guidelines
Is this sort of solution
appropriate for Australia?

Some similar trends are emerging
 Highly publicised cases of child abuse
either in the care system or uninvestigated
allegations of abuse in biological families
 Strong emphasis on child protection (e.g.,
Layton report in South Australia)
 Increasing interest in permanency planning
(e.g., in Qld)
What would make this
approach justifiable?

Children doing very badly in care
 High levels of placement ‘drift’
 Drift linked to poorer outcomes for children
 Low rates of family reunification
 Family preservation not working
South Australian evidence:
What happens when children
progress through the care
system?
Objectives of study

Profile the characteristics and needs of
children coming into care
 Placement patterns, breakdown rates and
causes of breakdowns
 Psychosocial effects of placement instability
 Identify children most ‘at risk’
Design considerations

Longitudinal design to address concerns
about cross-sectional analyses
 Cohort approach: all children included
 Frequent follow-ups
 Short and efficiently administered measures
 Information from multiple sources
 Mixed methodology
Mixed methodology
Multivariate analysis of child outcomes
Analysis of case profiles / child groups
Qualitative review of case histories
Interviews with children in care
Sampling strategy

All new emergency, short-term and longterm referrals (1 week+) between April
1998 and April 1999
 Both metropolitan and regional areas
 Age 4-17 years
 Exclusions: family reunification cases,
remand cases
Measurement points

Intake
 1st 12 months (every 4 months)
 Thereafter (every 6 months)
 Interviews with case workers, and a subset
of foster carers and children to assess the
reliability of measures
Sample characteristics

235 children (121 boys, 114 girls)
 73% from metropolitan area
 40 Indigenous/ 195 non-indigenous
 90 (38.%) were teenagers
 195 (83%) had a previous placement history
 40 (17%) had never been placed in care
before
Measures

Abbreviated CBCL, health, substance
abuse, sexualised behaviours, educational
and social adjustment, offending behaviour
 Placement movements: duration, location,
nature, reason for termination
 Family contact
 Case worker involvement
Two identifiable baseline
clusters





CLUSTER 1
N=132
More girls
Mean age =13.35 yrs.
Behavioural problems






CLUSTER 2
N=103
More boys
Mean Age = 7.44 yrs.
Parental problems
Neglect
Placement histories
Previous placement history at intake (%)
25
20
15
10
5
0
1 to 2
3 to 5
6 to 9
Placement numbers
10+
Placement destinations
Gone
Home
At 4
months
At 8
months
At 12
months
At 2 years
Stable in Unstable
care
in care
Other
59 (25%)
72 (31%)
92 (39%)
12 (5%)
85 (36%)
90 (38%)
49 (21%)
11 (5%)
92 (39%)
83 (35%)
43 (18%)
17 (7%)
95 (40%)
59 (25%)
50 (21%)
31 (13%)
Placement rates over 2 years
Mean changes per 4 months
3
2.5
2
1.5
1
0.5
0
4 mths 8 mths 12 mths 2 yrs.
Follow-up points
Why do placements end?

Take the 4-month (most unstable period)
 49% of placements only intended to be
short-term
 18% Broke-down due to child’s behaviour
 14% Family reunification
 7% Other arrangements secured
Problematic examples
4 mths
1
2
3
8 mths
12 mths
2 yrs
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Identifying challenging
children

Which children are struggling in care?
 What predicted the case profiles just
shown?
 ANSWER: 2 or more breakdowns due to
behaviour in 2 years
Comparative placement
destinations
Gone
home
Stable Unstable
in care in care
Other
Total sample 88 (48%) 55 (30%) 20 (11%)
(n=185)
23 (12%)
Challenging 7 (19%)
Group
(n=50)
9 (18%)
4 (8%)
30 (60%)
Psychological outcomes in
South Australian foster care
Analyses involved 3 groups
Group 1: Stable throughout
Group 2: Moderately unstable
Group 3: Very unstable
Conduct disorder
Stable
1
Very unstable
0.9
Mod unstable
0.8
0.7
0.6
0.5
0.4
0.3
Intake
1 year
2 years
Hyperactivity
Stable
1.7
1.6
1.5
1.4
1.3
1.2
1.1
1
0.9
0.8
0.7
Very unstable
Moderately
unstable
Intake
1 year
2 years
Social adjustment
Stable
3.3
3.2
Very unstable
3.1
Moderately
unstable
3
2.9
2.8
2.7
2.6
2.5
Intake
1 year
2 years
General trends

Children stable in care generally improve or
remain unaffected by foster care
 The most unstable children show
improvements in the short-term, but then
experience deteriorations in functioning
after 12 months
Results for the most
challenging children (n=50)

All adjustment measures poorer at baseline
and after 2 years
 Some improvement in conduct
 No improvement in hyperactivity and
emotionality
 Decrease in social adjustment
Summary of placement
findings





Placement instability is NOT as severe as
indicated by cross-sectional designs
Most placement changes are planned
Most children are doing well in foster care
Approximately 15-20% of children are
experiencing severe disruption
Placement disruption is not problematic unless it
is sustained
Thresholds and early
detection

It is possible to detect problematic cases
very early and using system data

If At intake: Age = 15 + Conduct disorder
items all in ‘frequent’ or ‘often’ range
THEN p (breakdown) = 80% in 1st 4
months
Further examples

If N (breakdowns due to behaviour) > = 2
within 2 years, then P(stability within 2
years) = 8%

If the child is not stable by 12 months,
psychosocial functioning will deteriorate
Significance: Supports the role
of indicators to monitor
progress

Need systematic inake assessment
 Case terminations need to be monitored
 Critical thresholds and indicators can be
used to ‘flag’ or identify cases at risk
 Problematic cases could be targeted for
early intervention
Evidence in support of
American model?

Placement instability appears harmful
beyond 12 months
 Monitoring outcomes is feasible and
worthwhile
 Interventions with families should occur
sooner rather than later
Is foster a ‘necessary evil’?
Children’s views
 Interviews were conducted with 100
children (50 in the current study and 50 in
existing long-term placements)
 In both groups, 95% believed they were
well treated by their carers, and felt safe and
accepted

Further conclusions

Foster care is a good option for many children and
most carers are doing an excellent job
 Foster care should be seen as a realistic option that
can benefit children; not simply a last resort
 We strongly endorse the need for monitoring and
early detection of children for whom foster care is
not working
 We believe that this monitoring and early
detection process is very feasible
Continued….

Prescriptive foster care (one rule for all) ignores
the fact that there are different clusters of children
in care
 Certain children are not suitable for family-based
care. Other options should be sought for them
 We endorse permanency planning, but believe that
this can be achieved without severing family ties
 Alternatives to foster care should only be
considered when there is evidence for genuine
disruption and instability
Continued…

The same rules should not be applied to
children who seem to be doing well in care
 Foster care should not be a one system fits
all
 The focus should be on what works rather
than rigid inflexible policies that are not
adaptive to differences within the care
system, e.g., carer classifications
Other issues examined

Predictors of family reunification
 Nature and effects of family contact
 Geographical distribution of placements
 Cost-analysis of special loadings
 Children and foster carers’ perceptions
Follow-up information

paul.delfabbro@adelaide.edu.au
 Personal home-page for reference list
(www.psychology.adelaide.edu.au)
 Australian Centre for Community Services
Research (ACCSR)
 Contact: priscilla.binks@flinders.edu.au