4. The chance to grow up safe and well

For the great majority of Australian children and young people, their families provide the support they need for their health and well-being. This includes the necessary resources and experiences that enable them to grow and develop to become contributing members of their communities.

In circumstances where the child or young person's immediate family may not be able to adequately provide for the development of their child or young person, or require support themselves, extended family or other forms of Out of Home Care are required to step in and take on a supportive role in meeting these needs.

For these children and young people it is important that the key objectives of the Out of Home Care system provides them with a safe environment with the aim that they are able to achieve the levels of health and well-being appropriate for their age.

The circumstances leading to a child or young person being placed in Out of Home Care can have a significant impact on a child's or young person's health and well-being. Therefore, it is important that Out of Home Care service providers are equipped and supported to fulfil the role of parents, either temporarily or for the longer term.

Over the last 10 years, all Australian governments and the non-government sector have increasingly recognised the importance of investing in the well-being of children and young people. Areas of investment have included early childhood services, health, education, family support, cultural safety and child protection to give children and young people the best start in life.

In conjunction with this approach Australia ratified the United Nations Convention on the Rights of the Child in 1991. The Convention on the Rights of the Child articulates the rights of children and provides a set of principles to assist the way children are viewed. Australia is accountable for this commitment before the international community.¹⁶

The World Health Organization (WHO) defines 'health' as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.¹⁷

The WHO considers a state of well-being¹⁸ to be one where an individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

The growing emphasis on children and young people's well-being has led to improvements in data and information collection on the circumstances and experiences of children and young people to support policy and practice. In Australia, the Australian Institute of Health and Welfare¹⁹ and state government reports – including the Victorian Government's The State of Victoria's Children Report 2006²⁰ and the New South Wales Commission for Children and Young People National Consultation Report²¹ – provide valuable information. Non-government organisations also produce reports such as the annual National Survey of Young Australians undertaken by Mission Australia²² and the CREATE Report Card 2009: Transitioning from Care: Tracking Progress.²³ Together, these sources contribute data and information on the experiences of children and young people, and provide insight into their views and aspirations.

A similar focus is evident internationally. For example, The State of the Nation's Children published by the Office of the Minister for Children and Youth Affairs in Ireland,²⁴ The Good Childhood Inquiry: What Children Told Us, from The Children's Society²⁵ in the United Kingdom, and The State of London's Children Report²⁶ published by the Greater London Authority, allow some inter-country comparisons to be drawn. It is also possible to assess changes in circumstances over time where studies are repeated, as is the case for the Australian Institute of Health and Welfare reports in Australia.²⁷

Whilst Australian and international research is not directly comparable, it is possible to identify several common areas where a 'good' childhood experience is considered essential for a positive transition to adulthood.

4.1 Outcomes for children and young people living in Out of Home Care

It is widely reported that children and young people who have been placed in Out of Home Care have poorer life outcomes than other children and young people.²⁸ Life outcomes are influenced by many factors, including the age that children and young people enter care and the number of care placements experienced.

Reports by the Australian Institute of Health and Welfare indicate that children are placed in care because they are the subject of a child protection substantiation, because their parents are incapable of providing adequate care or because alternative accommodation is needed during times of family crisis.²⁹ This indicates that children and young people placed in Out of Home Care are likely to have experienced a significant life disruption and may require support to catch up on developmental stages.

Research has also shown that parental risk factors are often present in cases where children and young people are placed in Out of Home Care.³⁰ Of parents with children and/or young people in care, 32 per cent had a psychiatric illness, 37 per cent reported alcohol abuse, 43 per cent reported substance abuse, and domestic violence was present in 56 per cent of cases.³¹

The disadvantage experienced by children and young people living in Out of Home Care is pronounced when looking at educational outcomes. Research indicates that young people leaving care have poorer educational qualifications, are younger parents, are more likely to be homeless and have higher levels of unemployment, offending behaviour and mental health issues.³²

Research from Barnardo's in the United Kingdom found that:

• 70 per cent of young people in foster care and over 80 per cent in residential care leave school with no qualifications;
• fewer than 20 per cent go onto higher education and fewer than one per cent to university;
• children in residential and foster care are 10 times more likely to be excluded from school than their peers; and
• up to 30 per cent do not participate in mainstream education, and between 50 and 80 per cent are unemployed between the ages of 16 and 25 years.³³

Similarly, the CREATE Education Report Card in 2006 found that young people in Out of Home Care do not perform as well as their peers at school and are more likely to have experienced disruption through relocation or exclusion.³⁴

The educational circumstances reported by participants in the Report Card, indicated a number of key challenges faced by children and young people in care, including that they:

• are less likely to continue within mainstream education beyond the period of compulsion;
• are more likely to be older than other children and young people in their grade level;
• attend a larger number of primary and high schools than other students; and
• miss substantial periods of school through changes of placement.³⁵

Of the young people who responded to the CREATE 2009 Report Card on their current activities, almost a third (29 per cent) reported being unemployed or looking for work. A similar proportion reported being in full-time, part-time or casual work (28 per cent). A small number were studying at TAFE (11 per cent) and 2.8 per cent reported that they were at university.³⁶

CREATE has also collated information on the health outcomes of young people in care.³⁷ Particular health challenges for these children and young people include illness and disability, higher rates of teenage pregnancy, risk-taking behaviour and self-harm and poor access to dental, optical and aural health services. Mental health is also a significant issue for young people in care; research by the Royal Children's Hospital Mental Health Service shows that nearly two-thirds of children and young people living in Out of Home Care had mental health diagnoses and required mental health referral.³⁸

There is a growing interest in examining the positive experiences of those children and young people where residential or foster care has contributed towards better outcomes for them. In 2006, the Social Work Inspection Agency in Edinburgh identified the following five factors as critical to success: having people who care about you, being given high expectations, receiving encouragement and support, being able to participate and achieve, and experiencing stability.³⁹

A recent Australian study also identified continuity of placement as an important factor in enhancing outcomes for children and young people in care. The study found that young people 'who had had one placement that lasted for at least 75 per cent of their time in care were more positive about their time in care, were less mobile, and had better outcomes twelve months after they left care'.⁴⁰ Another current research project is examining ways to improve and develop resilience within children and young people.⁴¹

For Aboriginal and Torres Strait Islander children and young people, a key factor to success in Out of Home Care is a well-matched placement with an Aboriginal or Torres Strait Islander family in line with the requirements of the Aboriginal Child Placement Principle.⁴²

Aboriginal and Torres Strait Islander people believe that a child or young person's cultural and spiritual needs, and their physical, emotional and developmental needs, are of equal importance.

'Kids need to know their culture, otherwise all the things they have inside them don't mean anything.'⁴³

4.2 What do children and young people need to grow up safe and well?

The Convention on the Rights of the Child affirms health and well-being as fundamental human rights – good health and well-being are crucial to effective participation in most aspects of life.

It is widely recognised that disruptions to a child or young person's development can have an impact on long-term outcomes. For example, failing to transition effectively from preschool to primary school may impact on a child's future learning and educational attainment.⁴⁴

For many children and young people, transition points can be disrupted as they move into care, when they are in care and also when they leave care.

The following six areas have been identified as being the key areas of overall child well-being and providing a pathway for successful childhood and adolescent transitions:

• physical and mental health;
• safety and security;
• culture, spirituality and community;
• identity;
• learning, participating and achieving; and
• family and relationships.

As indicated in Figure 1, for each area of well-being there are a number of positive conditions for healthy development. Family, relationships and community can influence these conditions.

Figure 1: Positive conditions for healthy development of children and young people in Out of Home Care
Source: The KPMG project team

Figure 1 outlines six areas which have been identified as being the key areas of overall child well-being that provides a pathway for successful childhood and adolescent transitions.

The six areas are: physical and mental health; safety and security; culture, spirituality and community; identity; learning, participating and achieving; and family and relationships.

Figure 1 indicates that for each area of well-being there are a number of positive conditions for healthy development.

The positive conditions for the healthy development of children and young people were subject to extensive discussion during the consultation process.

All of the positive conditions that children and young people require for healthy development set out in the figure above cannot be provided by the child protection system alone. The National Standards will require the support of a number of systems in assisting children and young people living in care to receive the positive supports they need.

4.3 The six areas of well-being discussed in consultations

4.3.1 Physical and mental health

• Support and encouragement to participate in physical activity
• Nutrition and healthy eating
• Timely access to appropriate health services including: dental, speech/occupational therapy, counselling, family support
• Access to therapeutic services

Identifying and promoting a nurturing environment for the healthy development and growth of a child or young person continues to be a key focus for Australian governments and non-government organisations.

The childhood and adolescent years are periods of significant growth, development and change and it is the responsibility of all families that the physical and mental health needs of their children/young people are supported.

Feedback from stakeholders during the consultation process indicated that the area of physical and mental health should be addressed by the National Standards. Stakeholders also emphasised the need for the improved provision of therapeutic support services and better access to mental health services to address the traumatic experiences of children and young people living in Out of Home Care.

Positive mental health is critically important for children and young people in developing emotional connections, stability and confidence. In research conducted in 2007, foster carers indicated that 54 per cent of children and young people living in foster care arrangements required professional help for their mental health issues; however, only 27 per cent received this assistance. Further, 61 per cent of children and young people in foster care had exhibited behavioural problems compared with 14 per cent of those in the general community.⁴⁵

The importance of enhancing the focus on mental health and therapeutic responses for children and young people living in Out of Home Care was highlighted in the consultations and submissions. The findings of a study undertaken by Sawyer et al (2007)⁴⁶ stated that the incidence of mental health issues in adolescents in home-based foster care was two to five times higher than that reported in the Australian Bureau of Statistics' National Survey of Mental Health and Well-being⁴⁷ for children and adolescents in the general population. Externalising problems, such as attention, delinquent, and social problems, were found to be more common than internalising problems, such as anxiety and depression.

Further, O'Neill and Absler's research found that children in non-biological care (foster, residential or kinship care) were referred to mental health services in far greater numbers than children in biological care.⁴⁸ Ensuring that carers are able to respond to the health and mental health needs of children and young people in care is also critically important. Butcher's research regarding foster carers in Queensland established that carers wanted training that was both practically oriented and nationally accredited, as well as specialist training to enable carers to provide therapeutic foster care.⁴⁹

The Australian Institute of Family Studies draws attention to numerous research articles which show that children in care experience significantly poorer mental health outcomes than children who had never been in care and a significant minority of children in care experienced complex psychological and behavioural problems.⁵⁰

The Child and Family Welfare Association of Australia submission noted that health outcomes and expectations are particularly important for children and young people who have a disability and are in care as 'they need access to additional specialised health services and effective coordination of case management'.

4.3.2 Safety and Security

• An environment that is safe and secure
• An environment free from violence and abuse
• A space to call your own.

Feeling safe and secure is essential to emotional well-being and is generally understood to be a necessary precondition for good health.⁵¹ 'Safety' also includes cultural safety, a concept that acknowledges the need for 'an environment that is safe for people: where there is no assault, challenge or denial of their identity, of who they are and what they need'.⁵²

'Children's sense of security and safety increases when they have the protection of parents, a personal safe place to be, or trusted people around them.'⁵³

Safety encompasses a range of personal considerations, such as protection from the risk of personal injury and accident, protection from harm, exploitation or maltreatment, and protection from violence.

The stability and security of a child's environment also contributes to their sense of feeling safe. Stability in a child's life is important in ensuring that connections to family and the community are made and maintained, in particular for social and educational activities, and particularly as education outcomes are closely associated with stability.⁵⁴

A submission from a Victorian foster carer suggested that security of placement is important because it provides a sense of "belonging and acceptance" into the family, and that children in Out of Home Care often need security of placement as permission to explore, experiment and test their boundaries as part of healthy development. Another submission from a foster carer (location not provided) supported the notion that stability underpins all the areas of well-being. The Child and Family Welfare Association of Western Australia also highlighted that the National Standards need to focus on stability and security.

A sense of security for a child or young person allows them to express themselves without fear, and develop self worth and confidence by feeling safe and secure in their environment (whether that be in care, at school or other places they attend).

Safety also involves external considerations, such as feelings of living in a safe neighbourhood and being free from the fear of crime. Both actual and perceived safety can have an impact on overall health and well-being. For example, there are associations between stress and anxiety in children and poor learning outcomes. Safety provides a key foundation for improved well-being and developmental outcomes.⁵⁵

4.3.3 Culture, Spirituality and Community

• Spending time with family or friend
• Participation in cultural activities
• Access to community services relevant to your culture or identity
• Support and encouragement to participate in cultural and spiritual events
• Participation in faith or community groups

Most children and young people recognise that they belong to a community, and they commonly define this in terms of where they live. It is within this environment that children and young people seek to access many of the cultural, sporting and leisure activities that allow them to participate in a community that is broader than their family or school environment. This has particular resonance for Aboriginal and Torres Strait Islander people, as well as people from other culturally and linguistically diverse backgrounds, including newly arrived migrants and refugees.

For Aboriginal and Torres Strait Islander children and young people, 'community' is defined in terms of a predominant connection to culture that is broader than the community within which they live,⁵⁶ and this has been found to be the case wherever the child or young person lives.

The maintenance of connections to family, community and country forms the basis of the development of the Aboriginal or Torres Strait Islander child or young person's identity as an Aboriginal or Torres Strait Islander person, their cultural connectedness, and the emergence of their spirituality.⁵⁷ For Aboriginal and Torres Strait Islander children and young people strong cultural identity is integral to who they are and a source of pride. The teaching, maintenance and regaining of Aboriginal cultural practices for Aboriginal children are the responsibility of the whole community.⁵⁸

For young people from culturally and linguistically diverse backgrounds, maintaining a sense of culture and connections to the community are also important. As noted in the submission from the New South Wales Department of Communities, children placed within culturally/ethnically similar families, or families specially trained and assessed to provide culturally competent care, have the following benefits:⁵⁹

• increased stability of placement;
• a positive sense of self and cultural identity;
• better communication and less misinterpretation due to language and cultural barriers; and
• familiarity with food, language and customs.

In their submission, Settlement Services International (SSI) proposed that:

"For children and young people who are members of culturally and linguistically diverse communities, maintaining relationships with key individuals and membership of groups can be essential to several areas of well-being identified (culture and community, spirituality) irrespective of placement stability and should be monitored throughout the child's time in care."

The majority of feedback from consultations on the National Standards for Out of Home Care focused on Culture and Community, particularly in relation to Aboriginal and Torres Strait Islander children and young people as well as children and young people from culturally and linguistically diverse backgrounds.

The term 'spirituality' is open to a range of interpretations, and is often used to describe a person's inner life or to define those aspects of a person that are unseen, or intangible, and give meaning or purpose to their life. Spirituality is also used to describe a set of personal beliefs; it can be connected to a person's cultural or religious heritage, and may be linked to institutional religions or participation in faith-based events and activities. It includes the beliefs and values that children and young people may hold and follow, as well as any faith-based activities that children and young people participate in. The Life Without Barriers' submission noted that culture and spirituality are strongly linked.

Spirituality can assist a child or young person to develop a positive sense of identity and to maintain connections with family and significant others which may help to enhance their sense of belonging.

There is strong evidence that spirituality is important in shaping a young person's perception of their quality of life and it is understood to be important for health and well-being.⁶⁰ Spirituality or connection to a church-based group as a strong protective factor for a child or young person is often cited in both Australian⁶¹ and international⁶² literature. Surveys of Australian youth provide evidence that spirituality, or faith, is important for 14 to 15 per cent of the young people surveyed.⁶³

For Aboriginal and Torres Strait Islander children and young people, the development of Aboriginal or Torres Strait Islander spirituality is closely linked to family and country or land, and spiritual development depends on connections to particular people and places being maintained. Aboriginal spirituality has been described as feeling connections with people and places⁶⁴ – feeling proud, knowing you have connections and bonds with people, and being welcomed.

4.3.4 Identity

• Open and honest communication in your care environment
• Constant relationship with a trusted adult
• Maintaining or developing friendships with peers

The Northern Territory Children's Commissioner felt that "self identity/self worth" must be included in the National Standards, as it is important for the well-being of the developing child or young person.⁶⁵ This was reinforced in the consultations and the submission process.

Strong and positive relationships with family, friends and community are important to a child or young person's sense of self-worth, well-being and to their development of values and morals. Families and significant adults play a principle role in teaching values. Connections provide children and young people with stability, without which emotional and psychological development can be adversely impacted. Maintaining relationships with significant people and groups promotes stability leading to better emotional and psychological development.

Some studies have shown an association between conditions such as depression and the presence of psychosomatic symptoms with poor child–parent relationships.⁶⁶ The evidence suggests that friends, parents, relatives and family friends are the top three sources of advice and support for all age groups;⁶⁷ that families are the main source for teaching values,⁶⁸ and family attachment is a strong, protective factor.⁶⁹

The Secretariat for Aboriginal and Torres Strait Islander Children reports that for Aboriginal and Torres Strait Islander children and young people, a key factor to success in Out of Home Care is a well-matched placement with an Aboriginal or Torres Strait Islander family in line with the requirements of the Aboriginal Child Placement Principle.⁷⁰

During the consultations, identity was raised as an important area for the National Standards for Out of Home Care to address. In their submission, the Children's Youth and Family Agencies Association of Western Australia suggest that identity is critical for all children and young people. Identity should address where the child has come from, their sexual or gender identity and who they want to be.

4.3.5 Learning, participating and achieving

• Attainment of practical life skills including: self care skills, making friends and networks, basic cooking, basic budgeting, problem solving, learning to drive
• Consistent attendance at school
• Encouragement and access to resources to achieve literacy and numeracy benchmarks
• Participation in a range of activities

Participation in education and learning is generally associated with positive lifelong outcomes. Such participation develops important cognitive skills and imparts knowledge that is important for a person's future. It also provides an environment where children and young people can develop important social and life skills.

The recent focus in Australian jurisdictions on the preschool and early primary years is supported by research demonstrating that participation in early childhood programs is beneficial for intellectual development and independence, sociability and concentration, and language and cognitive development. Participation in education is also associated with a lower incidence of personal and social problems in later life, such as school dropout, welfare dependency, unemployment and criminal behaviour. Participation, especially in the preschool and early primary years, is therefore of significant potential advantage to children from disadvantaged backgrounds.⁷¹

The submission from the Australian Children's Commissioners and Guardians stated that:

"For the National Standards to actually achieve the aim of giving children and young people in Out of Home Care the same opportunities as other children to reach their potential in all the key areas of well-being, financial support should extend to extra curricular activities. The opportunity to be involved in organised sport, learn a musical instrument, or attend drama classes, for example, would also assist children and young people in Out of Home Care to experience a more typical Australian childhood. Children and young people living in Out of Home Care have reported to ACCG members that they want to be able to do the types of things that their friends not in care are able to do."

Children and young people living in Out of Home Care need to be provided with opportunities to participate in extra curricular activities, including:

• community activities (i.e. sport, community groups);
• social activities (i.e. visiting friends, gallery, zoo);
• extra curricular activities (i.e. camps, bands, scouts); and
• employment (i.e. part time jobs).

The Convention on the Rights of the Child also outlines the right of the child to participate fully in cultural and artistic life, and encourages the provision of appropriate and equal opportunities for cultural, artistic, recreational and leisure activity.

The Benevolent Society submission supported the participation of children in the decision making process. This reflects the assertion by Delfabbro, Barber and Bentham⁷² in their 2002 article that ensuring decisions are made in line with children's wishes can result in better placements and outcomes, with better psychological benefits around their self esteem also evidenced. And is reiterated by O'Brien, who highlighted that giving a voice to children is based around the empowerment of young people, and in particular children and young people in care, to enable them to have a meaningful involvement in the decision-making processes which affect them.⁷³

In their submission, the Secretariat of National Aboriginal and Islander Child Care noted that provisions for participation and engagement of children in decisions and planning affecting their life should be incorporated into the National Standards. This was also noted in the New South Wales Children's Guardian submission.

In their submission Berry Street acknowledged that supporting the involvement of children and young people in healthy leisure and recreation activities enables them to develop supportive friendships and networks beyond the boundary of the Out of Home Care environment.

4.3.6 Family and relationships

• Positive relationship with parents
• Positive relationship with significant others
• Participation in community activities

The stability of relationships to significant others in a child and young person's life is important. Whilst connection and relationship building with family (including extended family) is of primary importance, where this is not possible, relationships with others outside of the family need to be encouraged.

An extract from the submission by Uniting Care Australia notes "Case management that engenders strong relationships between children and young people and their birth family or community – where possible and appropriate – can assist children's development of identity, culture, and spirituality."

The submission from the Family Inclusion Network (FIN), Australian Capital Territory, noted that, research suggests the majority of young people who leave care return home to their parents and/or relatives. This was also noted in the Child and Family Welfare Association of Australia submission which outlined that 'international evidence supports that over 80 per cent of children post their care experience return to live or have significant contact with their family (Ward, Bullock and Clough 2006)'.

The Care Leavers of Australia Network (CLAN) also believes that family relationships and connections are significant and should be an area of focus for the National Standards. The Anglicare Australia submission also stated that family and kinship connection is integral to the well-being of children and young people. The submission highlighted the results of the Queensland survey – The 2009 Views of Young People in Care – which indicated that children and/or young people felt that they did not have enough contact with their family. It also stated that it is critical that siblings should be placed together in care where possible. As noted by McBride (2007), siblings are family, and the connection to family helps give children their identity as well as their feeling of belonging in the world.⁷⁴

Relationships with significant others is also critically important. In a study by O'Neill in 2004, children reported that adults (such as teachers) who listened to and supported them in the long-term were a highly valued resource.⁷⁵ PeakCare also noted in their submission that "Young people who participated in the Listen Up Forum identified the importance of relationships in the healing and well-being of young people in care and stressed the need for young people to stay connected with those who they deem important in their lives (CREATE, Testro, PeakCare, and Queensland Youth Housing Coalition, 2009)."

WhilstUniting Care Australia noted that "Children's access to at least one adult role model is well documented as a fundamental protective factor particularly in situations of socio-economic disadvantage. Specifically in out of home care, Mason and Gibson (2004) have found that children and young people in care nominate "connections with people with whom they are familiar, know and/or have something in common" as an overarching need. This indicates the broad application of the need for high-quality relationships with any or all participants in an out of home care arrangement (this may be their teacher, an aunt or uncle from their kinship group or a respite carer)."

4.4 Positive outcomes for children and young people in care

The table below outlines the areas of focus discussed in this section, and examples of the outcomes sought by focussing on those areas.

4.5 Conclusion

The areas of focus cover the broad spectrum of elements that assist in developing healthy children and young people. Improving outcomes for children and young people in care requires a comprehensive response across their life course, including:

• early intervention and family support;
• providing better quality care to assist them in overcoming challenging circumstances they were in before entering into the Out of Home Care system;
• stability and continuity;
• providing opportunities for more gradual transition from care; and
• providing on going support particularly for children and young people with mental health problems and complex needs.⁷⁶