Community Services Directorate

Child Profiling

Discussion Paper

March 2014

Contents

1.Purpose

2.Background

3.Child Profiling Tool

4.Validation

5.Results

6.Discussion

7.Conclusion

Attachment A: Child Complexity Tool – Jurisdiction Analysis

Attachment B: Complexity Assessment Tool (CAT)

Attachment C: Counting Rules

Attachment D: Case Study

Attachment E: Reference list

1.Purpose

The purpose of the Child Profiling project was to gain a population measure of all children and young people in out of home care in respect to their current levels of need and the complexity of their behaviours. The project is a key deliverable to develop the five year Out of Home Care Strategy (Strategy) and the findings will be used to design future service models and interventions. Further discussions about the results will be held throughout the course of the Strategy’s development in order to deliver a more targeted and individualised system that best meets the needs of children and young people in the ACT.

The paper also seeks to explain the methodology utilised to complete the project and provide a baseline for future research to ensure the out of home care system adapts to the population over time.

2.Background

The Child Profiling project was part of a suite of research and data activities undertaken to inform the development of the Strategy. The project aimed to address the limited understanding about the needs and behaviours of children and young people in out of home care as a population group. It was recognised individual children and young people are assessed regularly through case planning activities however there were limited assessments, other than for national reporting requirements, to look at the out of home care population as a whole. Furthermore, national reporting often looks at outputs and activity based reporting through quantitative data, this project sought to look qualitatively at the needs of children in care and what conclusions might be drawn from the findings about their needs when mapped against some basic demographic information.

3.Child Profiling Tool

The child profiling project started in May 2013 and was undertaken by two Care and Protection Services senior practitioners. At the start of the project the purpose was:

•To identify a tool that could be used to create a profile of children and young people in out of home care. The data would aim to reflect relative levels of need and complexity by percentage of population. The data would support the development of the Out of Home Care Strategy.

•Gain a population measure of all children and young people in care according to their level of behavioural complexity and needs.

In order to meet the first purpose Australian jurisdictions were contacted to ascertain if they conducted any child profiling assessments. An overview of feedback from other jurisdictions is provided in a report at Attachment A. The findings from the analysis recommended the use of the Complexity Assessment Tool (CAT) which was authored by Professor Paul Delfabbrio for Families SA. Families SA agreed to give the ACT permission to use the tool for their analysis. The CAT is at Attachment B.

The CAT is a standardised screening instrument for assessing the complexity of children and young people and was developed for Families SA to use when children and young people enter out of home care, when they change placement, at the time of the Annual Review and when there is a review of the carers subsidy.

The CAT is split into the following components:

Part A: Children’s behavioural complexity

•Substance use

•Sexualised behaviour

•Offending behaviour

•School behaviour

•General behaviour

Part B: Children’s special needs

•Physical health

•Child development and intellectual health

•Mental health

•Physical disability

For each component the assessor scores the child or young person using a severity rating (A-E), the score is assessedusing a guide that describes behaviours a child would exhibit to be considered for each severity rating. A formula is then used to add the severity ratings together to provide a single assessment score in one of the following levels:

•Level 1: Minor or no problems

•Level 2: Moderate problems

•Level 3: Significant problems

•Level 4: Extreme problems

South Australia identified the range of supports needed to assist children and young people in the various levels. These supports ranged from interventions for the child, the placement or the carer. In terms of children assessed at a level 1 their needs were identified as those similar to the general population and included needs such as food, clothing, shelter, safety, love, nurturance, stability, spirituality, educational, psychological and maintained connections with families. Level 1 children needed an environment that is consistently responsive, nurturing and has a therapeutically supportive parenting environment. The carer is expected to act as any other parent and attend meetings, routine appointments and facilitate social, recreational and cultural activities.

Children who were assessed at a level 2 were identified as displaying more challenging behaviours, may have moderate developmental delays, disability or have additional health needs. The additional needs for the child may include additional supervision, additional educational support (tutoring, classroom support), therapeutic interventions and more frequent care planning reviews and assessments. These additional needs mean the carers should be more on hand to participate in various meetings and reviews and be generally more available to the child or young person.

Children who were assessed at a level 3 were identified as having a significant level of challenging behaviour that placed themselves or others at risk and/or they have significant developmental delays, disability and health or educational issues. The aim of the placement would be to assist the child’s recovery and help them to gain stability in relation to the management of their behaviours. A child in this level would need close supervision, alternative or structured educational programs, developmental programs, ongoing assessments and often have an emergency safety plan. A carer of a child in level 3 would need to maintain close communication with their case worker, participate in intensive therapeutic intervention plans and implement the emergency safety plan.

Children who were assessed at a level 4 were identified as having severe developmental delays, disability and health or educational issues and/or whose behaviours place themselves or others at extreme risk of significant harm. The aim of the placement would be to assist recovery in the child or young person and enable them to function in a less intensive/restrictive environment. Carers of these children would need to offer intensive supervision, monitoring and highly structured activities. Carers would need to be available to attend all appointments, maintain close communication with their case worker, implement the emergency safety plan and facilitate connection to a less restrictive environment.

The South Australian system operates on the premise that all carers for children and young people in out of home care should offer a therapeutically supportive parenting environment.

At 25 June 2013, there were 578 children and young people residing in out of home care in the ACT. However, from this total number 102 were assessed as not meeting the criteria to be included in the profiling exercise. Therefore, a total of 476 children and young people were assessed for the purposes of this project. Reasons for children and young people not being assessed included children subject to an Enduring Parental Responsibility Order, young people who had self placed with birth family and children and young people who were going through an active reunification process at the time of the assessment.

The following criteria were applied for inclusion:

•Residing in out of home care including, residential, foster care, kinship care, living independent or in a refuge; and

•Were in the full or shared care of the Director-General; and

•Were under the age of 18 years at 25 June 2013.

A full list of the counting rules is at Attachment C.

At the same time the assessor completed the CAT the following data was collected:

•Name;

•CHYPS ID;

•Date of Birth;

•Aboriginal and Torres Strait Islander status;

•Cultural background;

•Placement type;

•Gender;

•Number of siblings;

•Number of siblings in care;

•Length of Order;

•Age at assessment;

•Age child came into care;

•CAT level; and

•Current subsidy level.

4.Validation

There were limitations to the way the assessments were conducted. The assessments were based on the opinion of two senior practitioners conducting the project and heavily relied on the quality of documents used about the child or young person. The main documents used for the assessment were the Annual Review, Care Plan and/or Child Protection Assessment Report (CPAR).

The senior practitioners undertook a range of processes to provide additional validity to the project. The processes included:

  1. the senior practitioners undertook random samples of each other’s assessments;
  2. the senior practitioners verified 127 assessments with caseworkers and there were only two instances where the caseworker recommended a higher or lower complexity level; and
  3. the senior practitioners asked caseworkers to identify the children or young people they thought would be in level 3 and 4 and reassessed these children.

Following the third validation exercise the level of need rating was adjusted for 13 per cent of children. These changes have compromised the validity on this small cohort of the project somewhat as the senior practitioner in the third validation sought information from a wider range of sources than what was used in the original assessment. The wider range of documents included affidavits, Child at Risk Health Unit (CARHU) reports and agency reports.

The quality of all the documentation used for the assessments was highly variable and when additional documents were reviewed it was clear to see the story of the child or young person was a lot more complex that what is often portrayed in an Annual Review or Care Plan. A finding for the next evaluation will be to use a consistent document that is more holistic in nature and includes results of standardised testing.

5.Results

For most of the analysis presented, those with levels of need above minor are considered as a single group. This is because of the low number of children with higher levels of need.

The main findings from the analysis include:

Level of need

  • A total of 476 children and young people were assessed as they presented at 25 June 2013. The numbers of children and young people in care was non-linear in terms of declining numbers through the four levels.

Table 1: Level of need

Data Item / Group / Number / Percent*
Level of need / Level 1: Minor / 382 / 80.3
Level 2: Moderate / 46 / 9.7
Level 3: Significant / 22 / 4.6
Level 4: Extreme / 26 / 5.5

* These figures do not add to 100% because they were rounded up.

Sex

  • There were more males 258 (54.2%) than females 218 (45.8%) in the assessment.

Cultural background

  • There were 44 children and young people (9.2%) from culturally diverse backgrounds. The children were identified as culturally from 18 different countries. The highest proportion of children came from countries in Europe with the exception of Sudan.

Placement Type

  • The majority of children and young people were placed in kinship care 257 (54%). There were 183 (38.5%) children and young people in foster care and 36 (7.6%) in residential care or living independently.
  • Children in kinship care were less likely to be identified as having a level of need above minor (10%) than children in foster care (21%) or residential care (75%).

Siblings in care

  • The majority of childrenhave all of their siblings in care; this equates to 231 (65.1%).
  • Children in out of home care who had two siblings not in care were less likely to have a level of need above minor – 71% compared to 82% for all other children with sibling information.

Age child came into care

  • A large proportion of children came into care when they were 4 years and under (66%) – under 1 year - 127 (26.7%); 1-2 years - 106 (22.3%), 3-4 years -81 (17.0%). This means 34% were aged over 5 years at entry to care.

Aboriginal and Torres Strait Islander children and young people

  • At the time of the assessment Aboriginal and Torres Strait Islander children and young people made up 28.4% of the out of home care population.
  • There is double the number of Aboriginal and Torres Strait Islander males (90) than Aboriginal and Torres Strait Islander females (45) in the care system. Aboriginal and Torres Strait Islander males make up 34.9% of the male population and Aboriginal and Torres Strait Islander females make up 20.6% of the female population.
  • Aboriginal and Torres Strait Islander children are more likely than non-Indigenous children to have a level of need above minor (27% to 17%). Aboriginal and Torres Strait Islander males are almost twice as likely to have a higher level of need (32%) than both Aboriginal and Torres Strait Islander females (16%) and non-Indigenous males (17%).
  • Two-thirds of Aboriginal and Torres Strait Islander males in the oldest age group (15-18 years) had a level of need above minor.

Figure 1: Proportion of the total number of Aboriginal and Torres Strait Islander children and non-Indigenous children per complexity level

Length of time in care

  • Over 80% of children had been in the care system for less than nine years.
  • Out of the total number of children and young people who had been in care for at least nine years,children in this age group were more likely to have a level of need above minor (33%) compared to all other age groups (17%).
  • Five of the 13 Aboriginal and Torres Strait Islander males in care for at least nine years were in the extreme level of need category. In contrast, only two of 39 non-Indigenous males in care for at least nine years were in the extreme level of need category.
  • Young people aged at least 15 showed significant variance in terms of the length of time they have been in care and if they had a level of need above minor. For example, 41% of such young people with 2-3 years care before assessment, 56% with 4-5 years, 28% with 6-8 years and 46% with at least 9 years care before assessment.

Figure 2: Young people aged 15 years and their CAT level versus the number of years they have been in care

Age of children in care at assessment

  • Children who came into care aged 9-18 years were more likely to have a level of need above minor (36%) than those who came into care at younger ages (17%). Of these children, Aboriginal and Torres Strait Islanders were only slightly more likely (40%) to have higher levels of need than non-Indigenous children (35%).
  • A significant proportion of children aged 15-18 years when assessed (43%) had levels of need above minor. This compares with only 15% for younger children.

Subsidy payment

  • The majority of children who were assessed at a minor level of need were paid a standard payment (317). There were 56 children whose carers were being paid at a higher subsidy rate than standard who have been assessed as having minor needs.
  • Of the 56 children whose carers are being paid a higher subsidy rate than standard and who have been assessed as having minor needs 36 children are in foster care and 16 are in kinship care.
  • Alternatively, there were 22 children assessed at a level higher than minor who are only on a standard payment. Of these six children were in foster care and seven were in kinship care.

Table 2: Subsidy level versus CAT level

Standard / Care Level 1 / Care Level 2 / Intensive / Other* / Total
Minor / 317 / 20 / 30 / 6 / 9 / 382
Moderate / 14 / 4 / 8 / 9 / 11 / 46
Significant / 3 / 1 / 1 / 7 / 10 / 22
Extreme / 5 / 1 / 0 / 9 / 11 / 26
Total / 339 / 26 / 39 / 31 / 41

*Other includes negotiated rates, residential, payment by other state, therapeutic – On Track or no payment

6.Discussion

There is significant research that evidences the negative impact on a child or young person’s long term outcomes when they have resided in out of home care. There is continued debate about whether the poor outcomes are related to pre-care adversities, the placement in out of home care or a combination of both (Wade et al, 2011). Alarming research coming from the United States is showing children who are exposed to multiple trauma episodes have a life expectancy of 20 years less than the general population (Griffen, 2014). Reading through the case documents to undertake these assessments it is clear that the majority of children and young people who enter care have already experienced multiple trauma events and often experience additional trauma whilst in care as a result of continuing service failures including placement breakdowns and discontinuities of caseworker personnel.

The personal, financial and social impacts of abuse, neglect and out of home care is well documented in national and international research. As noted in the Australian Institute of Family Studies (2013) information paper on the costs of out of home care,adverse impacts include:

  • future drug and alcohol abuse;
  • mental illness;
  • poor health;
  • homelessness;
  • juvenile offending;
  • criminality; and
  • incarceration

The research to date simply highlights the need to ensure children have safe and stable placements where they can grow and develop into healthy adults.

The ACT has very little population data for children and young people in care as it is generally only collected at an individual level. Ongoingindividual case planning considers the child’s wellbeing and placement needs throughout the child’s time in care. This case planning information is used to inform decision making about whether a child should be reunified with their birth parents, the type of placement they require, what supports the carer will need to care for the child and whether the child’s placement should become permanent. This information is not able to be aggregated readily by the current child protection information system and as a result Care and Protection Services has had limited ability to understand the complexity of the needs of children and young people in care as a cohort and whether this has changed as a result of Care and Protection Services intervention. This is the first project of its kind in the ACT.