of children in out of homecare fell more or less steadily from 1980, reaching a low point in 1994 before rising again. The marked rise in children in out of homecare from 2008 is therefore the continuation of a longer-term, albeit fluctuating, trend. Changes in the size and composition of the care population from the mid-1960s to late 1980s were strongly, influenced by shifts in policy and institutional frameworks, especially in relation to youth offending, and also by high profile child deaths from abuse (Rowlands and Statham, 2009). Subsequent changes have been largely, though not solely, policy-driven. The Children Act 1989 tightened the legal grounds and legal process for the removal of children and introduced the concept of pro-active family support, reframing the earlier concept of prevention introduced by the Children and Young Person’s Act 1963. This led to a decline in the ‘flow’ of children into out of homecare during the early 1990s, accompanied by a rise in the ‘stock’ of children in placement on the annual census date. The raising of thresholds for compulsory intervention by the 1989 Act meant that fewer children were entering care, but those who did were being admitted for more serious reasons and therefore staying longer (Rowlands and Statham, 2009, Department for Education and Skills, 2003).
What are the individual and social indicators for the development of resilience or mental capital and success- ful outcomes? Those young care leavers who do well in terms of mental capital and wellbeing, progress to higher education, do not enter the crime statistics, and are able to maintain independent living with support. The research to date suggests that early entry into the care system, kinship or family based out-of-homecare, stabil- ity of placement and a personal sense of security promote these successful outcomes. These components promote, in as yet unknown ways, emotional wellbeing and educa- tional attainment. However, the studies use widely differ- ent methodologies (see Table S1; additional file 1) and additional work is required to confirm these indicators and to isolate the preferred pathways through care dependent on the reasons for and age at entry to out-of- homecare. For example, although kinship or family based out-of-homecare appears to offer the best outcomes for the entire cohort of children in care, there is clear evi- dence that this approach has limited success with older children with conduct disorder coming into out-of-homecare and may actually be contraindicated [44,45]. Thus more specific criteria, indicative of successful outcomes, need to be identified in order to develop policy systems which can maximize mental capital and wellbeing in the interests of the individual and the health and social care systems.
Another survey of social service agencies in the USA found that half of the states suggest a minimum of biweekly visits between children in out-of-homecare and their families, while the remaining states have no standards at all. For example, the Californian manual of policies and procedures suggests that, in the reunification process, the social worker should arrange visits between parents or guardians not less than once per calendar month, unless the court allows for less frequent contact (Edwards, 2003). The State of Maine provides a comprehensive set of recommendations (Maine Department of Human Services, Child and Family Services Manual, 2002, Section V.E). This is the most informative practice manual that can currently be located. The guidelines emphasise the importance of individual case planning, and advise that a sensitive and responsible assessment of the child’s capacity and response to contact is required.
For children who become known to the Department, this involvement over a range of service types and systems generally increases once the child is placed in out of homecare. As discussed earlier in this chapter, this can mean negotiating across quite complex systems. The issue here too, is when service provision remains uncoordinated, carers and families are left to negotiate across several systems at one time. This may be particularly problematic when these systems have different and/or competing agendas. As discussed earlier, in Australia this becomes more complicated by the way services are funded via the different layers of governmental funding. Some services are funded federally, whilst others are funded via the state, with very little coordination across jurisdictions to ensure duplication and/or gaps do not occur. Within Queensland; Health, Education, Disability Services and Child Protection are State jurisdictions dependent upon funding dollars. These government departments co-exist with other non-government services, which are, in the main, funded and monitored by these Government Departments. On a regional level these services experience skills shortages along with staff retention issues. Funding and staffing issues can and do play themselves out when trying to case manage children across services. Child and Youth Mental Health facilities will only service children with certain diagnosis. How the children who fall outside of these categories are serviced, becomes someone else’s problem. Education and disability services again provide extra funded resources for children who meet certain diagnostic criteria. Child Protection is often left with the responsibility of picking up those children in care who “fall through the cracks”, but it appears that they are ill equipped and underfunded to do so. The way in which this grappling for funding dollars within fairly structured service remits and outlines, to adequately service children who are experiencing difficulties plays itself out, can indeed be viewed as questionable as evidenced below.
and deformities can progress quickly; range-of-motion exercises should be routinely implemented in children who are nonambulatory, which may require input from the pediatric physical med- icine specialist. Elimination disorders can be managed with careful attention to regular bowel and bladder emptying, facilitated with regular bowel pro- grams, enemas, bladder irrigations, and intermittent catheterization as needed. Regulation of sleep-wake cycles is an- other strategy to minimize secondary conditions. Children may bene ﬁ t from early intervention services and home occupational and physical therapy for the establishment of exercise regimens and to ensure that appropriate equip- ment is available to optimize mobility and minimize complications (eg, hospi- tal beds, commodes, wheelchairs). Pain in children with complex, chronic conditions may be caused by ortho- pedic, gastrointestinal, or neurologic issues. Their irritability and discom- fort can be distressing to families and homecare providers. It may be chal- lenging to determine whether there is an underlying medical issue causing pain that requires intervention, par- ticularly in a child with limited com- munication abilities. 31 Validated and
When I began my study, the state departmental region was solely reliant upon foster care for out-of-homecare placements and there was a trend towards an increase in the need for out-of-homecare and demand for foster care as the primary option (Ainsworth, 1997; Bath, 1997). While there are now additional options resourced to meet the varying needs of children and young people in care the majority of out-of- homecare in Australia is still provided through foster and kinship care placements (Australian Institute of Health and Welfare, 2012). Although out-of-homecare is viewed as an intervention of last resort, in Australia it is foster care that is acknowledged as the primary strategy to meet placement needs (Commonwealth of Australia, 2009). The need for foster carers has been rising at a time when the availability of people willing to be foster carers is decreasing (Chalmers, Siminski, & McHugh, 2011; McHugh, 2002). The task for foster carers in looking after children and young people who often have complex needs is an onerous one. Increasingly foster carers are expected to be highly skilled and able to offer specialist support to the children placed in their care (Bath, 1997; Butcher, 2005b; Community Services Commission, 2000b; L. Murray et al., 2011). Recruitment of suitable carers is difficult (Bromfield & Holzer, 2008; Keogh & Svensson, 1999), and there are enough disincentives to prompt those who have tried fostering to leave the system (Maclay, Bunce, & Purves, 2006; McHugh, 2011; L. Thomson & McArthur, 2010; Triseliotis, Borland, & Hill, 1998).
Response to Concerns: The Children Acts Advisory Board (CAAB) in conjunction with a number of key agencies and professions including the HSE (policy, inspectorate, and residential managers), the IYJS, the Health Information and Quality Authority Social Services Inspectorate, and with professional guidance from a number of senior clinicians and academics has produced these best practice guidelines for the use and implementation of therapeutic interventions for children and young people in out of homecare settings. A literature review was completed to provide a knowledge base upon which best practice guidelines can be
In some circumstances, it may be appropriate for the case manager to lead and coordinate Looking After Children planning processes. As previously discussed, this could be where case management and care management responsibilities are undertaken by one person (such as for an alternative family placement). However it could also include where a child is being accommodated in a respite service where capacity to lead longer term care planning may be limited. This should be negotiated on a case-by-case basis.
Third, the special issue also aims to gain insight into the experiences of care leavers by examining what their life trajectories looked like after leaving care, what obstacles they experienced, and how they made sense of themselves and their time in care. Only considering objective markers of adult life adjustment may result in an incomplete picture of the lives of care leavers. Moreover, especially their subjective experiences during and after their time in care may be key to understanding why some do and others do not experience poor outcomes in adulthood (e.g. Stein, 2005). The three qualitative contributions to this special issue by Luyten, Nuytiens and colleagues, Cameron, and Cox et al. therefore help to provide a more in-depth understanding of the lives of care leavers.
Adoption is the legal process which permanently transfers all the legal rights and responsibilities of being a parent from the child's parents to the adoptive parent(s). In New South Wales, adoptions are made legally binding by the Supreme Court. For children in out-of-homecare, the parental responsibility order held by the Minister ceases to have effect once an adoption order is made.
1 Education makes a vital contribution to improving the outcomes and lives of children and young people in out-of- homecare. For these children and young people, school is often a place of safety and stability, where they connect with teachers and friends. Participation in education provides a significant gateway through which they can pass into adulthood, employment and effective participation in community life. However, the circumstances and background of children in out-of-homecare mean that they are likely to need additional assistance to gain access to educational opportunities, experience positive school engagement and improve academic performance if they are to realise their full potential.
HCN. The inability to staff medically stable CMC at home prolonged hospitalization and increased health care expenditures to a greater degree in new patients discharging for the first time to HCN than patients with preexisting homecare. DD was associated with tracheostomy and younger age but not the number of prescribed HCN hours or rural residence. Expanding the availability of homecare resources or postacute care facilities for this population could impact LOS. Unplanned 90-day readmissions were due to medical setbacks, not homecare failures. The high prevalence of unplanned 90-day readmissions in our populations may have been potentially preventable but likely reflects the underlying fragility of
The work of the multidisciplinary team in family education is essential for the prevention of complications such as accidental decannulation,    - obstruction of the cannula    pneumothorax , bronchopneumonia aspiration  stoma granuloma    and subcutaneous emphysema  . The the- rapist assists in the process of the care with the TQT, clarifying and integrating the family to homecare , orienting and training everyday skills .
We examine the first three of these domains using the Multistate Foster Care Data Archive, which includes longitudinal placement data allowing us to analyze admissions to care as well as moves across placement settings, permanency outcomes, returns to care, and the length of time children spend in care. These analyses include data from 14 states, in all regions across the country, which provide information for the years spanning 2000 to 2008. These analyses utilize placement data for children placed for the first time between January 1, 2000 and December 31, 2008. We examine the fourth domain using weighted data from the National Survey of Child and Adolescent Well- Being (NSCAW). NSCAW is a nationally representative survey of over 5,500 children aged 0 to 14 who were investigated for child maltreatment in 93 designated areas (counties or child welfare jurisdictions) within a 15-month period starting in October 1999. Finally, as no data exist at the epidemiological level, we examine the fifth domain, developmental vulnerabilities, by summarizing the existing research on smaller samples of foster infants and toddlers.
children entering OHC for the first time during adolescence is a more mixed group. Approximately one- third of the girls are placed by child welfare authorities because of severe behavioral problems. Teenaged OHC recipients are dominated by those having behavioral problems. Other prominent reasons for girls entering OHC in adolescence are severe family conflicts, parental rejection, and runaway behavior. Two out of 3 among these girls have a childhood history of severe household