The UK looking after children approach in Australia

Research Report No. 2 1999

Sarah Wise

Australian Institute of Family Studies, 1999. ISBN 0 642 39469 5

Contents

Table List

  1. Mean AIPS and PIPS scores pre- and post-implementation compared with scores from a UK sample of young people recently exited foster care
  2. Comparison of SEI scores pre- and post- implementation
  3. Adapted Rutter Problem Behaviour Scores pre- and post-implementation
  4. What are the needs of the sample before and after implementation?
  5. How far does the service succeed in meeting needs?
  6. How extensive are the risk factors?
  7. How much information does the care provider have of the child?

Appendices


Foreword

At the Australian Institute of Family Studies we have a long tradition of conducting research related to the influence which families have over how children and young people develop. The importance of families in the lives of children and young people received particular focus during the time the late Dr Harry McGurk had the post of Director of the Institute. As a child psychologist with a commitment to social justice issues involving children, Dr McGurk was responsible for initiating a number of research projects that he believed were important for the wellbeing of Australia's children and families.

Dr McGurk was associated with the Looking After Children project while Director of the Thomas Coram Research Institute in London, and was concerned to see this UK approach taken up in Australia. When it was announced that Looking After Children was to be trialed in Victoria, Dr McGurk was successful in obtaining funding from the Rotary Health Research Fund to conduct an independent evaluation of the trial. The purpose of the project was to determine whether the promise revealed in the United Kingdom would apply in Australia and, if so, to contribute to its wider adoption here. Sarah Wise, the author of this publication, worked on the project from the outset, and took over the responsibility for it after Dr McGurk's death in April 1998.

The UK Looking After Children approach in Australia is a useful resource for anyone concerned with the wellbeing of children and young people who, for whatever reason, are required to live away from the homes of their families of origin. The publication provides an informative account of the development of Looking After Children in the United Kingdom, and a keen analysis of its applicability in Australia. Evidence of the benefit of the Looking After Children approach revealed through the Institute's research, including the lessons that were gained through the pilot, should help inform future delivery of services to children in need of substitute care.

David I. Stanton
Acting Director
Australian Institute of Family Studies


Acknowledgements

This work would not have been possible without the contribution made by the former Director of the Australian Institute of Family Studies, Dr Harry McGurk. It was Harry who initiated the Institute's evaluation of the Victorian Looking After Children project in the hope that the benefits of this UK approach would extend to Australian children in need of substitute care.

Special recognition is given to the Rotary Health Research Fund, who provided funding for the Institute's evaluation of the Victorian Looking After Children project. Also acknowledged are other stakeholders, including the Children's Welfare Association of Victoria, who supported the Institute's involvement in the Victorian Implementation Project, and the Department of Human Services, who gave permission for the Institute to involve client children and their families in the evaluation.

Thanks are extended to Richard Dickins, Policy Manager of the Children's Welfare Association of Victoria, Robin Clark, Senior Research Fellow at Deakin Human Services Australia, and Lloyd Owen, Senior Lecturer at the Department of Social Work and Social Policy, LaTrobe University, who have given support and advice throughout the project, and have been wonderful mentors. Also acknowledged are the valuable contributions of Danni Melidio, who facilitated focus group interviews with young people, and members of the Institute's Looking After Children Research Advisory Group - Rod Pell, Ann Robinson, Rebecca Pirois and Katheryn Howe. Also very much appreciated is the interest shown and time given by care providers, caseworkers, supervisors and coordinators within the agencies.

Finally, a debt of gratitude is owed to the children who were directly involved in the evaluation project - for welcoming me into their homes, for sharing their opinions, and for their moving stories and experiences.

For reasons of confidentiality, names used throughout this book are not the real names of children who participated in the project.


The author

Sarah Wise has worked as a researcher at the Australian Institute of Family Studies since January 1996, and is currently engaged as a Research Fellow within the Institute's Children and Parenting Program. Sarah's research interest is in the broad area of child welfare and developmental psychopathology, and she has published on the topics of child and family support and child care. Sarah is also undertaking doctoral research on the development of problem behaviours among maltreated children.


1. Introduction

Good parenting is a complex, demanding and difficult task. It is also a vital one. A strong and happy family gives children and young people a stable, loving home environment and an open, supportive social environment, and it helps them to be happy, healthy, literate and confident, with a sense of security and identity. The caregiver-child context is, therefore, a core context for human development. However, research has drawn attention to the fact that partnership with, and support from, third parties such as social workers, teachers and health professionals can enhance the capacity of a caregiver to interact appropriately with a child, and can also affect a parent's capacity to facilitate child development. As Bronfenbrenner (1979:12) says, 'Like a three-legged stool, if one leg is broken and or shorter than the others, the support is not very stable, and the structure tends to collapse.' So, from time to time, all parents will need support in order to meet their child-rearing responsibilities.

Children and young people reared in Australian families are normally provided with the essential requirements to ensure their long-term wellbeing into adulthood. In a few families, however, they do not receive a reasonable standard of care and affection, or may experience physical, emotional or sexual abuse, which is detrimental to development. In such circumstances, their removal from their families for long or short periods may be deemed necessary to protect their welfare. In extreme situations, the discharge of parental responsibility may be transferred to the state to ensure that the developmental needs of these children and young people are met. 1

While placement 'in care' is intended to be a therapeutic intervention, a number of studies have drawn attention to the unfavourable aspects of out-of-home placement for the development of children and young people. Research conducted in Australia and overseas has found clear evidence of poor physical and psychological outcomes for some children looked after away from home, raising concerns about the quality of services provided to children and the extent to which the interventions of the child and family welfare system actually meet the needs of those for whom they are intended. Such concerns have recently combined with calls for accountability in the provision of public services from several quarters, increasing pressure on child care agencies to measure the outcomes of services, the effects of interventions provided to children, and the broader outcomes of looking after children away from home.

In the United Kingdom, concerns about the progress of children looked after by local authorities led the Department of Health in England to establish a working party of academics and practitioners. They were commissioned to examine the question of outcomes and were responsible for the development of a tool that would measure outcomes in child care. It was intended that such a tool would be designed to answer questions such as of the following: Do children and young people and their relatives benefit from the experience of substitute care? Do the advantages of substitute care outweigh the disadvantages of separation?

The working party began its deliberation in 1987, and its report, Assessing Outcomes in Child Care (1991), led to the development of the Looking After Children approach. Looking After Children is an assessment, case-planning and review system designed to promote positive development outcomes among children and young people who are required to live away from their families of origin. At the heart of the Looking After Children approach is a series of documents called the Assessment and Action Records (the records), which are the outcome assessment instruments that provide critical information about service quality and the outcomes of children looked after away from home. The Assessment and Action Records have a strong practice base, and are designed for use as part of a continuous process to improve service quality and enhance children's outcomes. Information recorded on the records is collected by social workers and care providers, and is used to inform their practice directly.

The Assessment and Action Record component of the Looking After Children materials produced by the Department of Health project in England appears to be the most comprehensive means of regular assessment available at present for measuring outcomes in child care. At the time of writing, the complete range of Looking After Children materials are being used for gathering information, making and reviewing plans and assessing the experience and progress of all children looked after in over 92 per cent of the local authorities in England and Wales. An adapted version of the materials is being piloted in Scotland (Bell 1998-99).

The assessment, planning and recording tools have also attracted much international interest. There have now been four international meetings in England at two-year intervals, the most recent in September 1999. Already the Looking After Children materials have been translated into other languages and adapted for local legislation and local culture, including work with some indigenous groups.

This work argues that the Looking After Children approach may have measurable benefits for child care services in Australia. The absence of a means to assess the effectiveness of our child care services, or to link the aim of promoting and safeguarding children's welfare to a comprehensive assessment of need, is highlighted as a clear indication of the requirement for such a tool in Australia. The experience of a Victorian pilot implementation of Looking After Children, including details from an evaluation of the success of the pilot in improving the health and wellbeing of the children and young people involved, is reported to demonstrate the potential of the approach to improve assessment, case-management and review systems, and in this way to secure children's wellbeing.

The work is divided into six further chapters and an appendices section. Chapter 2 provides an overview of research related to the health and wellbeing of children looked after away from home, both within Australia and in foreign child welfare systems. Chapter 3 highlights the universal need for outcome assessment in child care and traces the development of Looking After Children in the United Kingdom, including an overview of the practice application of the Assessment and Action Record component of the materials. Chapter 4 highlights the need for a means of assessing child care outcomes in Australia, and provides information about the research and implementation projects already developing the Looking After Children materials in this country. Chapter 5 describes a trial implementation of Looking After Children in Victoria, including an evaluation of the pilot conducted by the Australian Institute of Family Studies. Chapter 6 presents and discusses the findings from that evaluation. Chapter 7 draws together messages from the Institute's evaluation and the experience of implementation in the United Kingdom, which are included to help steer the wider adoption of the approach in Australia.


2. Review of the literature

It is a paramount principle in the practice of child welfare that children and young people should be removed from their families of origin through statutory intervention and placed in substitute care only when it is necessary to prevent significant harm (Fernandez 1996), or as the result of significant dysfunction (Standing Committee of Community Services and Income Security Administrators 1996), and when there is good reason to believe that the wellbeing of the children involved is thereby likely to be preserved and enhanced. Research suggests that the kind of children who become candidates for placement are almost invariably already disadvantaged; they frequently have been subjected to abuse or neglect, are from poor socioeconomic backgrounds, are in poor physical health, and are of low educational achievement.

Moreover, removal of a child from family of origin and reception into the public care system cannot solely be regarded as an end in itself, but as the beginning of a process that should be designed to result in the child having a stable, caring, loving environment on their return to live with their family of origin or in a substitute arrangement. Thus there is a responsibility upon professionals in the care system to provide a stable and caring environment for the child involved, and to ensure that the care the children receive away from the homes of their families of origin leads to an improvement in their welfare. Despite these imperatives, a wealth of research evidence informs us of the poor physical and psychological outcomes of a substantial number of children and young people looked after away from home. 2

Child care studies outside Australia

The most prevalent problems in children looked after away from home in countries outside Australia appear to be psychological. Maas and Engler (1959) found that 40 to 50 per cent of foster care children in nine communities in the United States had symptoms of psychological disturbance, in contrast to 10 per cent in the general school population. Psychological problems of similar breadth and severity were found in children in out-of- home care in studies conducted by Shah (1972); Schor (1982); Moffat et al. (1985); and McIntyre and Keesler (1986). In their study examining referrals of children who have experienced non-biological care, O'Neill and Absler (1999) cited a study by Verhulst and colleagues that focused on problem behaviours among international adoptees. The study found that the prevalence rate of psychiatric disorder was somewhat higher among international adoptees than the general population. In a review of studies undertaken between 1960 and 1970 in the United Kingdom and the United States, Howe and Hinings (as cited in O'Neill and Absler 1999) also found that children adopted by non-relatives were referred to child psychiatric settings at a higher rate than for the general population. Among 1520 new referrals, Howe and Hinings also found that the rate of referral for adopted children was approximately twice that for the general population.

Other studies of the effects of placement in out-of-home care have detailed the lasting and often undesirable effects on children and young people's emotional adjustment (Hodges and Tizard 1989a, 1989b). An impaired capacity for deep and trusting relationships (Bowlby 1951; Goldfarb 1945) and exaggerated dependency and emotional withdrawal during adolescence, even after years in a foster family (Hodges and Tizard 1989a 1989b), have been reported as long-term effects of repeated moves and separation from care providers.

The social development of children and young people looked after away from home has also been described as atypical. For example, Tizard and Tizard (1971) found that children and young people who had experienced institutional rearing tended to be more attention-seeking, 'over-friendly' to strangers, and indiscriminately affectionate to adults than a comparison group of children and young people who had never been in institutional care. In a later study, Hodges and Tizard (1989a, and 1989b) noted that children and young people who had spent the first two years of their life in residential care were likely to have more social and emotional problems than other young people during adolescence. Children 'in care' are also known to be more likely to lose contact with friends and family (Masson 1997).

Other studies have also highlighted further areas of difficulty in children and young people's social adjustment. Kaler and Freeman (1994) found severe impairments in peer relationships in children aged twenty-three months to fifty months living in a Romanian Orphanage. Similarly, Chisholm et al. (1995) found that a pattern of social disinhibition persisted in many children and young people even after adoption.

Conduct problems and antisocial and asocial behaviour, such as offending and substance use, have also been found to be more prevalent among children and young people placed in out-of-home care than in the general population (Shah 1972). Hulsey and White (1989) reported significantly higher scores on the Achenbach Child Behaviour Checklist (Achenbach and Edelbrock 1983) than those for a control group of children who had never been in care. In Lambert's (1981) study of children and young people who had been adopted from care, the proportion given high problem scores was more than double for those children and young people who had experienced placement in out-of-home care than for a comparison group. According to their teachers, 35 to 50 per cent of the ex-placement group tended to be restless, distractible, quarrelsome with peers, irritable and resentful if corrected by adults. In a later study, Hoopes (1982) found that teachers reported similarly high rates of problem behaviours, such as hostility toward adults and anxiety, among a group of children and young people who had experienced out-of-home placements in Delaware. Antisocial types of behaviour have also been found in studies of the long-term effects of out-of-home placements on children and young people who had later been adopted or returned to their biological parents (Hodges and Tizard 1989a 1989b; Goldfarb 1945).

Children and young people in out-of-home placements have also been found to have elevated rates of developmental delay at pre-school stage (Hochstadt et al. 1987; Simms 1989) and at the school-age stage (Moffat et al. 1985). Other educational problems, including low levels of academic achievement and school retention rates, have also been found among children and young people 'in care' (Chernoff et al. 1994; 1996; Moffat et al. 1985; Blyth and Milner 1994; Fletcher-Campbell and Hall 1990; Stein 1997). In a study of educational achievement of a nationally representative sample of youths who lived away from biological parents during childhood (in foster care, living with relatives or in institutions), William Prosser (1997) found that, on average, children who experienced forms of substitute care had lower educational achievement than those who grew up with both biological parents.

Although psychological problems have been found to be the most prevalent among children and young people in out-of-home placements, numerous studies have also detailed differences in the physical health status of children and young people between those in out-of-home care placements and the general population (Keinberger Jaudes et al. 1998). Pinkney (1994) found that children and young people in out-of-home placements are among the unhealthiest in the United States, experiencing higher rates of developmental disabilities, short stature, birth defects and chronic disease than the general population of the same age. Similarly, Takayama, Bergman and Connell (1994) found twice the rates of hospitalisation among foster care children and young people. Bilaver (1998) reported that children and young people in out-of-home placements were more likely to be referred to medical health services. In the United Kingdom, Butler and Payne (1997) found that only one-quarter of the children in the local authority they studied attended statutory medical examinations, and that the quality of these contacts was questionable. In addition, the paucity of research that exists on the sexual health of children and young people in care suggests that they are at high risk for early sexual activity (Risley-Curtiss et al. 1996), sexually transmitted diseases (Polit, White and Morton 1987), and pregnancy.

Child care studies in Australia

Although a number of longitudinal studies relating to the outcomes of looking after children away from home have been conducted overseas (Prosser 1997; Festinger 1986; Tizard and Tizard 1971; Quinton and Rutter 1988; Weiner and Weiner 1990; Fanshell and Shinn 1978), little longitudinal work has been conducted in this area in Australia. Research that has been conducted tends to be short-term follow-up studies and cross-sectional research studies. There have also been some follow-up studies of children once they leave care (Cashmore and Paxman 1996; Maunders, Liddell, et al. 1999).

Despite there being little longitudinal data on the outcomes of looking after children away from home in Australia, we know that state wards are among the most disadvantaged young people in the community. The Burdekin Report into homelessness (1989) pointed out that a great many of the homeless were state wards. Hirst's (1989) research in Victoria found that 59 per cent of homeless young people (0-15 year-olds) are wards of the state, while Carter estimates that up to half of homeless young people in Australia are wards of the state (Carter, as cited in Taylor 1990). Recent Australian research on 1671 homeless youth across Australia found that 1.2 per cent were adoptees, 1.4 per cent were foster children, and 2.7 per cent were in relative placements (Jordan 1994).

The over-representation of children 'in care' in juvenile justice statistics is also well documented. In New South Wales, for example, wards are fifteen times more likely to be accommodated by Juvenile Justice Centres than other members of the juvenile population (Voigt 1997). In Victoria, preliminary work into the overlap of clients between child protection and juvenile justice revealed that 11 per cent of juvenile justice clients were also clients of child protection at some point. Further analysis has shown that a minimum of 17 per cent of juvenile justice clients have concurrent or prior involvement with child protection. Overlap with mental health and alcohol and drug services is also believed to be high (Department of Human Services 1999).

Studies of the effects of out-of-home placements in Australia also tend to mirror the findings of research conducted overseas, highlighting deficiencies in the emotional, social, behavioural and educational outcomes in children and young people. In a study conducted by Elizabeth Fernandez (1996:64) of intervention into families resulting in the removal of children into substitute care, she concluded that 'the findings of the study in relation to the careers of children in the care system provide little evidence that the situations of these children improved as a result of entry into care'. These data reinforce the description by Schor of the child welfare system as 'poor care for poor children' (1975:186) and pose questions about whether the state is providing 'good enough' parenting or implementing practices in the child's 'best interests'.

Findings from the National Children's Bureau of Australia's 1989 survey of children in non-government substitute care in Australia showed that approximately 36 per cent of children surveyed were considered to have behaviour problems (Szwarc 1993), and other statistics show that children in non-biological care are referred to Melbourne's Alfred Child and Adolescent Mental Health Service in far greater numbers than children in the community (O'Neill and Absler 1998). However, the authors have suggested that systemic issues may be involved in referrals of children in non-biological care (O'Neill and Absler 1999).

Australian research has also highlighted poor educational outcomes among children who are looked after away from home. A study commissioned by the Children's Welfare Association of Victoria conducted by the Australian Council for Educational Research examined absenteeism and the educational needs of children and young people aged between five and seventeen years in state care in Victoria. Based on a survey of 1132 children and young people (75 per cent of population of children and young people living in residential and home-based care in Victoria), the study revealed that one in four children regularly stay away from school, and about 7 per cent of younger children aged five to eight were staying away from classes. The study also revealed that while 47 per cent of those in care were identified as having at least one learning or behavioural difficulty at school, the services provided were often not sufficient to address the problem ('Absenteeism high for one in four state care pupils', Age, 17 February 1998). Another Australian study of the educational needs of children in residential care has found that more than half of the sample population of 487 children and adolescents were below average age levels in literacy, numeracy, social skills and emotional and behavioural development (Cavanagh 1995).

In their study of wards leaving care, Cashmore, and Paxman (1996) reported that 23.4 per cent of their New South Wales sample of children and young people in 'out of home' placements had finished school below Year Ten, and only 6.4 per cent had completed the Higher School Certificate. In an earlier Australian study, Cliffe and Christie (1980) warned of interrupted attendance and frequent school changes among children and young people in residential care.


3. Looking after children away from home

Most societies provide some means of caring for children whose parents are unable or unwilling to care for them. The goals of this care, and the ways in which it occurs (within family or institutional settings, for example), can be important indications of how a society views its children and their upbringing. Until the beginning of the 1990s, it was generally accepted that separating deprived and maltreated children from their families of origin would lead to improvements in their care and, subsequently, improvements in their health and wellbeing (Ward 1993). Consequently, the outcomes of children looked after in the public care system were rarely examined, and social work practice operated on the assumption that interventions would prove beneficial to the children and families concerned.

During the 1990s, there has been a comprehensive revision of the out-of-home service system as a result of an increase in the amount of attention to child development needs, permanency planning and support to families 'at risk', and recognition of the paramount relationship between the child and their family of origin. These developments have led to a considerable erosion of the part played by tradition in the practice of child and family welfare, and a climate in which the need to develop a means of assessing outcomes of social work interventions with children has become a pressing concern.

New legislative structures adopted throughout the western world have swept aside several ways in which children could be separated from their families. The US Adoption Assistance and Child Welfare Act 1980, for example, emphasises placement prevention by focusing on the primary importance of services to families to avoid removing children into foster care. It enshrines the principles of permanency planning, which require that child welfare agencies form prompt and specific plans for children, either to return them to their birth homes or to provide them with adoptive parents (Bullock et al. 1991). The UK Children Act 1989 also codified the concept of parental rights by legislating that parents can no longer lose parental rights and responsibilities, except through adoption.

Similar principles are enshrined in the child welfare legislation of most Australian states and territories. In Australia, national out-of-home care standards have also been developed to promote a positive outcome and a common approach for all children, young people and their families who use the system. These standards adopt principles of permanency planning, accountability at reception, reunification and reconciliation, reception into out- of-home care only as the result of significant dysfunction, and out-of-home care for voluntary placements where the family requires temporary or ongoing support (Standing Committee of Community Services and Income Security Administrators 1996).

Research highlighting poor physical and psychological outcomes among children 'in care' from about the 1970s, and the discovery that children looked after away from their families of origin are not always protected from abuse (Farmer and Pollock; Hughes; Levy and Kahn; Williams and McReadie, as cited in Ward 1996), also challenged the assumption that the outcomes of social work interventions are beneficial to the children and families concerned, and created pressure for social workers to be more answerable to their clients, and for child care agencies to demonstrate the outcomes of the service they provide.

The establishment of a number of consumer groups, the institution of complaints mechanisms and increasing attention to the needs of birth parents are further trends that have compelled child and family welfare workers to consider the perspective of children and their families in decision-making, and to assume greater accountability for the outcomes of their interventions. The wider movement toward accountability in public services, which has been promoted by the pressure to gain value for money in service provision, has created even further pressure for child care agencies to demonstrate the efficacy of their services and to consider the outcomes of casework practice.

Despite the increasing demand for a means of assessing the outcomes of looking after children away from home, child care services in Australia and elsewhere have rarely gathered information to find out how the experience of being looked after affects children's subsequent health and wellbeing. When agencies have looked at the outcomes of their innovations they have tended to measure the success of services against factors that research suggests can predict child outcomes - single issues, mainly service outputs, such as the stability of placements or the proportion of children in foster or residential care. Many child care agencies gather information only haphazardly about both the characteristics and the progress of children for whom they accept and share responsibilities rather than measuring aspects of their service related to the quality of care and the effect on short-term, medium-term and long-term outcomes of interest.

The absence of a means of routinely collecting the information necessary to make such assessments and the complexity involved in differentiating the effects of interventions on children's outcomes from other effects are problems likely to have inhibited attempts to measure the effects of services on child outcomes (Ward 1996).

The UK Looking After Children project

Concern about the outcomes of looking after children away from home has a long history in the United Kingdom, and can be traced to events that were occurring early in the 1970s. Of particular importance was the introduction of legislative change in 1975, which was prompted by intensive media, public and government concern about the nature and quality of child welfare policies and practices. Nine research studies were commissioned to report to Parliament on the 1975 Act. These were carried out in forty-nine Social Service departments between 1979 and 1982, and involved a total sample of two thousand children in care. The findings from the nine research studies were published in a Department of Health and Social Security report (1985). The practice and policy themes outlined in this report, which relate to the delivery of child care services, are neatly summarised in Michael Clare's (1997) account of the development of Looking After Children in the United Kingdom.

Concerns about the findings reported in the Department of Health and Social Security publication and other forces that were increasing demand for a means of evaluating the effects of services provided to children 'in care' were encapsulated in a major research project funded by the Department of Health and Social Security in England. The purpose of this project was to develop an outcome assessment instrument that would produce an aggregate picture of the characteristics of children and young people being looked after in public care, the services provided for them, and the outcomes of their experiences. The result of the theoretical framework constructed by the working party was a series of measures to indicate the success of the social work intervention, called the Assessment and Action Records (the records). The Assessment and Action Records were published in 1991 together with a package of complementary forms designed to encourage the local authorities to integrate them into a comprehensive system for planning and reviewing children's cases. The complete set of practical measures produced by the working party on assessing outcomes in child care are known as the Looking After Children materials.

The Looking After Children approach has two explicit purposes: a practice function and an information and research function. The practice function, which is the primary focus of this work, aims to improve radically the standard of care provided for children looked after away from home through better supervision and planning, and to stimulate better inter-agency working. The information and research function aims to provide management with systematic information on the characteristics of the children looked after in their areas; on the quality of care they receive; and, ultimately, on the outcome of intervention. Much of the work that has been undertaken to date has involved the development and implementation of the Looking After Children materials. Current work is being undertaken to research ways of using the information recorded on the Looking After Children materials for management purposes.

After their publication in 1991, an extensive program of evaluation was carried out over three years in order to test some of the assumptions upon which the records were based. As part of this evaluation, the Assessment and Action Records were piloted in five local authority Social Service departments, and assessments were completed on a sample of 204 children and young people who were expected to spend at least a year in care or accommodation. This research was designed to discover how, or indeed whether, carers, social workers, and children would use the records, and the circumstances under which the work might best be taken. This study highlighted many of the issues that would need to be addressed by any organisation attempting to assess outcomes in the manner proposed3 . To test that the tools reflected the concerns and aspirations of ordinary parents, the records were also tested on a randomly selected group of 379 'non-client' children. This component of the evaluation showed that parents agreed that the age- related objectives identified in the Assessment and Action Records are likely to lead to successful outcomes. The study also confirmed that the records reflected the broad aims and assumptions of most parents in the community.

Social workers, carers, parents and children who completed the records for the two study groups were asked to provide formal feedback on the content of the materials. Responses from these groups identified a number of matters that needed further consideration. In particular, the study showed that the concerns of children with disabilities were not adequately addressed, and that the materials were not always applicable to children from minority ethnic groups. It was also evident that further work needed to be undertaken to ensure that outcomes measures used by social services aligned with procedures already in place in health authorities and education departments. Despite these difficulties, responses in the evaluation demonstrated that the issues covered by the records were generally both acceptable and important to care providers, social workers and children and young people in care or accommodation. Problems identified in the first edition of the records were rectified, and a revised version was published by the Department of Health in 1995.

The Centre for the Education and Training of Social Workers (CETSW) also funded a project to evaluate the use of the records as learning tools in four Diploma in Social Work programs in 1995-96. At the University of York, the experiences of participants using the materials were evaluated after post-graduate social work students and their practice teachers used the records during direct work with clients. The perceptions of service users, foster carers and the young people involved are reported in an article by Margaret Bell, a lecturer in social work at the University of York (Bell 1998-99).

For the Looking After Children approach to develop further and provide systematic and comparable data to agencies providing residential and care services, it is essential that the potential of the Looking After Children materials as a management information and research tool be realised. Preliminary studies funded by the Department of Health are currently under way in the United Kingdom to inform the best and most efficient way of aggregating the Looking After Children information for management and research purposes. The project aims to investigate whether data collected using the Looking After Children materials produce the appropriate management information that agencies and government departments need in order to monitor effectiveness of services for looked after children, to identify whether improvements can be made and how resources can be better delivered, and to provide information on children as groups.

Research evaluating the use of Looking After Children data for management purposes is being undertaken by Dr Harriet Ward, who has been a member of the Dartington Social Research Unit but is now located in the School of Social Work at the University of Leicester. This research has three elements. The first involves an audit of the quality and completeness of the data collected in six authorities and the development of a list of key information that can be abstracted from the complete set of Looking After Children materials. A first version of this key list has been drawn up by the research team working with thirteen authorities. The second element is a study that, in three successive years, will examine the characteristics of looked after children, changes to the quality of care provided by authorities, and changes in the two. The third study, also over three years, will look at the care careers and psychological development of children who enter long- term care in relation to their individual needs and circumstances.

Work is also being undertaken on the reliability and validity of the sections of the Assessment and Action Records dealing with emotional and behavioural difficulties. This section has been chosen first because it is high on the list of local authority concerns, and because understanding of outcomes depends critically on sound baselines in this area. This work is being undertaken by Professor David Quinton at Bristol University.

The Department of Health has also auspiced a project that has the objective of adapting the Assessment and Action Records for use with children 'in need', that is, children in the community needing assistance to achieve better functioning or children needing protection.

Once the development and implementation phase of the UK project is complete, the Department of Health is planning to take a less central role, and thus detailed analyses of the Looking After Children data are likely to be the responsibility of the authorities themselves. To help the authorities in this task, a data analysis network is planned to be implemented over a three-year period, which is to maintain the integrity and consistency of the Looking After Children system. The three-year development phase will initially involve the establishment of the first two of a number of regional centres, each with an advisory group involving participating authorities and with an overall coordinating committee linking the centres. The initial two centres will be based at the School for Social Policy at the University of Bristol, under the direction of Professor David Quinton. The second will be the School of Social Work, at the University of Leicester, under the direction of Dr Harriet Ward.

Other research initiatives

The Looking After Children approach has the potential for providing quantifiable information which will be of considerable assistance to researchers with an interest in child welfare. The results of outcome research will also have an important part to play in enabling the teachers and trainers of social workers to test and evaluate the information, perspective and theories about work with children that they offer to students.

Following the Third International Conference on Looking After Children held in September 1997 in Oxford, an international research committee was established to conduct cross-cultural research and international comparisons using the Looking After Children data.

Information from the records is also being used in a project called Evaluating Child Welfare Outcomes in Ontario, Canada. In its first report of empirical findings, this project assessed the test-retest reliability and convergent validity of single items from the records. It also compared developmental outcomes of forty-three children cared for by the Prescott-Russell Children's Aid Society and those of an approximate comparison group of 1600 children from the National Longitudinal Survey of Children and Youth (Prescott- Russell Children's Aid Society 1998). The findings showed high and low reliability and validity for different items on the records. The children in care had worse outcomes than the comparison children on indicators of educational success and negative behaviour, but not on measures of identity, social and family relationships, or pro-social behaviour (Flynn and Biro 1998).

The Prescott-Russell management team have used the data collected from the Looking After Children materials to obtain a picture of the characteristics of children in its care population, to guide its decision-making processes, and to prioritise specific agency objectives.

Assessment and Action Records

The UK Looking After Children project began with the establishment of the Department of Health Working Party on Child Care Outcomes, which comprised academics and practitioners with expertise in the child welfare field. The working party needed to give consideration to a number of technical and theoretical issues to establish a scheme of outcomes evaluation for child care services.

Perspectives on outcomes

The performance of a social service organisation can be seen from a number of different perspectives, all of which imply a different way forward for the evaluation of child care outcomes. In the report of the working party (Parker et al. 1991:20), five kinds of outcomes that reflect different perspectives and interests are outlined, including public outcomes, services outcomes and individual outcomes. Although it appreciated the importance of each perspective, the working party concluded that since the overall objective of the social work intervention was to enable children to achieve 'long-term wellbeing in adulthood', outcomes from child care would be measured in terms of children's functioning.

Construction of outcomes

Evaluating outcomes in terms of the extent to which the care experience impacted on subsequent development presupposed the construction of developmental outcome measures. These measures ask how far the specific objective of each particular social work intervention had been achieved in the context of assessing how far children's overall life changes had been improved (Ward 1996:243; Parker 1998; Parker et al. 1991). Examinating the effect of the social work interventions in terms of children's wellbeing brings attention to the parental responsibilities of the child care agency, rather than simply focusing on the specific aims of separation. Evaluating outcomes in this way also enables the effect of being looked after for any significant period of time to be measured.

It was also decided to adopt an uncalibrated developmental measure, which simply specified a number of specific outcomes or aims related to children's age and different dimensions of wellbeing. Children's general condition is, therefore, measured by using a number of indicators rather than attempting to develop a measure that specificies outcomes in detail. This decision was arrived at because of methodologcial problems related to the development of scales with qualities that would measure the outcomes of interest, such as reliability. Further problems related to the administration of such measures, and the fact that they only have meaning at an aggregate level, informed the decision as well.

The Department of Health Working Party identified seven developmental dimensions along which children need to make satisfactory progress if they are to achieve long-term wellbeing in adulthood. These dimensions are heath, emotional and behavioural development, self-care skills, family and social relationships, identity, education and social presentation. The theoretical basis for selecting these dimensions is outlined in the report of the working party (Parker et al. 1991:84-100).

Items on the records are designed to discover whether children are receiving certain inputs that research on effective parenting suggests are necessary to achieve fundamental aims related to children's age and the developmental dimension being assessed. Therefore, the records not only assess how far children are progressing across the spectrum of development, but also examine the extent to which they are given the opportunity to succeed. Thus the measures identify how far social service agencies are providing children with the type of experiences they need in order to make satisfactory progress, or failing to do so (Ward 1996). For example, the research evidence suggests that four-year-old children need to be read to and need to have access to books to achieve satisfactory progress in their education. Consequently, the records ask whether these experiences are provided to the children concerned. Responses to these questions provide a measure of how far the developmental needs of children are being met. In addition to questions related to parenting inputs, within each of the seven areas of development the respondents are also invited to assess how far the child is progressing toward a series of age-specific objectives (Ward 1996:243-4).

The introduction of the records throughout an agency providing placement and support services will therefore produce a pool of information about children's experiences and developmental progress. Data on individual children, collected over time through completion of the records, will provide a historical record of progress across the range of developmental dimensions and will show where additional help is needed.

Evaluating children's wellbeing

As already mentioned, the Department of Health Working Party identified seven dimensions upon which children's outcomes can be considered, and argued that an 'outcome' needs to be disaggregated into different areas of a child's life. These separate areas have not been re-assembled to obtain an overall outcome score for practical and theoretical reasons, which are explained in detail in the report of the working party (Parker et al. 1991).

The records also do not include a definition of what is a good or bad result after an assessment has been made, as the favourable or unfavourable nature of an outcome is often difficult to determine, except in extreme circumstances. This is true for both individual or organisational outcomes. With respect to the individual child, the comparisons are liable to be made with other children in similar circumstances. How the individual interprets their experience is also of considerable importance.

Relationship between individual and aggregate outcomes

Developing an outcomes assessment tool for individual children raises the question of what exactly the relationship is between the way in which organisational performance is assessed, and the manner in which the assessment of outcome for individual children is approached (Parker 1998:194). In particular, the ease with which data about individual children can be aggregated to assess organisational or service outcomes or performance is an important issue.

The records have been designed so that information about outcomes is collected in a format that can be aggregated. If this is done systematically, evidence about group outcomes can demonstrate the strengths and weaknesses of the service as a whole, so the information can be used to direct policy and decide where scarce resources can best be deployed. As Harriet Ward (1996) notes, 'It is only when the records are used for this purpose that they will be properly integrated into the structure of an organisation and their full potential exploited.'

Linking outcomes evaluation with practice

Studies of social work decision-making show that what is known about the experiences that are necessary to ensure children's developmental progress, and what little is understood about negative aspects of being looked after away from home, are often not always reflected in casework practice. In their work, Knapp and colleagues (1985, as cited in Parker, et al. 1991) found that social workers tend to disregard health and education, considering them to be matters for the attention of other professionals, whereas parents give them high priority. Studies conducted in the United States and Europe have also shown that children and young people often remain in care for long periods of time (Szwarc 1985), experience instability in relationships through multiple placements (Berridge and Cleaver 1987), receive little attention to their education (Grimshaw 1994), and are often prevented from maintaining links with parents, kin and caregivers.

Studies of the effects of out-of-home placements on the health of children and young people have also suggested that medical and mental health care is not always obtained when needed (Combs-Orme, Chernoff and Kager 1991). Moreover, there is evidence to suggest that children and young people in out-of-home placements rarely receive specialist help with emotional and behavioural difficulties, although these may have been a major factor in the decision to separate children and young people from their families (Millham et al. 1986). Furthermore, inadequate systems to monitor children and young people in care and other organisational risk factors such as frequent moves, poor long- term planning, and the absence of a designated social worker, are believed to lead to practices that can adversely affect outcomes for children (Voigt 1997; Chernoff et al. 1994; Risley-Curtiss et al. 1996; Combs-Orme, Chernoff and Kager 1991).

In their deliberations, the working party decided that any evaluative instrument they proposed should offer social workers and care providers as much direct and current information about processes and outcomes as possible (Parker 1991:39). The assessment process is, therefore, designed as part of a continuing process in which information is produced regularly for participants in a way that is intended to influence their behaviour directly. Implicit in the choice of a model that would provide this sort of information is a longitudinal approach to evaluation. Consequently, specification for the timing and frequency of assessments was included in the model. The process of evaluation that underpins the Looking After Children approach, and the improvement of practice that is believed to flow from it, will provide the focus for the remainder of this work.

Moving from assessment to action

Following the above overview of the development of the records in the United Kingdom, and the two primary functions for which they serve, the focus of this work is now on their practice function, and in particular the potential for their use in 'out-of-home' care services in Australia. The records have specifically been designed for use during regular casework practice; the information collected is intended to provide social workers and care providers with information that can directly influence their decision-making, and is expected to lead to an improvement of practice. The records also provide a model for moving from simple assessment to action, which, by focusing on parenting and development opportunities and outcomes, is intended to lead to an improvement in the quality of care provided to children and young people.

The records also act as an informational resource for children and young people, care providers and families, so that information about children's progress and intervention is not 'lost', and so interventions that are undertaken on children's behalf are not interrupted as the result of staff turnover or changes of placement. Thus, in addition to their function to gather data, which can be used for a range of purposes, the records can be used on two other levels: as discussion documents to facilitate casework between field social workers, care providers and clients, and as planning tools for care providers and clients.

Process of assessment and action

The Looking After Children method of assessment, case-planning and review is a four- stage process, and the format is the same for each of the seven areas of health and wellbeing already identified.

The first stage is a statement of objectives. For each of the seven areas of health and wellbeing, the records explain the overall objective of the assessment, case-planning and review process. The objective of parenting in the social and family relationships section, for example, is to provide children with a stable home environment, to ensure close, emotional ties with at least one care provider; to promote, where appropriate, contact with members of the child's family of origin; and to encourage healthy peer relationships.

The second stage is an assessment of whether care providers are providing children with opportunities that, according to research, children require to ensure their long-term wellbeing into adulthood. It is intended that field social workers, care providers, clients and their families are consulted in the assessment process. Further to this assessment exercise, respondents are asked to note how omissions will be rectified and to give explanations for any decision not to take actions that would appear to be warranted. The records therefore set an agenda for good parental care by identifying the necessary experiences, concerns and expectations of children at different developmental stages. Field social workers can also use information about the action needed to facilitate casework between workers, care providers and clients.

The third stage is an assessment of how far the child is progressing toward a series of age- specific objectives, which reflect the statement of objectives outlined at the beginning of each section. Once again, field social workers, care providers, clients and their families are consulted in the assessment process, and there is a section to record details of consensus or disagreement on the assessment.

The fourth stage in the process is a summary of work to be undertaken. At the end of the records there is a section to record work to be undertaken in relation to each of the seven dimensions.

To make the task of assessment more manageable, children for assessment are divided into six age-groups, chosen to cover key stages in psychological development rather than equal chronological periods (Ward 1996). There are six age-related records for children who are under one year, one to two years, three to four years, five to nine years, ten to fourteen years and fifteen years and over. It is intended that these instruments be used at regular intervals for each child in care.

Benefits for practice: setting a discussion agenda

When used as a focus of discussion, the records ensure that all aspects of development are monitored and assessed. Because the records are based on research evidence about effective parental practices, their regular use will convey important information to care providers in an easily digestible form. New information will also be passed on as the records are updated to take account of the growing body of knowledge about effective parenting.

Research conducted in the United Kingdom found that when the records were used as intended, important issues were identified that could be easily addressed through simple actions. For example, one pilot revealed that 25 per cent of sixteen-year-olds had received no information about contraception or sexually transmitted diseases. Use of the records also identified several short-sighted children who had lost or broken their glasses in earlier placements but whose new care providers were not aware that they needed to have them replaced (Ward 1996:246). Research conducted in the United Kingdom also suggested that the records were a useful way of opening up discussion with children and young people who found it difficult to talk about certain areas of their lives (Ward 1996). Foster care workers also found that regular use of the materials increased their sense of professionalism, and residential workers also felt the experience was useful.

Benefits for practice: plans and reviews

The information that is collected during the assessment process is designed to improve the nature and quality of decision-making in child welfare practice, which was a major problem identified in the Department of Health and Social Security Report (1985). As that report noted, 'Social workers and their seniors are not offered the opportunity to acquire the sophisticated skills, knowledge and qualitative experience to equip them to deal confidently with the complex and emotive issues raised by work with children and families.' Consequently, the records aim to provide a picture of the children's circumstances and to analyse how they might be helped further. Effective strategies can be devised to improve the progress of children on the basis of the information recorded on the records.

Within the complete range of Looking After Children materials are special planning and review forms, which are linked to the records in ways that meet the detailed requirements of the Children Act 1989. These forms demonstrate how responses to questions on the records can be used in developing a care plan.

Research conducted in the United Kingdom found that the complete range of Looking After Children materials does make it easier to plan improvements and to monitor how far these have been carried out. Evidence from the pilot also suggested that the entire process ensures the recording and regular updating of essential information in one accessible place. The process did prove difficult to repeat a year later under pilot conditions, however, because of staff turnover and changes of placement, and there was evidence that some people involved in the assessment process did not appreciate that the plans for remedial action were intended to be translated into practice (Ward 1996:247).

Practice principles

The Looking After Children materials are informed by the principles of the Children Act 1989, with a stated intention of strengthening working partnerships between the key people in a child's life and other neighbourhood networks, and to stimulate better inter- agency working in planning for children and young people during placement. It is also a stated intention to listen to the young person's views and wishes in making decisions that affect their lives, and to explore the potential strengths and resources within birth families themselves. The Looking After Children approach to practice also emphasises the importance of time as a significant variable in the care career of a child (Clare 1997).

Other principles embodied in the Looking After Children approach include practices that are consistent with the concerns and practices of ordinary parents; a broad perspective on child welfare; the monitoring of children and young people's developmental progress; appropriate action to remedy any deficits in the quality of care received; a deep and continuing sense of responsibility for each child; promoting continuities in the lives of children and young people; a focus on children and young people's long-term development; reducing, or where possible eliminating, placement disruption; and aggregating the characteristics of children and young people looked after, the services provided for them, and the outcomes of their experiences.


4. Assessing child care outcomes in Australia

Despite the clear priority in child welfare law across the country that the state, in assuming guardianship or custody of children, will act as 'the good parent would', the effectiveness of our child care services has never been measured, and there are no ties to how 'acting as the good parent' can be attained in practice, particularly how to achieve balanced psychosocial development in the context of a system of care.

Despite attempts to enhance the rigour of social work practice, there has been no direct attempt to establish practice indicators linked to successful outcomes for children and young people looked after away from home. However, research has identified some practice indicators linked to successful outcomes of work involving young people leaving school before the legal school leaving age. These were first established in the Under-Age School Leaving Project (Brooks et al. 1997:7). The project targets nine common strategies used by initiatives for 'at-risk' youth. Similar factors contributing to under-age school leaving have been established and applied in relation to the responsibility of schools in meeting the needs of at-risk students in the Galilee Day Program (Long 1998).

Several commentators have drawn attention to the absence of detailed reference to standards of care for children who are under guardianship orders in the Australian law. As Max and Margaret Liddell have noted (1997), 'Most states/territories now adopt common supporting principles in their legislation (sometimes implicitly) such as the need for the child to be safe; strengthening family relationships whether the child is living at home or not; avoidance of unnecessary disruption to the child's familiar environment; preservation of racial, ethnic, religious and cultural ties and identity; involvement of children and their families in decision-making; and prompt and timely decision-making.' However, there has not been any strategy established within any state or territory to define the steps that need to be undertaken to reach these outcomes.

Quality of care issues are usually addressed at a policy or procedural level rather than at a legislative level. For example, all states and territories are now acknowledging the National Baseline Standards for Out-of-Home Care endorsed by the welfare ministers in 1995 (Standing Committee of Community Services and Income Security Administrators 1996), and residential services usually embody their own 'mission' statements and objectives in residential care programs.

Research evidence suggests that there are similar gaps between ideological assertions about the aims of social work intervention and the practice experience. This point is emphatically spelled out by Tregeagle and Voigt (1995), who argue as follows: 'Law and social work need to acknowledge the poor outcomes experienced by young people unable to live with their families. Despite welfare rhetoric and laws which espouse appropriate principles, few of the issues raised above are being appropriately addressed in practice. This is partly a resource issue, but also results from poor focus within the system on goals for young people in care. The 'best interests' of young people are not being met, nor is Australian child welfare meeting its professional or international treaty obligations.'

Although there has not been an expressed attempt to establish a practical means of ensuring that children's welfare is promoted, professional opinion at the moment is that 'best interest' outcomes are achieved by working toward normal psychological development (Tregeagle and Voigt 1995). Alternative care is also expected to accord with expected community standards and norms, and quality of care is advocated.

The need for comprehensive information

There has been very little comprehensive research into out-of-home care systems or evaluation of their effectiveness in Australia, particularly at the national or state level4 . No data are available to assess the effectiveness of service systems across the states and territories. Although there is a great deal of data about the outcomes of interventions at the 'front end' of the child protection system, especially the outcomes of notifications, there are considerable deficits in data that measure outcomes at the 'back end'. For example, on a national basis data are not collected on the number of young people who are leaving care each year, let alone critical data on health and wellbeing outcomes (Green 1998).

Repeated calls have been made over the years for more consistent and comprehensive recording system for statistics on the out-of-home care of children (Ministerial Review Committee 1992:15-17; Mowbray 1992; Senate Standing Committee on Social Welfare 1985:58-9). For approximately ten years prior to 1984, statistical data collected by the Australian Bureau of Statistics, in collaboration with the Standing Commitee of Social Welfare Administrators, provided the main source of information on children in out-of- home care. Since that time, only very limited information has been available about children in substitute care in Australia.

One significant attempt to provide detailed information about the characteristics of children in substitute care was produced by the Children's Bureau of Australia (Szwarc 1993). Three national surveys were conducted in 1979, 1984 and 1989. Three reports, which publish findings from each survey, provide a detailed picture of the characteristics of children looked after by non-government operated services.

However, from the data that is currently available, it is not possible to determine national patterns for other important dimensions of care. As Howard Bath (1994) has urged, 'national initiatives are needed to facilitate the compilation of a reliably and regularly up- dated data base to inform policy and decision-making'.

Although some outcomes data may be collected by the agencies providing residential services, the key performance measures that are used by child care services usually concern service outputs: the number looked after, the type of placements they receive, the duration of each care episode. They rarely examine information about outcomes, or the impact of services on children's long-term life chances.

However, the need for a more comprehensive outcomes framework has been recognised by the relevant government departments. In May 1998, an international literature review and critical analysis of child protection and supported placement outcome indicators was commissioned by the Steering Committee for the Review of Commonwealth/State Service Provision (SCRCSSP), on behalf of the states and territories. The report by consultants Gain and Young (1998) noted that development and implementation of outcome indicators is still in its infancy, despite much discussion about their desirability over the past fifteen years. Thus, no preferred indicators for the child wellbeing goal were identified, given the lack of well-developed and well-tested indicators in the international literature.

A number of agencies that provide residential and foster care services around the world have been following closely the development and implementation of Looking After Children in the United Kingdom, and have been concerned to introduce the system within their own agency (Ward 1996). The materials are being adapted to meet the specific circumstances of a number of countries, and practice implementation is underway in Britain, Belgium, Canada, Norway, Sweden and Australia, and interest has been shown by people in many other countries, including New Zealand and Russia (Department of Health 1997). A system of licencing has been developed which potentially helps to track development, to preserve the integrity of the work and to permit sharing of the knowledge gained. The interest has spread through Europe and North America. Within Australia there is interest in its potential for use in research, and service quality improvement possibilities. Some administrators also find its system accountability possibilities attractive.

Looking After Children in Australian states and territories

Within Australia, a perceived need for a more long-term focus on caring for children and young people and greater consistency in the standard of care provided to children and young people during placement have been the catalyst for incorporating Looking After Children on a trial basis in several state child welfare systems. 5 However, very little work has been undertaken to coordinate efforts, or to monitor developments in each state to inform work happening elsewhere.

Lloyd Owen, a senior lecturer in social work and social policy at La Trobe University in Victoria, has been keeping informed about the progress of projects around the country. In November 1996, Mr Owen coordinated an Australasian seminar on Looking After Children, which was attended by Dr Harriet Ward, one of the original members of the Department of Health working party and principal investigator in current stages of the UK Looking After Children project.

Mr Owen is the principal source of the following information about the status of projects in the relevant Australian states and territories.

Australian Capital Territory

Staff and care providers in Barnardos in the Australian Capital Territory (ACT) have also introduced the Looking After Children approach to caring for children looked after away from home, and have revised the full range of materials so that they are consistent with the ACT legislation. Staff from Family Services in the ACT are currently showing interest in the use of Looking After Children, although there is no formal implementation project currently under way. However, a 1998 Substitute Care Review has recommended the introduction of Looking After Children as a method of case management.

New South Wales

In New South Wales, Barnardos has moved to full agency implementation of Looking After Children for children in their care. In partnership with the University of New South Wales, they are adopting an agency approach to localising the forms for others. Barnardos and Dr Elizabeth Fernandez of the University of NSW Social Work Department have also obtained Australian Research Council funding to conduct a national longitudinal project over ten years, 'Looking After Children, Pathways in Care', which involves the measurement of outcomes for children in care using select items from the Looking After Children materials and other outcomes measures (Gain and Young 1998). At the time of writing, the Department of Community Services in NSW was conducting a feasibility study of the state-wide implementation of Looking After Children, due for completion by September 1999. This study was prompted by the NSW Children and Young Persons (Care and Protection) Act 1998 (to take effect from July 2000) and its regulations and guidance, and the NSW Standards for Substitute Care Services, which was published in September 1998.

Northern Territory

In the Northern Territory, limited trialling of Looking After Children has been undertaken by the community-based sector, with some interest from the statutory departments. The government has also incorporated elements of the Looking After Children approach into its case management system with children in care.

Queensland

The Queensland Government has also expressed an interest in Looking After Children, although no formal work is currently under way.

South Australia

In South Australia, the Department of Family and Community Services has trialled the Looking After Children materials in three locations. The Government has also endeavoured to investigate the applicability of the Looking After Children materials to the South Australian legislative environment, and to those children in state care who have an Aboriginal cultural heritage and who have a non-English-speaking cultural heritage. Consideration was also given to whether Looking After Children, after adaptations to its standard documents and forms, is suitable for state-wide implementation across South Australia.

Tasmania

The Tasmanian Government engaged Barnardos to adapt Looking After Children for local use, however training and implementation has been put on hold pending resolution of budgetary problems.

Victoria

In Victoria, Kildonan Child and Family Services obtained a research licence and began using the materials within their agency in 1994. As a result of this work a group of interested agencies from the community-based sector who heard about Looking After Children began meeting, and this led to a grant application under Children's Welfare Association of Victoria auspice. Funds were allocated by the Stegley Foundation for a pilot on condition of a matching grant being obtained from the state. Implementation of the trial was conducted by Deakin Human Services, with a Rotary-funded evaluation by the Australian Institute of Family Studies.

Western Australia

Developments using the Looking After Children materials are most advanced in Western Australia. Michael Clare of the University of Western Australia discovered Looking After Children though a number of contacts with the project as it developed in the United Kingdom. He then used his sabbatical in Western Australia to pursue some trials of Looking After Children with agencies and departmental offices. The pilot was evaluated in the same year (Clare 1996). The trials were generally successful and have been extensively considered by departmental staff and agencies. State-wide adoption and adaptation of the Assessment and Action Records has now commenced, and will be used for all wards in the care of Family and Children's Services (FCS).

There are three other projects in Western Australia using the Looking After Children materials. The 'front-end forms' will be piloted with a view to their implementation in FCS, with implications for case planning, goal setting, and monitoring of FCS and non- government agencies providing foster care and residential care.

There is also a Leaving Care Project funded by the ANZ Foundation involving a training and mentoring programme provided by the Western Australian Association of Young People in Care. There will be an evaluation of the pilot programme, a literature review and draft standards for a Leaving Care Policy. The report is due by the end of 1999. The self- care dimension of the Assessment and Action Record for children fifteen years and older will be part of the recommended resources for case managers preparing a young person for independent or independent living.

Michael Clare has also secured research funding in partnership with the Department of General Practice at the University of Western Australia to evaluate general practitioner services for children in care, involving all stakeholders and critiquing the health dimension of the records. Consideration will be given to the value of a portable health record. Permissions have been secured and initial interviews have started. The project should be completed by the end of 1999.


5. Evaluation of a pilot implementation

The development of the Looking After Children materials in the United Kingdom involved extensive piloting, and the introduction of the materials into local authorities is subject to ongoing monitoring and evaluation. Although much work has been invested in the development of the Looking After Children materials, little research has been undertaken into whether Looking After Children actually succeeds in meeting the aim of improving children's health and wellbeing (Ward 1996). The research that is currently being undertaken over a three-year period under the direction of Dr Harriet Ward aims to establish whether implementation of the Looking After Children materials leads to improvement in the quality of care children receive and, ultimately, improvement in outcomes among the children and young people concerned.

In Victoria, a pilot implementation of Looking After Children into an initial five agencies providing residential services was evaluated by the Australian Institute of Family Studies to determine whether the use of the records would lead to improvement in physical and psychosocial health and wellbeing.

Overview of the Victorian pilot project

The piloting of the records in Victoria was prompted by a report presented at a Children's Welfare Association of Victoria (CWAV) workshop by a staff member at Kildonan Child and Family Services who had visited England and had found out about the development of Looking After Children. Considerable interest was expressed at the CWAV workshop, and this led to a proposal from Kildonan that CWAV should undertake a Victorian pilot. At this point, La Trobe University also became interested in Looking After Children, and organised a visit by two English Looking After Children trainers with the support of the British Council.

Following the visit by the trainers and expressions of support from a number of its member agencies, the Children's Welfare Association of Victoria submitted a proposal to the Stegley Foundation for funding for a pilot project. Following the provision of funding by the Stegley Foundation, the Victorian Department of Human Services also agreed to provide funding and to support the project.

Implementation of the trial was conducted by Deakin Human Services, and was overseen by an Advisory Group established by Children's Welfare Association of Victoria. The Advisory Group comprised representatives of the CWAV Board, the Department of Human Services, the Children's Court, the Victorian Association of Young People in Care, the Foster Care Association of Victoria, the Australian Institute of Family Studies (as observers), La Trobe University and the Stegley Foundation.

The overall aim of the Victorian trial was to improve outcomes for children and young people in out-of-home placements through a trial implementation of the records. 6 In particular, the project was seeking to assess whether the use of the records can lead to:

The project was also seeking to identify:

A report prepared by the Deakin consultants Robin Clark and Gabrielle Burke (1998), was forwarded to the Advisory Group in August 1998. It detailed the experiences of implementation, and the recommendations that were prompted from them.

At the commencement of the pilot early in 1997, fifty-one children and young people were identified as being likely to remain in an out-of-home placement for the duration of the twelve-month trial period. These children and young people were accommodated in foster care and residential care settings in both the non-government 7 and government sectors. They ranged in age from a few months to seventeen years of age.

The pilot commenced in February 1997 with a comprehensive training strategy for key players responsible for children and young people involved in the pilot developed from the English Looking After Children Training Guide. Child protection workers and their supervisors, case-planning chairpersons, care providers in foster or residential care and their supervisors and managers attended three half-day training sessions. At the end of the second training session, which took place in March 1997, an age-appropriate Assessment and Action Record was distributed for each child involved in the trial.

Implementation of the records was supported during the ensuing period through regular meetings of a Regional Reference Group established to address implementation issues and to foster communication between the Advisory Group and those directly involved in the implementation of the records. This group comprised representatives from the participating agencies, the Department of Human Services at a regional and state-wide level, Deakin Human Services and the Children's Welfare Association of Victoria. The Australian Institute of Family Studies was given observer status. Each agency also nominated a senior member of staff to support the implementation. Three newsletters providing information and updates about the pilot were distributed to those with a role in the implementation during the pilot period and to those interested in the project in the broader field.

Evaluation by Australian Institute of Family Studies

Late in 1996 the Australian Institute of Family Studies was successful in obtaining funding to carry out an independent evaluation of the effectiveness of the pilot in meeting its aims.8 Funds were obtained from the Rotary Health Research Fund of Australia, initially for a twelve-month period. A further twelve months funding was granted by Rotary for the 1998 calendar year to enable the project's completion.

Application for ethical clearance from the Institute's External Ethics Committee and the Department of Human Services Ethics Committee was granted prior to the commencement of the field work component of the research in March 1997. A Memorandum of Understanding between the Institute and the Department of Human Services, which established the duties and responsibilities of the Institute during the conduct of the evaluation research, was also developed before fieldwork commenced.

An Institute Research Advisory Committee was established to provide advice on matters relating to the evaluation. In addition to Institute research staff, the Committee comprised members from one of the non-government agencies participating in the trial, the Children's Welfare Association of Victoria, the Department of Human Services Eastern Metropolitan Region and the Department of Human Services Protection and Care Branch. A former consumer of out-of-home care services also joined the Committee to provide a young person's perspective on matters related to the evaluation.

An important component of the Institute's research throughout the conduct of the evaluation was the monitoring of the implementation project, and the sharing of information with key stakeholders and other providers engaged in the 'front-line' task of caring for children and young people involved in the pilot project. The open communication between the Deakin consultants and other partners in the pilot consortium and the Institute, enabled the evaluation to proceed in line with the implementation process - in particular, the collection of information at appropriate stages before implementation had commenced, and again approximately nine months later.

Aims of the evaluation

The primary objective of the Institute's evaluation was to determine the extent to which the records, as implemented in the Eastern Metropolitan Region of Victoria, succeeded in improving the health and wellbeing of the children and young people concerned. The evaluation also planned to identify promising, effective components from the trial which could contribute to the subsequent uptake of Looking After Children to raise the standard of case management and care provided to young people in public care, and to record the perceptions of care providers and children about the records.

The evaluation was directed by three principal questions:

Design and methodology

At the outset, it was intended that a standard pre-intervention/post-intervention research design would be adopted whereby the status of children and young people, and the involvement of children's families, would be assessed in advance of the implementation strategy, and once again approximately twelve months later. In this way, improvement in children's developmental status, and any change in the involvement of families after completion of the records, could be easily monitored. It was also proposed that both children involved in the pilot, and a matched group of children who were not involved in the pilot, would be assessed so that progress between groups could also be measured, and thus, the effects of exposure to the trial could be more easily interpreted.

The time demands of identifying children and young people for the research and establishing permissions and protocols for the conduct of research involving statutory clients outside the pilot region meant that data could only be collected on children exposed to the Assessment and Action Records. The final research design was therefore based on a single group before and after comparison survey design (Judd, Smith and Kidder 1991). Also, due to delays in getting under way in completing the records, it was only possible to measure the effect of nine months of exposure to the records.

The data that were used to inform the evaluation were collected during telephone interviews with each child's care provider, using the Institute's Computer Assisted Telephone Interview (CATI) facility, and during face-to-face interviews with children of appropriate maturity. Psychometric measures were also adopted as indicators of wellbeing. Information was also collected from children's caseworkers using self- administered questionnaires. Focus group interviews involving young people exposed to the process of implementation were also adopted.

Qualitative information about intervening events in children's lives during the evaluation period were recorded as file notes after liaison contact with children's caseworkers before face-to-face interviews with children, and after each interview with children's care providers. The process of implementation was also monitored during the evaluation period, through an audit of attendance at training, and through examination of the information recorded on the records.

To gain an understanding of the effects of implementation on the involvement of client families in caring for their children during placement, it was also intended to conduct interviews with children's biological parents pre- and post-implementation. Although an initial wave of interviews was conducted with eight parents, the second stage was abandoned because of the small number of parents who were engaged in completing the records, and due to difficulties experienced in the recruitment of parents for the evaluation project (see Appendix 2). The involvement of people other than a child's care provider in completing the records is reported in the discussion of findings section.

Limitations

The evaluation reflects various methodological limitations related to sample size, lack of randomisation, and an absence of a control group. Moreover, the follow-up period was relatively short, permitting an investigation of the effects of only nine months' implementation of the records on the health and wellbeing of the children and young people. Tests of significance were also not applied to the data used in comparisons of health and wellbeing to determine whether observed changes were the result of chance variation or random error. It was decided not to apply tests of significance to the data because:

It is also evident from available research that the outcomes of child welfare services depend on a complex set of factors that are interactive (Maluccio 1997). Owing to limitations of the research design, it is not possible to investigate the interactive processes that affect children and young people in this study. Rather, the analysis is bound by the traditional exploration of discrete factors. Further, the evaluation was based on a quasi- experimental style of research, owing to the small numbers involved in the trial and the sampling methodology. Consequently, descriptive statistics only could be used in the analysis.

There are additional limitations to drawing inferences from the evaluation to the population of children looked after away from home more broadly. These include the intrinsic differences between the child protection systems of the various states and countries. The aim of the analysis is, therefore, to promote an understanding of the influence of Looking After Children on the health and wellbeing of the research sample rather than attempting to establish causation, or to generalise findings to the broader population of children and young people in out-of-home placements. However, the issues identified in this evaluation are likely to occur in other out-of-home care systems in Australia and overseas. Moreover, many of the experiences and problems encountered by children and young people in this research will, to some extent, be reflected in the lives of children and young people in other regions of Victoria, and within Australian more broadly.

Research instruments

Several research instruments were adopted to inform the collection of information concerning the health and wellbeing of children and young people, the demographic profile of the evaluation sample, and the perceptions of care providers and children about the records. The instrument battery comprised the Care Provider Interview Questionnaire, the Child Interview Questionnaire, the Adapted Rutter Problem Behaviour Questionnaire, the Pre-school Behaviour Checklist (PBCL) (McGuire and Richman 1988), the Coopersmith Self-Esteem Inventory (SEI) (Coopersmith 1967), the Questionnaire for Case Managers, and the Key Variable Questionnaire. These instruments, including their origins and their use in the evaluation project, are reported in Appendix 3.

Measures

Various measures were used in the research to inform the collection of information related to children's wellbeing, their demographic characteristics, and child and carer perceptions of the records.

Child outcomes

Measures of health and wellbeing included problem behaviour as indicated by the Pre- School Behaviour Checklist, and the Adapted Rutter Problem Behaviour Questionnaire. Problem behaviour was also measured by the Adolescent Problem Behaviour Score (AIPS), and the Parent Interview Problem Behaviour Score (PIPS), which was developed by Hodges and Tizard (1989a, 1989b), and uses scores from select items on the Child Interview Questionnaire and the Care Provider Interview Questionnaire. Self-esteem was also used as a measure of wellbeing, as indicated by the Coopersmith Self-Esteem Inventory. Individual items on the Carer Interview Questionnaire and the Child Interview Questionnaire were used to measure children's developmental needs, the extent to which the child care service is meeting children's needs, and children's educational progress and physical health.

Children's demographic characteristics

Information related to children's demographic characteristics included children's age, Aboriginality, the presence of a learning disability, time in care, age at first admission into care, placement type, number of placements, contact with family of origin, and attributes of children's families of origin.

Perceptions of the records

Open-ended items included in the Care Provider Interview Questionnaire and the Child Interview Questionnaire, and questions included in the schedule used during focus group discussions, were used to record child and care provider perceptions of the records.

Open-ended items included in the interview with both children and care providers, and questions included in the schedule used during focus group discussions with young people, were also used to monitor the process of implementation. These items explored the care provider's knowledge of the purpose of the records, including the extent to which the records had been used during practice, and the number of plans that were made for remedial action after the records had been completed.

Respondents

All children and young people over the age of five years were targeted for involvement in child interviews. At the time of interview the AIFS researcher administered the Coopersmith SEI. Each child's care provider at the point of data collection was targeted for involvement in interviews. Young people who were involved in the pilot, and an additional group of children from Kildonan Child and Family Services, were targeted for involvement in focus group discussions. Each child's caseworker, either from the Department of Human Services or from another agency providing residential services, completed the Questionnaire for Caseworkers. The Key Variable Questionnaire was completed by the Institute's researcher.

Recruitment procedures

Rigorous procedures were followed to involve children and young people and their care providers in child interviews, focus group discussions and care provider interviews.

Child interview

Children and young people were invited to take part in the interview component of the evaluation on the advice of agency and departmental case managers. After discussion with caseworkers to establish suitability for involvement, children and young people were sent a recruitment letter inviting them to take part. Children and young people were then contacted by telephone to determine if they were willing to be involved, at which point a time for the interview to take place was arranged. Care providers and workers were then informed of the arrangements. Prior to interviews taking place, children and young people were asked to sign an informed consent form, which was witnessed by a responsible person over the age of eighteen. This methodology was undertaken pre-implementation, and repeated approximately nine months later. Participation was entirely voluntary on the basis of informed consent.

Focus groups

After a discussion between caseworker, care provider and Institute resarcher, potential participants were contacted directly via mail, in the course of which detailed information was provided about what taking part would involve. Written communication was followed up with telephone contact to determine whether young people were happy to take part in a focus group discussion. Participation was entirely voluntary on the basis of informed consent.

Two focus group discussions, each of two hours duration, were conducted and, with the permission of participants, tape-recorded. Five young people took part in each focus group. An Institute researcher and a consumer consultant with personal experience in out- of-home care facilitated discussions. A youth and child care worker was also in attendance to help supervise the children and young people.

Care provider interviews

Care providers were recruited via letter and follow-up telephone call. Informed consent forms, and the Adapted Rutter Problem Behavior Questionnaire, (for young people over ten years of age), or the Pre-School Behaviour Checklist, (for children of pre-school age), were enclosed in the original recruitment letter with a paid envelope to return to the Institute. In nine of the thirty-seven cases (24 per cent), different care providers were interviewed pre- and post- implementation. This was due to changes in placement, staff changes and leave arrangements.

Attrition

The data collection procedures outlined above did not yield the maximum possible data for the purpose of analysis. Although all self-administered questionnaires were distributed to the caseworkers concerned, not all were returned, despite repeated efforts and follow-up. Also, it was not possible to involve all targeted child participants in the interview component of the research because of concerns about the possible effects of exposure to the interview process for particularly vulnerable children. In addition, the Key Variable Questionnaire could not be completed in all cases because only twenty-five of a total forty-six Assessment and Action Records had been returned to Department of Human Services central files. Moreover, as the evaluation was based on a standard pre- intervention/post-intervention style of research, comparisons could not be made unless information was collected both before and after implementation. The consequence of this was that fewer cases were being subject to analysis for different measures than had originally been hoped. The actual number of subjects that were included in each analysis are recorded in the presentation of findings.

Profile of children

In the planning stage, it was recognised that the pilot's resources were limited, so it was preferred that the sample of children and young people involved should remain relatively stable. As a consequence, children and young people were selected on the basis of convenience; that is, they were in out-of-home care for at least four months, and were expected to remain in care for the duration of the pilot, or approximately twelve months. These criteria meant the sample selected for the trial had quite specific needs and characteristics compared with the out-of-home care population generally.

In the Eastern Metropolitan Region, 3800 notifications are made to Protective Services annually. Of the children in care at the time the sample was selected, only 125 were on court orders. Of this population, fifty-five had been in care for twelve months or more. Under the selection criteria, the fifty-five children and young people who had been in out- of-home care for twelve months or more formed the basis of the sample of children and young people that were targeted for involvement in the trial.

As mentioned earlier, fifty-one children and young people were originally identified to take part in the trial. Although records were completed or partially completed in respect of forty-three of these children and young people (Clark and Burke 1998), data collected in respect of only thirty-seven children and young people were examined as part of the Institute's evaluation. This attrition resulted because the legal status of a number of children and young people changed, and therefore the nature of the protective involvement changed prior to the nine-month implementation of the record.9 The profile of the children who were the focus of the evaluation is outlined below.

Data collected on the Questionnaire for Caseworkers were used to provide a profile of the children and young people involved in the evaluation prior to completion of the records.

Age

The thirty-seven children and young people in the evaluation sample were spread across the age groups specified on the records. Twenty children and young people were over ten years of age, ten children were less than two years old, and the remaining seven children were between three and nine years of age.

Placement type

The majority of children and young people in the evaluation sample (25) were in foster care placements (20) or Adolescent Community Placements (5). The remaining children and young people were in various forms of residential care, including family group homes (5), reception care units (1) and rostered residential units (6).

Contact with families of origin

As mentioned above, children and young people selected for involvement in the trial were expected to remain in out-of-home placements for at least twelve months, a fact that alone suggests some ongoing protective concern related to contact with their biological parents. Examination of information related to children and young people's contact with their parents indicated that seven children and young people did not have any contact with either biological parent. Almost three-quarters (26) of the children and young people involved had contact with their biological mother, however this contact was supervised in more than half of the cases. Only fourteen children and young people had contact with their biological father, and, once again, this contact was supervised in more than half of the cases.

Care history

The children and young people involved in the trial also had a long care history. Fifteen of the children and young people had been admitted into care more than once, and only two, including babies, had spent less than one year in care throughout their lives. In thirteen cases, children and young people were under one year of age when they were first admitted into care. Almost one-third (12) of the evaluation sample were admitted into care for the first time between the ages of ten and fourteen.

Time in out-of-home placements

Half of the children and young people in the evaluation sample (18) had spent more than a total of two years in out-of-home placements. Approximately one-third (13) had been in out-of-home placements for a total of one to two years, and only two had been in out- of-home placements for less than one year.

Number of placements

A significant number (14) of the children and young people in the sample had lived in between four and nine placements, and twelve had lived in between two and three placements during their entire career in care. Three children and young people in the evaluation sample had lived in more than ten placements. Ten children and young people in the evaluation sample also had siblings in care, although in none of these cases were siblings accommodated together.

Aboriginality

Not one child in the evaluation sample was classified as definitely Aboriginal by their allocated caseworker, however in one case was it recorded that a child could possibly be Aboriginal.

Learning disability

On the basis of information recorded on official files, approximately three-quarters of the evaluation sample were considered free of intellectual or learning disability. Three were either suspected to be, or registered as, intellectually disabled. Four were reported as experiencing developmental delay, and two were reported as having Attention Deficit/Hyperactivity Disorder10 .

Characteristics of children's biological parents

The profile of children and young people's biological parents indicated high levels of psychiatric illness, personal experience in out-of-home care, and a myriad of problem behaviours such as substance abuse, offending and violent behaviour. Information collected on the presence of six factors, including psychiatric illness (including hospitalisation), imprisonment, violent behaviour, alcohol/substance abuse, domestic violence and care history, revealed that approximately one-quarter of biological fathers presented with three or more factors, and approximately 15 per cent of biological mothers presented with three or more factors 11 .


6. Findings from the Institute's evaluation

Quantifiable items on all relevant instruments have been aggregated, and are reported to enable a comparison of outcomes pre- and post-implementation. Open-ended items on the Care Provider Interview Questionnaire and the Child Interview Questionnaire, and information gathered during focus group discussions with young people, are recorded to illustrate the perceptions of the records by care providers and children, and the influence that they had on the care provided to children during the evaluation period.

Conceptually, the results have three components:

Change in health and wellbeing

The following results report changes observed in children's wellbeing after implementation of the records in terms of the outcome measures outlined in this section.

Parent Interview Problem Behaviour Score

The Parent Interview Problem Behaviour Score (PIPS) is based on twenty-seven items on the Care Provider Interview Schedule. Scores on these items were aggregated to obtain a Parent Interview Problem Behaviour Score for each child involved in the evaluation. The minimum possible problem score is 0 and the maximum is 49.

A comparison of mean group PIPS scores pre- and post-implementation revealed low- level positive change. The group mean PIPS score pre-implementation was 19.5, with a standard deviation of 7.1. Post-implementation the PIPS score was 16.6 with a standard deviation of 6.9. Although improvement was observed after implementation of the records, these scores were considerably higher than scores recorded in Hodges and Tizard's study (1989a, 1989b) of young people who had recently exited foster care in the United Kingdom (Mean = 10.1; SD = 7.9).

Adolescent Interview Problem Behaviour Score

The Adolescent Interview Problem Behaviour Score (AIPS) is based on twenty-four items on the Child Interview Questionnaire. Scores on these items were aggregated to obtain a total problem score. The minimum possible score is 0 and the maximum is 48. AIPS scores were obtained for all children involved in the interview component of the evaluation (n=11).

A comparison of group mean scores pre- and post-implementation also revealed generally positive change. Pre-implementation, the group mean score was 17.0 with a standard deviation of 8.3. Post-implementation, the group mean score was 11.2 with a standard deviation of 4.8. Unlike the scores recorded on the PIPS measure, AIPS scores for the Victorian sample both before and after implementation were lower than the scores recorded in the UK study (Mean = 18.8; SD = 6.3). The scores recorded for the Victorian sample before and after implementation, on both the AIPS and the PIPS measures, are compared with the UK sample in Table 1.

Table 1. Mean AIPS and PIPS scores pre- and post-implementation compared with scores from a UK sample of young people recently exited foster care
Measure Pre-implementation Post-implementation UK sample
PIPS
(n)Vic. (n)UK Mean = 19.5
SD = 7.1
Mean = 16.6
SD = 6.9
Mean = 10.1
SD = 7.9
37 29
AIPS
(n) Vic. (n) UK Mean = 17.0
SD = 8.3
Mean = 11.2
SD = 4.8
Mean = 18.8
SD = 6.3
11 28

Source: Looking After Children Project, Australian Institute of Family Studies 1999.

Coopersmith Self-Esteem Inventory

The Coopersmith Self-Esteem Inventory (SEI) was administered to child participants as part of the Child Interview Questionnaire pre- and post-implementation. Mean group scores recorded for all sub-scale components of the SEI at both points in time were compared to obtain an indication of change on this measure of wellbeing. The results of this comparison are reported in Table 2.

Table 2. Comparison of SEI scores pre- and post- implementation
  Pre-implementation (n=8) Post-implementation (n=8)
Scale name Mean Median Mean Median
General self sub-scale score 18.9 19.0 20.1 21.0
Social self-peers sub-scale scores 6.4 7.0 6.9 8.0
Home-parents sub-scale score 5.7 6.0 5.8 6.0
School academic 5.0 6.0 5.8 5.0
Short-form total self score 66.0 68.0 61.9 72.0
Total self-esteem score 72.8 74.0 77.1 76.0
Lie scale 3.1 3.0 3.2 3.0

*High scores correspond to high self-esteem

Source: Looking After Children Project, Australian Institute of Family Studies 1999.

Pre-School Behaviour Checklist

The Pre-School Behaviour Checklist was completed pre- and post-implementation for only five children of pre-school age (between the ages of three and five years). No change was observed, either positive or negative, after implementation of the records. The overall mean group score pre- and post-implementation was above the score set to indicate problem behaviour, which require further attention from either staff at the pre-school or other professionals (McGuire and Richman 1988). The mean group score pre- implementation was 15.6 and the mean group score post-implementation was 14.8.

Adapted Rutter Problem Behaviour Questionnaire

The Adapted Rutter Problem Behaviour Questionnaire was administered via mail to care providers of children and young people over ten years of age pre- and post- implementation. The mean group scores for all sub-scale components of the Rutter Questionnaire, and the total problem score, are reported in Table 3.

Table 3. Adapted Rutter Problem Behaviour Scores pre- and post-implementation
  Pre-implementation (n=13) Post-implementation (n=13)
Sub-scale Mean Median Mean Median
Hyperactivity score .9 .8 .8 .8
Depression score .8 .7 .6 .7
Social aggression score 1.0 1.1 1.0 .8
Total problem score 35.9 29.0 16.1 16.0

*High scores correspond to behavioural problems

Source: Looking After Children Project, Australian Institute of Family Studies 1999

Single-item outcomes

Responses to single items on the Care Provider Interview Questionnaire and the Child Interview Questionnaire were analysed to provide some descriptive statistics related to the needs of the sample, the success of the service in meeting the needs of children during placement, the extent of risk factors believed to influence child outcomes, and the health information available to care providers pre- and post-implementation. The results of these analyses are reported in Tables 4 to 7.

Table 4. What are the needs of the sample before and after implementation?
Item description Pre-implementation Post-implementation Total (n)
Care Provider Interview Questionnaire
Child experiences serious illness or disability 6 (16%) 6 (16%) 37
Child short for age 10 (27%) 8 (22%) 37
Child overweight for height 9 (24%) 8 (22%) 37
Child underweight for height 10 (27%) 7 (19%) 37
Child has special educational needs 9 (30%) 7 (23%) 30
Child school/playgroup age and does not attend 8 (27%) 3 (10%) 30
Child experiences developmental delay 4 (19%) 8 (38%) 21
Child has few or no peer friends 5 (33%) 4 (27%) 15
Child Interview Questionnaire
Child does not have attachment to any adult person 4 (36%) 1 (9%) 11

Source: Looking After Children Project, Australian Institute of Family Studies 1999

Table 5. How far does the service succeed in meeting needs?
Item description Pre-implementation Post-implementation Total (n)
Care Provider Interview Questionnaire
Child received scheduled health checks 4 (50%) 8 (38%) 21
Routine dental visits undertaken 11 (42%) 9 (35%) 26
Adolescent health promotion undertaken 6 (67%) 7 (78%) 9
Routine immunisations undertaken 20 (54%) 24 (65%) 37
Childs educational attainment average or above 6 (75%) 7 (88%) 8
No unscheduled visits to the doctor 13 (37%) 14 (40%) 35
Improvement in child’s state of health 14 (38%) 30 (81%) 37
Care provider satisfied that educational needs are being met at school (attends school only) 8 (73%) 11 (100%) 11
Child Interview Questionnaire
Child receives assistance with school work from care providers 7 (100%) 7 (100%) 7
Key Variable Questionnaire
Child receiving psychiatric treatment 6 (46%) 3 (23%) 13
Child receiving other psychological or counselling/therapeutic service 6 (46%) 5 (39%) 13

Source: Looking After Children Project, Australian Institute of Family Studies 1999.

Table 6. How extensive are the risk factors?
Item description Pre-implementation Post-implemenation Total (n)
Care Provider Interview Questionnaire
Child enrolled in school less than 12 months (excludes scheduled changes, such as transition from primary to high school) 2 (17%) 4 (33%) 12
Child excluded from school 1 (8%) 1 (8%) 12
Child suspended from school 3 (27%) 3 (28%) 11
Care provider rates peer relationships problematic 15 (63%) 9 (38%) 24
Child has less than monthly contact with family of origin 6 (17%) 9 (26%) 35
Child in contact with police 11 (52%) 7 (33%) 21
Child Interview Questionnaire
Child smokes cigarettes on a daily basis 5 (46%) 4 (36%) 11
Child consumes alcohol frequently 5 (46%) 4 (36%) 11
Child does not attend all scheduled classes 2 (29%) 2 (29%) 7
Child has suicidal thoughts 1 (12%)* 0 (0%) 9
Child describes relationship with teachers as problematic 4 (57%) 2 (29%) 7
Child bullied by peers 3 (33%) 1 (11.1%) 9
Child uses other substances 5 (46%) 4 (36%) 11

*It should be noted that those responsible for this child were also aware of these feelings.

Source: Looking After Children Project, Australian Institute of Family Studies 1999.

Table 7. How much information does the care provider have of the child?
Item description Pre-implementation Post-implementation Total (n)
Care Provider Interview Questionnaire
Child’s health details unknown 13 (35%) 7 (19%) 37
Child’s immunisation record unknown 2 (5%) 1 (3%) 37

Source: Looking After Children Project, Australian Institute of Family Studies 1999.

Involvement of family and others

The following findings report the extent to which people in a child's family system and neighbourhood network were involved in completing the records.

Involvement of a family member

To understand the level of involvement of families in completing the records, and the difficulties that were encountered in attempts to engage families to help complete them, caseworkers were asked whether a family member had been contacted about Looking After Children. In the event that no family member was contacted, reasons for an absence of contact was investigated.

The findings revealed very poor involvement of family members in completing the records. Of the thirty-seven cases that were followed post-implementation, only six parents had been contacted about completing the records. Reasons for not contacting the remaining thirty-one families included the absence of contact details (four cases); children and young people being moved into permanent care (five cases); contact not considered beneficial to the child (six cases); either the parent or child did not wish family to be involved in developing a care plan (fourteen cases); and contentious court issues (one case). In one case it was not known whether a family member had been involved or not because the original caseworker had left the department and no case notes had been recorded about Looking After Children.

Coordination and cooperation between stakeholders

Although the records have been designed to facilitate joint working between protective workers, social workers and child care workers at the non-government agencies, and foster care workers, comments from carer providers indicated that implementation of the records did not always overcome problems that can arise when responsibility for children's care is shared between the government, and other sectors. Respondents reported:

I was disappointed at the control that workers took in the process and the fact that I was not given a copy of the booklet. (Foster carer)
For Alison12 it was almost a waste of time. DHS workers don't look at this information, and they're not concerned in all spheres of development. (Foster carer)
DHS workers have difficulty coming to terms with the assessments and recommendations of the care providers. DHS workers have trouble seeing care providers as professionals. (Foster carer)

There were, however, several positive responses to the records in respect of the extent to which they involved all partners. Respondents reported:

It [the record] is helpful with sharing information with DHS workers which has to change a great deal. (Foster carer)

The issue of involvement of people in a child's family system and neighbourhood network in completing the record was also discussed during interviews with children and young people. Their responses revealed that children and young people are happy for different people to be involved in the exercise, just as long as they are able to make that choice. The following statements from children and young people illustrate this point:

I would have liked my teachers to be involved in it so they don't give me so much detention because they would understand me better. (Paul, 15)
I am actually happy that my mum wasn't involved. (Jessie, 14)
The only person that I wanted to be involved in that book was my mum, cos she would understand. (Lillie, 14)
It's better if you choose who you want to talk to. I get along with most people but some people just irritate me. (Tom, 17)

Cross-sectoral working

Despite it being emphasised in training that many people in a child's network would have important information about the child, respondents involved in the evaluation conducted by Clark and Burke (1998:22) reported that there was no direct involvement of people from other professions, such as teachers and doctors, in completing the records.

Involvement of children and young people

In their evaluation of the implementation of the Victorian pilot, Clark and Burke (1998:22) reported that 'all respondents working with a child ten years or older said they involved that young person in completing the record, and some respondents indicated that children younger than ten were involved'.

When asked about their involvement in completing the record, young people involved in the Institute's evaluation indicated that messages from training about the most effective method of engaging children and young people were not always adopted in practice. Moreover, some children and young people helped complete the records in the absence of understanding how the information was to be used, and the role they were to have in planning for their care during placement. Respondents reported:

I was asked to fill in the booklet in one go after I had been out and we finished at 11 p.m. I was annoyed with it and it didn't look any different to all the other forms. (Will, 14)
Looking After Children is a dumb system that didn't work in the UK and it isn't going to work here. (James, 14)
I was asked for my opinion but workers filled it out and I didn't get to see what was recorded. (Jack, 14)
I was actually told that it would be for us only and that no-one else would be reading it, that it was for us to look back on to see how we have changed, but I haven't even got a copy of it. (Catherine, 16)
They [the social worker and care provider] just left me the form and I forgot about it for a while. (Millie, 16)

Jack's experience (age 14) is illustrated in the following exchange:

Jack: I didn't want to do it.
Interviewer: And was that fine with your worker?
Jack: Yeah.
Interviewer: Did they actually explain why they were doing it? Was it all explained to you why they were filling it in?
Jack: Nah, they just asked us to fill it in.

Perceptions of the records

The following findings report the extent to which children felt the records contributed to an improved sense of control over decisions that affect their lives, and the extent to which the approach helped in parenting children in need of substitute care.

Care providers' perceptions

A number of open-ended items on the Care Provider Interview Questionnaire administered after implementation of the records related to the care provider's perceptions of the benefit of the records, and their experiences with implementation. The initial reaction from care providers was generally positive. During interviews they made the essential point that the records are designed to enhance the quality of assessment, planning and reviewing of services to children in out-of-home care. Care providers reported that use of the records had assisted in the caring of children during placement in several ways, by:

Respondents reported as follows:

Looking After Children is important for continuity, and to have a summary of children's progress dating back years if applicable. It is a very good way of dealing with turnover of staff. (Foster carer)
Looking After Children is well worth the effort. It should be law. Although you would expect some of the things to be quite obvious, sometimes these things are not attended to. (Foster carer)
It [Looking After Children] was a helpful reminder of the things I should be doing for Jonty. (Foster carer)
It helps to see where a child is at in a developmental sense. You can pick up work straight away without breaks. It is very good for information and seeing children's progress. It is a good way of ensuring things get done. (Foster carer)
It is really good because kids get lost in the system and it may alleviate this and allow children's voice to be heard. Youth get fed up with telling workers what they feel and it just goes round and round until they give up. It's difficult for children to make a fuss. With Looking After Children they are encouraged to open up. These programs should start earlier than adolescence to get them used to being empowered from a young age. (Residential worker)
It is good for kids who feel that their voice is not being heard and think, 'What is the use?' (Residential worker)

Despite there being generally positive impressions of the materials, there was an indication that some care providers were not persuaded about the potential for the records to meet the aim of providing children and young people with a complete record of their lives during placement. There was also a perception among a number of care providers that the records would facilitate better outcomes among children and young people in short-term placements, residential placements or those experiencing instability in care. The records were also considered unnecessary for children in placements that resemble an ordinary family situation, such as is the case with long-term foster care placements or permanent care placements. Respondents reported:

Looking After Children doesn't give children a permanent record and a basic picture of their life because there simply isn't enough information recorded in it, like nutrition. It didn't give a picture of the child - what the child likes and doesn't like. It lacked detail for a carer to take over a child - you wouldn't be able to get a picture of the child. The training package tried to paint a picture that it did not fulfil. It has either failed to do what it had set out to do or it was sold as something it clearly wasn't. (Foster carer)
It wasn't really relevant in this case because we are taking on permanent care of Luke, but it is a good idea to start because information is necessary for care providers to have in the first instance. (Foster carer)
I just didn't feel that Looking After Children was a particular help. It wasn't a hindrance but it wasn't a help either. When you are looking after babies their care is pretty much 100 per cent of your time and you look after them as ordinary parents would. (Foster carer)
It is very worthwhile for children who are likely to be in care for a long time. (Residential worker)
Looking After Children is more use to kids who are likely to have different care providers and where strategies are not already in place. (Foster carer)
It is good for kids who get moved around a lot and are in shorter-term placements. It's not so important for children in permanent care, although it was good to get the information. (Foster carer)
For children who aren't in permanent placements it would be good, although I would have liked this information when Fredrick first came to stay with me. I didn't have much information then. Fredrick had had twenty-three placements before coming here. (Foster carer)
I felt that Looking After Children was duplicating existing work because an assessment and action plan is being conducted on a weekly basis, including developmental and health issues, not just behavioural concerns. Remedial action is a part of our existing program. (Residential worker)

Some care providers also felt the records needed adaptation to be used effectively, especially with the adolescent population. Respondents reported as follows:

I didn't like the booklet at all. It didn't reflect Australian conditions and it was difficult to respond to. (Foster carer)
Questions need to be pitched at adolescents, in their own language, not in psychological terms. (Residential worker)
It would be good if it could be presented in a more visual format - something the young people themselves could understand. (Foster carer)
The language is inappropriate for adolescents. (Residential worker)

Difficulty engaging children and young people was also a common theme that emerged during interviews with care providers. As two respondents with common experiences reported:

It is impossible to engage really difficult youth in the program because they won't go for any forms and generally will not work with workers. They are not interested in keeping a record of their lives because they are short-term focused. (Residential worker)
Toby was very unhappy about completing the record because it took him away from other activities. It required bribery to get the form completed. (Residential worker)

Worker inexperience and an absence of universally available services for children and young people in out-of-home placements were also issues that implementation had prompted for some care providers. Respondents reported:

It is a struggle for DHS to provide basic services for children, such as dental care and the booklet needs to acknowledge this. You shouldn't be making plans for things that you know can't be done. (Residential worker)
The social worker was not experienced enough to complete the exercise. (Foster carer)
I feel some social workers are not skilled enough to work with adolescents in this way. Foster care providers are the most appropriate [people] to complete the forms with the children. (Foster carer)

Children's perceptions

Some young people who were involved in the focus group discussions reported that involvement in completing the records had a positive impact on their lives, however this concerned their relationships with care providers and the attention that was associated with completing the records. There was no indication among the children concerned that completing the records influenced their feelings of control over decisions that affect their lives. Some of the positive statements that were reported include:

You can be listening to music, or watching TV at the same time as they [workers] are talking to you. (Tom, 17)
I got a lot of information that I didn't know about, things about my issues and health and stuff. (Janet, 14)
It made me closer with my mum [foster parent]. (Lillie, 14)
I liked the attention. (Rudy, 16)

Despite some general positive experiences, some children expressed concerns about completing the records. The young people concerned felt uncomfortable about recording information about their lives in the booklets, or were concerned how the information was to be used. These young people also reported that they lied on items related to offending and substance use. Young people also felt that they should have a say in who has access to information recorded on the records. Respondents reported:

Everyone, like, is going to read it and judge me on it. (Catherine, 16)
I just basically totally ignored the questions I didn't want to talk about. (Jessie, 14)
It's got nothing to do with them [workers], the information in the book. It's none of their business. It's got nothing to do with them. (Jessie, 14)

One exchange was as follows:

Interviewer: You were worried then that the information was going to be used against you?
Jessie: It worried me a hell of a lot.
Interviewer: Were you worried that things that you had done might get back to the police?
Jessie: I lied about it.

Discussion of findings

Here, the findings are discussed in terms of the three principal questions that directed the research - observed changes in children's wellbeing, the involvement of families and others in caring for children, and perceptions of the records.

Improvement in health and wellbeing

On balance, outcomes for children recorded after implementation of the Assessment and Action Records suggest modest improvement over the trial period. Scores on the Coopersmith Self-Esteem Inventory, the Adapted Rutter Problem Behaviour Questionnaire and the AIPS and PIPS scales changed in the direction indicating higher levels of self-esteem and lower levels of behavioural difficulty. Responses to single-item questions collected during interviews with children and young people and their care providers also implied a general improvement toward specific objectives related to children's educational achievement and physical health. The data also suggested that a smaller number of children were experiencing specific needs13 , either physically or emotionally, and that services had better success in safeguarding and promoting children's welfare. It should be noted, however, that these changes represented only a small number of children for each measure of health and wellbeing. Furthermore, due to the absence of significance testing, it is possible that observed changes could have been influenced by individual differences, recording error, and other sources of chance variation.

Furthermore, due to the qualitative nature of the evaluation, it is acknowledged that no formal claims can be made regarding the influence of implementing the records on children's outcomes. Outcomes for children in care depend on a complex set of factors that are interactive. Therefore, observed changes in health and wellbeing, if significant, might also have been affected by the interplay between individual differences and a host of family and environmental factors. It is only possible to determine the possible influence of implementation of the records on the observed improvements through inference. In addition to the testimony of children and care providers about the benefits that flowed from use of the records, an examination of other events in children's lives during the evaluation period, and the experience of implementation can be used to help form a conclusion about the influence of the records on children's health and wellbeing.

Events in children's lives

To help in the interpretation of the extent to which implementation of the records can be attributed to observed changes in children's health and well being, information was routinely collected about significant events in children's lives during the evaluation period. The information that was collected indicated high levels of disruption and instability - the types of events that one would expect to delay progress along dimensions of health and wellbeing rather than foster improvement. The experiences of young people in the evaluation sample are particularly telling.14 They included:

Use of the records in planning and decision-making

Of all the factors that can influence the quality of care provided to children after completion of the records, the extent to which they are used to make plans for remedial action will have a direct influence on the outcomes that flow from their use. Although it is difficult to quantify exactly how much work was undertaken, information was collected from twenty-five completed records to provide an indication of the number of assessments made, the number of areas in children and young people's lives where remedial action was required, and when plans for action were developed. The major findings from this investigation indicated:

These findings indicate that for the majority of children involved in the evaluation, completion of the records raised awareness about developmental deficiencies, or areas in children's lives that required further attention. Further, the exercise of completing the records was reported to improve knowledge about the general and specialist health needs of the children involved in the evaluation, such as the number of children requiring routine immunisations or dental check-ups.

Attendance at training

Experience of implementation in the United Kingdom has shown that training is critical to the success of implementation. Prior to implementation of the records in the Eastern Metropolitan Region, Department of Human Services caseworkers, their supervisors and managers, agency social workers and care providers attended three training sessions in the philosophy and implementation of the records. The training was generally well attended, and the majority of participants (56 per cent) reported that they found the training very useful (Clark and Burke 1998:32).

In summary, it would appear that use of the records helped care providers better understand the needs of the children involved in the pilot, and that completing the records has positive flow-on effects for the quality of care children received in different areas of their lives, and for setting an agenda for discussion with children about different aspects of their care. There was also indication that use of the records prompted numerous plans for remedial action. There was also no sign of other events in children's lives that could possibly account for changes observed in children's health and wellbeing. On the basis of these findings, a circumstantial case can be made that implementation of the records may be associated with increase in the quality of care provided to children, possibly to the point of leading to improvement in the health and wellbeing observed in the evaluation.

Involvement of people in children's personal communities

As noted in the methodology section, parents were generally not involved as partners in completing the records, nor were they consulted about the plans and actions that flowed from their completion, so use of the records did not meet its aim of contributing to the involvement of families in the lives of their children during placement. However, the characteristics of families noted earlier in this work indicates a high level of disruption and instability in the lives of families. Factors such as substance and alcohol abuse, high mobility, psychiatric illness and offending behaviour suggest the difficult task of workers in attempting to rehabilitate families with their birth children using the records. Moreover, there were several instances where contact with families was not deemed beneficial to children and young people. In addition, some families were resistant to working in partnership with protective workers and agency social workers, or were simply unwilling to be involved in the care of their children. Furthermore, case plans for the permanent care of children and young people was considered at odds with the principle of working in partnership with parents.

Care providers' and children's perceptions of the records

On balance, it should be said that care providers were generally very positive about the records, and their potential to lead to better child outcomes and inter-sectoral and inter- agency working. Care providers were also generally positive about the potential for use of the records to contribute to their confidence in parenting children in the public care. Some care providers were concerned about the effectiveness of the records for use with 'high- risk' adolescents, however, reporting that the format and language used in the forms would not be engaging for certain young people. Use of the records was also felt to be less relevant in circumstances where children and young people were in long-term foster care or permanent care placements.

The findings also indicated that a number of the young people involved in the evaluation were concerned about how information recorded on the records was to be used. Yet the young people reported some benefits of involvement in completing the records, and reported several benefits of use of the records over care-plan and case-plan meetings15 .

Limitations of the pilot outcomes

It should be said that the success of the pilot implementation was thought to have been hampered by a number of factors that are easily overcome through wider adoption of the records. The support that was provided to the pilot in terms of resources, administrative capacity and collaborative arrangements, for example, was not sufficient to deal with the complexities of implementation, and was thought to have limited the chance for a smooth integration of the records in practice.

Also, the records were implemented through a very management-driven and piecemeal approach, and there was a general lack of support and monitoring of work among caseworkers and their supervisors due to the demands of everyday practice. If the records were to become a cornerstone of services to children looked after away from home, problems in balancing the time demands of completing the records and other case management responsibilities would diminish significantly.

Staff turnover and changes of placements also meant that care providers and caseworkers who had not been trained in the use of the records were involved in the implementation in its later stages. In some circumstances, changes of placement meant that children and young people left a service altogether, and were placed by another service who were unfamiliar with the pilot and the use of the records. In the absence of ongoing support and monitoring of work in the use of the records, changes of placement and staff turnover can cause disruption to assessment procedures and implementation of remedial action.

There was also considerable discontinuity in case management responsibility for children and young people involved in the evaluation sample. Among Department of Human Services workers, case management responsibility changed in eighteen cases (49 per cent) during the evaluation period. In some instances, there were multiple case management changes during the trial period16 . Among agency workers, case management responsibility changed in nineteen cases (51 per cent).

It should be said, however, that implementation across an entire service system, or even under a whole-of-agency approach, would require considerable technical and systems changes, including a rationalisation of existing systems and procedures, as well as extensive changes in the way in which child protection workers and agency social workers think about their work. A successful reorientation of practice to the Looking After Children philosophy would therefore require committed management and a climate in which staff are receptive to new ideas and ways of approaching family and child welfare practice. Sufficient time to undertake the considerable work involved, and careful monitoring of the process of implementation, are also required to facilitate implementation in practice.


7. Adopting Looking After Children in Australia

There are a number of conditions that support the implementation of Looking After Children in Australia, and other difficulties that will require organisational and cultural change if clear benefits to using the system are to be derived in practice.

Conditions and difficulties

Specific issues relating to practice, program delivery and characteristics of service clientele need to be considered to ensure efficient and effective implementation of the records. The legislative provisions of most states and territories in Australia, and particular requirments at the policy level, should help the process along.

Legislative provision

Child welfare legislation in Australia is the responsibility of each state and territory. The state of Victoria has the Children and Young Persons Act 1989, which is consistent with the principles underpinning Looking After Children, and requires the welfare of the child to be given 'paramount importance' (Jones, Clark, et al. 1998). Consistency between the aims of Looking After Children and child welfare legislation enacted and administered by other states and territories further uphold the adaptability of the initiative to Australian circumstances.

The Looking After Children objectives in Australia

All children, irrespective of culture, share common developmental needs such as a nutritious diet, shelter, clothing, social interaction and health care. A wealth of research on child development informs us that children's chances of achieving satisfactory development are jeopardised if basic developmental needs are not met. Although Looking After Children aims to ensure children's basic requirements are met, it also aims to ensure a standard of parenting that will help children achieve quite specific developmental goals. The UK Children Act 1989 provides some guidance as to the threshold at which developmental objectives should be set (see Ward 1998:205), however they are quite broad in definition. The Looking After Children materials are the product of significant work to pin down what objectives social service agencies should aim to provide to children looked after away from home.

A UK study of the relevance of the records found that virtually all parents shared similar basic objectives for their children, and that most were aware of the actions that are necessary for their realisation. The differences lay in the ability of parents to make use of their knowledge. Early criticisms that the records set inappropriate standards of parenting were refuted (Ward 1998). There has also been indication from child welfare systems outside the United Kingdom that the materials require very little adaptation, and are culturally sensitive (Jones, et al. 1998). Work conducted in Australia also suggests that the objectives for parenting set out in the records are consistent with Australian culture and the aspirations that ordinary parents hold for their children. However, further work needs to be conducted with families across the range of different ethno-cultural backgrounds, including children from Aboriginal and non-English-speaking communities.

Although there is general consensus that the objectives set out in the records are consistent with Australian standards, there are particular dilemmas in that children's biological parents may not be able to meet a similar standard of care, making it difficult for parents to resume the care of their children even when the reasons for admission into statutory care are no longer current. As Clark and Burke warn (1998:35), 'while ensuring appropriate inputs to the child, the professional network must not over function to the detriment of the child's own parents'¤a point that warrants careful consideration and some future debate. Similar concerns were also expressed in the implementation study conducted by the Centre for the Education and Training of Social Workers, with students reporting that the records ignored the economic constraints of a number of families (1998-99:19).

Practice culture

As Looking After Children is designed to set an agenda for the way the child welfare system deals with the needs of children looked after away from home, implementation is likely to require extensive changes to the way in which practitioners think about and undertake their work (Jones 1995; Corrick, Jones and Ward 1995). As Ward (1998) noted about the UK experience, 'Implementation has raised numerous issues, many to do with the culture of social work practice.'

Although implementation of the records is designed to foster a sense of partnership between the various people involved in caring for children and young people, the Victorian experience of implementation showed that the existing culture of practice within Protective Services was a significant barrier to focusing the attention of workers on what happens to children and young people after placement. Guardianship orders are reviewed and determined by the courts in Victoria, giving rise to a very court-driven approach to practice within Protective Services. Moreover, because of the emphasis in practice on admission into the system, child protection workers have a tendency to concentrate their concerns on risk assessment rather than what happens to children and young people after placement. So, although protective workers in Victoria reported that the records were generally useful in enabling them to think more clearly about the developmental dimensions covered, this did not appear to have a direct influence on practice.

It should be said, however, that the small scale of the Victorian pilot, the ordinary pressures of day-to-day practice, and the difficulty in attempting to effect cultural change and to create an emphasis on collaboration with limited resources were also likely to be inhibitors. However, if Looking After Children is to function as intended in Victoria, it is important that there is a genuine commitment among all concerned to the practice philosophy that underpins the approach, and that the process of implementation is appropriately resourced.

The experience of implementation in the United Kingdom suggested that effective implementation is best achieved in a climate in which staff are receptive to new ideas and managers are aware of possible sources of difficulty and dissatisfaction. The UK experience also informs us that the records must be acceptable to those who use them. In order to create a sense of ownership of the materials and willingness in their application, the records should be adapted to reflect the unique cultural and legislative requirements of each state or territory.

The piloting of the records in the United Kingdom also showed that difficulties encountered with implementation demonstrate a need for better training of care providers and for careful supervision of their work. It should be the role of the supervisor to make sure that assessments are properly completed at the recommended intervals and to check that plans are being made and translated into action. The research showed that this task is likely to be made much easier if the Assessment and Action Records are introduced into existing structures for planning and reviewing children's cases (Ward 1996).

Use of the records in Australia must be appropriately resourced if their full potential is to be realised. This is particularly important at the point of entry into social service agencies when costs are likely to be highest. Adequate training and supervision must support implementation. Furthermore, sufficient time for implementing Looking After Children must be allocated as part of regular case practice. Successful implementation of the Looking After Children materials requires workers who are committed to ensuring that appropriate contact occurs with people in a child's personal network, and who have the time to prepare the children and young people, support the parents and encourage the compliance and commitment of care providers.

Another important reflection of the UK experience of implementation has been the importance of leadership, especially among coordinators at the local authorities. The involvement of managers was found to be important to keep the system going, and to monitor the quality of work that is conducted and the degree of compliance that exists (Moyers 1997). As Bell notes in her work, 'That forms are completed at all, of course, may indicate more about their management and auditing in local authorities than about the quality of social work practice' (1998-99:16).

In the Victorian trial, each of the participating agencies nominated a senior staff member as a contact person for the pilot project. In most cases, the agency representative also represented the agency at meetings designed to address issues related to day-to-day implementation issues.

Information that was to assist practitioners and care providers during the implementation was filtered through the agency representative, however, little day-to-day supervision was undertaken by the staff mentor during the process of implementation. This practice developed for a number of reasons. First, there were scarce resources available for supervision and monitoring of the implementation after the training period. Second, there was little emphasis on the Looking After Children approach to practice within agencies because of the small number of children and young people, workers and care providers within each agency that were involved in the trial. Third, implementation, and any supervision and monitoring of progress, had to be undertaken in addition to existing case work and heavy workloads.

The importance of leadership and support to the success of implementation is echoed in the following statements by care providers:

I could have been given greater support to complete the process because I didn't understand it. (Foster carer)
Training is important and you need a lot of support from agency workers if it is going to work. (Foster carer)

Policy climate

In Australia, the relevant Social Service department in each state and territory has overall responsibility for services to protect children 'at risk', and to deliver or commission services supplied by non-government social service agencies for the care of children who need to be looked after away from home. Services to children looked after away from home are delivered under the auspices of the child welfare legislation enacted and administered by the states and territories.

In Victoria, the current strategy of the Department of Human Services is to shift the major responsibility of service provision for children and young people in need of substitute care from government to non-government organisations. The projected role of government within this new arrangement will be primarily to assess, review and monitor standards and negotiate 'contracts' with service providers. This strategy is increasing pressure for services to monitor and assess service standards, as continued program funding may be dependent upon the provider's capacity to demonstrate the outcomes of the service.

Under the new arrangements for service provision, implementation of Looking After Children has clear benefits over and above the improvements in children's outcomes that are likely to flow from their use as a system of planning and review. When implemented, the Looking After Children materials will provide a systematic means of obtaining quantifiable data that non-government social service agencies can use to demonstrate the outcomes of different kinds of interventions, and the services that agencies provide in order to meet children's individual needs. There is also scope for governments to monitor the outcomes of different kinds of care careers, and to assess the extent to which the overall service is meeting the needs of client children¤to answer questions relating to the prevalence of alcohol and substance use and the number of teenage pregnancies. Regular mapping of such questions should be able to determine whether and in what way the service is contributing to children's chances of achieving long-term wellbeing. Knowing what proportion of children stay away from school, run away from children's homes, commit crimes, abuse other residents or are maltreated themselves will also set useful baseline standards against which progress can be measured (Davies et al. (eds.) 1998).

These applications will, of course, depend upon reliable recording of information by those who conduct the assessments. The audit of the extent to which the records were used, conducted in the United Kingdom in 1996, reports that they were not always completed, with standards of completion varying even in one authority across different offices and teams (Moyers 1997). Training and leadership are therefore important to ensure that the records are being used systematically, and to monitor the quality of the information recorded. As Moyes (1997) reflected on the experience of implementation in the United Kingdom, 'winning the hearts and minds of key people was essential for consistent implementation to be achieved'.

Service delivery in Australia

The current system of care in Victoria is unlike the circumstances in the United Kingdom, where local authorities have total responsibility for children looked after away from home. The responsibility for children's care in Victoria is shared between the relevant social service agency and Protective Services. The Victorian experience of implementation showed that this division of responsibility was a barrier to fostering a sense of partnership between the various people involved in a child's care. As testimony to this, the Institute's evaluation revealed that care providers were largely responsible for completing the records with children and young people, and were mostly responsible for actions that the assessment prompted. Moreover, it was apparent that information recorded on the records remained peripheral to the formal case-planning and decision- making processes orchestrated by Department of Human Services staff.

The experience of implementation in Victoria has shown that the records are best introduced within a comprehensive structure of planning and review, such as is provided by the Looking After Children planning and review forms. Harriett Ward (1996) suggests that one of the first tasks in the process of implementation should be a review of the current assessment, planning and review structure and how the records might fit within it. Various types of planning and review forms already exist in state welfare systems, so they are likely to complement the Assessment and Action Records just as the supporting Looking After Children materials do. Respondents involved in the evaluation conducted by Clark and Burke (1998:31) were also in favour of introducing the records as part of the entire Looking After Children approach.

After implementation of the records in Victoria, existing information recording, planning and review forms and protocols in the pilot region were modified to anticipate the synthesis of existing forms with the records.

Introduction of the records as part of a comprehensive system of care would help establish clear demarcation of roles and responsibilities between sectors, and help promote partnerships between social workers from social service agencies, care providers and protective workers. Implementing the records as a cornerstone of services to children and young people looked after away from home is also more likely to create an emphasis in practice on a holistic approach to caring for children and young people than if it was implemented as a stand-alone initiative. There remains, however, the issue of asking voluntary care providers (such as foster care workers) to take on the major responsibility to collect information on the outcomes of service provision.

Funding for additional services

The resources that are available to undertake remedial action is a further issue likely to affect the success of Looking after Children in Australia. During interviews with care providers after implementation of the records in Victoria, certain respondents reported that recommendations for remedial action were unable to be followed up owing to lack of funds and inadequate services, particularly in the area of dental care and specialist health care. The resources available to provide children with the parenting inputs that will help them achieve or maintain certain objectives is an obvious issue that will affect the success of implementation in Australia.

Therefore, implementation of Looking After Children should prompt deliberations about the responsibility of social service agencies to resource the areas identified on the Assessment and Action Records. Such an exercise would enable child care agencies and the relevant government departments to engage in a debate about the standard of care it would be most appropriate for them to provide with the resources available. Such a discussion should prompt questions such as: Do we provide funding for additional welfare services to ensure children are given opportunities to make friends? Do we offer specialist help with emotional and behavioural problems? Whose responsibility should it be to access these services, and to fund them, including making decisions about the threshold at which unmet needs are unacceptable or warrant provision of additional services? These are critical resource issues that are best managed in planning stages prior to implementation. As legal statutes governing care differ from state to state, as do policies for the provision of family support and out-of-home care, it is important that these deliberations are conducted within each state and territory individually.

Profile of client children and their families

Legislative changes in the 1989 Children and Young Persons Act in Victoria have, in line with similar legislation around Australia and overseas, significantly narrowed the focus of intervention to those children and young people who are at significant risk of harm and abuse, and for whom their families are unwilling or unable to provide for their care and protection. This means that children coming into care not only are likely to come from the poorest families in society, but are also those who have suffered significant deprivation. Generally speaking, children looked after away from home in Australia today are characterised by a high incidence of developmental delay and behavioural and emotional disturbances (Bath 1998; Clark and Burke 1998; Boss, Edwards and Pitman (eds) 1995).

There has also been a shift in the age that children and young people come into care. Throughout Australia, the highest number of substantiated cases of child abuse and neglect are for those aged thirteen and fourteen years (Broadbent and Bently 1997). In Victoria, comparisons with program data from placement and support services between five and ten years ago, although not meeting quite the same criteria, indicate that as a proportion of the total population of children in care, the number of adolescents coming into care has increased considerably. In 1989, the rate per thousand of the adolescents placed in care was 2.5. This rate has increased to 4.6 per thousand in 1995 (Department of Human Services 1997). Berry (1992) also observed that 'most placements in the 1980s and 1990s have involved older children, sibling groups or those with special physical and emotional needs'.

Within the adolescent population that are looked after away from home in Victoria, approximately 18 per cent, or around 220 young people over the age of twelve years, have been described as 'high-risk' or as having 'intensive support needs' (Department of Human Services 1997; Bath 1998). Research has found that young people who enter the care system during adolescence have poorer outcomes in comparison with those who have grown up in care, particularly in the case of those young people who lose contact with school and family (Garnett 1992; Courtney and Bath 1996).

Many children are placed in out-of-home care as a direct result of psychiatric illness and substance abuse (Besharov 1990; DeBettecourt 1990; Ribton-Turner 1992). In fact, it is estimated (from anecdotal evidence, based on the 1992-93 placement statistics from permanent care agencies) that up to 75 per cent of Victorian special needs permanent placements occur as a direct result of drug and alcohol and mental health problems, which are frequently associated with child abuse (Darivakis 1993).

The characteristics of families reported earlier in this work also indicate a high level of disruption and instability. Factors such as substance and alcohol abuse, high mobility, psychiatric illness and offending behaviour suggest the difficult task of workers in attempting to rehabilitate families with their birth children using Looking After Children. Moreover, the Victorian Looking After Children experience showed many instances where contact with families was not deemed beneficial to children. Some families were also resistant to working in partnership with protective workers and agency social workers, or were simply unwilling to be involved in the care of their children. Furthermore, permanent care case plans for children and young people were considered at odds with the principle of working in partnership with parents.

The population of client children for whom Looking After Children would be applied, as the Victorian experience of implementation demonstrated, is likely to create significant barriers to fostering a sense of partnership between the various people involved in the care of the child, and the involvement of client children themselves in completing the records. The high level of disruption and instability in children's lives was a particular barrier to involving children in completing the records.

Despite the challenges in working with client children and their families, the deficits experienced by children looked after away from home suggest an urgent need for an affirmative action approach if they are to achieve long-term wellbeing into adulthood. The profile of client children and their families, therefore, further upholds the benefits of Looking After Children for children looked after away from home in Australia.

Conclusion

Although there is overwhelming evidence of poor developmental and health outcomes among children and young people looked after away from home, the removal of children from their family homes is sometimes unavoidable and critical to the wellbeing of child and family. A major challenge confronting social service agencies with responsibility for caring for children in need of substitute care throughout the world is to establish a system of service delivery that maintains, or helps children achieve, long-term wellbeing.

There is now general consensus that implementing Looking After Children is a positive step toward ensuring that whenever out-of-home care is utilised it is maximally therapeutic and minimally harmful. The experience of implementing Looking After Children in Australia has shown that the approach does help set an agenda for good parental care, which through better supervision and planning can help mobilise appropriate practical and specialist help for children in need of substitute care. Findings from the Institute's evaluation of the Victorian pilot have also shown that these improvements possibly lead to improvement in the physical and psychosocial health and wellbeing of children.

The Australian experience shows that the objectives for parenting, and the practice principles that underpin the Looking After Children approach, are acceptable to those who would be required to use them. However, if its full benefits are to be delivered in practice, its implementation needs to be appropriately resourced, and it needs to be introduced as a cornerstone of services to children looked after away from home. Local and international links to keep abreast of the experience of implementation in other social service agencies and systems within Australia and around the world are also important to ensure successful implementation. Use of Looking After Children in Australia should also be informed by the ongoing evaluation of both the success of implementation, and the benefits to children and young people and families.

In addition to its practice function, Looking After Children has also been designed as a tool for gathering information about the outcomes of children looked after away from home. This would be of benefit to practitioners in order to measure the outcomes from particular interventions, to managers in order to measure outcomes from their services, and to Social Service departments, who may wish to determine the effectiveness of the services they commission. Current developments in the UK Looking After Children project suggests that a structure to ensure that information collected from the records is aggregated and analysed and then used to inform future decisions is not far away.

National implementation of the Looking After Children approach would also help rationalise documentation and create consistency between social service agencies and the states and territories. This will improve the chances of continuity, as paperwork can then follow children from one agency to another, from one system to another, and it will be possible to compare the experiences and progress of children in different settings, and within different agencies and welfare systems within Australia. It will also mean that practitioners will not have to be retrained if they move to a different organisation or interstate. National use of Looking After Children will also create possibilities for collecting national outcomes data, and will open up possibilities for state-by-state comparisons. Use of Looking After Children in countries throughout the world also opens up the opportunity for cross-national comparisons.

Evidence from initial work with Looking After Children under Australian conditions suggests that professional use of the materials can help service systems to ensure children achieve long-term wellbeing into adulthood. When information gathered from the use of the Looking After Children materials is used for management purposes, this will also help social service agencies demonstrate the outcomes of interventions into children's lives. Both outcomes point to the same conclusion: implementation of Looking After Children can help establish a service system that will help children maintain or achieve specific goals that will enable them to lead happy and healthy lives into adulthood.


Endnotes

1. It should be noted that children are also placed in supported accommodation for reasons of family crisis including illness of parents, and such placement may be voluntary (Steering Committee for the Review of Commonwealth State Service Provision 1999).

2. It should be noted however, that while there is clear evidence of poor physical and psychological outcomes among children in out-of-home care, it is unclear to what extent these deficits result from the circumstances precipitating entry into substitute care, the characteristics of the children or young people themselves or their natural parents, or the experience of being in substitute care. Some of the factors that might explain outcome disparities among those who experience substitute care, including aspects of the out-of-home care experience and the trauma and deprivation that lead to out-of-home care, are outlined in Appendix 1.

3. A detailed account of the implementation issues raised during this study are outlined in a paper by Dr Harriett Ward (1996). Findings from an in-depth study of implementation in one of the local authorities participating in the evaluation study can also be found in Jones (1995) and Corrick, Jones and Ward (1995).

4. The Australian Institute of Health and Welfare has developed statistics in the child protection system over recent years, however the information they have gathered has largely been aimed at demonstrating the numbers of children and families who fall into the child protection net who allegedly do not need to (Bath 1994).

5. For a good summary of the relationships that have developed between Australian jurisdictions and Looking After Children, see Owen, Jones and Corrick (1998).

6. Similar materials to those that form part of the Looking After Children system, such as the Essential Information Record and the Care Plan, for example, are already incorporated into the current practice framework in Victoria. It was also agreed that the pilot project would prioritise implementation of the Assessment and Action Records owing to their potential to improve outcomes for children and young people.

7. The Department of Human Services Eastern Metropolitan Region sought expressions of interest from local agencies wishing to take part in the trial, and initially five were selected. Owing to placement changes, three additional services were involved at later stages in the trial.

8. The Institute's evaluation of the Victorian Looking After Children implementation was conducted under the international research licence purchased by the Children's Welfare Association of Victoria.

9. Changes to the child or young person's legal status were the result of expiration or amendment to pre-existing court orders.

10. Attention Deficit/Hyperactivity Disorder is thought to be a neurological disorder. It is diagnosed by a cluster of behaviours that result in a child underachieving at school for their intelligence and potential and behaving worse at home than the quality of care would predict (Kiely 1999).

11. It should be noted that the status of biological fathers was not known in eighteen cases. The status of biological mothers was not known in four cases. Numbers are presented in terms of valid (or known) cases.

12. All children's names are pseudonyms.

13. The one exception related to the number of children experiencing developmental delay. Before implementation, the number of children who were considered to be experiencing developmental delay was four, whereas after implementation that number had increased to eight. Although there are a number of factors that may account for the variation, it is possible that a greater focus on developmental issues through implementation of the records increased knowledge of children's developmental status, and, hence, awareness of difficulties or delay in developmental progress.

14. This information was obtained during conversations with children and young people's caseworkers and care providers during consultations about the involvement of children and young people in the interview component of the research and was subsequently recorded as file notes.

15. Young people's perceptions of the materials were also sought in the Centre for the Education and Training of Social Workers study, and are reported in Bell (1998-99). Generally, the group of young people involved had welcomed their use.

16. Some of these changes were brought about as the result of reallocating case management responsibility to a recently established case contracting team within the Eastern Metropolitan Protective Services Unit.

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Note: this report is a pre-publication version, and there may be some minor variations between it and the published version. Contact the Institute if you would like a copy of the final publication.

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