How do Children Fare in Care: A Longitudinal Study of Outcomes in Foster Care Family Permanence and

1
How do Children Fare in Care A Longitudinal
Study of Outcomes in Foster CareFamily
Permanence and Foster Care Session 22

• Dr Elizabeth Fernandez
• School of Social Sciences and International
  Relations
• University of New South Wales
• Australia
• E.Fernandez_at_unsw.edu.au
• International Society for Child Indicators
  Inaugural Conference
• Chapin Hall Center for Children
• Chicago, Illinois
• June 26-28, 2007

2
Childrens Conceptions of Fostering

• What is a foster home? "Places of refuge where
  people can stay, where you get looked after.
  Would you call this home a foster home? "No,
  this is my house. (009, male, 11 years old)
• Would you call yourself a foster child? "Not
  really, I wouldn't call myself one cause my carer
  treats me as her own son, even though she's
  already got one and she's already got a daughter
  but she treats me as her own son. And I really
  adore her.
• No a normal kid like everyone else. Because here
  it is like a real family. Some parents dont care
  about children, thats why I came into foster
  care. (005, male, 12 years old)

3
Childrens Conceptions of Fostering (contd)

• A person who acts like your mum and dad, I
  havent got my mum and dad or my brother or the
  pets that I had before. Thats why its not the
  same. Youre in somebody elses house and its
  not your real mum and dad but its the person
  thats looking after you for the moment.
  (female, 8 years old)
• Sort of because they miss their mum and they
  really want to go back to her, and they wont be
  able to see her for a long, long time, so they
  act differently because of this. But once they
  settle in they get fine, and then um they just
  forget about it and start moving on. (male, 9
  years old)

4
The impact of the care experience on childrens
wellbeing

• Children come to the foster family setting as an
  already at risk group
• In relation to children's wellbeing in care
  research has identified a range of concerns
  including
• Instability in care placements (Barber
  Delfabbro, 2003 Fernandez, 1999 Pecora,
  Williams, Kesler Herings, 2003 Ryan and Testa,
  2004)
• Inability of care systems to ensure optimal
  educational outcomes (Jackson, 2000Dobel-Ober,
  Lawrence, Berridge Sinclair, 2003 Rosenfeld
  Richman, 2003 Zetlin, Weinberg Kimm, 2003)

5
Previous Research Highlights that

• Children in care are significantly more likely to
  exhibit psychological problems than children in
  the general population (Anderson et al. 2004
  Clausen et al. 1998 Barber Delfabbro, 2003
  Minnis Devine, 2001 Meltzer et al. 2003).
• Evidence of indications of emotional and
  behavioural concerns in the clinical range
  (McMillen et al. 2004 Callaghan et al. 2003
  Garland et al. 2003 Stahmer et al. 2005
• Children who experience multiple changes in
  caregivers tend to develop elevated emotional and
  behavioural problems (Stanley et al. 2005)
• Children with externalising behaviours are
  particularly vulnerable to placement breakdown
  (Stijker et al. 2005 Newton et al. 2000 Mc
  Auley Trew, 2000).
• Children leaving the care system are
  disproportionately likely to experience
  homelessness, unemployment, depression and become
  involved in problematic activity (Courtney
  Dworsky, 2006 Stein, 1994).

6
Previous Research Highlights (cont)

• Studies undertaken internationally point to the
  educational deficits which children bring to the
  care experience (Jackson, 2001 Harker et al.
  2004 Mitic Rimer, 2002 Zetlin et al. 2003)
• Low educational attainment, poor attendance,
  overrepresentation in school exclusion, frequent
  school changes ,low completion rates and high
  unemployment among those who age out of the
  system are noted (Blome, 1997 Harker et al.
  2004 Jackson, 2001 Pecora et al. 2006 Stein,
  1994)
• Limited supports are available in schools to
  respond to the emotional and behavioural
  difficulties children present (Elliot, 2002
  Remsbery, 2003 )

7
The impact of the care experience on childrens
wellbeing

• Current research points to limitations of cross
  sectional studies in capturing developmental
  sequences
• Increasing recognition of the need to give a
  central place to the voices of children in
  research and practice (Gilligan, 2002 Newman,
  2003)
• Limited research that views outcome from
  different participants in the foster care process
  (Courtney, 2000 Kelly Gilligan, 2002)

8
The Research Aims

• To document the needs and experiences of children
  in care from the perspective of their carers,
  case workers, birth parents and children
  themselves
• To analyse the perceived adjustment and
  psychosocial functioning of children over the
  study period and document placement and
  developmental outcomes
• To establish how the children and their carers
  experience social work support, and the impact of
  professional input on outcomes
• To explore childrens perceptions of their
  developing relationships with foster families,
  and their established relationships with their
  birth family and significant others

9
Data Collection

• Interviews were carried out at 4 months after
  entry to care and 18-24 month intervals
  thereafter
• Child interviews (8 18 yrs)
• Caseworkers (of children of all ages)
• Foster/adoptive carers (of children of all ages)
• Birth parents (of children of all ages)

10
Interviews Explored

• Conceptions of fostering
• Childs placement history
• Reasons for entry to care
• Relationship with the carer and foster siblings
• Relationship with the birth family
• Schooling experience
• Physical health
• Emotional and behavioural development
• Identity and self image
• Relationship with caseworker and agency

11
Data Collection (contd)

• Measures used in the study
• Looking after children AAR subscales (completed
  by caseworkers and children)
• Achenbach CBCL (completed by carers)
• Achenbach TRF (completed by teachers)
• Hare self esteem scale (completed by children)
• Interpersonal parent and peer attachment scale
  (completed by children)
• Attachment styles questionnaire (completed by
  carers)
• Foster care alliance scale (completed by children
  and carers)
• Strengths and Difficulties Questionnaire
  (completed by children)

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About the Children

• 59 children participated in the study
• Boys 52
• Girls 48
• Ages ranged from 3 to 15
• 12 years was the most frequently occurring age
• Children are from Barnardos Find-a-Family Centre,
  an integrated service for permanent family care
  and adoption for hard to place children
  requiring long-term placement. Many have
  multiple failed placements prior to their
  Find-a-Family placement and, almost none have
  adoption care plans on entry

13
Primary Reasons for Care

• Factors related to the Birth Mothers
• Drug or alcohol dependence (29)
• Mental health 22 cases
• Physical abuse and neglect 36 of cases
• Factors related to the Birth Father
• Abandonment 39 of cases.
• Physical or sexual abuse or neglectful parenting
  39
• Domestic violence (22)
• Child factors
• Emotional and behavioural factors (25) including
  antisocial behaviour or severe emotional
  disturbance such as depression

14
Care History

• Respondents have been in care for 8.2 years on
  average and have been in Barnardos care for the
  majority of that time (6.3 years). Respondents
  have had on average 4.4 placements in total.
• Males have spent longer in care on average (9
  years) than have females (7.4 years)
• The majority (71) of children are in non
  relative foster families and 19 are adopted

15
Change of Placement and Childrens Responses

• Many of the children interviewed had multiple
  carers over time. Childrens placements ranged
  from 2 to 7 foster homes, an irony that is
  presented by one of the children when asked why
  they thought they were in care
• Ah, cause we've moved around a lot (male,
  11yrs)
• Every kid should get a prize for having the
  courage to move. Something like a hundred
  dollars (male,13 yrs)
• Below another child advise around an issue that
  many of the children have experienced, that is
  being moved because of challenging behaviours.
• Dont chuck temper tantrums. And that's it(
  male,13 yrs)

16
Change of Placement and Childrens Responses
(cont)

• Many children were aware that they would
  eventually find a permanent foster placement,
  even though they were not sure how long their
  present placement would last
• (SIGH) well if I am very very, extremely good I
  might stay here and this might be my forever
  family but if um, if this isnt a good place I
  will have to move, which I dont want to
  (female, 8 yrs)
• (Until) I'm old enough to move out into a flat
  (female, 11yrs)

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Change of Schools

• Three quarters of the children had experienced
  at least one
• change in schooling since their separation from
  their birth family
• More than half of the children had had three or
  more changes
• Heaps, probably about 5 or 6 times. I think I
  get stupider every time I have to move
  (female,14 yrs)
• Ive been to thousands of schools...about, 5 or
  6. I don't know (male, 11yrs))
• When asked to evaluate how they were doing at
  school, most children attempted to assess their
  own abilities.
• can't hardly readand plus I'm year 5 going in
  year 6can't even hardly read or do neat
  writing (female, 10 yrs)
• Um, playing and English. I'm not so good at my
  maths (female, 11yrs)
• Hand writing everything. Not everything in the
  world thoughI'm good at mostly everything
  (female, 8yrs)
• Q. what are you like compared to your
  classmates?
• Um, middle of the class. I mean, we got graded
  and it goes up to A's and I'm in the(middle)
  (male, 12yrs)

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Foster Parent Cohesion

• Forty-eight per cent of respondents indicated
  they got on 'very well' both with their foster
  mother and their foster father.
• All but one respondent indicated that they got on
  with their foster mother very well or quite
  well
• Almost 9 out of 10 respondents were positive
  about their relationship with their foster
  father, rating 'very well' or 'quite well
• Just over 1 in 10 respondents indicated that they
  got on with their foster father 'not very well'
• Eighty-six per cent of respondents were positive
  about their relationship with their foster
  sibling
• However nearly 1 in 10 respondents indicated that
  they got on with their foster sibling 'not very
  well'

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Childrens perceptions of cohesion

• The relationships with the foster mothers
  remained very positive, especially amongst boys
  and younger children
• Children who had a stronger level of maternal
  attachment were more likely to sustain highly
  cohesive relationships within the foster families
  
• The higher the cohesion with the foster mother
  the higher the cohesion with the foster father
  (r0.37, n40, p0.021)
• Age was significantly related to cohesion with
  the foster father (r0.5, p0.01) such that older
  children were less likely to report getting on
  very well with the foster father

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Childrens perceptions of cohesion (contd)

• The childs cohesion with other children from the
  foster family, was significantly related to the
  childs number of placements
• Children who got on very well with the children
  of the foster family had significantly fewer
  placements than children who did not get on very
  well (p 0.018)

22
Cohesion (cont)

• She's (female carer), understanding, she's nice.
  She helps me with lots of things. Shes just a
  very kind person she's got a nice heartsometimes
  I give a hug to (carer) before I go to bedI
  don't know what's the most important thing. When
  I go shopping with her, just me and her by
  ourselves we just talk you know. I like how we
  have time by ourselves sometimes (female, 17yrs)
• She, umm, she'll spend lots of time on me and
  she's really nice, andshe helps me with things
  when I need help...she always has the right
  advice to tell me...cause they treat me like Im
  part of the family so I think I am (female,
  10yrs)

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Frequency of Contact

• Birth Mothers and siblings were the most
  frequently contacted family members
• One child in 5 had contact with his or her birth
  mother at least fortnightly
• Nearly three-quarters of children (72) saw their
  birth mother at least once every 3 months
• A quarter had no contact at all
• Just over half (56) of the children had no
  contact at all with their birth father
• 28 saw their father between once a month and
  every few months or holidays

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Current Contact with Family of Origin

• Q. How do you feel when you see her? (Birth
  Mother)
• HappyMmm, I dunno I just have this feelingMmm,
  nice, mmm happy, mmm that's about it (006, male,
  11yrs)
• Um, the fact that I'm happy (007, female,
  11yrs)
• Im always missing my mum. It doesn't happen
  that much now, cause I see her every month
  (male, 13yrs)
• I ask her a lot of questions, I ask her what was
  she like when she was little, what was I like
  when I was littleJust to see herShe realises
  what she's done and she tried to change but
  that's her (female, 17yrs)
• Most of the time she doesn't turn upShe might
  turn up every second time.She's heaps nice. And
  she never laid a hand on me (male, 14yrs)

26
Current Contact with Family of Origin (cont)

• Compared to Interview 1, the only significant
  change was an increase in childrens desire to
  see their fathers
• Many of the children expressed that they never
  see their birth fathers, they did however appear
  to be interested in seeing them and establishing
  a connection
• I'd like to see him (father) a lot more, heaps
  and heaps and heaps more times, it makes me feel
  happy(female, 8yrs)
• I dont have a real dad, I never did. I only
  have false dads (female, 8yrs)
• Ive never had a first dad (male, 11yrs)

27
Childrens Self Esteem

• Childrens self esteem was assessed using the
  Hare self esteem scale. Includes peer
  self-esteem, home self esteem and school
  self-esteem and a total score
• Girls and boys both had an average of 82
• Peer self esteem was negatively correlated with
  total number of placements, (r -0.42, p0.05) so
  that the more placements children had the lower
  their peer self esteem
• Age at entry to care was also found to be related
  to global self esteem (r0.37, p0.05). That
  is, children who went into care at an older age
  had higher self esteem at interview 2

28
Hare Self Esteem Scores, including gender
breakdown

• Girls were found to have remained stable from
  Interview 2 to Interview 3 on all the subscales
  and the total self esteem score
• Boys however had significantly higher home self
  esteem scores and total self esteem scores at
  Interview 3 compared to interview 2.
• This finding is encouraging given the small
  sample sizes and indicates that boys responded
  positively to the foster home environment.

29
Self esteem and Childrens care history

• From the childrens interviews it was apparent
  that being in care affected their self esteem.
  However, the children did also compare themselves
  to their peers for some reassurance.
• Its like we're second hand kids unless that's
  how all kids feel who are my age (female,
  12yrs)
• When I see my friends with their parents I see
  nothing different...it just seems the same, like
  Ive got play stations and Nintendos, and being
  allowed to play and going to friends houses as
  well (male, 13yrs)
• Some people in my class don't even have a dad.
  And I get lots of stuff (female, 10yrs)

30
Looking After Children Assessment Action
Records
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Relationship skills

• At Interview 3, 11 skills were reported by more
  than 75 per cent of the children, an increase of
  six skills from Interview 1 and four from
  Interview 2
• At Interview 3 more children were reporting
  feelings of trust, confidence amongst their peers
  and less demanding with their carers
• Several behaviours did not improve very much from
  Interview 2 to 3 including comfort others who
  are upset, considerate of others feelings,
  not getting into fights, sharing, ability to
  make friends

33
LAC Scores and Cohesion

• A positive correlation exists between the number
  of reported relationship skills and the level of
  cohesion with the foster mother (r0.42, n42,
  p0.006) and the foster father (r0.38, n42,
  p0.014).
• Cohesion also relates to some LAC subscales
• The greater the foster mother cohesion the fewer
  relationship problems with carers (Carer
  Subscale r-0.41, n42, p0.006)
• The greater the foster father cohesion the fewer
  relationship problems with carers (Carer
  Subscale r-0.36, n42, p0.020), the fewer the
  conduct problems
• The nature of the relationship with the foster
  father at interview 1 appears to have had an
  important developmental influence on the
  children, so if there was very good cohesion the
  child increased their relationship skills by
  interview 2 3

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Anxiety problemsChildren self assessment

• Worrying a lot was the most frequently reported
  symptom over a third of the children reported
  this
• Nearly a quarter of children reported
  anxiety-related somatic complaints
• Females appeared to have more anxiety problems on
  average than did males (t(40)-1.95, n40,
  p0.058)
• Just under a third of children experienced
  multiple anxiety symptoms at the time of the
  third interview
• Improvements at interview 3 were in relation to
  reduced feelings of misery and sadness, fears and
  sleeping difficulties

37
Child Behaviour Checklist

• In the present study the CBCL 4-18 was used
• This is an observational measure for children
  aged 4 to 18 (Achenbach 1991) which assesses 113
  problem behaviours to provide information on 3
  overall problem scores
• Internalising Problems inhibited or
  over-controlled behaviour (I, II and III)
• Externalising Problems antisocial or
  under-controlled behaviour e.g., delinquency or
  aggression (IV and V)
• Total Problems Scale all mental health problems
  reported by parents or adolescents

38
Child Behaviour Checklist (contd)

• 8 further subscales
• 1.Somatic Complaints chronic physical complaints
  without known cause or medically verified basis.
• 2.Withdrawn shyness and social isolation.
• 3.Anxious/Depressed feelings of loneliness,
  sadness, being unloved, worthlessness, anxiety
  and general fears.
• 4.Delinquent Behaviour breaking rules and norms
  set by parents and communities (e.g., lying,
  swearing, stealing or truancy).
• 5.Attention Problems difficulty concentrating
  and sitting still, and impaired school
  performance.
• 6.Aggressive Behaviour bullying, teasing, temper
  tantrums and fighting.
• 7.Social Problems impaired peer relationships.
• 8.Thought Problems strange behaviour or ideas,
  obsessions.

39
Children aged 4-17 years in clinical range of
problems on CBCL, compared to the Mental Health
of Young People in Australia (MHYPA) Survey
(n3870)
Comparisons are made with the findings of the
Australian governments mental health of young
people in Australia (2000), based on a national
representative sample
40
Carer Ratings on the Achenbach Child Behaviour
Checklist interview 1

• 43.4 of the children were in the clinical range
  for number of total problems,
• 35.8 for internalising problems
• 34.0 for externalising problems
• Clinical rate for Total Problems is three times
  the Australian community sample
• Internalising and externalising problems exceeded
  the MHYPA community norms

41
Carer Ratings on the Achenbach Child Behaviour
Checklist interview 2

• Between 7.5 and 28 demonstrated clinically
  significant problems on the subscales
• Attention problems, social problems, delinquent
  behaviour, anxiety and depression rated in the
  clinical range.
• 38 of children were in the clinical range of
  total problems
• 22 for internalising problems
• 37 for externalising problems

42
Comparison data of scores from Interviews 1 to 2

• Significant decreases detected between carer
  ratings at Interview 1 and 2 on the internalising
  scores (t2.07, df 50, plt0.05) and the anxiety
  and depression subscale (t2.01, df 50, plt 0.05)
• Fewer children fell into the clinical range of
  total problems at the second interview
• Ratings remained above the Australian normative
  data on all subscales total problems and
  externalising problems
• Internalising problems had dropped.

43
CBCL Teacher Report Form (TRF)

• Teachers of children in care were asked to
  complete the Achenbach teachers check-list, a
  companion to the child behaviour checklist
• The instrument is norm referenced and assesses
  key problem sub-scales and overall problem scores
  
• The TRF also includes an Adaptive Functioning
  Scale which include 5 ratings over two subscales
  on the childs positive attributes as displayed
  at School

44
TRF (contd)

• Academic Performance
• teachers ratings of the childs performance in
  academic subjects
• Adaptive Functioning
• Four adaptive characteristics and the sum of the
  four characteristics
• How hard the child is working
• How appropriately he/she is behaving
• How much he/she is learning
• How happy he/she is

45
Who were included in this part of the study?

• The TRF was completed for children aged between 5
  and 17, with an average age of 11.1 years (sd 3.1
  years)
• Additionally each childs main teacher completed
  a checklist for another child in the class,
  matched for age and sex but who resides in a
  birth family

46
Table T-scores for TRF Problems at Assessment 1
for Care and Control Groups
47
Table (contd)
48
Children in care

• The problem subscale scores have a minimum of 50,
  and a clinical cut off of 64
• The maximum scores for the children varied from
  67 (withdrawn) to 91 (for aggressive behaviour)
• The average scores ranged from 52.6 (somatic
  complaints) to 58.63 (social problems)
• the highest average scores for girls was social
  problems (mean 59.65) and for boys, aggression
  (mean 58.48)
• There were 14 children in the clinical range for
  the summary scores for internalising problems,
  (greater than 63 on the teacher ratings), 21
  with externalising problems and 177 over
  threshold on total problems

49
Control Group Children

• Compared to the children in care only two
  significant differences were detected
• Firstly the children in care had higher t-scores
  on aggressive behaviour (means 58.2 for care
  and 54.3 control P0.013)
• The care group had higher t-scores for
  externalising problems (means 56.7 for care,
  52.1 for control, p0.019)
• The control group had high level of children in
  the clinical range of scores for internalising
  problems
• 25of the children in the control group had
  scores which fell in the clinical range for
  internalising problems

50
Figure 11 Percentage of children in the clinical
range for TRF summary scales compared to the
sample of matched children, not in care
51
Table T-scores for adaptive functioning scales
for children in care and control group
A high score is indicative of more adaptive
functioning
52
Adaptive Functioning Scales (TRF)

• Children in care
• children in care had the highest average score
  for happiness and the lowest for behaving
  appropriately
• By gender, girls had their highest average
  ratings for working hard (mean 44.85)
• and the boys, being happy (46.35) or working hard
  (46.5)
• The highest percentiles in the scales for this
  group ranged from 73rd percentile (behaving
  appropriately) to the 93rd percentile (learning)
• Control group
• The control group childrens percentile means
  varied from a low of 30.31 for learning, to a
  high of 37.40 for working hard

53
Figure 13 Adaptive scale percentiles for
children in care and the matched children, not in
care for academic performance and the sum of the
adaptive scales
54
Comparisons between the care and control samples

• Girls in care, appear to function at a lower
  average percentile to their non care peers
• Boys samples appear more evenly matched
• In relation to the subscale behaving
  appropriately children in care have lower
  ratings

55
Comparisons between the groups at assessment 2

• Both groups demonstrated significant changes in
  their TRF problem scores from the first
  assessments
• With regard to the summary scales, both groups
  showed significant reductions in the ratings
• In the subscales, the care group changed in six
  areas, as opposed to 4 areas in the control group
• The strongest changes for the control group
  surrounded the internalising cluster
• The care children showed most change in the
  externalising clusters

56
Summary

• Both the children in care and control group had
  arrange of problems detected
• Evidence of a greater prevalence of problems in
  the care group
• The high prevalence of internalising problems
  amongst the control group
• At the second assessment there were no
  differences between the two groups on the problem
  subscales, which, in a restorative program is a
  positive finding

57
Summary (contd)

• On the adaptive functioning scales, children in
  care showed significant improvements across all
  subscales
• Children in care were functioning near to the
  50th percentile, based on the normal population
• Control group showed some significant gains but
  without the same breadth or magnitude
• Some of this change may be attributed to the
  effects of restorative care and the Barnardos
  intervention

58
Comparisons between the groups at assessment 2
(contd)

• the teachers not blind to the status of the two
  children that they were assessing
• factors need to be considered when interpreting
  these data
• Some of these changes might be apportioned to
  different rating styles of the teachers at the
  different time points, but this is a constant for
  the two groups.
• Some may be natural maturation although the age
  related norms should also account for this
  effect.
• Finally some of the effects may be attributed to
  the effects of the Barnardos intervention

59
Teacher Carer Ratings on the Achenbach Rating
Scales

• There was significant agreement between the
  carers and teachers on the ratings of children
• They were more likely to agree on the
  identification of children below clinical
  threshold problems than above
• Carers would rate more children at above
  threshold levels than teachers, especially with
  regard to externalising and total problems

60
Teacher Carer Ratings on the Achenbach Rating
Scales (contd)

• This difference may be an indication that
  teachers were more conservative than the carers
• Have a better idea of the normal range of
  behaviour
• The structure of the classroom provides
  sufficient guidelines for the children to behave
  within non clinical levels
• In the absence of such structure, the carers
  observe more problematic spectrum

61
Summary and implications

• Children had high levels of psychological need
• Problems with attention, social interactions,
  anxiety, aggression approximate estimates from
  other studies
• Findings underline the importance of recognising
  emotional and behavioural difficulties
  experienced by children in care early and
  identifying their impact on carers.
• Vulnerabilities and strengths of children based
  on gender and age, and the need for
  individualised and differential responses from
  carers and caseworkers.
• Recognise adversities which threaten Childrens
  wellbeing in care such as, maltreatment
  histories, disrupted attachments and interrupted
  schooling
• Externalising behaviours have been cited as a
  strong predictor of placement breakdown
  (Leathers, 2002)
• Strengthen professional decision making to ensure
  children are less likely to move

62
Summary and implications (cont)

• Monitor children at increased risk of instability
  in care
• Support children at risk of psychological
  difficulties with therapeutic services
• Support carers in enhancing their relationship
  with troubled children
• Skill foster parents in approaches needed for the
  sensitive management of childrens emotional and
  behavioural problems
• Support carers and teachers through professional
  training to identify and work with vulnerable
  children to prevent the development of
  psychopathology

63
Focus on Strengths and Competencies of Children
in Care

• Childrens sense of happiness improved overtime
  is a positive finding implying placement in care
  provided a route to rehabilitative intervention
  for children with maltreating histories
• Permanent care afforded a context to develop a
  more secure base
• Being in care offered a pathway into restorative
  services
• School environment and the educational process
  can potentially offer structure, boundaries and
  security to the children in care systems

64
Focus on Strengths and Competencies of Children
in Care (cont)

• The importance of school in offering children
  positive role models and benefits of routines
  and rituals for children experiencing upheaval
  and adversity in their environment
  (Gilligan,1998)
• Research attributes positive school experience
  and achievement to happy adult behaviour
  (Rutter, Quinton et al. 1993)
• Instability of care placements and the
  difficulties involved in starting new schools on
  a regular basis present significant challenges to
  children in care

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Resilience enhancing interventions

• Develop strategic interventions that promote
  childrens strengths and competence
• Foster childrens relationship building skills
• Support carers in acknowledging and reinforcing
  childrens prosocial behaviours
• Develop co-ordinated multidisciplinary response
  to address overlapping domains of need, such as
  education and mental health