I-CARE: Predicting and preventing child removals and optimising the child protection system for Aboriginal children in Western Australia
More than 14 years after the National Apology and 25 years since the tabling of the Bringing Them Home report, the disproportionate rate of Aboriginal children in out-of-home care remains a national crisis. Aboriginal children are up to 18.9 times more likely to enter out-of-home care than non-Aboriginal children and on any one night nationwide, one in 17 Aboriginal children are in foster, kinship or residential care (AIHW, 2022). Alcohol and other drug use has been documented as a mitigating factor in child removal (De Bortoli, Coles, & Dolan, 2013; Chandler et al, 2013). Given the legacy of the Stolen Generations and continuing harms from institutional child removals, Aboriginal kinship carers play a fundamental role in allowing children in care to stay connected to family, culture and community, which is crucial to their social and emotional wellbeing and development. Kinship carers are Aboriginal carers who are a member of the child’s community or of a compatible community or language group (AIHW, 2022).
While data suggests the numbers of Aboriginal children entering out-of-home care are increasing, the proportion placed with kinship carers is declining (SNAICC, 2021) and, despite their vital role, kinship carers are critically undervalued and unsupported (McPherson et al., 2022; Austin, 2022).
What is the I-CARE project?
The I-CARE project is an NHMRC-funded project awarded to Professor Sandra Eades, from the University of Melbourne. Being conducted in partnership with communities and community-controlled health services in Western Australia, I-CARE aims to predict and prevent Aboriginal child removals and optimise the child protection system to better support Aboriginal children and kinship carers, in partnership with those communities and health services. Quantitative analysis of linked data to identify the intergenerational demographic, social and health predictors of children entering out-of-home care in WA is being conducted by the University of Melbourne’s Indigenous Epidemiology and Health Unit, while NDRI’s Dr Jocelyn Jones is leading the qualitative component of the project. This has included yarning style interviews with 48 Aboriginal kinship carers from five regions across Western Australia to explore their views and narratives about positive and negative experiences of providing out-of-home care to Aboriginal children, and their perceptions of how they can be better supported.
Yarning is a validated research method that facilitates the storytelling process and enables the collection of rich qualitative data in a culturally secure way (Bessarab & Ng’andu, 2010). An online survey and focus group discussions, involving 49 staff from seven Aboriginal Community-Controlled Health Organisations (ACCHOs) across the five WA regions, were also conducted with Aboriginal primary health care staff to obtain their views on:
- how services can be strengthened to support families at risk of having their children removed.
- ways to increase kinship carer arrangements; and
- how to better support kinship carers.
What have we found so far?
As hypothesised, interviews have revealed a high level of unmet need and support for kinship carers and the children in their care. Carers reported a variety of health conditions and disabilities impacting the children, with a high burden of neurodevelopmental disability, mental health issues and trauma, consistent with previous research noting the poorer health outcomes for children in out-of-home care (Maclean et al, 2016). About 80% of kinship carers we spoke to were caring for grandchildren and almost half (44%) had an informal care arrangement, resulting in a lack of financial and other forms of support. Of those with formal care arrangements, one-third were under an 18-year protection order. Longer-term orders have been documented as one of the probable drivers of the increasing number of Aboriginal children in out-of-home care (Bilson et a., 2015).
The reasons for child removal, as reported by kinship carers, were usually a complex interconnection of issues including alcohol and other drug (AOD) use, family violence, and mental health and/or other disability. Parental alcohol or other drug use issues were highlighted as the leading reasons for removal, present in 63% and 70% of cases respectively. Family violence and/or neglect were the next most frequently self-reported reasons for removal, with both represented in approximately half of these cases. Parental incarceration was present in around one-third of child removals, and issues with housing and mental health were also mentioned in several cases. These issues are caused by and linked to grief and loss, intergenerational trauma, disconnection from culture and entrenched disadvantage, making overcoming them immensely challenging. These complex problems are exacerbated by the trauma of child removals, especially in families already harmed by institutional child removal, which further heightens barriers to reunification (Paradies, 2016, Zubrick et al., 2014).
Kinship carers perceived parental AOD issues to be primarily driven by mental health, family violence, grief and loss, and intergenerational trauma. They highlighted the cyclical nature of mental health, AOD issues and family violence, as each perpetuates the others and creates a cycle that is extremely challenging for families to overcome.
Kinship carers also highlighted some of the barriers to reunification faced by families. Poor engagement with and accessibility to treatment are two significant barriers, with concurrent mental health and family violence named as key factors impacting parents’ ability to engage with treatment. Other barriers to accessing services can include being ‘in crisis’ and/or experiencing homelessness, which is problematic given the interconnectedness of AOD use and family violence.
Staff at ACCHOs reported several barriers to accessing in-patient treatment, particularly surrounding cultural security. They documented a lack of culturally secure or Aboriginal community controlled AOD treatment services, as well as feelings of discomfort from Aboriginal people who feel stigmatised when they access mainstream (especially religious-based) services. Staff reported that clients usually present to primary health services due to some form of crisis, with child protection involvement and/or illness/injury due to violence and/or AOD use named as the most common reasons for seeking help. They highlighted that given the complexity of the problems faced by clients, the importance of culturally secure outreach and proactive follow-up cannot be overstated.
What are the implications of our findings?
Kinship carers identified the urgent need for better health and disability assessments for children in out-of-home care to enable early identification and timely intervention. Children with FASD, for example, are significantly over-represented in the child protection system, and alcohol use in pregnancy is strongly associated with family and domestic violence, a history of trauma, poor living conditions, housing insecurity and entrenched socioeconomic disadvantage (Rutman et al., 2020). This highlights the importance of child protection authorities ensuring timely intervention and equipping kinship carers to support children with complex needs. FASD and other conditions associated with poor emotional regulation can result in children being separated from siblings or having unstable or a high turnover of placements, further impacting their development and wellbeing (Koponen et al., 2009).
Emerging findings from interviews with kinship carers indicate significant issues with how the Department of Communities manages children with suspected FASD. Carers and stakeholders highlighted inadequate screening for FASD and other neurodevelopmental disabilities, greatly contributing to underdiagnosis and inhibiting early intervention. Issues with poor assessment practices were highlighted by one kinship carer, when the child in her care was diagnosed with a learning or intellectual disability, which she felt did not explain many of the child’s needs and behaviours. This is compatible with research evidence of FASD often being co-diagnosed or misdiagnosed as attention deficit hyperactivity disorder (ADHD), intellectual disability and/or autism spectrum disorder (ASD). Identification of FASD can be further complicated by concurrent trauma, which can also manifest in developmental delays, emotional dysregulation and irritability (Bower & Elliott, 2016).
People with FASD are at a higher risk of developing substance use problems and of child protection involvement, and also have significantly heightened barriers to accessing and engaging with treatment (Rutman, 2013). With timely and appropriate intervention, however, their risk of substance use, poor mental health outcomes, and criminal justice involvement can be mitigated or avoided altogether.
Our research highlighted that kinship carers are exhausted and exasperated by having to relentlessly advocate to get better outcomes for the children in their care. Carers emphasised that departmental failure to provide appropriate support to carers and to the children, particularly in terms of diagnostic assessments and support for health and disability, results in harmful cycles being perpetuated across generations. One carer was left heartbroken when, after leaving her care, one boy developed substance use issues which led to criminal justice involvement. She believed this could have been prevented with the right support from the department for his disability.
By not investing in early intervention for mental health problems and disabilities such as FASD, we are failing children and young people in out-of-home care, as well as their kinship carers and families. There is a compelling and urgent need for more support for children in out-of-home care and for kinship carers, particularly informal carers, with the greatest identified needs being financial support and respite for carers, and improvement in the quality of cultural plans.
We must address the structural barriers to reunification, with particular focus on cultural security and other factors impacting the ability of families to engage with healing and treatment services. If action is not taken to address the structural issues within the child protection system, as the University of Canberra’s Professor Chris Sarra puts it, “in 20 years we will find ourselves in an even worse position, outraged and appalled as we apologise to yet another stolen generation and wonder where we went wrong.”
We thank all the Aboriginal kinship carers who have participated in the study for sharing their stories and recommendations around what needs to be changed. We also thank all the partner ACCHOs and their staff who participated and supported the project, including those from Broome Regional Aboriginal Medical Service, Derby Aboriginal Health Service, Derbarl Yerrigan Health Service, Geraldton Regional Aboriginal Medical Service, Pilbara Aboriginal Medical Service, Southwest Aboriginal Medical Service and Yura Yungi Aboriginal Medical Service.
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