Positive reading achievement outcomes in children who experience out-of-home care: Characteristics and predictors.

BACKGROUND: Children who enter out-of-home care ('care') are at increased risk for low academic achievement. Nonetheless, some children who have experienced out-of-home care achieve highly. Several qualitative studies of academically successful young adults with care histories have highlighted factors that may contribute to positive outcomes; however longitudinal cohort research is needed to identify characteristics and predictors of higher achieving younger children who experienced care. OBJECTIVE: To describe characteristics and circumstances of children with higher reading achievement who had entered care, and predictors of higher achievement. PARTICIPANTS AND SETTING: The study included 778 children from the Pathways of Care Longitudinal Study (POCLS) in New South Wales, Australia. METHODS: Prospective cohort data from interviews and linked administrative child protection and education data were used to identify factors associated with higher Year 3 reading achievement among Aboriginal and non-Aboriginal children that may assist in improving outcomes. RESULTS: Although a lower proportion than the general population, almost half (46 %) of children who entered care were in the higher achievement group. Higher achieving students were a diverse group and faced many adversities commonly found among children who experienced care generally. Multivariable logistic regression showed higher achievement in the cohort was significantly associated with: average or above cognitive ability, low externalizing behaviour, highly-educated carers, and non-Aboriginal students. Several supports and services were associated with higher achievement, but inconsistently across analyses. CONCLUSIONS: Results indicate potential interventions could target cognitive ability, wellbeing and environmental factors, and involve interventions directly with children and via carers to improve student outcomes.

Adolescent education outcomes and maltreatment: The role of pre-existing adversity, level of child protection involvement, and school attendance.

BACKGROUND: Maltreated children are at high risk for low educational achievement, however few studies have accounted for confounding risk factors that commonly co-occur (including child, family and neighbourhood risk factors) and results have been mixed, particularly for adolescents. OBJECTIVES: We aimed to 1) examine the relationship between maltreatment and low educational achievement among Year 9 students, taking into account child, family and neighbourhood risk factors; 2) assess subgroup differences in outcomes based on level of child protection involvement and maltreatment type; and 3) identify prevalence and risk factors for low educational achievement. PARTICIPANTS AND SETTING: A population birth cohort of West Australian children (N = 33,866) who sat national reading achievement tests between 2008 and 2010 was used for the main analysis. METHODS: Linked administrative data from Departments of Health, Communities (Child Protection and Family Support), Education, and the Disability Services Commission was used to conduct a series of logistic regression analyses. RESULTS: Maltreatment was significantly associated with low Year 9 achievement, even after accounting for many child, family and neighbourhood risk factors (aOR 1.51, 95 % CI 1.35-1.69). Educational outcomes were consistently poor across subgroups in the child protection system, including those with different levels of child protection involvement and maltreatment types. Other notable risk factors for low achievement included intellectual disability, attendance, parents' level of education, Aboriginality, and being older (indicating possible grade retention). CONCLUSIONS: Adolescents with a history of maltreatment are at risk for poor educational outcomes and need additional support. Multiple contributing risk factors suggest the need for whole-of-government solutions.

Out-of-Home Care and the Educational Achievement, Attendance, and Suspensions of Maltreated Children: A Propensity-Matched Study.

OBJECTIVE: To estimate the influence of out-of-home care on reading scores, attendance, and suspensions by comparing a matched sample of maltreated children who entered out-of-home care and maltreated children who remained at home. STUDY DESIGN: Linked administrative data for all children born in Western Australia between 1990 and 2010 was used, focusing on those with substantiated maltreatment before year 9 achievement tests (n = 3297). Propensity score modelling was used to address differences in preexisting risk factors (child, family, neighborhood characteristics, maltreatment history, and reading scores) and compare outcomes for children placed in out-of-home care and those remaining in in-home care. RESULTS: Both groups of maltreated children had poor educational outcomes. After accounting for group differences in risk characteristics, there was no difference in year 9 reading achievement for the out-of-home care and in-home care groups. There was no difference in suspensions for the groups. The only significant difference was children in out-of-home care had fewer school absences than children in in-home care. CONCLUSIONS: Out-of-home care was not found to be a significant factor in the adverse educational outcomes of these children; however, there is a clear need for further educational support to address poor outcomes for children involved with child protection services.

Relationship between out-of-home care placement history characteristics and educational achievement: A population level linked data study.

Studies generally show children who have entered out-of-home care have worse educational outcomes than the general population, although recent research suggests maltreatment and other adversities are major contributing factors. Children's out-of-home care experiences vary and may affect their outcomes. This study examined the influence of placement stability, reunification, type of care, time in care and age at entry to care on children's educational outcomes. We conducted a population-based record-linkage study of children born in Western Australia between 1990 and 2010 who sat State or national Year 3 reading achievement tests (N=235,045 children, including 2160 children with a history of out-of-home care). Children's educational outcomes varied with many aspects of their care experience. Children placed in residential care were particularly likely to have low scores, with an unadjusted OR 6.81, 95% CI[4.94, 9.39] for low reading scores, which was partially attenuated after adjusting for background risk factors but remained significant (OR=1.50, 95% CIs [1.08, 2.08]). Reading scores were also lower for children who had experienced changes in care arrangements in the year of the test. A dose-response effect for multiple placements was expected but not found. Older age at entering care was also associated with worse reading scores. Different characteristics of a child's care history were interwoven with each other as well as child, family and neighbourhood characteristics, highlighting a need for caution in attributing causality. Although the level of educational difficulties varied, the findings suggest a widespread need for additional educational support for children who have entered care, including after reunification.

Trends in alcohol-related injury admissions in adolescents in Western Australia and England: population-based cohort study.

BACKGROUND: Alcohol-related harm in young people is now a global health priority. We examined trends in hospital admissions for alcohol-related injuries for adolescents in Western Australia (WA) and in England, identified groups most at risk and determined causes of injuries. METHODS: Annual incidence rates for alcohol-related injury rates were calculated using population-level hospital admissions data for WA and England. We compared trends in different types of alcohol-related injury by age and gender. RESULTS: Despite a decrease in the overall rate of injury admissions for people aged 13-17 years in WA, alcohol-related injuries have increased significantly from 1990 to 2009 (from 8 to 12 per 10 000). Conversely, alcohol-related injury rates have declined in England since 2007. In England, self-harm is the most frequently recorded cause of alcohol-related injury. In WA, unintentional injury is most common; however, violence-related harm is increasing for boys and girls. CONCLUSION: Alcohol-related harm of sufficient severity to require hospital admission is increasing among adolescents in WA. Declining trends in England suggest that this trend is not inevitable or irreversible. More needs to be done to address alcohol-related harm, and on-going monitoring is required to assess the effectiveness of strategies.

Maltreatment Risk Among Children With Disabilities.

BACKGROUND: Children with disabilities are at increased risk of child maltreatment; however, there is a gap in the evidence about whether all disabilities are at equal risk and whether risk factors vary according to the type of disability. METHODS: A population-based record-linkage study of all children born in Western Australia between 1990 and 2010. Children with disabilities were identified by using population-based registers and risk of maltreatment determined by allegations reported to the Department for Child Protection and Family Support. RESULTS: Although children with disabilities make up 10.4% of the population, they represent 25.9% of children with a maltreatment allegation and 29.0% of those with a substantiated allegation; however, increased risk of maltreatment was not consistent across all disability types. Children with intellectual disability, mental/behavioral problems, and conduct disorder continued to have increased risk of an allegation and substantiated allegation after adjusting for child, family, and neighborhood risk factors. In contrast, adjusting for these factors resulted in children with autism having a lower risk, and children with Down syndrome and birth defects/cerebral palsy having the same risk as children without disability. CONCLUSIONS: The prevalence of disabilities in the child protection system suggests a need for awareness of the scope of issues faced by these children and the need for interagency collaboration to ensure children's complex needs are met. Supports are needed for families with children with disabilities to assist in meeting the child's health and developmental needs, but also to support the parents in managing the often more complex parenting environment.

Pre-existing adversity, level of child protection involvement, and school attendance predict educational outcomes in a longitudinal study.

Maltreatment largely occurs in a multiple-risk context. The few large studies adjusting for confounding factors have raised doubts about whether low educational achievement results from maltreatment or co-occurring risk factors. This study examined prevalence, risk and protective factors for low educational achievement among children involved with the child protection system compared to other children. We conducted a population-based record-linkage study of children born in Western Australia who sat national Year 3 reading achievement tests between 2008 and 2010 (N=46,838). The longitudinal study linked data from the Western Australian Department of Education, Department of Child Protection and Family Support, Department of Health, and the Disability Services Commission. Children with histories of child protection involvement (unsubstantiated maltreatment reports, substantiations or out-of-home care placement) were at three-fold increased risk of low reading scores. Adjusting for socio-demographic adversity partially attenuated the increased risk, however risk remained elevated overall and for substantiated (OR=1.68) and unsubstantiated maltreatment (OR=1.55). Risk of low reading scores in the out-of-home care group was fully attenuated after adjusting for socio-demographic adversity (OR=1.16). Attendance was significantly higher in the out-of-home care group and served a protective role. Neglect, sexual abuse, and physical abuse were associated with low reading scores. Pre-existing adversity was also significantly associated with achievement. Results support policies and practices to engage children and families in regular school attendance, and highlight a need for further strategies to prevent maltreatment and disadvantage from restricting children's opportunities for success.

Maternal mental health and risk of child protection involvement: mental health diagnoses associated with increased risk.

BACKGROUND: Previous research shows that maternal mental illness is an important risk factor for child maltreatment. This study aims to quantify the relationship between maternal mental health and risk of child maltreatment according to the different types of mental health diagnoses. METHODS: The study used a retrospective cohort of children born in Western Australia between 1990 and 2005, with deidentified linked data from routine health and child protection collections. RESULTS: Nearly 1 in 10 children (9.2%) of mothers with a prior mental health contact had a maltreatment allegation. Alternatively, almost half the children with a maltreatment allegation had a mother with a mental health contact. After adjusting for other risk factors, a history of mental health contacts was associated with a more than doubled risk of allegations (HR=2.64, 95% CI 2.50 to 2.80). Overall, all mental health diagnostic groups were associated with an increased risk of allegations. The greatest risk was found for maternal intellectual disability, followed by disorders of childhood and psychological development, personality disorders, substance-related disorders, and organic disorders. Maltreatment allegations were substantiated at a slightly higher rate than for the general population. CONCLUSIONS: Our study shows that maternal mental health is an important factor in child protection involvement. The level of risk varies across diagnostic groups. It is important that mothers with mental health issues are offered appropriate support and services. Adult mental health services should also be aware and discuss the impact of maternal mental health on the family and children's safety and well-being.