Developmental trajectories of socio-emotional outcomes of children and young people in out-of-home care - Insights from data of Pathways of Care Longitudinal Study (POCLS).

BACKGROUND: There has been a limited understanding of the longitudinal trajectory and determinants of socio-emotional outcomes among children in out-of-home care (OOHC). OBJECTIVES: This study aimed to examine child socio-demographics, pre-care maltreatment, placement, and caregiver factors associated with trajectories of socio-emotional difficulties of children in OOHC. PARTICIPANTS AND SETTING: The study sample (n = 345) included data from the Pathways of Care Longitudinal Study (POCLS), a prospective longitudinal cohort of children aged 3-17 years who entered the OOHC system in New South Wales (NSW) Australia, between 2010 and 2011. METHODS: Group-based trajectory models were used to identify distinct socio-emotional trajectory groups based on the Child Behaviour Check List (CBCL) Total Problem T-scores completed at all four Waves 1-4. Modified Poisson regression analysis was conducted to assess the association (risk ratios) of socio-emotional trajectory group membership with pre-care maltreatment, placement, and caregiver-related factors. RESULTS: Three trajectories of socio-emotional development were identified: 'persistently low difficulties' (average CBCL T-score changed from 40 to 38 over time), normal (average CBCL T-score changed from 52 to 55 over time), and clinical (average CBCL T-score remained at 68 over time) trajectories. Each trajectory presented a stable trend over time. Relative/kinship care, as compared with foster care, was associated with the "persistently low" socio-emotional trajectory. Being male, exposure to ≥8 pre-care substantiated risk of significant harm (ROSH) reports, placement changes, and caregiver's psychological distress (more than two-fold increased risk) were associated with the clinical socio-emotional trajectory. CONCLUSIONS: Early intervention to ensure children have a nurturing care environment and psychological support to caregivers are vital for positive socio-emotional development over time among children in long-term OOHC.

Analysis of acute presentations for child protection medical assessments in a large, culturally diverse metropolitan setting.

OBJECTIVE: South Western Sydney has a large culturally diverse population with many vulnerable subgroups; little is known about the health and social outcomes following acute child maltreatment assessments. We aimed to describe acute presentations of maltreatment in South Western Sydney-including examination findings of the assessment, determine health and social outcomes for children following medical assessment, to inform service development. DESIGN: We gathered data from the acute child protection database on all children <16 years referred for physical abuse and neglect and/or sexual abuse assessment between 2013 and 2015 to one hospital service. We reviewed clinical records of the children assessed, using the reports to classify findings of the examination. We performed simple descriptive analysis on the data. RESULTS: There were 304 children referred, 279 seen for acute assessment. Most (72%) were female, 204 (73%) referrals were for sexual abuse, 75 (27%) were for physical abuse and neglect. There were age, gender and ethnicity differentials depending on type of maltreatment presentation. Twelve per cent of sexual and 19% of physical abuse cases were found not to be abuse related. Unmet medical, developmental and behavioural concerns were identified in the majority (54%) assessed. Just under half (48%) of all children went home with families with no statutory agency support; those seen for physical abuse were more likely to be placed in care (p<0.001). CONCLUSIONS: Children assessed for child maltreatment had a range of health and social concerns identified, needing further intervention. Comprehensive medical assessments have a critical role to play in child protection assessments.

Audit of child maltreatment medical assessments in a culturally diverse, metropolitan setting.

OBJECTIVE: Child maltreatment (CM) is a major public health problem globally. While there is evidence for the value of medical examination in the assessment of CM, little is known about the quality of clinical assessments for CM. South Western Sydney (SWS) has a large metropolitan population with many vulnerable subgroups. We aimed to describe acute presentations of CM in SWS over a 3-year period-with a focus on the quality of the clinical assessments. We wanted to determine whether the cases assessed fulfilled established minimum standards for clinical assessment of CM and whether the assessments were performed in a child-friendly manner. DESIGN: We gathered data from the acute child protection database on all children <16 years referred for assessment between 2013 and 2015. We performed simple descriptive analysis on the data. We measured the assessment, report writing and follow-up against criteria for minimum standards for CM assessments, and identified whether assessments were child-friendly from available clinical information. RESULTS: There were 304 children referred; 279 seen for acute assessment; most (73%) were for sexual abuse, 75 (27%) were for physical abuse/neglect. Over half the assessments identified other health concerns; joint assessments performed by paediatric and forensic doctors were better at identifying these health concerns than solo assessments. Most assessments were multidisciplinary and used protocols; half were not followed up; a third were performed after-hours and a third had no carer present during assessments. CONCLUSIONS: We identified strengths and weaknesses in current CM assessments in our service. Locally relevant standards for CM assessments are achievable in the acute setting, more challenging is addressing appropriate medical and psychosocial follow-up for these children. While we have established baseline domains for measuring a child-friendly approach to CM assessments, more should be done to ensure these vulnerable children are assessed in a timely, child-friendly manner, with appropriate follow-up.