This may be the author’s version of a work that was submitted/acceptedMarketing Research and Data Analysis
for publication in the following source:
Crane, Phil
(2016)
Should we extend ’care’ or ’care’?
Parity, 29(1), pp. 6-8.
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Should we Extend
‘Care’ or ‘care’?
Dr Phil Crane, Senior Lecturer Faculty of Health, School of Public Health and Social Work
Queensland University of Technology
Over the past two years as I have
travelled to different places around
Australia as an academic I have asked
experienced practitioners with young
people the question ‘In your
experience which is the more
complex — the lives of the young
people or the systems you work
with?’ On no occasion has an
experienced practitioner nominated
the young people they work as
presenting greater complexity —
systemic rather than ‘client’
complexity is experienced as the
greater challenge.
Commonly cited logics for developing
additional ‘post care’ support are:
• It is needed! Young people
‘leaving care’ face additional
(though varied) levels of personal,
social and economic difficulties
when compared to young people
generally. Heightened
vulnerabilities to homelessness,
mental health issues, incarceration
and poverty have been identified
by various studies and data
collections as typifying a
significant proportion of young
people leaving care. Often
couched in terms of multiple and
complex needs, mapping the
experience of moving through and
from care for young people
generally, and for particular subpopulations has been a major
focus of research effort to date.
The tone of this line of inquiry is
generally problem oriented.
• It is right! There is a moral
imperative to change policies and
practices. While the overall pattern
of transitional support for young
adults generally has changed over
time, with an extended role for
parents and informal support
networks well into young
adulthood, this shift has not been
adequately reflected in what
relational, material and service
provisions are available for young
people as they leave statutory
care. The tone of this logic is
essentially moral and around what
constitutes ethical good parenting
when it is the state that has taken
on a guardianship role. The value
of formally extending fostering
arrangements where these provide
positive support has been
promoted as part of this logic.
• It is possible! Other countries that
Australian social policy often takes
a lead from have introduced
various provisions to extend
beyond 18 years of age formal
care arrangements for young
people who are in state care.
While these have taken somewhat
different forms, overall the impacts
have been judged as positive.
At this broad level there appears to
be both a substantial evidence base
and substantial consensus. While
these provide a positive common
starting point there are significant
complexities to unravel in considering
how to proceed in Australia. In other
words, what specifically are the ‘it is’
in the above statements! Here the
frame of complexity is useful.
Young people leaving care are not a
homogenous group with the same
experiences and needs. There are
patterns of continuity evident in
experiences of young people in care
through to post care in terms of
stability and volatility in living situation
and personal wellbeing. Young
people with ‘complex needs’ are most
likely to experience homelessness
during and after care, and constitute a
proportion of those leaving care who
face the greatest challenges in
establishing young adult lives. These
young people are unlikely to have
continuity in fostering arrangements
and ongoing positive relationships
with adult carers. They are more likely
to have experienced a multitude of
out of home placements including
residential care and have ‘felt’
homeless on more than one occasion.
Further, the geographic and cultural
contexts in which they live are diverse.
A key challenge in extending care is
how we better support young people
with complex needs in a context
responsive way. And do we address
critical gaps in current arrangements?
The need for far greater support of
Indigenous communities across
Australia is a case in point. Certainly
there are long-term ongoing costs to
the community of not providing
timely and persistent support to those
young people with the most complex
needs, particularly if life span and
inter-generational frames are used to
calculate costs and savings.
We now know a lot more about the
needed character of effective case
management with young people who
have complex needs. The evidence to
date suggests effective responses to
young people with complex needs 1
requires ecologically complex services
which involve service providers and
informal supports at multiple levels,
accessible coordinated services
across the lifespan, continuity of
services along with well-orchestrated
support for service to community
transitions, privileging the voices of
those who receive services in the
negotiation of what happens, and a
well-designed service system
incorporating a continuum of services
from least to most intrusive.
However, support for individuals will
fail if it simply individualises their
situations. This involves enhancing a
person’s social ecology, a relational
process which builds reciprocal
personal networks and ongoing
access to social institutions such as
housing, education, health and the
labour market.
6
The same or similar implications have
also been identified in various leaving
care studies undertaken in Australia,
and in the homelessness literature (for
example, Gronda’s 2 excellent analysis
of evidence for effective case
management around homelessness).
There is value in drawing on theory
about complexity in social systems to
understand why a particular character
of response is needed. In complex
social systems things do not happen
in linear ways. Complex systems are
not just complicated — while we can
understand some of the different
variables at play to some extent, we
will never be able to fully map,
understand or predict the social
world. This means we have to
genuinely explore with young people
what is happening, seeking and
appreciating emergent knowledge,
possibilities, relationships and ‘fit’.
I suggested earlier that the systems
level is experienced by experienced
practitioners as even more complex
than that presented by young people.
This is particularly pertinent when
considering whether and if so how we
should extend care. Various aspects
of how care systems function and
young people’s experience of them
have been examined. A recent South
Australian study of leaving care by
Malvaso and Delfabbro found:
‘the principal challenges related to
difficulties in matching the
structure of formal services to a
population with highly
unstructured living arrangements,
a history of problematic
engagement with the care system,
and difficulties arising due to
service ineligibility issues.’ 3
Sources of complexity that need
consideration include:
• Ensuring the voices and authority
of young adults are respected in
the face of constructions that can
undermine their standing at case
and policy levels. We need to be
aware that notions that young
people, particularly those whose
needs are seen as complex, are
developmentally ‘damaged’, can
play a role of ‘othering’ them in
policy and practice processes. It
would be a shame if extending
Care resulted in new forms of
proceduralism which undermine
rather than value the development
of positive relationships as an
ongoing narrative and source of
reciprocity in the lives of young
people. As Ungar et al. indicate:
Unfortunately, those with the
power to define problems and
solutions (policy makers and
professionals) are often the
ones to get their treatment
plans privileged despite
strenuous negotiations by
clients.4
• One practical strategy to assist
identify leaving care support
strategies that are effective in
particular contexts is to embed
participatory action research into
the fabric of service and policy
development. This has the
potential to simultaneously build
engagement, strategy and
evaluative insight, which in turn
can inform management and
policy. An ongoing inquiry
approach of some form is a critical
component of responding
effectively to complexity in
particular contexts.
• Clarifying and distinguishing those
aspects of a strategy that seek to
extend Care, in that they formally
endorse changed legal
parameters/ policy provisions of
the child protection and out of
home care system versus those
aspects which extend care which
has a focus on service and support
eligibility for those who have left
care. The former might include the
introduction of formal
arrangements to recognise
extended foster carer relationships,
while the latter may refer to
enhanced housing eligibility.
• It cannot be assumed that
extending care without extending
support beyond care as well will
reduce later homelessness. The
Mid-west Study involving 732
cases found that young people
who were allowed to stay in foster
care until 21 years of age were no
less likely to become homeless in
the 30 months after exiting.5
In other words, remaining in foster
care until 21 did not have a
preventive effect on later
homelessness, and ageing out of
foster care still presents major
challenges for many young people
regardless of the age at which this
occurs. The implications noted by
Dworsky are for better transition
planning around housing and
enhanced access to housing,
including rental assistance and
support beyond 21 years of age.
• The need to involve different
jurisdictions in our federal system in
the development of an ‘extending
care’ strategy. While a collaborative
approach has been established
through the National Out of Home
Care Standards process and the
National Transitioning to
Independence Priority, there is a
need for substantial and ongoing
commitment by governments to
deal with policy and systems level
complexities.
• While the long-term cost-benefit of
supporting young adults leaving
care has an evidence base both in
Australia and overseas, getting
support and coordination from the
political and public administration
environments is a constant
challenge and can mean that
holistic frames for practice have
little or partial adoption.
7
Amelia ©Monique, Home Is Where My Heart Is 2015 — image courtesy of YACWA
The importance of peak bodies
such as CREATE, publications such
as Parity and ongoing research and
advocacy cannot be
underestimated.
Despite the complexities, there are
significant foundations in Australian
policy and practice to build on. There
may well be useful ways that ‘Care’
and ‘care’ can be extended. Building
strategies that appreciate and
respond to various types of
complexity is essential.
Consistent with the conclusion
drawn by Ungar and colleagues, we
need to combine best practices in
supporting young people develop
supportive, non-coercive and
ongoing relationships, provide
service support and systems of the
character we know is necessary for
responding to complex needs, and
make sure that young people
leaving care have access to
environments that reflect the social
determinants of health, including a
safe, stable and affordable place to
live where they can live, which can
form a platform for the next steps in
their lives.
Endnotes
1. Ungar M, Liebenberg L and Ikeda J 2014,
‘Young People with Complex Needs:
Designing Coordinated Interventions to
Promote Resilience across Child Welfare,
Juvenile Corrections, Mental Health and
Education Services’, British Journal of
Social Work, vol.44, no.3, pp.675–693.
2. Gronda H 2009, What Makes Case
Management Work for People
Experiencing Homelessness? Evidence for
practice, Australian Housing and Urban
Research Institute Final Report No. 127,
AHURI, Melbourne.
3. Malvaso C and Delfabbro P 2015,’ Young
People with Complex Needs Leaving Outof-Home Care: Service Issues and the Need
to Enhance Practice and Policy’’, Children
Australia, no.10, pp.1–11.
4. Ungar M, Liebenberg L and Ikeda J 2014,
op cit p688.
5. Dworsky A and Coutney M 2010,
‘Assessing the impact of extending care
beyond age 18 on homelessness:
Emerging findings from the Midwest
Study’, Chapin Hall Issue Brief, March 2010,
pp.1–10.
8
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