Infants, children and young people enter out of home care in distressing circumstances. They have often suffered traumatic experiences and have had their primary relationships disrupted. They and their families and carers have specific mental health needs at this time but few have attended a mental health service. A systematic comprehensive therapeutic assessment approach is described for all child protection clients who entered out-of-home care for the first time in one calendar year. The work of the programme is described using both case study and assessment findings. More than 60 per cent of participants met criteria for a major psychiatric diagnosis, with Post Traumatic Stress and Adjustment Disorders being the most common diagnostic categories. Nearly three-quarters of participants over the age of 5 years scored in the borderline or abnormal range on the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997). There was an over-representation of infants less than 1 year of age and adolescents in the cohort, representing particular developmental challenges. The findings are discussed within the context of specific mental health service delivery to this vulnerable population of maltreated infants, children and young people.
American Psychiatric Association. (APA). ( 1994). Diagnostic and statistical manual of mental disorders (4th Ed.). Washington, DC: Author.
2.
Arcelus, J.B., Bellerby, T., & Vostanis, P. (1999). A mental-health service for young people in the care of the local authority. Clinical Child Psychology and Psychiatry, 4(2), 233—245.
3.
Barber, J.G., Delfabbro, P.H., & Cooper, L.L. (2001). The predictors of unsuccessful transition to foster care. Journal of Child Psychology and Psychiatry, 42(6), 785—790.
4.
Blower, A., Addo.,A., Hodgson, J., Lamington, L., & Towlson, K. (2004). Mental health of `looked after' children: A needs assessment. Clinical Child Psychology and Psychiatry, 9(1), 117—129.
5.
Callaghan, J., Vostanis, P., & Young, B. (2001). Evaluation of mental health services for children looked after by local authorities. Leicester: Greenwood Institute.
6.
Callaghan, J., Young, B., Pace, F., & Vostanis, P. (2004). Evaluation of a new mental health service for looked after children. Clinical Child Psychology and Psychiatry , 9(1), 130—148.
7.
Department of Human Services Victoria. (2005 ). Child abuse reporting statistics: 1992/1993 to 2004/2005 . Downloaded from http://www.office-for-children.vic.gov.au/children/ccdnav.nsf/FID/-ECC344E5A9DB878E4A25679A0001F16B?OpenDocument
8.
Dimigen, G., Del Priore, C., Butler, S., Evans, S., Ferguson, L., & Swan, M. (1999). Psychiatric disorder among children at time of entering local authority care: Questionnaire survey. British Medical Journal, 319(7211), 675.
9.
Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry , 38(5), 581—586.
10.
Goodman, R., Renfrew, D., & Mullick, M. (2000). Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. European Child and Adolescent Psychiatry , 9, 129—134.
11.
Hill, C., & Thompson, M. (2003). Mental and physical health co-morbidity in looked after children. Clinical Child Psychology and Psychiatry, 8(3), 315—321.
12.
Hochstadt, N., Jaundes, P., Zimo, D., & Schacter, J. (1987). The medical and psychosocial needs of children entering foster care. Child Abuse and Neglect, 11, 53—62.
13.
Hodges, J., Steele, M., Hillman, S., Henderson, K., & Neil, M. (2000). Effects of abuse on attachment representations: Narrative assessments of abused children. Journal of Child Psychotherapy, 26, 433—455.
14.
Kenrick, J. (2000). `Be a kid': The traumatic impact of repeated separations on children who are fostered and adopted. Journal of Child Psychotherapy, 3, 393—412.
15.
Leslie, L.K., Gordon, J.N., Ganger, W., & Gist, K. (2002). Developmental delay in young children in child welfare by initial placement type. Infant Mental Health Journal , 23(5), 496—516.
16.
Lieberman, A.F., & van Horne, P. (1999). Attachment, trauma and domestic violence: Implications for child custody. Child Custody, 7(2), 423—443.
17.
McCann, J.B., James, A., Wilson, S., & Dunn, G. (1996). Prevalence of psychiatric disorders in young people in the care system. British medical Journal, 13(7071), 1529—1530.
18.
Milburn, N., Lynch, M., Jackson, J., & Salo, F. (2004). The assessment and treatment of infants entering out of home care: Promoting going on being. Paper presented at the World Association of Infant Mental Health 9th World Congress , Melbourne.
19.
Minnis, P., Pelosi, A.J., Knapp, M., & Dunn, J. (2001). Mental health and foster carer training. Archives of Diseases in Childhood, 84, 302—306.
20.
Mount, M.J., Lister, A., & Bennum, I. (2004). Identifying the mental health needs of looked after young people. Clinical Child Psychology and Psychiatry , 9(3), 363—382.
21.
Perry, B.D., Conrad, D.J., Dobson, C., Schick, S., & Runyan, D. (2000). The Children's Crisis Care Centre Model: A proactive, multidimensional child and family assessment process. Downloaded from hjttp://www.bcm.tmc.edu/cta/cccc_paper.htm
22.
Pilowsky, D. (1992). Short-term psychotherapy with children in foster care. In P.J. O'Brien, D. Pilowsky, & O. Lewis (Eds.), Psychotherapies with children and adolescents: Adapting the psychodynamic process. Washington DC.: American Psychiatric Press.
23.
Prior, M., Smart, D., Sanson, A., & Oberklaid, F. (1999). Relationships between learning difficulties and psychological problems in preadolescent children from a longitudinal sample . Journal of the American Academy of Child and Adolescent Psychiatry, 38, 429—436.
24.
Reams, R. (1999). Children birth to three entering the state's custody . Infant Mental Health Journal, 20(2), 166—174.
25.
Sawyer, M.G., Arney, F.M., Baghurst, P.A., Clark, J.J., Graetz, B.W., Kosky, R.J., Nurcombe, B., et al. (2001). The mental health of young people in Australia: Key findings from the child and adolescent component of the national survey of mental health and well-being. Australian and New Zealand Journal of Psychiatry, 35(6), 806—814.
26.
World Health Organization. (WHO). (1992). International classification of diseases (10th revision). Geneva: Author.
27.
Zeanah, C.H., Larrieu, J.A., Heller, S.S., Valliere, J., Hinshaw-Fuselier, S., Aoki, Y., & Drilling, M. (2001). Evaluation of a preventative intervention for maltreated infants and toddlers in foster care. Journal of the American Academy of Child and Adolescent Psychiatry, 40(2), 214—221.
