Authors

1. Riitano, Dagmara BA, GradDip(Psych), BHSc(Hons)
2. Pearson, Alan AM RN, ONC, DipNEd, MSc, PhD, FRCNA, FCN, FAAG, FRCN

Abstract

Review question/objective: The review question is: What is the best available evidence regarding the effectiveness of interventions designed to improve academic outcomes in children and adolescents in out-of-home care?

Background: Children and adolescents in out-of-home care (OOHC) are young people under the age of 18 years who have been removed from their homes and placed into alternative accommodation because they have been abused, neglected or identified as being at risk of significant harm.1 OOHC is an umbrella term that encompasses different types of placement settings and is variably defined within the literature; however, the most common types of settings include foster care, relative or kinship care and therapeutic residential care.1

Internationally and nationally, the number of children entering OOHC is increasing dramatically. In Australia, a record of 12,240 children entered out-of-home care in 2011-12 and at 30 June 2012, there were 39,621 children in out-of-home care, a rate of 7.7 per 1,000 Australian children.1 The responsibility of statutory child protection within Australia lies with state and territory governments who financially support the placement of young people in OOHC and are tasked with ensuring their safety, welfare and healthy development until adulthood.

Given the serious effects of maltreatment on wellbeing, efforts to help young people in OOHC to reach their potential have focused primarily on strategies that are therapeutic in nature. Considerably less attention and resources have been directed towards interventions that improve academic and school outcomes in this population, despite numerous studies that indicate significant disparities in educational attainment between young people in OOHC and their peers in the general population.2,3 For example, foster cared children have been found to perform worse than non-foster care peers with similar cognitive abilities,4 and are also less likely to perform well in reading and mathematics.5 Research has also found that twice as many foster children and adolescents repeat a grade in both primary and secondary school than their peers who are not in care.6,7 Not surprisingly, research findings consistently indicate that children living in OOHC are at high risk for school failure. Young people in foster care graduate from school at lower rates than their peers,8 and fewer go on to secondary and post-secondary education compared to peers with similar cognitive capacity and compared to peers with similar school achievements in primary school.9 Those students that do proceed to post-secondary education graduate at a slower rate than their non-foster care peers.10 In summary, these findings suggest that many children in OOHC perform below their capacity and potential.

A number of factors have been attributed to the low educational status of children in OOHC. First, young people entering care placements often present with a range of emotional, psychological and behavioral problems as a result of their complicated histories and negative early experiences, which can adversely affect their confidence and ability to perform academically. Unfortunately for some children in OOHC, experiences of trauma and neglect can also have a negative impact on their normal development that result in delays and deficits in cognitive functioning. For example, research indicates that up to 65% of maltreated children demonstrate cognitive delays,11 and up to 64% demonstrate speech and language delays.12 Consequently, many of these children exhibit significantly lower scores on tests of cognitive functioning than their non-maltreated peers.13 Second, because a majority of this population exhibits behavioral problems in the classroom, they are significantly more likely to be suspended or expelled from school and have higher rates of absenteeism than children in the general population.14 Together with placement instability and disruption, or multiple school placements or changes, many children and adolescents in OOHC spend extended periods of time away from school, which has an adverse impact on the continuity of educational instruction received and consequently educational attainment and school performance.15

It is well established in the literature that low levels of educational attainment can have a serious negative impact on a range of long-term outcomes. Young people not provided with adequate educational attainment during their school years will be ill equipped to move into independent living, which can start as early as 16 years of age in Australia, and become at risk for serious disadvantage for securing employment and acquiring the social supports and economic benefits that come from being part of such a network. Numerous studies indicate that low levels of education have been associated with long-term unemployment (or a lack of employability), social isolation, adverse health outcomes and psychological wellbeing16 even after controlling for birth parents' characteristics, time in care and age at placement.17

A recent scoping review found that research on interventions designed to improve academic achievements in children in OOHC is limited.9 However, results from this preliminary examination of the evidence found positive findings for the majority of interventions included in the review, highlighting that the academic achievement of children in OOHC can be improved. For example, the review found that tutoring programs, distribution of learning materials and tailored individualized support or the use of an education liaison all had a positive impact on school performance within this population.

The proposed systematic review seeks to build on the findings of the scoping review by conducting of a comprehensive search of both the published and grey literature surrounding this topic and through a quality assessment of the included studies. In doing so, it aims to inform further research, policy and practices in the field. Improving academic and school outcomes within this ever increasing population is critical to this population's long-term health and wellbeing as adults.