Understanding the mental health and wellbeing of children in out-of-home care

Children in out-of-home care (OOHC) often experience a higher rate of mental health challenges compared to children who have not been in care. To effectively support children’s mental health in OOHC and tailor support to their individual needs, practitioners need a foundational understanding of:

• the OOHC system in Australia (including placement types and population groups that are over-represented)
• common mental health challenges that children in OOHC may experience; and
• what influences the mental health and wellbeing of children in OOHC (including OOHC-specific factors).

This resource provides information about the OOHC system in Australia, the mental health outcomes of children in care, and the various factors that can influence psychosocial¹ outcomes for children. Programs and practice approaches to support children’s mental health and wellbeing in OOHC are outlined in complementary resources (e.g. programs to support the mental health of children in care and guiding principles for effective practice) and further information is available in the related resources section of this paper.

The Australian out-of-home care system

In Australia, individual states and territories are responsible for child protection systems and arrangements (AIHW, 2021a). Child protection services include intensive family support services (to support families at-risk of OOHC placement), investigation of allegations of child maltreatment and the provision of legal arrangements for child welfare (i.e. care and protection orders), and the OOHC system (AIHW, 2021a; Productivity Commission, 2021).

Out-of-home care refers to alternative living arrangements for children who are in contact with the child protection system. Most children in OOHC (95%) are on care and protection orders which defer all legal responsibility for the child’s welfare to state or territory child protection departments and/or agencies (AIHW, 2023; Productivity Commission, 2021). Child protection departments and/or agencies are responsible for providing ongoing case management throughout a child’s time in OOHC, and for engaging with relevant community service organisations (CSOs) and/or Aboriginal community-controlled organisations (ACCOs) (AIHW, 2021a). CSOs and/or ACCOs provide everyday care of children in OOHC and are responsible for recruiting, training and maintaining foster and kinship carers and paid residential staff (AIHW, 2021a).

The most common OOHC placement types include:

• foster care: in which a child is placed into the care of a foster carer
• kinship care: in which a child is placed into the care of another family member or known adult; and
• residential care: in which a child is cared for in residential facilities by paid staff.

Kinship care can include both formal and informal care arrangements. Formal kinship care refers to arrangements that have occurred following engagement with the child protection system. Informal kinship care placements are arrangements made by families without formal involvement of child protection services or agencies. As there is limited data on children in informal kinship care and carers, in this resource we focus on formal kinship care.

The Aboriginal and Torres Strait Islander Child Placement Principle (ATSICPP) is a national policy aimed at decreasing the number of Aboriginal and Torres Strait Islander children in child protection and OOHC and supporting cultural continuity and connectedness for children within OOHC (AIHW, 2022). Under the ATSICPP, all Aboriginal and Torres Strait Islander children in OOHC should be placed with kin or in the care of Aboriginal and/or Torres Strait Islander carers (AIHW, 2022a; SNAICC, 2019). In addition to preferencing kinship placement, the ATSICPP also outlines other special care provisions for Aboriginal and Torres Strait Islander children. However, the implementation of ATSICPP and related policies has been inconsistent (Blackstock et al., 2020; McDowall, 2016). For example, only two-thirds (63%) of Aboriginal and Torres Strait Islander children in OOHC nationally are living with Aboriginal and/or Torres Strait Islander kin, non-Indigenous kin, or other Aboriginal and/or Torres Strait Islander carers (AIHW, 2022a).

It should be noted that placement arrangements for children can, and often do, change. Children may move between placement types (e.g. from foster care to residential care) and between placements (e.g. from one foster home to another).

Children in out-of-home care in Australia

As of June 2022, there were around 45,400 Australian children living in OOHC, including 19,400 Aboriginal and Torres Strait Islander children (AIHW, 2023). A significant number of children in care are aged between five and 14 years old (61%); around 21% are under five years and 17% are over 15 years old (AIHW, 2023). Most children (70%) are in long-term care arrangements and/or have been in care for more than two years (AIHW, 2023).

Most children in OOHC in Australia are either in foster (35%) or kinship care (54%) (AIHW, 2023). These care arrangements are collectively referred to as ‘home-based care’. A smaller proportion (9%) of children live in residential care (AIHW, 2023). Kinship care is the most common OOHC placement for Australian children, even when excluding children who have informal care arrangements (AIHW, 2023).

Aboriginal and Torres Strait Islander children are vastly over-represented among children in OOHC (O’Donnell et al., 2019; Liddle et al., 2022). This over-representation is linked to historical and systemic factors, such as the ongoing impacts of colonisation, intergenerational trauma, and racist policies, including the forced removal of Aboriginal and Torres Strait Islander children (Blackstock et al., 2020; Human Rights and Equal Opportunity Commission, 1997; Yoorrook Justice Commission, 2023). Aboriginal and Torres Strait Islander children are more than 10 times more likely to have contact with the child protection system than non-Indigenous children (AIHW, 2021a; O’Donnell et al., 2019; Liddle et al., 2022). Despite the high rates of removal of Aboriginal and Torres Strait Islander children and government commitments to reducing their over-representation in care, the numbers of Aboriginal and Torres Strait Islander children in care continue to increase (AIHW, 2021a, 2023).

There is strong evidence of a social gradient in contact with child protection and OOHC; that is, children from lower socioeconomic backgrounds experience a greater risk for contact with child protection and OOHC placement (AIHW, 2021a; Turney & Wildeman, 2017; Wood et al., 2022). In Australia, more than a third of children who receive child protection investigations are from the most socioeconomically disadvantaged neighbourhoods (AIHW, 2021a). Children with disability are also over-represented in OOHC, and there is emerging evidence of high numbers of LGBTQ+ children and young people in OOHC (Baams et al., 2019; Maclean et al., 2017; Schaub et al., 2022; Shannon et al., 2023).

The following section outlines common psychosocial (psychological and social) outcomes for children in OOHC and factors that influence mental health that have been outlined in research literature. Much of the existing research on the mental health of children in OOHC has focused on the extent of mental health disorders, challenging behaviours, and risks for poor mental health. Relatively less research has explored and identified protective factors, and how to promote good mental health and wellbeing for children in care (ACYP, 2021; Devaney et al., 2023).

It is important to note that children in OOHC are a heterogeneous (diverse and varied) group, whose mental health and other outcomes can vary depending on complex and intersecting factors (which are explored in the next section). Mental health outcomes and presentations are also influenced by children’s experiences prior to OOHC (including exposure to adversity) and their experiences within OOHC (including their placement arrangements). As a result, it is difficult to determine the prevalence of specific mental health challenges among children in OOHC.

Common child mental health outcomes in out-of-home care

Children in OOHC have often experienced potentially traumatic events and disrupted attachment with caregivers and other significant people in their lives. They may also have experienced abuse or neglect. This can have substantial impacts on their mental health and wellbeing and lead to a higher risk of mental health challenges than for their peers who have not experienced OOHC care.

Research literature indicates that children in OOHC often experience poor mental health outcomes, including a higher rate of mental health challenges and disorders compared to children with no care experience (Engler et al., 2022; Tarren-Sweeney & Hazell, 2006). Some children in OOHC will not experience any long-term mental health challenges and will experience good psychosocial outcomes (Alvarez et al., 2022; Bell et al., 2015; Washington et al., 2018). However, around half to two-thirds of children in OOHC will experience a mental health challenge of some kind (AIFS et al., 2015; Westlake et al., 2023).

Some mental health challenges that may present among children in OOHC include²:

• Trauma-related outcomes: Many children in OOHC have experienced potentially traumatic events. For some, the impacts of trauma can persist in the form of  trauma-related, stress-related or dissociative challenges and/or disorders (e.g. post-traumatic stress disorder (PTSD; Bollinger et al., 2017; Hiller et al., 2021; John et al., 2019; McGuire et al., 2021; Perzow et al., 2013; O’Hare et al., 2021). Please refer to our accompanying practice guide for details about trauma-informed practice for children in OOHC.
• Attachment challenges: Many children in OOHC experience disruption to their relationships and attachments with caregivers and other significant people in their lives. Moreover, some children have experiences of maltreatment and/or interpersonal trauma that can impact their sense of safety and trust in others. These challenges can be temporary, and children can still develop strong attachments with others. However, for some children, these challenges can persist, and in some cases will progress into attachment-related disorders (e.g. reactive attachment disorder [RAD], disinhibited social engagement disorder [DSED]; Baldwin et al., 2019; Guyon-Harris et al., 2019; Guyon-Harris et al., 2018; Humphreys et al., 2017; Tarren-Sweeney, 2021). Please refer to our fact sheet for more details on attachment-based and interpersonal programs, and to our practice guide for details on relationships-focused practice for children in OOHC.
• Psychological distress, internalising symptoms and mood disorders: Some children in OOHC experience distress, which can manifest as internalising symptoms – internally-directed emotions or behaviours including sadness, anxiety, guilt, social withdrawal, or disordered eating. Children in OOHC have higher rates of internalising symptoms and depression and anxiety disorders, compared to children with no OOHC contact (AIFS et al., 2015; Engler et al., 2022; Gabrielli et al., 2015; Larsen et al., 2018; Westlake et al., 2023).
• Externalising symptoms: Psychological distress can also manifest as externalising symptoms – emotions or behaviours that are externally directed or displayed, including aggression and impulsivity (Westlake et al., 2023). For some children in OOHC, these symptoms are more severe and/or long-lasting and in these cases, a behavioural problem and/or an externalising disorder may be present (e.g. conduct disorder, oppositional defiance disorder [ODD]; AIFS et al., 2015; Engler et al., 2022; Goemans et al., 2016; Vanderwerker et al., 2014). Although externalising behaviours can be challenging for parents or carers, it is important to recognise that they can be a response to distress or other mental health challenges. To ensure children receive appropriate support, practitioners should therefore seek to identify what underlying factors may be influencing their behaviour and mental health.

Other less common mental health, developmental and psychosocial challenges include disordered eating (Cox et al., 2017; Tarren-Sweeney & Hazell, 2006; Walsh et al., 2018), executive control difficulties, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD; Baidawi & Piquero, 2021; Cidav et al., 2018; Tarren-Sweeney, 2017), personality disorders and conduct disorders (Engler et al., 2022; Vanderwerker et al., 2014; Walsh et al., 2018).

There is also strong evidence that children and young people who have been in OOHC are at higher risk for developing long-term psychosocial challenges, including poor mental health outcomes in adulthood (Mendes & Chaffey, 2023; Seker et al., 2022), self-harm and risk for suicide (Gabrielli et al., 2015; Palmer et al., 2021; Taussig et al., 2014), and substance use and addiction issues (Maclean et al., 2016; Walsh et al., 2018). Children who have been in OOHC are also at increased risk for chronic illnesses and of dying prematurely, poor educational and employment outcomes, homelessness, early pregnancy and intergenerational contact with the OOHC system, and contact with the justice system (Batty et al., 2022; Jaggi et al., 2022; Steenbakkers et al., 2018; Tarren-Sweeney, 2018; Walsh et al., 2018).

To understand why children in OOHC have a higher risk for poor mental health and psychosocial outcomes, and to design effective mental health and wellbeing supports, it is important to be aware of the factors that can influence their mental health. This can enable support to be tailored to children’s individual strengths and needs. Common factors that research evidence has shown to be key influences on the mental health of children in OOHC are summarised in the following section.

Mental health and wellbeing outcomes for children in care are influenced by a complex interplay of psychosocial factors (Tarren-Sweeney, 2017; Walsh et al., 2018). Taking a ‘whole child’ approach is useful for understanding the various psychosocial factors that may influence mental health and wellbeing among children in OOHC. A whole child approach recognises that mental health outcomes are shaped by interactions across different levels or systems, including environmental, family and social, interpersonal, and individual. This includes both protective factors (things that promote mental health and/or wellbeing, or that mitigate other risk factors for wellbeing) and risk factors (things that can negatively influence children’s mental health or wellbeing).

The following section outlines factors that are commonly reported in the research literature as influential for the mental health and wellbeing of children in OOHC. It should be noted that most of the reviewed literature focused on poor mental health outcomes, and risk factors for poor mental health.

Children’s mental health and wellbeing in OOHC is influenced by experiences and factors that occur prior to children entering OOHC, and factors specific to the OOHC experience. Children’s experiences of transitioning and leaving OOHC, and the systems and environments that they interact with when doing so, are also likely to affect their mental health and wellbeing. However, an examination of these factors is beyond the scope of this resource, as our review did not specifically explore these factors (for more information on leaving care, see Everson-Hock et al., 2011; Harwick et al., 2020; Mendes & Chaffey, 2023).

It is important to note that these factors do not necessarily mean that a child will experience a mental health challenge, and possible risk and protective factors interact with each other and other factors at various levels. As outlined by Walsh and colleagues:

Select the headings to read more about how different factors influence the mental health and wellbeing of children in care.

Children’s perspectives on OOHC are often absent from research and practice (Fox & Berrick, 2007; Rafeld et al., 2020). However, existing literature indicates that children can have both positive and negative experiences in care (McDowall, 2018; Steenbakkers et al., 2021). Children’s experiences of mental health and wellbeing are often multi-dimensional and influenced by the individual, interpersonal and OOHC-specific factors described previously (Zhang & Selwyn, 2020).

The following are common themes in the literature around children’s experiences in OOHC:

Information and participation

Children have described how a lack of information about their care, and limited involvement in decision-making, can contribute to feelings of powerlessness and uncertainty (ACYP, 2021; CCYP, 2019; McDowall, 2018; Selwyn & Briheim-Crookall, 2022). Children often perceive a lack of support from care workers and/or that their feelings or concerns have been dismissed or minimised (Moore & McArthur, 2023; Smales et al., 2022; Smales et al., 2020). As a result, children often want more communication about their care or case planning and greater involvement in decision-making (CCYP, 2019; McTavish et al., 2022; Robertson et al., 2017; Selwyn & Briheim-Crookall, 2022).

Sense of security and safety

Children often highlight the need for safety, as well as a sense of ‘felt safety’ in care. Children have highlighted how feeling safe with carers, having suitable levels of privacy (e.g. having a private bedroom), and the presence or absence of neighbourhood crime or violence can affect their sense of safety (CCYP, 2019; Moore & McArthur, 2023; Robertson et al., 2017). Stability and consistency are also critical to a child’s sense of safety. This can include stability in placements and care environments, as well as continuity of carers, caseworkers and other professionals (ACYP, 2021; CCYP, 2019; McDowall, 2018; Selwyn & Briheim-Crookall, 2022).

Healthy and consistent relationships

Healthy, secure and consistent relationships are critical to children’s wellbeing. When given the chance to express their opinions, children in OOHC have highlighted the importance of maintaining contact with their birth families (particularly siblings), friends and other important people in their lives (CCYP, 2019; McDowall, 2018; Robertson et al., 2017; Sprecher et al., 2021; Zhang & Selwyn, 2020). Maintaining connections to family, kin, culture and community are particularly important for Aboriginal and Torres Strait Islander children (ACYP, 2021; Krakouer, 2023; Krakouer et al., 2018; McDowall, 2016; Raman et al., 2017).

Children see consistent and positive relationships with carers and professionals as critical to their wellbeing (Brown et al., 2019; Harder et al., 2017; Robertson et al., 2017; Zhang & Selwyn, 2020).

Children in care also emphasise the importance of peer relationships for their wellbeing. Frequent changes in care arrangements and disruptions to school and extracurricular activities mean that maintaining relationships while in OOHC can be challenging. Some children in care also report stigma from peers about being in care and experiences of bullying (ACYP, 2021; CCYP, 2019; Selwyn & Briheim-Crookall, 2022). On the other hand, consistent and supportive friendships are often highlighted as important for the subjective wellbeing of children in OOHC (ACYP, 2021; CCYP, 2019; Selwyn & Briheim-Crookall, 2022).

Research consistently demonstrates that children in OOHC have increased risks of developing mental health difficulties and are also more likely to experience long-term adverse psychosocial outcomes. It is important to note, however, that negative outcomes are not inevitable. Experiences in OOHC are highly heterogeneous, and mental health outcomes are influenced by a complex interplay of risk and protective factors that operate at various socioecological levels including the interpersonal, environmental and system levels (Devaney et al., 2023; Walsh et al., 2018). A comprehensive understanding of the complexity of factors that influence mental health for children who have experienced OOHC, and a child-centred approach that acknowledges the heterogeneity of experiences, is essential to inform effective support.

There is also a need for more holistic and strengths-based research on mental health and wellbeing among children in care. Researchers need to move beyond identifying mental health challenges, and instead explore the resilience of children and ways to support positive mental health and wellbeing (ACYP, 2021; Devaney et al., 2023). Involving children with lived experiences of OOHC in research and the design and evaluation of interventions can also help shape more effective services (Green et al., 2022; Kertesz et al., 2018; Knight & Kingston, 2021; McTavish et al., 2022; Stafford et al., 2021).

Finally, it is critical to note that Aboriginal and Torres Strait Islander children are disproportionately represented among the OOHC population, and often experience adverse outcomes within OOHC (Gatwiri et al., 2020; Liddle et al., 2022). There is an urgent need to ensure that Aboriginal and Torres Strait Islander children’s cultural rights are respected, including compliance with the ATSICPP. Moreover, there is a need to prioritise Aboriginal and Torres Strait Islander-led solutions in this space to prevent over-representation and to promote cultural connection for children in OOHC (Creamer et al., 2022; Raman et al., 2011; Raman et al., 2017).

Further guidance for practitioners when supporting children who have experienced OOHC can be found in the following related resources and reading section.

More from Emerging Minds and AIFS

• Child Family Community Australia (CFCA) provides a range of relevant resources including information on:
  • mandatory reporting
  • child safety
  • over-representation of Aboriginal children in OOHC
  • preventing children from going into OOHC
  • barriers to implementation of the ATSICPP and how to improve the implementation of the ATSICPP
  • information on permanency and placement stability
  • residential models of care
  • discussion of the need to raise the age at which children leave care (from 18 years to 21 years)
  • intersections between OOHC and the justice system
  • the need for co-design research in OOHC; and
  • how practitioners can look after their own wellbeing.

Further resources

• To learn more background information about OOHC in Australia, you can refer to the latest reports and datasets from the Australian Institute of Health and Wellbeing (AIHW). The NSW Department of Communities and Justice (DCJ) and Family and Communities Services Insights, Analysis and Research (FACSIAR) also have evidence maps for OOHC; refer to the report and datasets.
• To learn about the history of OOHC in Australia and the reasons for the over-representation of Aboriginal and Torres Strait Islander children in care, refer to the Human Rights Commission’s Bringing them home report, Healing Foundation resources (e.g. on Stolen Generations), and resources from SNAICC including the annual Family Matters report.
• Learn more about the physical health (and developmental and mental health) needs of children in care in this recorded webinar from the Thriving Children Thriving Communities series.
• Resources relating to children’s experiences in OOHC and their rights are available from the Commission for Children and Young People (CCYP) Victoria (including a report on the experiences of children and young people in OOHC in Victoria), the Advocate for Children and Young People (ACYP) NSW (including a report and video on children’s experiences in OOHC), and the CREATE Foundation (including this guide on encouraging child participation in OOHC).
• The Centre for Excellence in Therapeutic Care (CETC) has comprehensive research reviews and practice guides for professionals working with children in OOHC. For example, research on LGBTIQ young people in care, kinship carers and trauma-informed care.
• The Australian Childhood Foundation (ACF) hosts a library of resources on child health and development. ACF and the library provide a host of research and practice literature on supporting children’s mental health and development and trauma recovery.
• The Centre for Excellence in Child and Family Welfare (CECFW) offers a range of resources (including a specialised education hub for resources relating to residential care) and an excellent program of training and events.

How was this resource developed?

We conducted a review of peer-reviewed and grey literature published between 2013 and 2023. We searched for evidence on the mental health outcomes of children (aged 5–12 years) in care, including common mental health issues, supportive factors, and programs or initiatives to improve the mental health of children in OOHC.

Our literature review focused on Australian children aged 5–12 years of age in OOHC. As such, this resource does not include extensive information about preventing contact with child protection or OOHC, entry and exit from OOHC, leaving care experiences, in-depth analysis of the outcomes of infants and toddlers in care, or outcomes into adolescence or adulthood.

References

Advocate for Children and Young People (ACYP). (2021). The voices of children and young people in out-of-home care. Sydney: Office of the Advocate for Children and Young People.

Australian Institute of Family Studies (AIFS), Chapin Hall Center for Children University of Chicago, and NSW Department of Family and Community Services. (2015). Pathways of Care Longitudinal Study: Outcomes of children and young people in out-of-home care in NSW. Wave 1 baseline statistical report. Sydney: NSW Department of Family and Community Services.

Australian Institute of Health and Welfare (AIHW). (2021a). Child protection Australia 2020–21. Canberra: AIHW.

AIHW (2021b). Improving the mental health of Indigenous children and young people in child protection. Indigenous Mental Health and Suicide Prevention Clearinghouse. Cat. no. IMH 3. Canberra: AIHW.

AIHW (2022a). The Aboriginal and Torres Strait Islander Child Placement Principle (ATSICPP) indicators. Canberra: AIHW.

AIHW (2022b). Safety of children in care 2020–21. Canberra: AIHW.

AIHW (2023). Child protection Australia 2021–22. Canberra: AIHW.

Alvarez, R., Parra, L., ten-Brummelaar, M., Avraamidou, L., & Lopez, M. (2022). Resilience among LGBTQIA+ youth in out-of-home care: A scoping review. Child Abuse & Neglect, 129, 105660.

Baams, L., Wilson, B., & Russell, S. (2019). LGBTQ youth in unstable housing and foster care. Pediatrics, 143(3).

Baidawi, S., & Piquero, A. R. (2021). Neurodisability among children at the nexus of the child welfare and youth justice system. Journal of Youth and Adolescence, 50(4), 803-819.

Baldwin, H., Biehal, N., Cusworth, L., Wade, J., Allgar, V., & Vostanis, P. (2019). Disentangling the effect of out-of-home care on child mental health. Child Abuse & Neglect, 88, 189-200.

Batty, G., Kivimäki, M., & Frank, P. (2022). State care in childhood and adult mortality: A systematic review and meta-analysis of prospective cohort studies. Lancet Public Health, 7(6), e504-e514.

Bell, T., Romano, E., & Flynn, R. (2013). Multilevel correlates of behavioral resilience among children in child welfare. Child Abuse & Neglect, 37(11), 1007-1020.

Bell, T., Romano, E., & Flynn, R. (2015). Profiles and predictors of behavioral resilience among children in child welfare. Child Abuse & Neglect, 48, 92-103.

Blackstock, C., Bamblett, M., & Black, C. (2020). Indigenous ontology, international law and the application of the Convention to the over-representation of Indigenous children in out of home care in Canada and Australia. Child Abuse & Neglect, 110.

Bollinger, J., Scott-Smith, S., & Mendes, P. (2017). How complex developmental trauma, residential out-of-home care and contact with the justice system intersect. Children Australia, 42(2), 108-112.

Brown, R., Alderson, H., Kaner, E., McGovern, R., & Lingam, R. (2019). “There are carers, and then there are carers who actually care”; Conceptualizations of care among looked after children and care leavers, social workers and carers. Child Abuse & Neglect, 92, 219-229.

Commission for Children and Young People (CCYP). (2019). ‘In our own words’: Systemic inquiry into the lived experience of children and young people in the Victorian out-of-home care system. Melbourne: Commission for Children and Young People.

Chodura, S., Lohaus, A., Symanzik, T., Heinrichs, N., & Konrad, K. (2021). Foster parents’ parenting and the social-emotional development and adaptive functioning of children in foster care: A PRISMA-guided literature review and meta-analysis. Clinical Child and Family Psychology Review , 24(2), 326-347.

Cidav, Z., Xie, M., & Mandell, D. S. (2018). Foster care involvement among medicaid-enrolled children with autism. Journal of Autism and Developmental Disorders, 48(1), 176-183.

Cox, R., Emond, R., Punch, S., McIntosh, I., Hall, K., Simpson, A., & Skouteris, H. (2017). “It’s not as easy as saying, ‘just get them to eat more veggies'”: Exploring healthy eating in residential care in Australia. Appetite, 117, 275-283.

Creamer, S., Blair, S., Toombs, M., & Brolan, C. E. (2022). Indigenous services leading the way for Aboriginal and Torres Strait Islander children in out-of-home care. Social Work Education, 1-25.

Devaney, J., Power, L., Jacobs, P., Davidson, G., Hiller, R., Martin, J., McCartan, C., McCusker, P., McGuire, R., Phillips, A., Roesch-Marsh, A., & Thapar, A. (2023). An agenda for future research regarding the mental health of young people with care experience. Child & Family Social Work, 28(4), 960-970.

Engler, A., Sarpong, K., Van Horne, B., Greeley, C., & Keefe, R. (2022). A systematic review of mental health disorders of children in foster care. Trauma Violence Abuse, 23(1), 255-264.

Fawley-King, K., Trask, E. V., Zhang, J., & Aarons, G. A. (2017). The impact of changing neighborhoods, switching schools, and experiencing relationship disruption on children’s adjustment to a new placement in foster care. Child Abuse & Neglect, 63, 141-150.

Fox, A., & Berrick, J. (2007). A response to No One Ever Asked Us: A review of children’s experiences in out-of-home care. Child and Adolescent Social Work Journal, 24(1), 23-51.

Gabrielli, J., Hambrick, E. P., Tunno, A. M., Jackson, Y., Spangler, A., & Kanine, R. M. (2015). Longitudinal assessment of self-harm statements of youth in foster care: rates, reporters, and related factors. Child Psychiatry and Human Development, 46(6), 893-902.

Galvin, E., O’Donnell, R., Breman, R., Avery, J., Mousa, A., Halfpenny, N., & Skouteris, H. (2022). Interventions and practice models for improving health and psychosocial outcomes for children in residential out-of-home care: Systematic review. Australian Social Work, 75(1), 33-47.

Gatwiri, K., McPherson, L., Rotumah, D., Cameron, N., & Parmenter, N. (2020). What are the needs of Aboriginal and Torres Strait Islander children and young people in care? (Research brief). Sydney: Centre for Excellence in Therapeutic Care.

Goemans, A., van Geel, M., van Beem, M., & Vedder, P. (2016). Developmental outcomes of foster children: A meta-analytic comparison with children from the general population and children at risk who remained at home. Child Maltreatment, 21(3), 198-217.

Green, R., Hatzikiriakidis, K., Tate, R., Bruce, L., Smales, M., Crawford-Parker, A., Carmody, S., & Skouteris, H. (2022). Implementing a healthy lifestyle program in residential out-of-home care: What matters, what works and what translates? Health & Social Care in the Community, 30(6), 2392-2403.

Guyon-Harris, K. L., Humphreys, K. L., Degnan, K., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2019). A prospective longitudinal study of reactive attachment disorder following early institutional care: Considering variable- and person-centered approaches. Attachment & Human Development, 21(2), 95-110.

Guyon-Harris, K. L., Humphreys, K. L., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2018). Course of disinhibited social engagement disorder from early childhood to early adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 57(5), 329-335.e322.

Harder, A., Knorth, E., & Kalverboer, M. (2017). The inside out? Views of young people, parents, and professionals regarding successful secure residential care. Child and Adolescent Social Work Journal, 34(5), 431-441.

Hassall, A., Janse van Rensburg, E., Trew, S., Hawes, D. J., & Pasalich, D. S. (2021). Does kinship vs. foster care better promote connectedness? A systematic review and meta-analysis. Clinical Child and Family Psychology Review, 24(4), 813-832.

Hiller, R., Meiser-Stedman, R., Elliott, E., Banting, R., & Halligan, S. (2021). A longitudinal study of cognitive predictors of (complex) post-traumatic stress in young people in out-of-home care. The Journal of Child Psychology and Psychiatry, 62(1), 48-57.

Hindt, L. A., & Leon, S. C. (2022). Ecological disruptions and well-being among children in foster care. American Journal of Orthopsychiatry, 92(1), 39-50.

Hodgdon, H. B., Kinniburgh, K., Gabowitz, D., Blaustein, M. E., & Spinazzola, J. (2013). Development and implementation of trauma-informed programming in youth residential treatment centers using the ARC framework. Journal of Family Violence, 28(7), 679-692.

Human Rights and Equal Opportunity Commission. (1997). Bringing them home: Report of the national inquiry into the separation of Aboriginal and Torres Strait Islander children from their families. Human Rights and Equal Opportunity Commission: Sydney.

Humphreys, K., Nelson, C., Fox, N., & Zeanah, C. (2017). Signs of reactive attachment disorder and disinhibited social engagement disorder at age 12 years: Effects of institutional care history and high-quality foster care. Development and Psychopathology, 29(2), 675-684.

Jackson, Y., Gabrielli, J., Fleming, K., Tunno, A., & Makanui, P. (2014). Untangling the relative contribution of maltreatment severity and frequency to type of behavioral outcome in foster youth. Child Abuse & Neglect, 38(7), 1147-1159.

Jaggi, L., Jaramillo, J., Drazdowski, T., & Seker, S. (2022). Child welfare involvement and adjustment among care alumni and their children: A systematic review of risk and protective factors. Child Abuse & Neglect, 131, 105776.

Jimenez-Morago, J., Leon, E., & Roman, M. (2015). Adversity and adjustment in children in institutions, family foster care, and adoption. Spanish Journal of Psychology, 18, E45.

John, S., Brandt, T., Secrist, M., Mesman, G., Sigel, B., & Kramer, T. (2019). Empirically-guided assessment of complex trauma for children in foster care: A focus on appropriate diagnosis of attachment concerns. Psychological Services, 16(1), 120-133.

Kertesz, M., Spriggs, M., & Humphreys, C. (2018). Who makes decisions for vulnerable young people? Shifting sands and murky waters. Australian Social Work, 71(3), 332-344.

Knight, R. L., & Kingston, K. L. (2021). Valuing beneficiary voice: Involving children living in out-of-home care in programme evaluation. Evaluation Journal of Australasia, 21(2), 69-84.

Krakouer, J. (2023). Journeys of culturally connecting: Aboriginal young people’s experiences of cultural connection in and beyond out-of-home care. Child & Family Social Work, 28(3), 822–832.

Krakouer, J., Wise, S., & Connolly, M. (2018). “We live and breathe through culture”: Conceptualising cultural connection for Indigenous Australian children in out-of-home care. Australian Social Work, 71(3), 265-276.

Larsen, M., Baste, V., Bjørknes, R., Myrvold, T., & Lehmann, S. (2018). Services according to mental health needs for youth in foster care? – A multi-informant study. BMC Health Services Research, 18(1), 634.

Larsen, M., Goemans, A., Baste, V., Wilderjans, T. F., & Lehmann, S. (2021). Predictors of quality of life among youths in foster care–a 5-year prospective follow-up study. Quality of Life Research, 30(2), 543-554.

Lee, E., Kramer, C., Choi, M. J., Pestine-Stevens, A., & Huang, Y. (2020). The cumulative effect of prior maltreatment on emotional and physical health of children in informal kinship care. Journal of Developmental & Behavioral Pediatrics, 41(4), 299-307.

Liddle, C., Gray, P., Burton, J., Kumar, R., Tunny, T., Prideaux, C., Armstrong, E., McCracken, A., French, B., Attenborough, I., Wolfe, H., Harris, L., Lally, D., Corrales, T., Krakouer, J., Beaufils, J., & Behrendt, L. (2022). The Family Matters Report 2022. Measuring trends to turn the tide on the over-representation of Aboriginal and Torres Strait Islander children in out-of-home care in Australia. Melbourne: SNAICC.

Liming, K. W., Akin, B., & Brook, J. (2021). Adverse childhood experiences and foster care placement stability. Pediatrics, 148(6).

Lum, J. A. G., Powell, M., & Snow, P. C. (2018). The influence of maltreatment history and out-of-home-care on children’s language and social skills. Child Abuse & Neglect, 76, 65-74.

Maclean, M., Sims, S., Bower, C., Leonard, H., Stanley, F., & O’Donnell, M. (2017). Maltreatment risk among children with disabilities. Pediatrics, 139(4), e20161817.

Maclean, M. J., Sims, S., O’Donnell, M., & Gilbert, R. (2016). Out-of-home care versus in-home care for children who have been maltreated: A systematic review of health and wellbeing outcomes. Child Abuse Review, 25(4), 251-272.

Macpherson, L., Gatwiri, K., Mitchell, J., & Macnamara, N. (2022). Research brief: sibling placement in out of home care. Sydney: Centre for Excellence in Therapeutic Care.

McDowall, J. (2015). Sibling placement and contact in out-of-home care. Sydney: CREATE Foundation.

McDowall, J. (2016). Connection to culture by indigenous children and young people in out-of-home care in Australia. Communities, Children and Families Australia, 10(1), 5-26.

McDowall, J. (2018). Out-of-home care in Australia: Children and young people’s views after five years of National Standards. Sydney/Brisbane: CREATE Foundation.

McGuire, A., Cho, B., Huffhines, L., Gusler, S., Brown, S., & Jackson, Y. (2018). The relation between dimensions of maltreatment, placement instability, and mental health among youth in foster care. Child Abuse & Neglect, 86, 10-21.

McGuire, A., Huffhines, L., & Jackson, Y. (2021). The trajectory of PTSD among youth in foster care: A survival analysis examining maltreatment experiences prior to entry into care. Child Abuse & Neglect, 115, 105026.

McTavish, J. R., McKee, C., & MacMillan, H. L. (2022). Foster children’s perspectives on participation in child welfare processes: A meta-synthesis of qualitative studies. PLoS One, 17(10), e0275784.

Mendes, P., & Chaffey, E. (2023). examining the mental health care needs and outcomes of young people transitioning from out-of-home care (OOHC) in Australia. Institutionalised Children Explorations and Beyond, 0(0).

Moore, T., & McArthur, M., (2022). Take notice, believe us and act! Exploring the safety of children and young people in government run organisations. Hobart: Tasmanian Commission of Inquiry into the Tasmanian Government’s Responses to Child Sexual Abuse in Institutional Settings.

Moore, T., McArthur, M., Death, J., Tilbury, C., & Roche, S. (2018). Sticking with us through it all: The importance of trustworthy relationships for children and young people in residential care. Children and Youth Services Review, 84, 68-75.

O’Donnell, M., Taplin, S., Marriott, R., Lima, F., & Stanley, F. J. (2019). Infant removals: The need to address the over-representation of Aboriginal infants and community concerns of another ‘Stolen Generation’. Child Abuse & Neglect, 90, 88-98.

O’Hare, K., Hussain, A., Laurens, K., Hindmarsh, G., Carr, V., Tzoumakis, S., Harris, F., & Green, M. (2021). Self-reported mental health of children known to child protection services: An Australian population-based record linkage study. European Child & Adolescent Psychiatry, 32(1), 101-112.

Palmer, L., Prindle, J., & Putnam-Hornstein, E. (2021). A population-based case control study of suicide among youth reported for abuse and neglect. Child Abuse & Neglect, 117, 105060.

Perzow, S. E., Petrenko, C. L., Garrido, E. F., Combs, M. D., Culhane, S. E., & Taussig, H. N. (2013). Dissociative symptoms and academic functioning in maltreated children: A preliminary study. Journal of Trauma & Dissociation, 14(3), 302-311.

Productivity Commission. (2021). Report on Government Services 2021. Part F, Section 16: Child protection services. Canberra: Productivity Commission.

Rafeld, J., Moeller-Saxone, K., Cotton, S., Rice, S., Monson, K., Harvey, C., & Herrman, H. (2020). ‘Getting our voices out there’: Acceptability of a mental health participation programme for young people with out of home care experience in Australia. Health Promotion International, 35(5), 1085-1093.

Raman, S., Reynolds, S., & Khan, R. (2011). Addressing the well-being of Aboriginal children in out-of-home care: Are we there yet? Journal of Paediatrics and Child Health, 47(11), 806-811.

Raman, S., Ruston, S., Irwin, S., Tran, P., Hotton, P., & Thorne, S. (2017). Taking culture seriously: Can we improve the developmental health and well-being of Australian Aboriginal children in out-of-home care? Child: Care, Health and Development, 43(6), 899-905.

Robertson, C., Laing, K., Butler, M., & Soliman, R. (2017). The views of NSW children and young people in out-of-home care: NSW results from the National Out-of-Home Care and NSW Residential Care Surveys. Sydney: NSW Department of Family and Community Services.

Ryder, T., Zurynski, Y., & Mitchell, R. (2022). Exploring the impact of child and placement characteristics, carer resources, perceptions and life stressors on caregiving and well-being. Child Abuse & Neglect, 127, 105586.

Schaub, J., Stander, W. J., & Montgomery, P. (2022). LGBTQ+ young people’s health and well-being experiences in out-of-home social care: A scoping review. Children and Youth Services Review, 143, 106682.

Seker, S., Boonmann, C., Gerger, H., Jäggi, L., d’Huart, D., Schmeck, K., & Schmid, M. (2022). Mental disorders among adults formerly in out-of-home care: A systematic review and meta-analysis of longitudinal studies. European Child & Adolescent Psychiatry, 31(12), 1963-1982.

Selwyn, J. & Briheim-Crookall, L. (2022). 10,000 voices: The views of children in care on their well-being. Oxford: Coram Voice and the Rees Centre, University of Oxford.

Shannon, J., Wilson, N. J., & Blythe, S. (2023). Children with intellectual and developmental disabilities in out-of-home care: A scoping review. Health & Social Care in the Community, 2023, 2422367.

Shlonsky, A., Albers, B., Taylor, D., Featherston, R., Ma, J., & McCann, B. (2017). Children and families evidence: Findings from six evidence gap maps. Report for Victoria Department of Health and Human Services. Melbourne: University of Melbourne.

Smales, M., Morris, H., Savaglio, M., Skouteris, H., & Green, R. (2022). ‘I’m dealing with all these health issues that could have been addressed when I was younger’. Delivery of health services to Australian young people in out-of-home care: Lived experiences. Health & Social Care in the Community, 30(4), e1406-e1414.

Smales, M., Savaglio, M., Morris, H., Bruce, L., Skouteris, H., & Green, R. (2020). “Surviving not thriving”: Experiences of health among young people with a lived experience in out-of-home care. International Journal of Adolescence and Youth, 25(1), 809-823.

SNAICC. (2019). The Aboriginal and Torres Strait Islander Child Placement Principle: A guide to support implementation. Melbourne: SNAICC.

Sprecher, E., Tuitt, I., Hill, D., Midgley, N., & Sleed, M. (2021). No typical care story: How do care-experienced young people and foster carers understand fostering relationships? Adoption & Fostering, 45(3), 248-264.

Stafford, L., Harkin, J., Rolfe, A., Burton, J., & Morley, C. (2021). Why having a voice is important to children who are involved in family support services. Child Abuse & Neglect, 115, 104987.

Steenbakkers, A., van der Steen, S., & Grietens, H. (2018). The needs of foster children and how to satisfy them: A systematic review of the literature. Clinical Child and Family Psychology Review, 21(1), 1-12.

Steenbakkers, A., van der Steen, S., & Grietens, H. (2021). On the bright side: Young people’s most positive memories of family foster care. Clinical Child and Family Psychology Review, 26(2), 544-555.

Tarren-Sweeney, M. (2017). Rates of meaningful change in the mental health of children in long-term out-of-home care: A seven- to nine-year prospective study. Child Abuse & Neglect, 72, 1-9.

Tarren-Sweeney, M. (2018). The Mental health of adolescents residing in court-ordered foster care: Findings from a population survey. Child Psychiatry & Human Development, 49(3), 443-451.

Tarren-Sweeney, M. (2021). A narrative review of mental and relational health interventions for children in family-based out-of-home care. Journal of Family Therapy, 43(3), 376-391.

Tarren-Sweeney, M., & Hazell, P. (2006). Mental health of children in foster and kinship care in New South Wales, Australia. Journal of Paediatrics and Child Health, 42(3), 89-97.

Taussig, H. N., Harpin, S. B., & Maguire, S. A. (2014). Suicidality among preadolescent maltreated children in foster care. Child Maltreatment, 19(1), 17-26.

Troller-Renfree, S., McLaughlin, K., Sheridan, M., Nelson, C., Zeanah, C., & Fox, N. (2017). The beneficial effects of a positive attention bias amongst children with a history of psychosocial deprivation. Biological Psychology, 122, 110-120.

Turney, K., & Wildeman, C. (2017). Adverse childhood experiences among children placed in and adopted from foster care: Evidence from a nationally representative survey. Child Abuse & Neglect, 64, 117-129.

Vanderwerker, L., Akincigil, A., Olfson, M., Gerhard, T., Neese-Todd, S., & Crystal, S. (2014). Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths. Psychiatric Services, 65(10), 1281-1284.

Vasileva, M., & Petermann, F. (2018). Attachment, development, and mental health in abused and neglected preschool children in foster care: A meta-analysis. Trauma Violence Abuse, 19(4), 443-458.

Walsh, P., McHugh, M., Blunden, H., & Katz, I. (2018). Literature review: Factors influencing the outcomes of children and young people in out-of-home care. Pathways of Care Longitudinal Study: Outcomes of children and young people in out-of-home care. (Research report number 6). Sydney: NSW Department of Family and Community Services.

Washington, T., Wrenn, A., Kaye, H., Priester, M. A., Colombo, G., Carter, K., Shadreck, I., Hargett, B., Williams, J., & Coakley, T. (2018). Psychosocial factors and behavioral health outcomes among children in foster and kinship care: A systematic review. Children and Youth Services Review, 90, 118-133.

Westlake, M. F., Hillman, S., Kerr-Davis, A., Viziteu, A., Silver, M., & Dykiert, D. (2023). A systematic review and meta-analysis of the type and prevalence of mental health disorders and symptoms among children living in residential care. Developmental Child Welfare, 5(4), 223-246.

Wood, S., Scourfield, J., Stabler, L., Addis, S., Wilkins, D., Forrester, D., & Brand, S. (2022). How might changes to family income affect the likelihood of children being in out-of-home care? Evidence from a realist and qualitative rapid evidence assessment of interventions. Children and Youth Services Review, 143, 106685.

Yoorrook Justice Commission. (2023). Yoorrook for Justice: Report into Victoria’s child protection and criminal justice systems. Melbourne: Yoorrook Justice Commission.

Zhang, M., & Selwyn, J. (2020). The subjective well-being of children and young people in out of home care: Psychometric analyses of the “Your Life, Your Care” Survey. Child Indicators Research, 13(5), 1549-1572.

Ziviani, J., Feeney, R., Cuskelly, M., Meredith, P., & Hunt, K. (2012). Effectiveness of support services for children and young people with challenging behaviours related to or secondary to disability, who are in out-of-home care: A systematic review. Children and Youth Services Review, 34(4), 758-770.