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JCPSLP Volume 15, Number 3 2013 131
Clinical Insights
Keywords
Challenges
Maltreatment
Out of home
care
Speech
pathology
Strategies
This article
has been
peer-
reviewed
Nicole Byrne
(top) and Tania
Lyddiard
Challenges and practical strategies
for speech pathologists working
with children in out of home care
(OOHC)
Nicole Byrne and Tania Lyddiard
social interactions, poorer syntactic development, reduced
receptive and expressive vocabulary, delayed receptive
language development, delayed cognitive development
and delayed speech skills than other children (Allen &
Oliver,1982; Culp et al., 1991; Eigsti & Cicchetti, 2004;
Hwa-Froelich, 2012).
Some researchers consider it to be the early
impoverished environment rather than the length of time in
that environment that impacts most significantly on speech
and language development (Croft et al., 2007). However,
other researchers suggest children who enter into foster/
adoptive care at a later age take longer to catch up to
expected developmental milestones, indicating length
of time in impoverished environment does contribute to
outcomes (Glennen & Masters, 2002; Roberts et al., 2005).
Crucial time periods for removal from maltreatment have
been identified as 6 months after maltreatment onset for
maintaining an equivalent IQ (Castle et al., 1999) and 15
months for maintaining receptive and expressive language
skills (Windsor et al., 2011).
Children in out of home care are more likely to have
significant health needs, including speech, language
and hearing disorders (Hoff, 2003; Royal Australasian
College of Physicians, 2006). Australian researchers have
indicated that 45% of children under the age of 5 years
who have been maltreated had speech delay and 20% of
older children had language delay (Nathanson & Tzioumi,
2007) as compared to the general population rate of 12%
(children aged 5–18 years) (McLeod & Mckinnon, 2007) to
14.3% for children aged 5;4 to 6;10 years (Jessup, Ward,
Cahill & Keating, 2008). These results are supported by
Snow and Powell’s (2011) identification of young offenders
in jail who presented with a language impairment, and
had also had an OOHC placement, thus highlighting the
increased incidence of communication difficulties in children
in OOHC. Similarly, Golding, Williams and Leitão (2011)
found that 55% of foster carers had taken a child in their
care to a speech pathologist.
Aboriginal children are at a higher risk of communication
disorders due to cumulative factors such as being in OOHC
and having a higher incidence of otitis media than non-
Aboriginal children, which may result in hearing loss and
associated language delay (Couzos, Metcalf & Murray,
2001). In Australia, Aboriginal children are overrepresented
in OOHC. In 2011, the rate of Aboriginal children in OOHC
was 10 times higher than that of non-Aboriginal children
(AIHW, 2012).
This paper pertains to a specific vulnerable
group of children who have experienced
maltreatment and as a result, have been
removed from the care of their parents into
out of home care (OOHC). OOHC includes
both foster and kinship care. In this paper, the
challenges associated with working with
children in OOHC in a community-based
speech pathology service are identified. The
strategies that have been implemented within
OOHC are outlined in order to provide speech
pathologists working with children who have
been maltreated and their carers with
practical strategies to consider implementing
within their own setting.
Many children within Australia, for various reasons,
are unable to live with their parents. Factors such
as poverty, level of parent education, family size,
parent mental health, substance abuse, housing/mobility
issues and parenting practices often contribute to increased
stress within households and may subsequently contribute
to child maltreatment (COAG, 2009; McIntosh & Phillips,
2002, Stone, 2007). The term child “maltreatment” is used
as the umbrella term to incorporate five maltreatment
subtypes: physical abuse, emotional maltreatment, neglect,
sexual abuse and witnessing family violence. Children who
have suffered maltreatment may be removed from the care
of their parents and placed into government-regulated out
of home care (OOHC). In Australia, from 2010 to 2011
there were over 40,466 substantiated child protection
notifications and 37,648 children placed in OOHC. This
suggests a high likelihood that children in care have
suffered from some form of maltreatment, most commonly
emotional abuse and neglect (AIHW, 2012).
There is strong evidence that a child’s maltreatment
impacts their development across many domains, including
language, cognitive, social-emotional and academic, and
that these difficulties may extend into the long-term (Hwa-
Froelich, 2012; Stone, 2007). A lack of stimulation, parental
support and interaction, and parental withdrawal has a
significant impact on a child’s receptive and expressive
language development. Research has indicated that
children who have been maltreated have less flexible
problem-solving abilities, poorer self-regulation, fewer