JCPSLP Voll 15 No 3 Nov 2013

Clinical Insights

Challenges and practical strategies for speech pathologists working with children in out of home care (OOHC) Nicole Byrne and Tania Lyddiard

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. M any 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

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).

Keywords Challenges Maltreatment Out of home care Speech

pathology Strategies

This article has been peer- reviewed

Nicole Byrne (top) and Tania Lyddiard

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JCPSLP Volume 15, Number 3 2013

www.speechpathologyaustralia.org.au