Children At Risk Evaluation

Children At Risk Evaluation (CARE) is a study of health, development and care needs in high-risk children. Children in out-of-home care (OOHC), and children of mothers in opiate maintenance treatment (OMT), have an increased risk of physical and mental health problems, as well as delayed or deviant development. The project is led by the University of Oslo, in research collaboration with Norce and Oslo Metropolitan University, stretching from 2016 until 2023. It is funded mainly by a grant from the Norwegian Research Council, with additional funding from the DAM Foundation, NORCE, the Directorate of Health, the State Child Welfare Services for the southern region and Vestfold Hospital Trust. The two latter have also contributed clinical personnel to the study. The study has three work packages. Work package 1; Model evaluation International guidelines recommend routine multi-professional trauma-informed needs assessment in children entering OOHC. The assessment covers their need for health services, educational support and individual care needs, as a base for offering services for the child and for supervision of its new carers. This work package evaluates a new model for how such assessment may be performed, with two multi-professional teams assessing close to 200 children entering or already living in OOHC. Experiences from youth themselves, carers, child welfare staff and team members have been collected and analyzed. Preliminary findings were presented to user organizations, directorates and ministries at a seminar in January 2020. The seminar also included a debate among members of parliament, who supported making such assessment a legal right for all children entering OOHC. The final evaluation report was launched digitally in November 2020, due to the corona pandemic. Findings will also be reported in international peer-reviewed scientific journals. Unfortunately we did not managed to include enough children of mothers in OMT in order to evaluate if the assessment model was suitable also for them. The government has from 2021 allocated funding for a gradual implementation of assessment teams, based on the model evaluated here, with the aim of nationwide coverage for this new service. The new Child Care Act introduced in 2023, specifies an obligation for municipal child welfare services to refer all children entering OOHC for this assessment. Work package 2. Young in fostercare. In this two-wave longitudinal study, we assess mental health, quality of life, as well as access to and experiences with services, five years after the first study of this group. Data on around 400 youth and their foster parents have been collected. Through international collaboration a diagnostic interview, the RADA, was developed for assessing attachment- and relational problems. This work package includes two PhD projects, of which one was successfully defended in the spring of 2022. This PhD project investigates access to and experience with services, an predictors for quality of life among youth in foster care. The second PhD project, to be completed in spring 23, investigates different aspects of internalizing difficulties in this group. Overall, we find a high prevalence of PTSD, internalizing problems and sleep disturbances among youth in foster care. Exposure to maltreatment was associated with stress- and trauma-related symptoms. We also found lowered quality of life among foster youth. Our findings indicate that foster parents in general are quite satisfied with services offered them, and more than half reported improvement in the youth´s health and wellbeing over time. Still, carers point to challenges regarding information flow, collaboration across services and sectors, regular contact / follow-up, and waiting time. The youth also reported lower quality of life than other youth. Findings indicate a need for broad assessment of their experiences, mental problems and resources. Results are published in 14 international peer-reviewed journals, and disseminated through 25 presentations at national and international meetings. Work package 3; the OMT study This work package is a follow-up study of women in OMT and their children born 2005-2006. The focus is mental health and quality of life in children of school age. The results show that 81% of the mother had kept custody of their children. These mothers overall functioning was better than women who had lost custody. Children living in their family of origin had better mental health than children moved to OOHC or non-exposed foster children. We also studied associations between parenting stress and child behavior problems over a timeframe of 8 years. Mothers in OMT reported more parenting stress and psychological distress than a comparison group of mothers. Child behavior problems increased for both groups until age 4, and continued to increase towards school-age for the OMT group .

Vår utprøving og evaluering av modell for kartlegging av helse og omsorgsbehov hos barn som flyttes ut av hjemmet (CARE modellen - delprosjekt 1) har hatt stor betydning for at tverrfaglig helsekartlegging nå bygges ut som en ny landsdekkende tjeneste, og for at barnverntjenesten i den nye Barnevernloven er pålagt å henvise til slik kartl. Bufdir og Helsedir har deltatt i prosjektets referansegruppe og sammen med departementene blitt orientert i separate møter. Barneombudet har også vært en viktig samarbeidspartner og bidragsyter til arbeidet med lovendringen og det nye tjenestetilbudet. Vi har også avgitt skriftlige og muntlige høringsuttalelser til Stortinget for behandling av lovforslaget. Prop. 222L, Endringer i barnevernloven mv (tverrfaglig helsekartlegging) fra 2020/2021, nevner CARE studien 15 ganger og beskriver den i en egen boks. Etablering av tverrfaglig helsekartlegging etter CARE modellen innebærer et nært samarbeide mellom helsevern og barnevern, både på myndighetsnivå og for de utøvende tjenestene. Evalueringen har vist at rapportene fra kartleggingen i stor grad avdekker behov hos barna som ikke var kjent for barneverntjenesten, de gjør det lettere å få henvist barn til nødvendige tjenester, og de gir et godt grunnlag for veiledning av barnets nye omsorgspersoner. Dette er viktig for barnas trygghet, helse og utvikling. Arbeidspakke 2 Ung i Fosterhjem har generert internasjonalt forskningssamarbeid gjennom sampublikasjoner med forskere fra ulike europeiske, kanadiske og nord-amerikanske universiteter. Samarbeidet har resultert i et nytt klinisk intervju for kartlegging av relasjonsforstyrrelser; RADA. Verktøyet er fritt tilgjengelig for bruk i klinikk og forskning, og finnes på engelsk, fransk, norsk og portugisisk. En av stipendiatene har hatt utvekslingsopphold ved Universitetet i Leiden. Både stipediatene og delprosjektleder Stine Lehmann har vektlagt formidling av resultater i nasjonale og regionale fora, rettet mot sentrale målgrupper som beslutningstakere, praktikere i barnevern og psykisk helsevern, og foster foreldre. Delprosjektleder har holdt flere fagdager i psykisk helsevern og barnevern. Her har prosjektresultatene blitt formidlet med vekt på de praktiske og kliniske implikasjonene av våre funn. Fremover vil resultatene anvendes i undervisning av masterstudenter i barnevern og profesjonsstudenter i psykologi ved Universitet i Bergen. Arbeidspakke 3 er en 8års ppfølgingsundersøkelse av barn født av mødre i LAR. Resultatene viser at barn eksponert for LAR-medikamenter i fosterlivet og blir boende i biologisk familie har bedre psykisk helse enn de som flyttes ut av hjemmet. Vi fant også at atferdsproblemer hos barna var økende over tid sammenlignet med en gruppe ikke-ekponerte barn og at dette hang sammen med foreldrerelatert stress.Resultatene har vært formidlet internasjonalt og blant brukere i regi av brukerorganisjonen ProLarNett. Helsekartleggingen var ikke egnet for barna i arbeidspakke 3.

In recent studies we and others have documented high prevalence of mental disorders in foster children and in children of mothers in opiate maintenance treatment (OMT), with one in two children meeting criteria for mental disorders. Recent guidelines are now calling for a closer collaboration between Child Protection Services (CPS) and Mental Health Services (MHS) to implement routine assessment models so that mental health needs of high-risk children are not neglected. For children entering out-of-home care, we here propose a systematic evaluation of two models. In one model the assessment team is integrated in the CPS, in the other the team is integrated in the MHS. We will also assess the utility of performing screening versus immediate full assessment. Also included in the project are follow-up studies of mental health in these high-risk populations. WP 1: Evaluation of teams for mental health assessment based in CPS and MHS respectively WP 2: A follow-up study of foster children 5 years after their first mental health assessment WP 3: A national cohort study of children with mothers in OMT from birth until 7-10 years The project will provide unique information on the mental health needs of such high-risk children in Norway. It will also assess predictors for healthy development to guide supervision and services. The project will assess effects of hosting an assessment team at municipal level (within the CPS), compared to hosting it at county level (within the MHS), and also cost-effectiveness aspects. The value of child mental health assessments for the supervision of carers, access to services, placement stability and mental health development is addressed in a quasi-experimental design. Informants will include children, parents or carers, team staff, collaborating services, and administrators of the host services.