Better or worse? Returning children with complex health needs to their communities

Abstract

Children who are placed in out-of-home care have experienced abuse and/or neglect and as a result may have a history of trauma, attachment disorders, intellectual disability, poor physical, mental and dental health, self-harming behaviours and/or substance misuse. The philosophical approach to child protection practice gives preference to family reunification to either parents or kin for these children where possible. The significant shortage of foster carers, particularly the shortage of Indigenous foster carers for Indigenous children, combined with the need to prevent another Stolen Generation, has resulted in greater attempts to return these children to their kin. The increased recognition of Indigenous perspectives on health and well-being that involve not just physical health but connection to Country and the environment, connection to family and community, sense of Indigenous identity and culture is also necessitating more than just a medical focus on the needs of these children. However, reunification of Indigenous children often means they are being returned to their kin in rural and remote communities where there are scarce health services. This situation presents many difficulties for kin carers particularly those who are caring for children with a disability and those whose psychosocial adjustment has been detrimentally affected by cumulative harm as a result of further abuse while in care. Many of these children have been previously placed with carers in regional towns where there has been access to specialist health services. It these very services which sometimes object to children being moved to live with kin out of a concern about whether adequate medical follow care will be available. This paper will present two case studies which identify some of the complexities of meeting the health care needs of children returned to kin in rural and remote communities along with some suggestions for how these children's wellbeing can be better monitored.