Fenandez, Elizabeth --- "Adults damaged as children in care" [2017] PrecedentAULA 75; (2017) 143 Precedent 48

Concern has grown nationally and internationally about the trauma and victimisation experienced by members of profoundly disadvantaged and vulnerable groups. Forgotten Australians, former Child Migrants and members of the Stolen Generations often experienced mistreatment while in public care, suffering significant and lifelong impacts of such trauma.

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Adult care leavers’ lived experience of the conditions of their care and their current outcomes are profiled through a national research study conducted by the University of New South Wales in Australia and reported in this article. Using a mixed methods approach, the research explored the range of experiences and outcomes for those who spent their childhoods in residential and foster care. The study included surveys, personal interviews and focus groups, the sample comprising 700 respondents from across Australia. This article draws on both quantitative findings and voices of research participants. Implications of the findings for redress, and for policy and practice in contemporary out-of-home care systems are also discussed.

Many children were placed in orphanages and a range of institutions that were run by the state, religious groups and other organisations during the last century. It is estimated that in Australia during the 20th century, 500,000 children spent time in care.^[1] This research explored the in-care and post-care experiences of three cohorts in institutional and out-of-home^[2] care (OOHC) during the period 1930-1989. They included the ‘Forgotten Australians’ (mainly non-Indigenous Australian-born children who were in OOHC^[3]) the Child Migrants (children exported from the British Isles to Australia^[4]) and the ‘Stolen Generations’ of Indigenous Australians (Aboriginal children forcibly removed from their families and placed in white families and institutions^[5]).

Much recent discussion on the treatment of children in institutional care has concerned the 20th century. There are living survivors who spent their childhoods in care and for whom justice and service responses are needed to make an impact on their current lives and their families. There have been national apologies to the Forgotten Australians, former Child Migrants and members of the Stolen Generations acknowledging their stolen childhoods in care. Although various inquiries have examined the issues in relation to historic abuse in care, there remains limited public knowledge of the nature of these experiences and the magnitude and duration of the consequences for those who spent their childhoods in care. National concern and lobbying from policy makers and advocacy groups culminated in the establishment of the Royal Commission into Institutional Responses to Child Sexual Abuse^[6] focusing on organisations with responsibility for children in their care. Unlike the Royal Commission, whose terms of reference limit its focus to sexual abuse, this research, implemented in parallel with the Royal Commission’s hearings, examined the complete experience of adults who spent their childhoods in care in the 20th century, eliciting their accounts of all the ‘wrongs’ they were subjected to, and positive and negative outcomes.

State intervention targeting families and assuming control over children can be traced to the early period of white settlement in Australia with the establishment of orphanages, industrial schools and boarding out systems. There were significant child welfare concerns in the early period of settlement when major economic, housing, physical and mental health, death and incarceration of parents and social control issues prevailed.^[7] The 19th century saw the establishment and proliferation of a range of institutions intended to respond to child welfare needs at the time. The conditions experienced by children in these institutions were harsh and unrelenting. Concern about conditions in OOHC triggered many public inquiries.

The practice of housing large numbers of children in institutional care was not unique to Australia but was widespread in Britain, Europe, North America and elsewhere. The limited published independent research into the long-term impact of living in institutional environments comes from overseas.^[8] These and formal inquiries overseas document widespread practices in child welfare institutions that were psychologically, physically and sexually abusive and characterised by neglect.^[9] The experiences of Australian care leavers and the impact of being in care are documented in autobiographical accounts,^[10] oral disclosures and personal submissions to the Parliament’s Senate Inquiry into Children in Institutional care^[11] and various state investigations,^[12] and more recently in Royal Commission reports and research. These accounts describe narratives of abuse and neglect, deprivation and degradation and negative adult outcomes.

The research was conducted from 2014 to 2016 at the University of New South Wales in collaboration with the University of Chicago (Professor Mark Courtney) and University of York (Professor Mike Stein) and six community partners: Alliance for Forgotten Australians, Association of Children’s Welfare Agencies, Berry Street Victoria, Relationships Australia NSW, CatholicCare Diocese of Broken Bay, Families Australia and Micah Projects.

Key areas of inquiry included the identification of significant events during and after care; problems, strengths and achievements of participants; and the provision or absence of services critical for long-term health and wellbeing outcomes. Using a life-course approach,^[13] the study attempted to capture a wide range of outcomes including physical and psychological health, education and employment, and identify areas for intervention.^[14]

This study used a mixed-methods design to gain both broad and in-depth information.^[15] It included surveys, interviews, and focus groups. Using a convergent parallel design,^[16] quantitative and qualitative research components were run simultaneously with equal priority.

Of the 669 survey participants, 75.9 per cent were Forgotten Australians, 10.0 per cent were Child Migrants, 6.0 per cent identified themselves as members of the Stolen Generations, and 8.1 per cent did not report their group identification. The mean age of survey participants was 61.74 where the youngest participant was 27 years old and the oldest participant was 100 years old. More than half (57.4 per cent) were female. In terms of Aboriginal status, 86 per cent were non-Indigenous, 7.8 per cent were Aboriginal/Torres Strait Islander, and 6.3 per cent did not identify. About half of respondents were married (42.7 per cent) or in a de facto relationship (7.7 per cent) at the time of the survey. Participants were from all Australian states and territories, although the majority of participants were from the most populated states, New South Wales (35.3 per cent), Queensland (28.9 per cent), and Victoria (18.6 per cent).

The questionnaire focused on experiences in care; experiences of leaving care; life outcomes after care (education, employment, health, wellbeing, and relationships); current service needs; and participation in care leaver organisations and the Royal Commission into Institutional Responses to Child Sexual Abuse. The questionnaire included two standardised scales: the Kessler Psychological Distress Scale (K10)^[17] and the Multidimensional Scale of Perceived Social Support (MSPSS).^[18] The interview guide for care leavers broadly focused on the same issues explored in surveys. In addition, participants were asked about their coping strategies and resilience, and significant events post-care to the present. The focus group guide covered the same themes; however, less emphasis was given to questions about individual experiences, due to focus groups being collective in nature.

At the time of entry into care, 52.9 per cent of survey participants were state wards and they were 6.28 years old on average (ranging from at birth to 17.58 years old). Respondents entered into care for multiple reasons. The most cited reasons were parents’ inability to cope (39.4 per cent); marital problems between parents (36.4 per cent); neglect (27.2 per cent); abandonment (24.6 per cent); domestic violence (24.4 per cent); parental drug and alcohol problems (24.2 per cent); financial difficulties (22.1 per cent); and parental illness (21.2 per cent).

Respondents experienced various types of placements. The majority of them (84.8 per cent) were placed in children’s homes/orphanages; 33 per cent in foster care, 25 per cent in youth correctional facilities, and other care settings (such as residential care, family group home, boarding house, psychiatric hospital, or training institution). While in care, 24.5 per cent of respondents did not have any contact with their family, 19.4 per cent had contact less than yearly, 19.6 per cent had contacts 2‒3 time a year, 16.3 per cent had contact monthly, and 20.2 per cent had contact fortnightly or more.

Research participants provided detailed comments on their perceptions of the circumstances that led to their entry to care. They also commented on the regimented orientation of institutions and the depersonalisation they had experienced. In reporting the comments of research participants pseudonyms have been assigned.

‘When I went in there, I was only a number, and it wasn’t until I was 10, 11 years old when I found out, that I had a name.’ (‘Frank’)

Research participants also commented on the demeanour of staff and the lack of warmth in the care environment.

‘There was a sort of militaristic background to a lot of them, but there was always this glass barrier between you and the staff, and the staff were never to get close. They were never allowed to hug the children, they could never show any bit of love to the children.’ (‘Ethan’)

		n	Frequency	%	Mean	SD	Range
Attending school while in care		421
	Yes		296	70.3
	Sometimes		71	16.9
	No		54	12.8
Schooling affected by care		379
	Yes		325	85.8
	No		31	8.2
	Don’t know		23	6.1
Level of schooling		651
	Higher School Certificate		125	19.2
	Intermediate Certificate		155	23.8
	Some secondary school		189	29.1
	Finished primary school only		41	6.3
	Some primary school		60	9.2
	Never attended school		8	1.2
	Other		72	11.1
Number of schools		390			2.59	2.58	0–21
Age at leaving school		368			15.04	1.68	8–28

Educational neglect was rampant and many left care illiterate and innumerate. The majority of respondents (85.8 per cent) said their schooling was affected by their experience of being in care. Only 19.2 per cent obtained a Higher School Certificate (or Leaving Certificate, Matriculation, Senior Certificate, Year 11 or Year 12); 23.8 per cent obtained an Intermediate Certificate (or School Certificate, Junior Certificate, Achievement Certificate, Year 10); and 56.9 per cent did not obtain any school certificate although most of them attended primary and secondary schools. One of the participants observed that being a ‘home kid’ attracted low expectations and stigma.

‘We were never permitted to be called by name. We were all called simply "home kid". We were ostracised by both teachers and students. Our school work and/or homework was never checked as we were told that we were only home kids and not expected to do anything in life other than life on government assistance.’ (‘Anon’)

‘What education? My education, my educational potential was like my childhood, stolen, I don’t know what I could have been. I had no education. I was taken out of school before I turned 14 and was sent to work on a dairy farm.’ (‘Luan’)

Findings reveal that emotional, physical and sexual abuse and gross neglect occurred frequently and concurrently. Children were also subject to hard physical labour from a very young age. Maltreatment in care was extensive. The majority of those in care (96.7 per cent) experienced some type of maltreatment in care and 41 per cent of participants reported that they had experienced all forms of maltreatment in care. The most prevalent type of abuse by adults was emotional abuse (87.3 per cent), followed by verbal abuse (82 per cent). The most prevalent abuse by peers was bullying (77.6 per cent), followed by verbal abuse (73.7 per cent). Sexual abuse was widespread and over 60 per cent experienced this form of abuse from someone: 55.3 per cent experienced sexual abuse by adults and 41.8 per cent experienced sexual abuse by peers. (Figure 1)

Note: The sample size varies, n = 416 to 418. Bars indicate percentages of people who responded yes to the item.

In interviews and focus groups, participants detailed their experience of verbal, physical, emotional, and sexual abuse.

‘That (indicating deep scarring on leg) was from the [name of the institution]. The Major belted me with a piece of wood. It aches all the time (60 years later). If I get a rash on it, there’s a good chance it’ll break out again because it’s right down on the bone....They put a... rag on my leg and gave me a pair of crutches for 6 months...’ (‘Bill’)

Accounts of sexual abuse by staff and visiting professionals were common in both genders. Typically, children were silenced, disbelieved, or threatened if they attempted to disclose the abuse.

‘I didn’t know what to do, and they told us to shut our mouth or we’ll never ever get released from the home. They had us over a barrel.’ (‘Maxine’)

Aboriginal children were cruelly punished for speaking languages other than English, or for expressing their culture of origin in other ways.

‘[If you spoke language] You’d get a big – you’d get put in a corner with no food. You’d get in trouble– you’d get ah, no blanket, no mattress, just sleep as you are. And the clothes you go on your back. Like they won’t give you another clothes til you learn not speak language.’ (‘Russell’)

Survey participants left care on average at 15.20 years, with ages of exit ranging from 3 weeks to 22 years. About 62 per cent did not have a job when they left care. Over half of the respondents (51 per cent) said that they were not prepared at all for living independently at the time.

‘I didn’t even know how to catch a train when I got out, which is quite funny because I was invited to a wedding and I didn’t even know how to get there [laughing]. You know, because you didn’t know those things.’ (‘Kathy’)

The consequences of maltreatment in care extended well beyond respondent’s childhoods, persisting into adulthood. Results indicate that those who experienced poly-victimisation through multiple types of abuse had generally worse outcomes in various domains of well-being. As noted in Figure 2, over half of survey participants (50.9 per cent) had a disability. At the time of the surveys, 68.2 per cent had physical illnesses requiring ongoing treatments and 6.1 per cent had experienced such illnesses in the past. Among them, 46.7 per cent considered these physical illnesses to be related to their experiences in care. Fifty-nine per cent of respondents reported having mental illnesses requiring ongoing treatments at the time of survey, and about 11 per cent had had such illnesses in the past. Among them, 85.9 per cent considered these mental illnesses to be related to their experiences in care. Seventy-six per cent of survey participants reported having flashbacks, 64.9 per cent had suicide ideations, and 38.8 per cent had attempted suicide at some point.

Note: The sample size varies, n = 389 to 412. Bars indicate percentages of people who responded yes to the item.

Care leavers in this study experienced high levels of psychological distress. Compared to Australian community samples (2007 HILDA and 2007 NSMHWB), much higher percentages of care leavers in this study reported ‘very high’ (38 per cent) or ‘high’ (21 per cent) levels of distress. For instance, when the percentage of people with ‘very high’ distress is compared, the percentage found in this study is 8.5 times greater than the percentage found in the Household Income and Labour Dynamics Australia (HILDA) study (2007) and 14.4 times greater than the percentage found in the National Survey of Mental Health and Wellbeing (NSMHWB) study (2007). (Figure 3)

Note: n of study sample = 392. HILDA refers to Household Income and Labour Dynamics Australia and NSMHWB refers to National Survey of Mental Health and Wellbeing. Source: Wooden, M. (2009).

Very few participants left care with an adequate education. The deficit in formal preparation, together with health and mental health issues and financial disadvantage made participation in continuing education enormously difficult. This study’s narratives are consistent with existing research.^[19]

Participants relayed that leaving care was an experience of profound fear and abandonment. The widespread systemic abrupt and accelerated discharge of care leavers practised during the study period has had predictably tragic consequences for many research participants. Protracted periods of homelessness and various forms of institutionalisation – especially in mental health facilities, youth justice or prisons – have been described by many participants as the impacts of care leaving; this is consistent with existing evidence.^[20] Many young people attempted to reconnect with their families though most of these attempts were unsupported and proved unsuccessful, resulting in experiences of further trauma and abandonment.

Participants’ recounted experiences in care characterised by neglect, deprivation, degradation, maltreatment and loss of identity. They were violated in many and serious ways. Sexual abuse was one of those violations; horrendous physical abuse, psychological abuse, inadequate food and clothing, educational neglect and arduous child labour were further ‘harms’ they endured which have had lifelong impacts. Their accounts also provided insights into strengths and resilience that have enabled them to cope and survive the trauma and stress they experienced.

While each type of maltreatment is presented separately in Figure 1, in reality, care leavers experienced multiple, co-occurring and intertwined forms of abuse defined by Finkelhor et al^[21] as poly-victimisation. Maltreatment experienced in single or multiple forms is associated with negative and long-term consequences on wellbeing.These consequences are not easily manifested in exclusionary patterns, associated with each type of abuse. Rather the impact is cumulative.^[22]

Greater effort is required to understand the complex manner in which co-occurring forms of child maltreatment intersect to influence traumatic responses and impact on identity and self-image and functional impairment across the life course. The culture of violence that permeated institutions and care systems without mechanisms for accountability and monitoring resulted in failures to identify and address the abuse. The experiences of maltreatment have left indelible scars on participants including lifelong fear, mistrust, low self-esteem and hypervigilance. The abuse has also resulted in horrendous injuries leading to chronic physical conditions, serious mental health impairments, and a range of disabilities.^[23] For Aboriginal participants, there is the added painful loss of family culture and language to be acknowledged.

It is intended that findings from this research will inform strategies to ameliorate the negative impact of past experiences of care on health, well-being and life potential. Findings should contribute to a knowledge base to underpin better social and health strategies to improve physical and mental capacities of ageing care leavers overall, and at critical transition points such as entering aged care facilities and hospitals. Furthermore, outcomes can assist to promote better understanding of the needs and challenges adult care leavers confront and prompt more sensitive and just responses to them besides providing a knowledge base for more responsive service provision.

The long-term emotional cognitive and social impacts of the trauma associated with maltreatment and cumulative adversities in care has therapeutic, legal and public policy implications for adult care leaver participants in this study. These include:

Evidence-based policy, practice and principles are sorely needed to ensure that care is delivered in a manner that safeguards vulnerable children and youth in current OOHC systems.

Professor Elizabeth Fernandez is a Professor of Social Work at the School of Social Sciences, at the University of New South Wales. She has specialised for over two decades in the areas of child abuse, trauma, family violence, care and protection and field-based learning and supervision. PHONE (02) 9385 1865 EMAIL e.fernandez@unsw.edu.au.

The author acknowledges members of the research team: Dr Jung-Sook Lee, Dr Hazel Blunden, Dr Patricia McNamara, Ms Szilvia Kovacs, and Mr Paul-Auguste Cornefert. The funding supporting this presearch from the Australian Research Council is gratefully acknowledged.

^[1] Senate Community Affairs References Committee, Parliament of Australia, Forgotten Australians: A Report on Australians Who Experienced Institutional or Out-of-Home Care as Children (2004).

^[2] ‘Institutional and out-of-home care’ includes the range of service types that operated in the 1930–1970s period to provide care for children who did not live with their own family. This typically included institutions run by religious orders, NGOs and state governments and, in NSW, a form of department-sponsored home-based care. In addition, detention centres and psychiatric institutions were also sometimes used to provide custody for children and young people where it was determined that additional control or treatment was required.

^[4] P Bean and J Melville, Lost Children of the Empire, Unwin Hyman, London, 1989.

^[5] Commonwealth, Human Rights and Equal Opportunity Commission, Bringing Them Home: Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Families (1997).

^[6] Commonwealth, Royal Commission into Institutional Responses to Child Sexual Abuse, Creating Child Safe Institutions (2016).

^[7] D Scott and S Swain, Confronting cruelty: Historical perspectives on child protection in Australia, Melbourne University Press, Carlton, 2002. See also: R van Krieken, Children and State: Social Control and the Formation of Australian Child Welfare, Allen and Unwin, Sydney, 1991.

^[8] R B McKenzie, ‘The Impact of Orphanages on the Alumni’s Lives and Assessments of Their Childhoods’, Children and Youth Services Review, 25(9), 2003, pp 703-53; J Perry, J Sigal, S Boucher, and N Paré, ‘Seven institutionalized children and their adaptation in late adulthood: The children of Duplessis (les Enfants de Duplessis)’, Psychiatry, 69(4), Winter 2006, pp283–301.

^[9] S Ryan, The Commission to Inquire into Child Abuse , Commission Report (2009) vols I-V; Government of Canada Law Commission of Canada, Restoring dignity: Responding to Child Abuse in Canadian Institutions (2000).

^[10] J Penglase, Orphans of the living: Growing up in ‘care’ in Twentieth-century Australia, Fremantle Arts Centre Press, Fremantle, 2005; R Szablicki, Orphanage Boy: Through the Eyes of Innocence, New Holland, Sydney, 2010.

^[14] E Fernandez, J-S Lee, H Blunden, P McNamara, S Kovacs and P-A Cornefert, No Child Should Grow Up Like This: Identifying Long Term Outcomes of Forgotten Australians, Child Migrants and the Stolen Generations, University of New South Wales, Kensington, 2016.

^[15] L Doyle, A M Brady, and G Byrne, ‘An Overview of Mixed Methods Research’, Journal of Research in Nursing, 14(2), 2009,pp175–85.

^[16] J W Creswell and C V L Plano, Designing and Conducting Mixed Methods Research, SAGE Publications, Los Angeles, 2011.

^[17] RC Kessler, G Andrews, L J Colpe, E Hiripi, D K Mroczek, S L Normand and A M Zaslavsky, ‘Short screening scales to monitor population prevalences and trends in non-specific psychological distress’, Psychological Medicine, 32(6), 2002, pp959–76.

^[18] G D Zimet, N W Dahlem, S G Zimet and G K Farley, ‘The Multidimensional Scale of Perceived Social Support’, Journal of Personality Assessment, 52(1), 1988, pp30-41.

^[19] M E Courtney, A Dworsky, A Brown, C Cary, K Love and V Vorhies, Midwest Evaluation of the Adult Functioning of Former Foster Youth: Outcomes at Age 26, Chapin Hall at the University of Chicago, Chicago, 2011; P Pecora, R Kessler, K O’Brien, C Roller, J Williams and E Hiripi, ‘Educational and employment outcomes of adults formerly placed in foster care: Results from the Northwest Foster Care Alumni Study’, Children & Youth Services Review, 28(1), 2006, pp459–81.

^[20] P Mendes, and P Snow (eds), Young People Transitioning From Out-of-Home Care: International Research, Policy and Practice, Palgrave Macmillan, London, 2016; See also Senate Community Affairs References Committee, above note 1.

^[21] D Finkelhor, R K Ormrod and H A Turner, ‘Poly-Victimisation: A Neglected Component in Child Victimisation’, Child Abuse & Neglect, 31(1), 2007, pp7-26.

^[22] A Segura, N Pereda, G Guilera, and J Abad, ‘Poly-Victimisation and Psychopathology Among Spanish Adolescents in Residential Care’, Child Abuse and Neglect, 55, 2016, pp40-51; J C Clemmons, K Walsh, D DiLillo, T L Messman-Moore, ‘Unique and Combined Contributions of Multiple Child Abuse Types and Abuse Severity to Adult Trauma Symptomatology’, Child Maltreatment, 12, 2000, pp172-81; R E Norman, M Byambaa, R De, A Butchart, J Scott and T Vos, ‘The Long-Term Health Consequences of Child Physical Abuse, Emotional Abuse, and Neglect: A Systematic Review and Meta-Analysis’, PLoS Medicine, 9(11), 2012.

^[23] E A Fernandez and J-S Lee, ‘Experiences and outcomes of adults who endured maltreatment as children in care in Australia in the twentieth century’ in A V Rus, S R Parris and E Stativa (eds) Child Maltreatment in Long-Term Residential Centers: History, Research and Current Implications (Springer Publishers) pp419-60.

Precedent (Australian Lawyers Alliance)

Fenandez, Elizabeth --- "Adults damaged as children in care" [2017] PrecedentAULA 75; (2017) 143 Precedent 48