CEI has delivered an independent assessment of a specialised out-of-home care (OOHC) program in New South Wales (NSW), Australia, that places children and young people who have complex trauma histories and high behavioural needs in the home of professional therapeutic carers.
The Professional Individualised Care (PIC) program has operated at the “pointy end” of NSW’s OOHC system since 2018, working with children and young people either in or at risk of entering emergency or temporary accommodation or residential care.
“Referral to PIC happens when all other placement options have been exhausted,” explains CEI Director Dr Vanessa Rose. “Typically, these young people have experienced multiple placement breakdowns. With a skilled therapeutic professional (such as a social worker) as their primary carer, the child or young person has the opportunity to heal and build an authentic and secure one-to-one relationship – something they’ve usually been missing out on.”
Grounded in a well-evidenced relationship-based caring model from Germany, PIC uses individualised care plans, reliable and authentic relationships with carers, and young people’s participation in decision-making processes to achieve program goals.
CEI's assessment identified four overarching insights that extend understanding of PIC and how it differs from business-as-usual out-of-home care:
The right match is more important than a quick match
Getting the right match between a child / young person and a carer, the PIC team have learned, leads to fewer placement breakdowns and the acceleration of a strong relationship for personal growth.
The PIC model is driven by the child or young person
The views, choices and goals of the child or young person drive activity in PIC, including the matching process and the course of each placement. This is a much greater level of child involvement and decision-making than in standard child-centred OOHC.
PIC’s relationship-based practice offers multiple layers of support
While the carer-young person relationship is a core component of the PIC model, the child or young person is also encouraged to build a social network of supportive and attuned adults. This might include their PIC Coordinator, members of their carer's family or pre-existing relationships the young person has chosen, as well as local youth workers or previous case workers.
A mission-driven organisational culture
The model’s backbone is a single-minded focus on impact for children and young people with complex needs. Staff share a high motivation for change, underpinned by supportive organisational structures such as low caseloads as well as the autonomy to adapt PIC and generate creative solutions to meet individual circumstances.
CEI's approach
CEI was asked to assess PIC through an implementation science lens to articulate key factors supporting the program’s success and implementation. An evaluation framework was also developed, with Monash University and the Behavioural Insights Team.
“We looked at the model’s underpinning theories and evidence, we asked young people and their professional carers about their direct experience, we reviewed relevant documents and interviewed key staff to find out how the program works on the ground,” Vanessa explains.
“We organised our assessment around the young person’s relationship with the program, from their initial contact to their eventual transition to independent living. And because programs do not operate in isolation, we also needed to explore the context in which PIC operates – which is itself dynamic and undergoing constant change.”
Background on the model
The PIC model is supported by extensive research demonstrating its effectiveness for high-needs youth. It is based on Germany’s most successful OOHC, the Individual Social Pedagogy model, which consistently outperforms other forms of care.
The model's success is attributed to key factors such as individualised care plans, strong client-carer relationships, and client participation in decision-making.
Longitudinal research indicates that this approach leads to better long-term outcomes, with children and young people more likely to successfully transition out of care and maintain constructive relationships. Additionally, comparative studies show that PIC is more effective in motivating youth to attend school regularly and achieve formal qualifications, with most participants obtaining school leaving certificates despite previous educational challenges.