Children and young people entering Out-of-Home Care (OOHC) often bring with them a history that has been shaped not by choice, but by trauma, instability, and disrupted relationships. Their experiences prior to entering care often include neglect, abuse, family violence, exposure to substance misuse, chronic stress, and inconsistent or unsafe caregiving. These early adversities profoundly shape how a child understands the world, relates to others, and responds to stress.
In these contexts, behaviours of concern are rarely “problem behaviours” — they are communication, stress responses, and adaptations to environments that were once unpredictable or unsafe. The behaviours that we consider challenging are their learned way of surviving.
This is where Positive Behaviour Support (PBS) becomes not only helpful, but transformational. Behaviour support in OOHC is more than a plan, a strategy, or a document; it is a therapeutic, trauma-informed process that empowers children to heal, regulate, connect, and thrive.
This blog explores the correlation between OOHC and behavioural outcomes, the role of trauma-informed interventions, why family involvement matters, and the therapies that are currently underused but deeply effective for children with trauma histories.
Table of Contents
Why Behaviour Support Matters in OOHC
Children in OOHC have significantly higher rates of emotional and behavioural difficulties compared with their peers. Research consistently shows that children in care experience:
- 2–4 times higher rates of behavioural challenges
- Increased emotional dysregulation
- Higher rates of anxiety, depression, and trauma responses
- Difficulties with attention, executive functioning, and impulse control
- Relationship and attachment challenges
This is not because of OOHC itself — but because most children enter care following complex developmental trauma. As Tarren-Sweeney (2013) emphasises, children in OOHC frequently present with “complex, trauma-related psychopathology” due to early adversity.
These behavioural and emotional difficulties often become the focus of support needs, leading to the implementation of behaviour plans, therapeutic interventions, and professional supports.
But it is important to understand that, for these children: Behaviour support is not about fixing behaviour — it is about supporting healing, connection and development so that they can learn to live without needing to use the behaviour to survive.
The Correlation Between OOHC and Behavioural Outcomes (Rewritten in Essay Style)
The relationship between Out-of-Home Care and behavioural outcomes is well established in recent literature, and it reflects the significant impact that early adversity has on a child’s emotional, social, and cognitive development. Children who enter OOHC have often experienced prolonged exposure to abuse, neglect, domestic violence, inconsistent caregiving, and chronic stress—factors known to alter brain development, attachment systems, and the child’s capacity for regulation (Dozier et al., 2006; Perry, 2006). As a result, children in OOHC are statistically more likely to present with externalising behaviours such as aggression, defiance, or running away, as well as internalising difficulties like anxiety, withdrawal, and depression. These behavioural patterns are not inherent to OOHC placement itself; rather, they reflect the child’s history of trauma and the adaptations they developed in order to survive unsafe environments.
A powerful body of research illustrates how placement instability further contributes to behavioural difficulties. Each additional placement change has been shown to increase behavioural challenges, emotional dysregulation, and distrust in adults, creating a cycle in which instability fuels behavioural escalation, and behavioural escalation leads to further instability (Rubin et al., 2007). This bidirectional relationship highlights the importance of providing consistent, specialised behavioural intervention within OOHC settings. Studies examining structured behaviour support programs—particularly those that involve carer coaching and predictable routines—have demonstrated significant improvements in behaviour, emotional functioning, and placement stability.
Trauma-informed behaviour support plays a crucial role in improving outcomes because it acknowledges that behaviour is a communication of unmet needs, dysregulation, and fear, rather than defiance or intentional misconduct. When children feel safe, supported, and regulated, they are better able to engage in relationships, participate in education, and learn new coping strategies. Importantly, research shows that early intervention further enhances outcomes: children who receive behaviour support soon after entering care show better long-term developmental trajectories, including improved attachment, emotional regulation, and resilience (Fisher et al., 2011; Harden, 2004).
Together, the evidence demonstrates a clear correlation: children in OOHC face higher behavioural and emotional challenges due to early trauma, but effective behaviour support is one of the most impactful ways to improve their outcomes, enhance stability, and support long-term wellbeing. Behaviour support acts as a protective factor, helping children move from survival-based behaviours toward more adaptive, regulated, and connected ways of relating to their world.
Why Trauma-Informed Behaviour Support Is Essential
Traditional behaviour management strategies often focus on consequences, reward charts, compliance, or punishment.
For children in OOHC, these approaches can be not only ineffective — but harmful.
Trauma-informed behaviour support recognises that:
- Behaviours are protective responses the child has learned over time
- Children are not “choosing” to be oppositional; they are dysregulated
- Safety, connection, and co-regulation must come before skill building
- The nervous system must be calm before logic, learning and communication can occur
Only once a child feels safe and regulated can behaviour plans be effective.
Behaviour support in OOHC therefore focuses on:
- reducing triggers
- building emotional safety
- providing predictable routines
- teaching regulation strategies
- strengthening relationships with carers
- supporting the child’s identity and story
This is the foundation of behaviour change.
Highly Effective Therapies of Behaviour Support
Many children in OOHC do not respond well to talk-based therapies because their trauma occurred before they had the language to describe it.
This is where expressive, sensory, and play-based therapies are extremely powerful — yet surprisingly underused in the behaviour support space.
Play Therapy
Research: Bratton et al. (2005) conducted a meta-analysis showing significant improvements in emotional regulation and behaviour for children receiving play therapy.
Why it works:
- Children process trauma through play, not conversation
- It improves emotional expression and regulation
- It builds relational safety
Why it should be used more:
Many PBS practitioners rely heavily on cognitive or behavioural strategies, yet play therapy is often more developmentally appropriate for children in care and often more preferred for children under 15.
Art Therapy
Research: Pifalo (2006) found significant reductions in PTSD symptoms; Malchiodi (2015) emphasises its value for non-verbal trauma expression.
Why it works:
- Externalises fear, shame and confusion
- Regulates the nervous system through creative sensory engagement
- Helps children tell their story safely
Why it should be used more:
Often misunderstood as “craft activities” rather than a trauma modality. It is a less formal form of therapy, children can talk through their art.
Sand Tray Therapy
Research: Cunningham’s (2016) meta-analysis shows strong effectiveness for internalising and externalising trauma symptoms.
Why it works:
- Supports symbolic, sensory, non-verbal processing
- Reduces avoidance
- Helps children explore their identity, fears, and trauma safely
Why it should be used more:
It is incredibly effective but requires training and is under-integrated in PBS.
Sensory-Based Therapies
Research: Perry (2006) and Fraser et al. (2022) highlight that sensory interventions calm the lower brain systems impacted by trauma.
Why it works:
- Directly regulates the nervous system
- Supports emotional control
- Reduces behavioural escalation
- Prepares the child for learning or reasoning
Why it should be used more:
PBS often focuses on cognitive strategies without addressing the physiological side of trauma. It is important to be mindful of individuals sensory needs and processing before implementing this therapy.
Mind–Body Regulation Therapies
Research: van der Kolk (2014) and Spinazzola et al. (2011) show how movement, breathwork, rhythm, and grounding significantly reduce trauma symptoms.
Why it works:
- Trauma is embodied; the body must be involved in healing
- Supports vagus nerve activation and reduces hypervigilance
- Gives children concrete regulation tools
Why it should be used more:
Behaviour support plans rarely include body-based practices, despite their importance. body-based practices are highly underrated but children love it!
The Power of Family Involvement in OOHC Behaviour Support
Family involvement plays a crucial and often underestimated role in the wellbeing and behavioural outcomes of children living in Out-of-Home Care. Although many children in OOHC have limited or disrupted relationships with their families due to safety and wellbeing concerns, the research consistently shows that maintaining appropriate, safe, and supported family connections offers significant benefits.
Children who have ongoing, healthy relationships with family members experience greater emotional stability, reduced anxiety, and improved regulation. This is particularly important for children with trauma histories, who often struggle with fears of abandonment, grief, loss, and identity confusion. Studies highlight that when children feel connected to their family—even in a structured or supervised format—they are less likely to engage in high-risk behaviours such as running away, aggression, or emotional shutdowns. Maintaining contact helps reduce the internal distress that frequently drives behavioural escalation, thereby supporting the effectiveness of behaviour support plans (Dozier et al., 2014; Rubin et al., 2007).
Family involvement also strengthens the quality and accuracy of behaviour support. Families possess unique historical knowledge about the child—their personality, developmental background, cultural identity, trauma triggers, and what has helped or harmed in the past. This context is invaluable for completing functional behaviour assessments and developing tailored support strategies. Involving family members in behaviour planning ensures greater consistency across environments, helps children generalise new skills, and enhances the child’s sense of safety through relational continuity.
Research on behaviour and placement stability shows that when carers, practitioners, and families collaborate, children experience fewer behavioural incidents, improved relational trust, and stronger long-term mental health outcomes (Chamberlain et al., 2003; Cashmore & Paxman, 2006).
Ultimately, the power of family involvement lies in its ability to ground the child in connection, identity, and relational safety—the three things most disrupted by trauma and placement. Even when circumstances are complicated or contact must be supervised, safe family involvement acts as a protective factor that enhances behavioural, emotional, and developmental outcomes. For children in OOHC, connection is healing, and families—when supported appropriately—play an irreplaceable role in helping children feel valued, remembered, and worthy of love.
What Effective Behaviour Support Looks Like in OOHC
High-quality behaviour support for children in care includes:
✔ Strong assessment
- functional behaviour assessment
- sensory profiling
- understanding trauma triggers
- mapping developmental needs
✔ A trauma-informed lens
- regulation first
- safety and predictability
- co-regulation before discipline
✔ Engagement with the child
- allowing choice and voice
- building trust
- involving the child in their own support plan
✔ Collaboration with carers and family
- carer coaching
- consistent strategies
- safe family involvement
✔ Expressive and sensory therapies
Integrated into everyday routines, not just therapy rooms.
✔ Building skills
- emotional literacy
- coping skills
- communication
- daily living skills
- problem solving
✔ A focus on connection over compliance
Children do well when they feel safe, valued, and understood.
Behaviour Support Has the Power to Change Trajectories
Behaviour support in OOHC is not simply about reducing incidents or managing challenges — it is a therapeutic, relational, and developmental process that acknowledges the complex histories children bring with them. When delivered well, behaviour support:
- stabilises placements
- strengthens identity
- promotes emotional regulation
- reduces the impact of trauma
- increases resilience
- supports healing
- empowers children to thrive
Final Thoughts
These children are not “broken” or “behaving badly.”
They are communicating, adapting, and surviving with the tools they currently have.
Behaviour support, when combined with trauma-informed practice, family involvement, expressive therapies, and strong relational foundations, offers them new tools, new pathways, and ultimately new possibilities.
Transform Life is a NDIS registered organisation that provide support for you and your family.
Book your consult with an experienced Therapist at Transform Life to explore how OT, PBS and Speech Therapy can support you and your family.
