Australian Child Research Articles

Cohort profile: Understanding the influence of early life environments and health and social service system contacts over time and across generations through the Western Australian Aboriginal Child Health Survey (WAACHS) Linked Data Study

PurposeDespite the volume of accumulating knowledge from prospective Aboriginal cohort studies, longitudinal data describing developmental trajectories in health and well-being is limited. The linkage of child and carer cohorts from...

Association Between Pain and Bullying in Australian Adolescents: A Secondary Analysis of Cross-Sectional Data From the Australian Child Wellbeing Project

ObjectiveThis study aimed to describe the frequency, and the strength of the association, between bullying and pain in Australian schoolchildren. MethodsWe used nationally representative data from the 2014 Australian Child Wellbeing Project, comprised students aged 8 to 14 years from 180 schools. Weighted, multiple logistic regression models (adjusting for sex and school year) were constructed to quantify the association between weekly or more frequent bullying and weekly or more frequent pain. Estimates of association for the relationship between bullying and pain were reported as odds ratios (OR). ResultsThe sample was comprised of 5,440 schoolchildren (51.9% female). The prevalence rates of weekly or more frequent pain in the sample were headache (32.3%), backache (23.5%), and stomach ache (21.7%). Between 4.3% and 7.9% of participants reported weekly or more frequent bullying. In schoolchildren reporting bullying, the prevalence of pain ranged from 43.1% to 64.3%. Logistic regression modeling showed moderate-to-strong positive associations (OR, 2.1 [95% CI, 1.8-2.5] to 4.5 [95% CI, 3.7-5.6]) between the experiences of schoolchildren reporting any bullying type and any pain type. ConclusionAustralian schoolchildren who reported bullying were more likely to experience headache, stomach ache, and backache. The moderate-to-strong positive association is consistent with previous international studies that have examined the association between bullying and pain in young people. These findings have significant implications for clinicians who provide care for young people, as well as educators and healthcare policymakers, highlighting the important role of coexisting psychosocial factors in the management of adolescents who report pain.

Research engagement and impact: The Australian Child Maltreatment Study and pathways to evidence-based policy and practice

Research engagement and impact: The Australian Child Maltreatment Study and pathways to evidence-based policy and practice

Postseparation Financial Abuse Perpetrated Through Government Systems: A Survey of Australian Mothers' Experiences of Child Support.

Financial abuse is a form of violence that can extend well beyond intimate partner relationship breakdown. A survey of 540 Australian separated parents examined how financial abuse was perpetrated, with a focus on child support and other government systems. Women reported that their ex-partners minimized and withheld child support payments to inflict direct financial harm, while interactions between the family court, taxation, and benefit payment systems were taken advantage of to threaten or control them. Findings revealed how the mandatory and complex Australian child support system provided perpetrators with a useful means of perpetrating financial abuse across households.

The scale and timing of child protection system contacts from 0-18 years: a study of 1.9 million Australian children

IntroductionTo prevent abuse, neglect and poor outcomes for children and families, including child protection intervention, maltreatment, and removals, it is critical to understand the scale and timing of child protection system contacts to identify opportunities for early prevention. Objectives and ApproachWe quantified the cumulative incidence of child protection contacts during childhood, including initial reports, screened-in reports, investigations, substantiations and removal into out-of-home-care, among all children in two Australian states. We used child protection system data linked for the South Australian (SA) BEBOLD and NSW Child E-Cohort data platforms as the numerator, and census data for the denominator, for 571,497 SA children (birth-years 1991-2019) and 1,362,505 NSW children (birth-years 2005-2018). ResultsOf children born in 2005 (NSW SA): Two in five children were reported to child protection by age 14; one in ten children were the subject of a child protection investigation in NSW and SA; one in twelve children in NSW and one in 17 in SA, were substantiated at least once; and one in 35 children in NSW and one in 40 in SA were removed into out-of-home care at least once by age 14. Approximately half of all types of child protection contact first occurred by the child’s fourth birthday. Conclusions/implicationsThe scale of lifecourse child protection contact underscores the opportunities for early health and social supports to prevent child maltreatment and escalating child protection intervention. Child protection reports also represent an asset to generate public health intelligence to inform early prevention.

Child Maltreatment, Mental Health Disorders, and Health Risk Behaviors in People With Diverse Gender Identities.

This study examined rates of mental health disorders and health risk behaviors in people with diverse gender identities and associations with five types of child maltreatment. We used data from the Australian Child Maltreatment Study (ACMS), a nationally representative survey of Australian residents aged 16 years and more, which was designed to understand the experience of child maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, exposure to domestic violence). Mental disorders-major depressive disorder, generalized anxiety disorder (GAD), alcohol use disorder, post-traumatic stress disorder (PTSD), and health risk behaviors-smoking, binge drinking, cannabis dependence, self-harm, and suicide attempt in the past 12 months were assessed. People with diverse gender identities who experienced child maltreatment were significantly more likely to have GAD (43.3%; 95% CI [30.3, 56.2]) than those who had experienced child maltreatment who were either cisgender men (13.8%; [12.0, 15.5]) or cisgender women (17.4%; [15.7, 19.2]). Similarly, higher prevalence was found for PTSD (21.3%; [11.1, 31.5]), self-harm (27.8%; [17.1, 38.5]) and suicide attempt (7.2%; [3.1, 11.3]) for people with diverse gender identities. Trauma-informed approaches, attuned to the high likelihood of any child maltreatment, and the co-occurrence of different kinds may benefit people with diverse gender identities experiencing GAD, PTSD, self-harm, suicidal behaviors, or other health risk behaviors.

How we achieved “the most significant Australian child welfare reform in a generation”

How we achieved “the most significant Australian child welfare reform in a generation”

Borderline personality disorder and parenting capacity: Understanding child protection population characteristics

Objective This paper describes an audit of borderline symptoms, risk factors for maltreatment and types of abuse among parents who completed a parenting capacity assessment at a South Australian health-based child protection service. Method A retrospective case note audit within a 28-month period was conducted and included parents ( n = 107) who had completed a Mclean’s screening instrument for borderline personality disorder and/or had a psychiatric review with a formal diagnosis. Parents who had a borderline personality disorder diagnosis or endorsed five or more symptoms were categorised into the ‘high’ borderline symptom group. Rates of parental risk factors for maltreatment and type of abuse were compared between parents with low or high borderline symptoms. Results Forty percent of parents endorsed at least five borderline symptoms on the screening tool. On average, parents high in borderline symptoms had a greater number of parental risk factors. Conclusions These findings highlight the importance of screening for personality pathology among parents presenting to child protection services. Foundational training for staff and making evidence-based interventions available should be considered in such settings.

The prevalence of child sexual abuse perpetrated by leaders or other adults in religious organizations in Australia

BackgroundNumerous national public inquiries have highlighted the problem of child sexual abuse in religious organizations. Despite this, evidence of population-wide prevalence is scarce. ObjectiveTo provide the first nationally representative prevalence estimates of child sexual abuse perpetrated by adults in religious organizations in Australia. MethodsThe Australian Child Maltreatment Study (ACMS) surveyed 8503 people aged 16 and over about their experiences of child maltreatment. Weighted prevalence estimates were calculated based on responses to the child sexual abuse questions from the Juvenile Victimization Questionnaire-R2: Adapted Version (ACMS). ResultsOne in 250 people reported being sexually abused as a child by an adult in a religious organization (0.4 %, 95 % CI, 0.3–0.6 %). Men reported significantly higher rates of child sexual abuse by these perpetrators (0.8 %, 95 % CI, 0.5–1.2 %), compared to women (0.1 %, 95 % CI, 0–0.3 %). This type of sexual abuse was overwhelmingly perpetrated by men (0.4 %, 95 % CI, 0.3–0.6 %), compared to women (0 %, 95 % CI, 0–0.1 %), and was substantially more often experienced in Catholic organizations (71.9 %) than other Christian denominations or other religions. Prevalence of child sexual abuse in religious organizations has declined over time (2.2 % of men 65 years and older, compared with 0.2 % of 16–24-year-old men). ConclusionsChild sexual abuse has been widespread in religious organizations in Australia. A decline over time indicates progress has been made in preventing sexual abuse of children. Religious organizations must take all reasonable measures to prevent child sexual abuse, with a particular need for interventions targeting male leaders, and organizational cultures.

Burden of Mental Disorders and Suicide Attributable to Childhood Maltreatment

The proportion of mental disorders and burden causally attributable to childhood maltreatment is unknown. To determine the contribution of child maltreatment to mental health conditions in Australia, accounting for genetic and environmental confounding. This meta-analysis involved an epidemiological assessment accounting for genetic and environmental confounding between maltreatment and mental health and 3 cross-sectional national surveys: the Australian Child Maltreatment Study (ACMS) 2023, National Study of Mental Health and Well-being 2020-2022, and Australian Burden of Disease Study 2023. Causal estimates were derived on the association between childhood maltreatment and mental health conditions from a meta-analysis of quasi-experimental studies. This was combined with the prevalence of maltreatment from the ACMS to calculate the population attributable fraction (PAF). The PAF was applied to the number and burden of mental health conditions in Australia, sourced from 2 population-based, nationally representative surveys of Australians aged 16 to 85 years, to generate the number and associated burden of mental disorders attributable to child maltreatment. Physical abuse, sexual abuse, emotional abuse, or neglect prior to age 18 years. Proportion and number of cases, years of life lost, years lived with disability, and disability-adjusted life-years of mental health conditions (anxiety, depression, harmful alcohol and drug use, self-harm, and suicide attempt) attributable to childhood maltreatment. Meta-analytic estimates were generated from 34 studies and 54 646 participants and applied to prevalence estimates of childhood maltreatment generated from 8503 Australians. Childhood maltreatment accounted for a substantial proportion of mental health conditions, ranging from 21% (95% CI, 13%-28%) for depression to 41% (95% CI, 27%-54%) of suicide attempts. More than 1.8 million cases of depressive, anxiety, and substance use disorders could be prevented if childhood maltreatment was eradicated. Maltreatment accounted for 66 143 years of life lost (95% CI, 43 313-87 314), primarily through suicide, and 184 636 disability-adjusted life-years (95% CI, 109 321-252 887). This study provides the first estimates of the causal contribution of child maltreatment to mental health in Australia. Results highlight the urgency of preventing child maltreatment to reduce the population prevalence and burden of mental disorders.

The Impact of Shared Book Reading on Children and Families: A Study of Dolly Parton’s Imagination Library in Tamworth, Australia

ABSTRACT This longitudinal cohort-study investigated the impact of Dolly Parton’s Imagination Library (the Imagination Library) in Tamworth, Australia. The Imagination Library delivers age-appropriate books to children from the time of their birth until their fifth birthday. Caregivers of Tamworth children completed surveys about their experience with the program after receiving one book (“baseline;” N = 343) and then at six months (N = 116) and three years (N = 89). Their responses indicated that children in the Imagination Library were read to more frequently, for longer durations, and had more books in their homes than the average Australian child, as represented by large independent databases. Tamworth caregivers who read to their child at least once a day at baseline were nearly five times more likely to read daily after six months and three years than those who did not read daily at baseline (OR 4.9 (95% CI 1.8,13.7)). Further, children who were read to daily at three years showed more emerging literacy skills than those who were not read to daily. These outcomes suggest that shared book reading generally, and the Imagination Library specifically, encourages sustained reading practices that are associated with developing emerging literacy skills.

The Prevalence of Peer Sexual Harassment During Childhood in Australia.

Sexual harassment inflicted by adolescents on their peers is a major public health issue, but its prevalence across childhood is not known. We provide the first nationally representative data on the prevalence of peer sexual harassment across childhood, using cross-sectional data from the Australian Child Maltreatment Study (ACMS). The ACMS surveyed 8,503 people aged 16 and over about their experiences of child maltreatment and associated health outcomes. The prevalence of peer sexual harassment was assessed using the Juvenile Victimization Questionnaire (JVQ)-R2 Adapted Version (ACMS), with survey data weighted to reflect characteristics of the Australian population. Overall, 1 in 10 (10.4% (95% Confidence Intervals (CI) [9.7, 11.3])) Australians experienced peer sexual harassment during childhood. Peer sexual harassment is an issue disproportionately affecting gender-diverse individuals (24.0%, 95% CI [15.5, 35.2]) and women (15.3%, 95% CI [14.0, 16.7%]), compared to men (5.0%, 95% CI [4.3, 5.9]). Rates of peer sexual harassment were also very high among sexuality diverse participants (prevalence estimates ranging between 14.2% and 29.8%). Peer sexual harassment was predominately inflicted by male peers (9.6%, 95% CI [8.9, 10.4]), compared to 1.8% (95% CI [1.5, 2.2]) reporting harassment from female peers. These findings have implications for understanding and reducing attitudes supporting peer sexual harassment in childhood, particularly against girls and gender and sexuality diverse youth, and associations with other gendered violence both in childhood and later life.

Exploring Child-Parent Relationship Therapy -CPRT- Impact on Externalised Behaviours of Foster Children Experienced Complex Trauma: A Case Study

IntroductionMany foster children experience traumatic events that result in a wide range of disruptive behaviours, such as temper tantrums, superficially charming, no sincere remorse, and so forth. These problematic behaviours are challenging to the implementation of holistic therapeutic interventions.ObjectivesThe purpose of the current study is to explore the effectiveness of employing Child-Parent Relationship Therapy (CPRT) on externalised behaviours of a traumatised child at home and in social interactions.MethodsThis study used a case study to explore the influence of CPRT on externalised behaviours of traumatised foster children. The case study focused on the externalised problematic behaviours of an Australian Aboriginal child fostered under long-term care at 18 months by a Caucasian family. The foster parent and the foster child received a 10-session structured CPRT across ten weeks. The child’s externalised behaviours were evaluated through the Child Behaviour Checklist (CBCL) form.Results The findings describe the process of a 10-session structured CPRT with a foster child who exhibits externalised disruptive behaviours because of abandonment and complex trauma. The themes in the foster parent’s role and the play therapy approach relate to traumatic events and attachment issues. The results indicated a slight reduction in these behaviours. According to the follow-up interview, the child still showed aggressive behaviours in social interactions but not at home. Interviews with the foster parent indicated both the parent and child require additional support and further sessions of CPRT.Conclusions This case study identified an improvement in externalised behaviours for foster children with experience of complex trauma and abandonment after a 10-session CPRT. Further research is required to explore the effectiveness of a longer-term session of CPRT alongside additional support services for foster parents.Disclosure of InterestNone Declared

What is known about Australian child protection practitioners’ participation in the health care of children living in out of home care: a scoping review

PurposeThere is a growing recognition of the urgency to enhance health outcomes for children and young people residing in out-of-home care (OOHC). Research underscores the need to establish effective pathways to quality health care for children and young people who have been exposed to trauma. Child protection (CP) practitioners should play a vital role in proactively improving health outcomes and navigating the intricacies of healthcare systems. Their involvement in initiating and collaborating on healthcare interventions is pivotal for the well-being of these vulnerable children and young people. However, challenges associated with poor health literacy and the complexities of healthcare systems hinder collaborative service delivery in the Australian context. This review explores how CP practitioners support the health care of children and young people in their care.Design/methodology/approachA scoping review followed Arksey and O’Malley’s framework, employing a narrative synthesis to assess the selected studies.FindingsHealth outcomes for children and young people in OOHC remain under-researched and potentially under-resourced within the realm of CP practice. There is room for enhanced practices and system integration in CP service delivery to better address health needs and prevent further health and well-being disparities.Originality/valueThrough this scoping review and involving industry experts in the discussion of findings, this study contributes valuable insights to the existing knowledge base regarding the active participation of CP practitioners in addressing the healthcare needs of vulnerable children.

Australian child and adolescent mental health services

We aim to describe the Australian child and adolescent mental health system, which has its historical origins in the child guidance clinic, with recent efforts at modernisation to meet community needs and major policy innovations, including the National Disability Insurance Scheme (NDIS) and expansion of digital/telehealth services. Shared funding/responsibility across commonwealth and state/territory governments has resulted in country-wide variations, allowing innovation but also introducing fragmentation and duplication. The increase in demand outstripping supply (which was exacerbated by workforce shortages resulting from the pandemic), the lack of robust evaluation, and poor service integration (which make navigation difficult for families) are ongoing challenges.

Caring records: professional insights into child-centered case note recording

The consequences of poorly processed reports of child abuse and neglect, along with governance challenges in child protection systems, are well-documented. Recent research, inquiries and royal commissions emphasise the need for child-centered and participatory practices that support the rights and dignity of children and their families. However, the challenges of quality case recording in child protection systems and contexts remain unclear. This paper reports on the findings from a pilot study that interviewed (n = 22) and surveyed (n = 56) social work students and social work curriculum developers from Australian Universities and practitioners currently working in the Australian child protection service system. By capturing participants' professional insights, we aim to understand the embedded barriers to transforming child-centered systems by focusing on strengths and possibilities in current practices rather than reiterating deficiencies in recordkeeping. This paper reveals insights into how professionals working in the child protection system understand and are supported in child-centered case note recording and recordkeeping practices. It also identifies the possibilities for the crucial role that interdisciplinary collaboration and alignment between social work and recordkeeping informatics can play in transforming and supporting recordkeeping approaches and practices that prioritise and uphold the rights and dignity of the child.

Attachment and the (mis)apprehension of Aboriginal children: epistemic violence in child welfare interventions

Child protection systems in Australia continue to disproportionately investigate Aboriginal families and intervene to remove Aboriginal children, applying non-Indigenous constructs and understandings of child development that contribute to these enduring inequities. Attachment theory is one such prevalent framework with significant applications in child protection. While constructions of attachment have attempted to grapple with diversity, its application in Australian child protection policy and practice reflects dominant socio-cultural perceptions as a foundation for decision making that misrepresents Aboriginal families and their children’s developmental needs. We position this socio-legal application of attachment specifically, and developmental sciences more broadly, within a long history of settler-colonial intervention, providing a façade of scientific authority that perpetrates further harms on Aboriginal children, families and communities. We offer insights about a new frame for attachment that respects Aboriginal worldviews as part of structural transformations to address those harms.

Prevalence of Diverse Genders and Sexualities in Australia and Associations With Five Forms of Child Maltreatment and Multi-type Maltreatment.

This study presents the most comprehensive national prevalence estimates of diverse gender and sexuality identities in Australians, and the associations with five separate types of child maltreatment and their overlap (multi-type maltreatment). Using Australian Child Maltreatment Study (ACMS) data (N = 8503), 9.5% of participants identified with a diverse sexuality and .9% with a diverse gender. Diverse identities were more prevalent in the youth cohort, with 17.7% of 16-24years olds identifying with a diverse sexuality and 2.3% with a diverse gender. Gender and sexuality diversity also intersect - for example, with women (aged 16-24 and 25-44) more likely than men to identify as bisexual. The prevalence of physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence was very high for those with diverse sexuality and/or gender identities. Maltreatment was most prevalent for participants in the youth cohort with diverse gender identities (90.5% experiencing some form of child maltreatment; 77% multi-type maltreatment) or diverse sexualities (85.3% reporting any child maltreatment; 64.3% multi-type maltreatment). The strong association found between child maltreatment and diverse sexuality and gender identities is critical for understanding the social and mental health vulnerabilities of these groups, and informing services needed to support them.

Child, parent and contextual factors associated with child protection system involvement and child maltreatment in the family: A rapid evidence review

AbstractChild abuse and neglect in the home is a prevalent and significant issue in Australia. Recent findings from the Australian Child Maltreatment Study revealed that 62.2 per cent of participants had experienced at least one type of maltreatment during childhood, with most reporting multi‐type maltreatment. This rapid evidence review was aimed at understanding factors associated with child abuse and neglect in the family context. Results from the included studies indicated that there is a complex interplay between various child‐related factors, parent or family characteristics and contextual factors in understanding child maltreatment. Implications for a reliance on proxy measures of child maltreatment, including involvement with child protection systems, are also considered. A key finding across the included studies was that parent characteristics were consistently identified and should be a key target for prevention. Further research is needed to explore the role of parenting capacity and skills in the prevention of harm, the intersection between associated factors, how protective factors and strength‐based approaches can inform prevention efforts and how policies and practices can be designed to appropriately address this issue.

Does the Nutritional Intake and Diet Quality of Children With Chronic Kidney Disease Differ From Healthy Controls? A Comprehensive Evaluation

Children with chronic kidney disease (CKD) experience many obstacles to achieving optimal dietary intake. Dietary intake patterns remain unexplored or poorly described. This study compares nutritional intake and diet quality of Australian children with CKD to controls. A food frequency questionnaire captured intake data and was compared to controls. Nutritional intake was determined using individualized nutrient reference values, and diet quality described using the Australian Guide to Healthy Eating and the Australian Child and Adolescent Recommended Food Score. Children with CKD (n=36) and controls (n=82) were studied. Children with CKD had lower weight and height z scores, but higher body mass index (P<.0001 for all parameters). Children with CKD had adequate energy intake, and excessive protein and sodium intake (336% and 569%). They were significantly less likely to meet requirements for vitamin A (P<.001), thiamine (P=.006), folate (P=.01), vitamin C (P=.008), calcium (P< .0001), iron (P=.01), magnesium (P=.0009), and potassium (P=.002). No child met recommended vegetable intake; however, less than half of children with CKD met fruit (44%), grains (31%), and dairy serves (31%). They were also less likely to meet recommended fruit and dairy serves (P=.04 and P=.01, respectively). Non-core foods provided 36% of energy, and although comparable to controls, was contributed more by takeaway foods (P=.01). Children with CKD have reduced nutritional intake of key nutrients and consume more takeaways than controls. Attention to increasing core foods, limiting sodium intake, and managing restrictions while promoting nutrient density appears necessary.