Child Protection Notifications Research Articles

Prevalence of exposure to domestic and family violence among Aboriginal and non-Aboriginal children in the Northern Territory of Australia

IntroductionAlthough there is substantial evidence regarding the detrimental effect exposure to domestic and family violence (DFV) has on healthy child development, there is a paucity of information on the prevalence of childhood DFV exposure. This study aimed to estimate the prevalence of DFV exposure among Aboriginal and non-Aboriginal children in the Northern Territory (NT) of Australia. MethodsThis was a retrospective observational cohort study using linked individual-level records. The cohort consisted of all children aged 0-17 residing in the NT and exposed to DFV as recorded in Child Protection Services and police data in 2018. ‘Exposure to DFV’ was defined broadly as being a child in a household in which DFV occurred, including children who were not physically present at the time of the incident. In our main analyses, exposure to DFV was defined as having either any DFV-related notification or any DFV-related substantiated notification with Child Protection Services, or any DFV-related record in police datasets. ResultsIn 2018, 13.3% of NT children had a record of exposure to DFV with the prevalence for Aboriginal children around six times greater than non-Aboriginal children (24.4% compared to 4.2%). Using a single data source, the estimates of exposure to DFV, for Aboriginal and non-Aboriginal children, varied from: 3.3% and 0.3% respectively, for substantiated child protection notifications; 7.1% and 1.1% for investigated notifications, 15.9% and 2.6% for all notifications; and, 17.2% and 2.9% for police data. Prevalence of exposure varied with age and was highest for Aboriginal children aged from 0-4 years (31.4%) and for non-Aboriginal children aged 14-17 years (4.9%). ConclusionsMany NT children are exposed to DFV, with much greater exposure among Aboriginal children. The prevalence estimates varied between sources of data and with the definition of childhood exposure to DFV. Our findings highlight the value of linking records from multiple sources to provide a more comprehensive estimate of the magnitude of exposure of children to DFV, an essential base on which to plan a public health response to DFV prevention.

A naturalistic evaluation of parent-child interaction therapy (PCIT) and PCIT with trauma-directed interaction (PCIT with TDI) in Australian children exposed to abuse and neglect

BackgroundTo optimize PCIT treatment with children exposed to abuse and neglect, PCIT with Trauma-Directed Interaction (PCIT with TDI) was created. ObjectiveThe current study was a quasi-experimental cohort study (PCIT and PCIT with TDI treatment groups) with pre/post-treatment comparisons. The study was conducted in a statutory child protection agency and was a naturalistic evaluation of the outcomes achieved by this service. The outcomes under investigation included caregiver and child posttraumatic stress symptoms, child behavior problems, parenting stress, caregiver mental health, child protection notifications, and placement permanency goals. Participants and settingChildren were included in the study if they were aged between 2 and 7 years, had behavioral difficulties or trauma symptoms and/or their caregivers were experiencing parenting stress. MethodsFamilies were allocated to treatment group by clinician availability/preference (i.e., preference allocation). Caregivers were asked to report on child posttraumatic symptoms and behavioral issues; and to self-report on posttraumatic stress, general stress, parenting stress, and depression and anxiety at prescribed points in treatment. FindingsSixty-eight children and their caregivers were treated with either PCIT (n = 22) or PCIT with TDI (n = 46). Statistically significant changes were observed for both treatment conditions for some of the outcomes of interest for both children (i.e., child behavioral problems, posttraumatic stress) and their caregivers (i.e., general stress, posttraumatic stress). There was no significant main effect of treatment on any of the outcomes of interest. ConclusionFuture research should include a randomized controlled trial to adequately determine the efficacy of PCIT versus PCIT with TDI with this population.

Infant and Pre-birth Involvement With Child Protection Across Australia.

Infants (<1 year old) are the age group in Australia with the highest rate of involvement with child protection. Many jurisdictions across Australia and internationally are implementing policies focused on prenatal planning and targeted support. This study investigates Australian trends in prenatal and infant child protection notifications, substantiations and out-of-home care; and the extent of over-representation of Aboriginal and Torres Strait Islander infants. Data was provided by the Australian Institute of Health and Welfare for the period 1 July 2012-30 June 2019. Univariate Poisson regression analysis was conducted, reporting the percentage change in the incidence rate ratios. All Australian jurisdictions who collect and approved release of prenatal notification data experienced increases in the rates of children with prenatal notifications, with a 4% (IRR: 1.04(1.04-1.05)) overall increase per year across Australia. Approximately 33% of children had substantiated prenatal notifications. Rates of infant notifications and entry to care in Australia increased overall by 3% (IRR:1.03(1.03-1.04)) and 2% per year (IRR:1.02(1.01-1.03)), respectively. With rising numbers of families reported prenatally and during infancy, greater evidence of the effectiveness of policies, interventions and outcomes for children and families is required.

Intergenerational welfare and contact with the child protection system.

ObjectivesSocioeconomic disadvantage and poverty are considered important drivers of child maltreatment, particularly child neglect. We examine the prevalence, cumulative incidence, and notification rate of child protection (CP) contact among children who experienced intergenerational welfare contact (IWC) compared to families with other types of welfare contact (WC). ApproachA whole-population linked administrative data study of children in South Australia born 1991-1995 (n=94,358), followed from birth up to age 20 years and their parent/s (n=143,814). The study used de-identified data from the Better Evidence Better Outcomes Linked Data (BEBOLD) platform including data from Australian Government Centrelink (welfare payments), birth registration, perinatal birth records, and child protection records. Children were classified as: No WC, parent only WC, child only WC, or IWC. Child protection contact prevalence, rates, and cumulative incidence were estimated by age, level of contact (reported notifications, screened-in reports, investigations, substantiations and out-of-home care), and WC group. ResultsUsing Australian Government Centrelink data, WC was defined as parent/s receiving a means-tested welfare payment (low-income, unemployment, disability or caring) when children were aged 11-15, or children receiving payment at ages 16-20. IWC was WC occurring in both parent and child generations. Children who experienced IWC accounted for 84.7% of all CP notifications at ages 0-17 years and had the highest prevalence of CP contact (37.3%, n=12,286), compared to children experiencing parent only WC (16.1%), child only WC (11.6%), and no WC (4.7%). This trend was consistent across all levels of CP contact. Children who experienced IWC had higher notification rates at every age compared to all other WC types. Conclusions and RelevanceChildren experiencing IWC represent a third of the population aged 11-20, yet account for 84.7% of all child protection notifications. Our study shows that children who experience IWC have higher personal (cumulative incidence and prevalence) and societal (notification rates) child protection costs than their counterfactual (parent only WC).

Factors associated with child protection recurrence in Australia

The aim of the current research was to advance understanding of child protection in Australia by examining the factors associated with recurrence of child protection notifications to the formal child protection system. Extant research has been primarily undertaken in the USA and it is important to understand whether similar factors associated with recurrence actually hold in the Australian context. Administrative data were obtained for a sample of 9608 children first subject to a screened-in report in 2011–12. Children were followed for 12 months. Cox Proportional Hazard models were used to measure associations between 26 independent variables and four types of recurrence: subsequent reports, subsequent investigations, subsequent substantiations, and subsequent intervention. Factors associated with recurrence in Australia were broadly similar to those identified in other jurisdictions, including reports and substantiation for neglect, younger age, prior child protection involvement in the household, and parental characteristics including drug use, mental health problems, and history of maltreatment as a child. As in previous studies, post-investigative service provision was positively associated with recurrence. In prior US research, race did not predict recurrence. However, in the present study, Indigenous Australian children were significantly more likely to be subject to all types of recurrence measured. Future research on recurrence should aim to disentangle the complex relationships between child protection recurrence, child maltreatment, and service delivery. Recurrence is not a good proxy indicator of child safety. The findings have implications for the equity of recurrence-based risk assessment tools as they are applied to indigenous populations.

What is the role of health systems in responding to domestic violence? An evidence review.

Objective The aim of the present study was to review and analyse academic literature and program evaluations to identify promising evidence for health system responses to domestic violence in Australia and internationally. Methods English-language literature published between January 2005 and March 2016 was retrieved from search results using the terms 'domestic violence' or 'intimate partner violence' in different combinations with other relevant terms, resulting in 1671 documents, of which 59 were systematic reviews. Electronic databases (Medline (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psycinfo, Social work Abstracts, Informit, Violence and Abuse Abstracts, Family Studies Abstracts, Cochrane Library of Systematic Reviews and EMBASE) were searched and narrative analysis undertaken. Results This review details the evidence base for the following interventions by health services responding to domestic violence: first-line responses, routine screening, risk assessment and safety planning, counselling with women, mother-child interventions, responses to perpetrators, child protection notifications, training and system-level responses. Conclusions There is growing evidence for the effectiveness of health service interventions to reduce the extent of harm caused by domestic violence. What is known about the topic? Domestic violence is a significant problem globally with enormous human, social and economic costs. Although women who have experienced abuse make extensive use of healthcare services, health services have lagged behind the policing, criminal justice and other human service domains in responding to domestic violence. What does this paper add? The present comprehensive review identifies best-practice health system responses to domestic violence. What are the implications for practitioners? Health systems can play a key role in identifying and responding to domestic violence for women who often do not access other services. There is growing evidence for the effectiveness of health service interventions to reduce the extent of harm caused by domestic violence, in particular for specialist counselling, structured risk assessment and safety planning, training for first-line responses and interventions for mothers and children affected by domestic violence.

Workforce Development: A Pathway to Reforming Child Protection Systems in Australia

The Australian child protection system is struggling to successfully address voluminous child protection notifications, increasing numbers of children in state care, decreasing foster-carers and chronic workforce issues. In this paper, we argue that the capacity of statutory child protection agencies to achieve their social policy objectives is severely hampered by their failure to acknowledge or challenge the competing ideologies that underpin contemporary child protection practices. This failure means that the individuals who work in this area experience contradictory demands that compromise their capacity to work effectively and often render their work conditions intolerable, amidst the ongoing threat of media criticism that they are failing. Meanwhile, children and families in need experience risk assessment and interventions often reported to be debilitating and traumatising. This paper highlights many of the problems experienced by people working in and for child protection services in Australia and advocates for urgent reform. To build more sustainable and high-quality child protection services, we argue, workforce development must be central to institutional and organisational reform. In order to achieve necessary change, improve workforce retention and the quality of work, we posit that workforce development strategies must include the reconceptualisation of underpinning ideologies and current approaches practice.

Children of substance‐using mothers: child health engagement and child protection outcomes

Maternal substance use has been associated with a range of child risk factors. The study investigated the relationship between engagement with child health services and child protection outcomes for children of substance-using mothers. The sample comprised 119 children of mothers who disclosed opiate, amphetamine or methadone use during a maternity admission between 2000 and 2003. Statutory child protection agency and child health engagement information for the first 2 years of life was obtained. The relationship between type of maternal substance use, child health engagement and child protection outcomes was examined. Of study group infants, 72% were engaged with child health services during the first 2 years of life. Chi-squared analysis showed no significant relationship between child health engagement and child protection reports. Child health engagement was associated with decreased substantiated child protection notifications for children of methadone using mothers, but not for children of illicit substance users. Almost a quarter of identified children of substance-using mothers are not accessing standard child health services in their first 2 years of life. This study provides support for increased attention to the provision of child health services for children of methadone using mothers. Further research into effective intervention strategies for children of illicit substance-using mothers is indicated.

The role of research in child protection policy reform: a case study of South Australia

Abstract Governments across Australia are struggling to address escalating child protection notifications, increasing numbers of children in state care, decreasing numbers of foster carers and chronic child welfare workforce shortages. The complex social problem of child abuse and neglect has a high media profile, and policy reform in such a politicised domain poses many challenges. What role does research play in the process of child protection policy development? Using recent child protection reform in South Australia as a case study, this paper analyses primary documentary sources and in-depth interviews with key actors to explore this issue.

The Planets Aligned: Is Child Protection Policy Reform Good Luck or Good Management?

Governments across Australia are struggling to address escalating child protection notifications, a marked increase in the number of children in State care, a decrease in the number of foster carers and chronic workforce shortages in child welfare services. This paper explores the reform process that culminated in the proclamation of the Victorian Children, Youth and Families Act, 2005 and represents an aspect of the response in Victoria to these wider issues. It explores the history of the reform from the perspective of key actors from government, non-government sectors and academics who participated in the process. The paper explores the “ingredients of social policy reform” and how the change process was managed in Victoria. It does not seek to evaluate the reform but rather to understand the complex processes through which a propitious moment for reform was both seized and constructed.

Longitudinal trends in child protection statistics in South Australia: A study of unit record data

In Australia, it is commonly reported that rates of child protection notifications have increased over time. More and more children in any given year are subject to a child protection notification. On the whole, these conclusions have been based on cross-sectional notification counts or rates recorded in a given year (e.g. AIHW 2009). Although useful, such analyses are limited in that they do not account for the fact that child protection incidents are unevenly distributed across individual cases. Crosssectional analyses also do not indicate the incidence of notifications within a given cohort of children.In this paper, we summarise the longitudinal and comparative analysis of data relating to children born in 1991, 1998 and 2002. The results highlight the increasingly early involvement of child protection systems in children's lives, higher annual incidence rates, as well as increasingly steep cumulative involvement curves for cohorts tracked from their year of birth. The implications of these findings for mandatory reporting policies are discussed.

Child abuse and neglect — is it time for a public health approach?

Australia is seeing an unprecedented increase in the rate of child protection notifications and children being taken into care. The burden of such high levels of notifications and removals impact not only the children and families but also the system which is trying to resource them. The concern is that these increases are unsustainable and overloaded child protection systems can be dangerous for the vulnerable families and children they are trying to protect and support. This paper hopes to raise some alternative thinking as to the overall approaches to child abuse and neglect with a greater focus on prevention. Is it time to consider a public health approach, using population-based measures of child abuse and neglect to accurately describe the epidemiology of population risk and protective factors? Should we investigate the potential of universal health, welfare and education services as platforms for prevention? And should we investigate whether the provision of secondary prevention for vulnerable families which address major contributing factors, such as parental substance dependence and mental health issues are effective in reducing abuse of children in these families?

Negotiating Foster-Families: Identification and Desire

Foster care systems across Australia are widely recognised as being ‘in crisis’. Problems of both supply (a lack of appropriate placements for children) and demand (increasing numbers of child protection notifications) are central to this crisis. Addressing these problems requires an approach to social work practice that encourages greater support for existing foster carers, and that in so doing, helps to attract new carers to the system. One of the ways in which this may be achieved is through an emphasis on foster care as a form of family based care that holds the potential to meet the needs not only of children, but of adults seeking to engage in familial relationships with children. Drawing upon a psychoanalytically-informed approach to social work, this paper presents and analyses data from a national research project examining existing Australian foster carers' experiences of care provision. The results demonstrate that despite considerable adversity (which often takes the shape of foster families not being recognised as such), foster carers continue to form unique, supportive families with children. Implications are drawn from this for a social work practice that acknowledges diversity in family forms and which validates the identifications and desires that circulate within foster families.

Non-accidental fractures in infants: risk of further abuse.

To look for features of non-accidental fractures in infants aged under I year and assess the risk of subsequent morbidity and mortality. A retrospective analysis of 99 children aged under 1 year who presented to the Mater Children's Hospital, Brisbane, between January 1990 and December 1993, and were found to have a fracture. The 99 infants were divided into non-accidental and accidental groups. Comparison was made between the two groups for age, sex and type of fracture. Deaths, subsequent injuries and child protection notifications until March 1997 were compared between groups. Of the 99 infants with fracture (64 males, 35 female), the skull and femur were the most prevalent sites of fracture. Twenty-six infants had fractures assessed as non-accidental. This group was younger but did not differ significantly in gender or site of fracture. Infants aged under 4 months had a significantly greater risk of their fracture being non-accidental (P = 0.0007). Subsequent substantiated child protection notifications occurred in nine of the non-accidental group and in one of the accidental group (P = 0.000001). There was no significant difference in the rate of subsequent notifications between those infants with abuse who were removed from their carers and those not removed. Subsequent injuries presenting to hospital occurred in 17 of the accidental group and three of the non-accidental group (P = 0.20). There were no deaths. Infants aged under 1 year with fractures have a high prevalence of abuse. The risk of abuse as cause for the fracture is greater in those aged under 4 months. Infants with non-accidental fractures have a high risk of further abuse even with intervention.