Child Protection Outcomes Research Articles

Use of AI-driven support system to help courts in predicting child custody outcomes in India

Predicting child protection outcomes using AI-driven support systems under Indian law raises interesting possibilities and challenges. This study examines the feasibility of using AI in Indian courts to assist in child custody decision-making. The Indian legal system is complex and topical in child custody cases, where sociocultural and family factors heavily influence judicial decisions. The potential integration of AI provides an opportunity for objectivity and continuity in accuracy to enter the system. However, there are several challenges to implementing such a system in India. These areas include addressing ethical concerns related to algorithmic decision-making about sensitive family matters using the right, this research topic raises questions about the feasibility of introducing AI into the Indian childcare decision-making process. This suggests the need to carefully consider these challenges and their potential benefits when assessing the utility and appropriateness of using AI-driven support systems in Indian courts to set childcare outcomes to help judges in faster fact-finding and to make decisions on the same. In addition, we analyzed the use of AI in other countries.

Identifying risk of child welfare involvement in Orange County births with the Bridges Program

To promote the early identification and support of children at risk for developmental issues and other adversities, seven of Orange County, California’s largest birthing hospitals have adopted a “hospital screening” process comprised of an initial clinical data scan, followed by the completion of a more robust bedside assessment. This approach to hospital screening and referral, termed the “Bridges Program,” is used to connect parents of high-risk newborns to home visiting services aimed at providing support and resources. Orange County also has four birthing hospitals that do not participate in the Bridges Program, which allowed for the comparison of births occurring between 2011 and 2012 at Bridges hospitals (n = 53,302) to births at non-Bridges hospitals (n = 25,146) on various child protection outcomes by age five, accounting for program engagement and demographic differences. Bridges assessments successfully identified births at higher risk for child protection service involvement, and high-risk Bridges births not forwarded for agency outreach were significantly more likely to be reported and substantiated for maltreatment compared to low risk Bridges births (RR = 1.18, CI = [1.08, 1.30]; RR = 1.30, CI = [1.10, 1.54]). These results highlight a subset of births that would benefit from alternative strategies for engaging with home visiting services.

Child protection system involvement in children of incarcerated mothers: A linked data study

BackgroundWomen prisoners are a growing portion of the prison population. Health and social outcomes of their children have been studied and found to be poor, but little is known about child protection outcomes. ObjectivesAscertain child protection system contact of children exposed to maternal incarceration. Participants and settingAll children born between 1985 and 2011 exposed to the incarceration of their mothers in a Western Australian correctional facility and a matched comparison group. MethodsA matched cohort study using linked administrative data on 2637 mothers entering prison between 1985 and 2015 and their 6680 children. We estimated hazard ratios (HRs) and incidence rate ratios (IRRs) of child protection service (CPS) contact post maternal incarceration (four concern levels), comparing rates for children exposed to maternal incarceration with a matched non-exposed group, adjusting for maternal and child factors. FindingsExposure to maternal incarceration increased risk of CPS contact. Unadjusted HRs exposed vs unexposed children were 7.06 (95%CI = 6.49–7.69) for substantiated child maltreatment and 12.89 (95%CI = 11.42–14.55) for out-of-home care (OOHC). Unadjusted IRRs were 6.04 (95%CI = 5.57–6.55) for number of substantiations and 12.47 (95%CI = 10.65–14.59) for number of removals to OOHC. HRs and IRRs were only slightly attenuated in adjusted models. ConclusionsMaternal incarceration is a warning flag for a child at high risk of serious child protection concerns. Family-friendly rehabilitative women's prisons, incorporating support for more nurturing mother-child relationships could provide a placed-based public health opportunity for disrupting distressing life trajectories and intergenerational pathways of disadvantage of these vulnerable children and their mothers. This population should be a priority for trauma-informed family support services.

Effects of a Nurturing Care Group behavior change program on child protection outcomes in Ghana: A controlled before and after trial

BackgroundAs part of an effort to rigorously apply behavioral science to child protection efforts, a behavior change model called Nurturing Care Groups (NCGs) was tested for effectiveness in changing child abuse and corporal punishment behaviors. ObjectiveThe primary research question was to what degree NCGs could change child protection knowledge, attitudes, and practices among caregivers in a low-cost program with broad reach, which could feasibly be scaled. Participants and settingThe NCG project was implemented in two distinct ecological zones in Ghana, reaching 73,959 caregivers of children under 5 across 41 communities; while 20 communities were control sites with no NCG intervention. MethodsStratified random sampling was used to select intervention area respondents. Cluster sampling was utilized in control areas, using the Probability Proportional to Size method. Standard measures were used to assess changes in practices of violence and abuse, stress experience and management, parenting techniques, and the household environment. Difference-in-difference linear regression was used to compare intervention and control results. ResultsIntervention areas demonstrated statistically-significant and substantial changes in reported knowledge, attitudes and behaviors related to physical abuse and corporal punishment. Knowledge of negative impacts of stress on parenting, as well as stress reduction techniques increased in intervention areas, as did positive discipline and parenting practices. ConclusionsThe NCG model demonstrated important promising results for changing child protection behaviors in this descriptive study. Statistically-significant decreases in reported physical and psychological punishment and corresponding increases in reported positive discipline indicate that this may be an effective and low-cost intervention for child protection behavior change.

Māori Health Review: Oranga Tamariki and the Well Child Tamariki Ora review

It is well established that Aotearoa, New Zealand has high rates of child abuse compared to other OECD (The Organisation for Economic Co-Operation and Development) countries. From 2007 to 2017, 12% of homicides were of tamariki (children) under 12 years of age. On average, a child dies every five weeks from family violence, ranking Aotearoa 7th highest for child homicide and 35th out of 41 OECD countries for child wellbeing outcomes. Inequities in health outcomes exist outside of child abuse as well — Māori tamariki with meningococcal disease are hospitalised at 3.5 times the rate of non-Māori, non-Pasifika children. Māori tamariki with skin infections are also hospitalised at 2–2.5 times the rate of non-Māori, non-Pasifika children. These examples serve to highlight the inequitable outcomes Māori tamariki experience in both disease and abuse. With the prevalence of child abuse, there is a corresponding amount of activity in the child protection sector. Oranga Tamariki is the branch of government that oversees care for children of the state, youth offenders, and children at risk of harm from violence. In the 12 months prior to September 2021, 5100 children were entered into the care and custody of Oranga Tamariki. Out of these children in state custody, 57% identified as Māori and a further 11% identified as both Māori and Pasifika.5 These statistics serve to demonstrate the inequitable picture that makes up child protection interventions and outcomes in Aotearoa. The conclusive evidence that we have a child abuse epidemic in our country needs to be framed in the context of its inequitable representation. It is Oranga Tamariki and its subsidiaries that are responsible for upholding the legislative duty of the New Zealand Government as the Crown partner in Te Tiriti o Waitangi (the Treaty of Waitangi) to provide equitable outcomes for Māori children and their whānau (families).

Racial sensitivity training: An inadequate solution to systemic racial disparities in child protection systems

Calls continue for staff training as an instrumental response to racially based differences in rates of child protection system interactions and outcomes. These recommendations echo a reliance on implicit bias and diversity training (referred to broadly as “anti-bias and racial sensitivity training”) across disciplines of social and human services in the United States as a feasible and politically expedient solution to racial disparities. But focusing on anti-bias training to address racial disparities in child protection systems will almost certainly fail to achieve desired objectives for at least three reasons: (a) there is no evidence that implicit bias or racial sensitivity trainings change behavior; (b) personnel training initiatives misapply an individual behavioral solution to an institutional and structural problem; and (c) an emphasis on internal training initiatives distracts and reduces the accountability of other systems of care better positioned to produce change. We conclude that if the goal is to reduce racial disparities, systemic innovations and broader policy reforms both internal and external to the child protection system are needed. Training will not meaningfully shift the downstream effects of structural racism.

Local child protection in the Philippines: A case study of actors, processes and key risks for children

AbstractThis article explores the child protection actors, processes and child maltreatment issues in a regional Local Government Unit in the Philippines. Utilising a qualitative case study design, it engages with 14 young people with histories of child maltreatment and 13 key child protection actors, exploring their views and experiences of child protection actions, processes and outcomes. The findings highlight informal community‐based actors, including neighbours, family, friends and non‐government organisations in initial responses to child maltreatment, compared to formal child protection actors, who respond to severe maltreatment utilising a legal framework. Actors are constrained by limited government capacity and community reach, revealing misalignment between formal child protection activities and breadth of risks for children. Non‐government organisations assist child protection efforts through the provision of residential care. Policy recommendations include strengthening relationships between formal actors and communities, expanding early intervention activities, and developing the capacity of community‐based child protection actors.

Caring Dads intervention for fathers who have perpetrated abuse within their families: Quasi-experimental evaluation of child protection outcomes over two years

BackgroundIn Canada, two of the most common forms of maltreatment substantiated by child protective services are child exposure to domestic violence and child physical abuse. Fathers are identified as the parent responsible for a substantial proportion of this maltreatment. ObjectiveThis study examined whether providing a group-based intervention program for fathers was associated with greater engagement of fathers in child protection case management and with lower rates of subsequent father-perpetrated abuse. ParticipantsA quasi-experimental design compared child protection outcomes in families in which fathers were referred to an intervention program (Caring Dads) and either completed the group (n = 85) or remained on a waitlist for future service (n = 100). MethodsData were collected from a retrospective review of administrative files over two years, starting from the time of referral to Caring Dads. ResultsInitial comparisons found no significant differences in intervention and comparison group fathers in demographic characteristics, child protection concerns, and all but one area of risk and needs. Completing intervention, as compared to being waitlisted, was associated with a greater number of contacts between child protection workers and fathers over two years (M = 30.3 vs. M = 16.7), a difference that was significant and large in size (d = 0.81) and with lower rates of verified re-referral due to fathers' maltreatment (20.5% vs. 36.0%), a difference that was significant and between small and medium in size (V = 0.17). ConclusionsCurrent results suggest that there may be significant benefits of involving fathers in child protection-linked intervention.

Impacts of health-related school closures on child protection outcomes: A review of evidence from past pandemics and epidemics and lessons learned for COVID-19

Through a rapid review drawing on pandemics and epidemics with associated school closures, this article aims to understand first, the state of the evidence on impacts of school closures on select child protection outcomes and second, how governments have responded to school closures to protect the most vulnerable children. Only 21 studies out of 6433 reviewed met the inclusion criteria, with most studies exploring the effects of Ebola. While few studies were identified on harmful practices, a more robust evidence base was identified in regards to adolescent pregnancy, with studies pointing to its increase due to the epidemic or infection control measures, including school closures. The evidence base for studies exploring the impact on violence outcomes was limited, with sexual violence and exploitation located in a few studies on Ebola. Important lessons from this exercise can be applied to the COVID-19 response, particularly the inclusion of the most vulnerable children in programming, policy and further research.

Redressing ‘unwinnable battles’: Towards institutional justice capital in Australian child protection

Australia’s history of negative child protection outcomes for children in state care highlights the sustained, systemic nature of serious harm. Situated in emerging conversations on structural challenges and state violence for parents involved in child protection systems, we trace the resources and barriers to responsive and ‘just’ child protection practice, highlighting how institutions can serve to compound disadvantage and injustice. We argue that addressing challenges such as access to advocacy at the level of the individual is to miss the underlying politics of oppression that serves to keep families marginalised. Instead, we need to rethink how parental rights and responsibilities are best facilitated at institutional levels – what we term institutional justice capital. This requires public conversation about thresholds for child removal, transparent treatment of families, access to mechanisms to challenge the determinations of child protection authorities, and inter-organisational respect and collaboration to support families to navigate complex and multiple systems.

Child Protection Inequalities in New Zealand: Exploring Relationships with Social Gradient Using National Linked Administrative Datasets

IntroductionContact with child protection systems are a key site of the expression of social inequalities. ‘Child welfare inequalities’ by deprivation have been documented in a number of countries including the United Kingdom. The size and nature of this relationship is sparse in the New Zealand system context. Objectives and ApproachThe integration of data routinely collected by NZ’s Ministry for Children into Statistics NZ’s Integrated Data Infrastructure (IDI) provided the opportunity to examine how child protection data relates to deprivation and location. Anonymised person-level data in the IDI was used to obtain a population-based retrospective sample of children estimated to be resident in NZ in 2013/2014 and less than 17 years of age. Using pre-linked data in the IDI, all children with at least one of three child protection outcomes in 2013/2014 were ascertained. Deprivation was assessed using a small-area level national index derived from census data. The most recent residential address recorded in the IDI was used to assign deprivation deciles to each child based on the small area in which they lived. ResultsOf 1,016,928 children, 13,851 had had at least one substantiation of interest, the least serious of the outcomes considered. Compared to children living in the least deprived quintile of small areas, children in the most deprived quintile had 13.1 times (95%CI for Incidence Rate Ratio 12.0, 14.4) the rate of substantiation, 18.0 times (95%CI 15.4, 20.8) the rate of a family group conference, and 6.5 times (95%CI 5.6, 7.6) their rate of placement in foster care. Conclusion / ImplicationsA marked relationship was observed between small-area deprivation and child protection contact. Action is needed to address the causes of deprivation, provide services that respond to families living in poverty, and examine carefully the interactions between demand and supply of services across deprivation levels.

A quasi-experimental study of the Multi-Agency Investigation & Support Team (MIST): A collaborative response to child sexual abuse

To improve the holistic response to child sexual abuse in Perth, Western Australia, a group consisting of government and community support agencies developed a new co-located approach that combined support services with investigations, called the Multi-agency Investigation & Support Team (MIST). The model was comparable to the prominent Children’s Advocacy Centre approach, with adaptations for Australian conditions. This study evaluated the fidelity with which this new program was delivered and examined whether it resulted in improved criminal justice, child protection, and service outcomes compared to existing practice. Drawing on service data linked across participating agencies the study found MIST was delivered with reasonable fidelity to its planned procedure, but with some challenges for delivery of the program due to the relative workload for staff in the MIST condition. The service demonstrated high levels of caregiver satisfaction with the response and high rates of children’s engagement with therapy. A quasi-experimental comparison between MIST (n = 126) and Practice as Usual (n = 276) found MIST was significantly faster throughout the criminal justice and child protection processes, but the conditions did not differ in the rate of arrest or child protection actions. While embedding support services within the investigation process may not have a dramatic influence on criminal justice and child protection outcomes, the high rates of uptake of therapeutic services and parental satisfaction suggest other benefits that require future exploration.

Maternal Alcohol-Use Disorder and Child Outcomes

OBJECTIVES: Investigate the relationship between maternal alcohol-use disorder and multiple biological and social child outcomes, including birth outcomes, child protection, justice contact, and academic outcomes for both Indigenous and non-Indigenous children. METHODS: Women with a birth recorded on the Western Australian Midwives Notification System (1983–2007) and their offspring were in scope. The exposed cohort were mothers with an alcohol-related diagnosis (International Classification of Diseases, Ninth Revision and International Classification of Diseases, 10th Revision) recorded in an administrative data set and their offspring (non-Indigenous: n = 13 969; Indigenous: n = 9635). The exposed cohort was frequency matched with mothers with no record of an alcohol-related diagnosis and their offspring (comparison cohort; non-Indigenous: n = 40 302; Indigenous: n = 20 533). RESULTS: Over half of exposed non-Indigenous children (55%) and 84% of exposed Indigenous children experienced ≥1 negative outcome. The likelihood of any negative outcome was significantly higher for the exposed than the comparison cohort (non-Indigenous: odds ratio [OR] = 2.67 [95% confidence interval (CI) = 2.56–2.78]; Indigenous: OR = 2.67 [95% CI = 2.50–2.85]). The odds were greatest for children whose mothers received a diagnosis during pregnancy (non-Indigenous: OR = 4.65 [95% CI = 3.87–5.59]; Indigenous: OR = 5.18 [95% CI = 4.10–6.55]); however, numbers were small. CONCLUSIONS: The effects of maternal alcohol-use disorder are experienced by the majority of exposed children rather than a vulnerable subgroup of this population. These findings highlight the need for universal prevention strategies to reduce harmful alcohol use and targeted interventions to support at-risk women and children.

Maternal alcohol use disorder hurts most offspring: Australian study

Most children whose mothers have alcohol use disorder (AUD) experience adverse effects — not just a vulnerable subgroup — according to new research published in Pediatrics last month. The study looked at multiple outcomes, including birth, child protection, justice contact and academic outcomes for indigenous and nonindigenous children (the study was conducted in Australia). The adverse effects were higher in the indigenous children. For the study, all women with a birth recorded from 1983 to 2007 and their offspring were included. Fifty‐five percent of the exposed nonindigenous children and 84% of the indigenous children whose mothers had AUD experienced a negative outcome. The odds of experiencing a negative outcome were highest for those children whose mothers were diagnosed while pregnant; however, this was a small number overall. The researchers concluded that universal prevention strategies are needed to reduce harmful alcohol use and to support at‐risk women and children. O'Leary C, Lawrence D, Hafekost K, et al: Maternal alcohol‐use disorder and child outcomes. Pediatrics. 2020 Feb 24. pii: e20191574. doi: 10.1542/peds.2019‐1574. [Epub ahead of print]

Maternal Alcohol-Use Disorder and Child Outcomes.

Investigate the relationship between maternal alcohol-use disorder and multiple biological and social child outcomes, including birth outcomes, child protection, justice contact, and academic outcomes for both Indigenous and non-Indigenous children. Women with a birth recorded on the Western Australian Midwives Notification System (1983-2007) and their offspring were in scope. The exposed cohort were mothers with an alcohol-related diagnosis (International Classification of Diseases, Ninth Revision and International Classification of Diseases, 10th Revision) recorded in an administrative data set and their offspring (non-Indigenous: n = 13 969; Indigenous: n = 9635). The exposed cohort was frequency matched with mothers with no record of an alcohol-related diagnosis and their offspring (comparison cohort; non-Indigenous: n = 40 302; Indigenous: n = 20 533). Over half of exposed non-Indigenous children (55%) and 84% of exposed Indigenous children experienced ≥1 negative outcome. The likelihood of any negative outcome was significantly higher for the exposed than the comparison cohort (non-Indigenous: odds ratio [OR] = 2.67 [95% confidence interval (CI) = 2.56-2.78]; Indigenous: OR = 2.67 [95% CI = 2.50-2.85]). The odds were greatest for children whose mothers received a diagnosis during pregnancy (non-Indigenous: OR = 4.65 [95% CI = 3.87-5.59]; Indigenous: OR = 5.18 [95% CI = 4.10-6.55]); however, numbers were small. The effects of maternal alcohol-use disorder are experienced by the majority of exposed children rather than a vulnerable subgroup of this population. These findings highlight the need for universal prevention strategies to reduce harmful alcohol use and targeted interventions to support at-risk women and children.

Briefly Noted

Most children whose mothers have alcohol use disorder (AUD) experience adverse effects — not just a vulnerable subgroup — according to new research published in Pediatrics last month. The study looked at multiple outcomes, including birth, child protection, justice contact and academic outcomes for indigenous and nonindigenous children (the study was conducted in Australia). The adverse effects were higher in the indigenous children. For the study, all women with a birth recorded from 1983 to 2007 and their offspring were included. Fifty‐five percent of the exposed nonindigenous children and 84% of the indigenous children whose mothers had AUD experienced a negative outcome. The odds of experiencing a negative outcome were highest for those children whose mothers were diagnosed while pregnant; however, this was a small number overall. The researchers concluded that universal prevention strategies are needed to reduce harmful alcohol use and to support at‐risk women and children. For the study, go to https://pediatrics.aappublications.org/content/early/2020/02/20/peds.2019‐1574.

The effect of child mental health service use on child safety and permanency in substance misusing families

Research has shown that parental substance misuse leads to a great number of adverse child protection outcomes for children including delays in reunification and reentry into out-of-home care. Although studies suggest that provision of behavioral health services for children can serve as a protective factor in this regard, empirical evidence for the beneficial effect of these services for families experiencing substance misuse is lacking. This study examined whether receipt of children’s behavioral health services mitigated the effects of parental substance misuse with regard to child safety and permanency outcomes. The study sample included all children who either entered or exited out-of-home care in Florida anytime between July 2007 and June 2010 and were enrolled in the Child Welfare-Prepaid Mental Health plan. Data were obtained from the Florida Safe Families Network (FSFN) and Medicaid claims data sets. Cox regression was used to examine time to reunification and time to reentry into care. Findings revealed that parental substance misuse was significantly negatively associated with family reunification. The presence of parental substance misuse significantly reduced the likelihood of family reunification, whether or not children received mental health services. However, children who received mental health services and were reunified with their parents were almost three times less likely to reenter out-of-home care – even in families experiencing parental substance misuse. Receipt of behavioral health services was differentially associated with time to reunification and reentry into out-of-home care. As child welfare systems strive to become more family focused, e.g. addressing parent and child needs, these findings suggest that mental health service delivery to children in foster care remains important.

Analyzing and improving national and local child protection data in Nepal: A mixed methods study using 2014 Multiple Indicator Cluster Survey (MICS) data and interviews with 18 organizations

BackgroundGlobally, progress to improve data on child protection outcomes has been slower than efforts to improve data on child nutrition, vaccination and development outcomes in the under-five age group. The Sustainable Development Goals included several child protection targets further necessitating the need to track progress on child protection, but few studies have examined the varied data landscape for child protection within countries. ObjectiveThis mixed-methods study aims to examine (1) the prevalence of child protection outcomes in Nepal, (2) the types of data the child protection sector uses, and (3) recommendations to improve the collection, analysis and use of child protection data. Participants and SettingWe used: (a) secondary data from the nationally-representative 2014 Nepal MICS which surveyed over 13,000 households to measure the national prevalence of child labor, child marriage, and violent discipline, and (b) primary data from 18 qualitative key informant interviews with organizations in Nepal’s child protection sector. MethodsWe conducted descriptive quantitative analyses of the secondary data and thematic inductive and deductive qualitative analyses of transcripts of key informant interviews. ResultsThe burden of violent discipline (82%), child labor (37%), child marriage (12%), and their co-occurrence is high in Nepal. Respondents described using a range of data sources which included: large-scale surveys, case data from the police, court system, newspapers, community consultations, and child participation. Recommendations to improve data included developing a national child protection information system, ensuring the definitions of child protection outcomes were comparable across data sources, and improving the dissemination of data.

Improving Information Sharing for Youth in Foster Care.

There are ∼443 000 children in child protective custody (ie, foster care) in the United States. Children in protective custody have more medical, behavioral, and developmental problems that require health care services than the general population. These health problems are compounded by poor information exchange impeding care coordination. Health care providers often do not know which of their patients are in protective custody and are not privy to the critical social history collected by child protective services, including placement history and maltreatment history. Meanwhile, the custodial child protection agency and designated caregivers (ie, foster caregivers and kinship providers) often lack vital elements of the health history of children in their care, which can result in poor health care delivery such as medication lapses, immunization delay, and poor chronic disease management. In this case study, we address this critical component of health care delivery for a vulnerable population by describing a process of developing an information sharing system between health care and child welfare organizations in collaboration with child protection community partners. Lessons learned include recommended steps for improved information sharing: (1) develop shared community vision, (2) determine shareable information components, (3) implement and analyze information sharing approaches, and (4) evaluate information sharing efforts. A successful example of advocating for improvement of information sharing for youth in protective custody is explored to highlight these steps. In collaboration with child protective services, pediatricians can improve information sharing to impact both health care delivery and child protection outcomes.

Child protection outcomes of the Australian Nurse Family Partnership Program for Aboriginal infants and their mothers in Central Australia.

BackgroundThe Nurse Family Partnership Program developed in the USA, designed to improve mother and infant/child outcomes, has reported lower rates of child protection system involvement. The study tested the hypothesis that an adapted Nurse Family Partnership Program implemented in an Aboriginal community in Central Australia (the FPP) would improve Child Protection outcomes.MethodsThis was a retrospective and prospective cohort study drawing on linked administrative data, including birth registry, primary health care client information system, FPP program data, and child protection data. Participants were children of women eligible for the FPP program (an exposed and a control group of women, eligible but not referred) live-born between 1/3/2009 (program commencement) and 31/12/2015. Child protection data covered all reports, investigations, substantiations and out-of-home care placements from the time of the child’s birth to 31/12/2016. Generalised linear modelling was used to estimate the relative risk (RR) of involvement with child protection and type of involvement (report, investigation, substantiation, out-of-home-care placement) among FPP and control children.ResultsFPP mothers (n = 291) were on average younger, were more likely to be first-time mothers and experiencing housing instability than control mothers (n = 563). Among younger mothers ≤20 years, FPP children had statistically significantly lower rates of involvement with child protection (ARRreport = 0.49, 95% CI: 0.29 to 0.82; ARRinvestigation = 0.34, 95% CI: 0.19 to 0.64; ARRsubstantiation = 0.45, 95% CI: 0.21 to 0.96) and experience fewer days in care (ARR = 0.10, 95% CI: 0.02 to 0.48). Among children of first-time mothers, FPP children also had statistically significantly lower rates of involvement with child protection (ARRreport = 0.50, 95% CI: 0.30 to 0.83; ARRinvestigation = 0.36, 95% CI: 0.19 to 0.67; ARRsubstantiation = 0.38, 95% CI: 0.18 to 0.80) and fewer days in care (ARR = 0.06, 95% CI: 0.01 to 0.27).ConclusionStudy results suggest a modified Nurse Family Partnership delivered by an Indigenous community-controlled organisation may have reduced child protection system involvement in a highly vulnerable First Nations population, especially in younger or first-time mothers. Testing these results with an RCT design is desirable.