Child Protection as a Public Health Issue

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Child Protection as a Public Health Issue

• Fiona Arney

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Overview

• Introduction
• Child Protection as a Public Health Issue
• Determinants and outcomes
• Goals and actions
• Promising Practice, Programs and Resources

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My Background

• University of Adelaide Psychology (Honours)
• Womens and Childrens Hospital
• Child and adolescent behaviour, physical and
  mental health, chronic illness
• Victorian Parenting Centre
• Strengths-based ways to work with families
• Parenting adaptability and resilience
• PhD, 2005 (University of Adelaide, Dept of
  Psychiatry)
• Senior Research Fellow at the Australian Centre
  for Child Protection
• Promising interventions with families to prevent
  and respond to child abuse and neglect (includes
  intersectoral projects)

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• The Australian Centre for Child Protection aims
  to
• enhance life opportunities for children in
  Australia who are at risk of abuse or neglect
  through
• research
• professional education
• advocacy
• Commonwealth
• Government (DIISR) and
• University of South
• Australia Initiative

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History of Child Protection

• First wave late nineteenth century child
  savers began the child rescue movement for
  destitute and neglected children
• Second wave mid-late twentieth century eg 1960s
  battered baby syndrome and 1980s child sexual
  abuse, leading to forensic models and risk
  assessment
• Third wave early twenty-first century public
  health and whole of government approaches to
  prevention and remediation

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Lancet editorial 2003, p. 443

• Maltreatment is one of the biggest paediatric
  public-health challenges, yet any research
  activity is dwarfed by work on more established
  childhood ills (Editorial 2003, 443)

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South Australian Cohort Study (Hirte et al, 2008)

• Children born in 1991 (15 and 16 years old at
  time of analysis)
• 22.5 of the cohort had been the subject of a
  notification
• Allegations of physical abuse and neglect were
  most common
• 5.6 had at least one substantiated case of child
  abuse and/or neglect
• Comparative data for children born in 1998 and
  2002

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Figure 20 Cumulative percentage of children with
a notification for children born in 1991, 1998
and 2002
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• Aboriginal and Torres Strait Islander children
  were found more likely to
• Be the subject of a child protection notification
  (57-76), investigation and substantiation
• Be the subject of more serious notifications of
  abuse
• Be notified for emotional abuse and neglect
• Have a first notification at a younger age
• Be notified on multiple occasions
• Experience an alternative care placement,
  adolescent at risk intake, emergency financial
  assistance or young offender order.
• Aboriginal and Torres Strait Islander girls
  emerged as particularly at risk.

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Figure 36 Cumulative percentage children with
Aboriginal or Torres Strait Islander background
with a notification born in 1991, 1998 and 2002
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What is a public health model?

• Baums (1998) core features
• Focus on populations as entities
• Emphasis on health promotion and disease
  prevention
• Health systems based on contributions to
  population health outcomes
• Emphasis on underlying determinants of health as
  they affect whole populations

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Focus on populations as entities

• Requires knowledge of the prevalence of a
  condition not just incidence (eg number of
  reported cases of suspected abuse).
• Requires measurement of changes over time on the
  basis of prevalence measures or proxy measures
• Depends on epidemiology as a core discipline and
  good data linkage systems

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Why is a public health approach to necessary?

• 1. Because residual approaches are failing, with
  demand outstripping the capacity of statutory
  child protection services.
• 2. Because the long term effects of child abuse
  are so serious.
• 3. Because the current cure (removing children)
  may be causing some children greater harm.

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Common risk factors

• Poor early parent-child attachment
• Low peer and school connectedness
• Little social support
• Parental poverty
• Durlak (1998)Common risk factors and protective
  factors in successful prevention programs,
  American Jnl of Orthopsychiatry, 68, 512-520

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Child abuse has serious effects

• Strong correlation between poor adult physical
  health and mental health outcomes and adverse
  childhood experiences
• recurrent physical abuse
• recurrent emotional abuse
• sexual abuse
• neglect
• incarcerated household member
• someone who is chronically depressed, suicidal,
  institutionalised or mentally ill
• Intimate partner violence
• one or no parents
• Middlebrooks, J.S, Audage N.C., The Effects of
  Childhood Stress on Health Across the Lifespan.
  Atlanta (GA) Centers for Disease Control and
  Prevention, National Center for Injury Prevention
  and Control, 2007

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Child abuse and neglect a child health,
education and juvenile justice problem

• Low birth weight
• Child behaviour problems
• Low literacy
• Non-completion of school
• Juvenile crime
• Drug use
• Teenage pregnancy

Durlak (1998) Common risk factors and protective
factors in successful prevention programs,
American Jnl of Orthopsychiatry, 68, 512-520
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Emphasis on underlying determinants

• By understanding the underlying determinants, we
  might develop targetted strategies to reduce risk
  factors and enhance protective factors.
• Poverty
• Substance misuse
• Mental health problems
• Family violence
• Family breakdown
• Social isolation and exclusion

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Addressing the determinants of the determinants

• Grief and loss
• Changes in cultural norms and traditional
  parenting styles
• Impact of invasion and past child removal
  policies and other policies
• Intergenerational issues
• Family and community breakdown
• Impact of racism and low self esteem
• Lack of employment and economic opportunities
• Impact of current government policies

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Levels of Intervention

• Primary prevention
• Secondary prevention
• Tertiary prevention
• Individual
• Family
• Community
• Society
• System

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Preventing child abuse and neglect - goals
(Schorr and Marchand, 2007)

• Children and youth nurtured, safe and engaged
• Strong, connected families
• Identified families access services and supports
• Families free from substance abuse and mental
  illness
• Caring responsive communities
• Greater capacity to respond in vulnerable
  communities

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National Framework for Protecting Australias
Children Discussion Paper

• Stronger prevention focus
• Better collaboration between services
• A common approach to protecting Indigenous
  children
• Better service models for protecting Indigenous
  children in towns and cities, and in remote
  communities
• More responsiveness to Indigenous childrens
  issues within existing services
• Supporting compliance with the Aboriginal child
  placement principle
• Initiatives for Indigenous young people in
  pregnancy
• Consideration of alcohol supply and advertising

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Drug and alcohol - Indigenous perspectives in
ANCD Research Paper Drug Use in the Family
Dawe et al. (2007)

• Supply reduction strategies
• Harm minimisation (e.g., safe houses,
• night patrols)
• Educaring approach understanding
  relationships between historical and
  socio-political influences that result in social
  trauma and violent behaviour (intergenerational
  emergence of drug and alcohol use and parenting
  difficulties, grief and loss)

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Good Practice Principles for Organisations and
Funding Bodies

• Recognise the needs of children
• Provide organisational support
• Endorse treatment models that address many
  aspects of families lives
• Interagency practice guidelines
• Responsive to needs of families to engage them

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Promising Practice, Programs and Resources - Good
Practice Principles

• For clinicians
• Training in empirically sound models
• Regular supervision
• Time
• Content
• No single treatment
• Immediate access
• Thorough assessment of family functioning
• Work actively to address multiple needs of the
  family (not just drug use)
• Plans continually reviewed and updated
• Engagement and therapeutic alliance critical
• Evaluation

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Indigenous Programs

• Addressing multiple disadvantage
• Cultural relevance and appropriateness
• Address intergenerational and socio-political
  issues
• Family and community-focused
• Family Wellbeing
• Journey to Respect
• Journey of Healing

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A healthy start to life

• Anangu Bibi
• Nganampa Health Council antenatal care program
• Family Home Visiting
• Homemaker Services (e.g., in Amata)

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Through Young Black Eyes A handbook to protect
children from the impact of family violence and
child abuse (SNAICC, 2008)

• Impacts of family violence on children
• Recognising child abuse and neglect
• Reporting child protection matters
• Resources and Services Information

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Enhancing knowledge and skills of DA workers

• The Parenting Support Toolkit (Odyssey and the
  Parenting Research Centre) is a resource to help
  alcohol and other drug workers address the vital
  role that parenting plays in their clients
  lives. It aims to help workers provide better
  outcomes for their clients and the best care for
  their children.
• helps DA workers identify the needs of parents
  and their children when parents attend drug
  treatment
• provides workers with resources and strategies to
  effectively respond to clients parenting needs
• contains 3 Booklets and a Quick Reference Card

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Community Development Approaches

• Communities with low SES but high social
  capital have lower levels of child maltreatment.
  Promising outcomes of holistic community
  development strategies (eg Victorian Long Gully
  project).

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Sharing knowledge, experience and success

• Successful Stories in Indigenous Health (ANTAR)
  http//www.antar.org.au/images/stories/PDFs/Succes
  sStories/success_stories_final.pdf
• Rio Tinto Child Health Partnership Delivering
  Improvements in Aboriginal and Torres Strait
  Islander Child and Maternal Health
  (http//www.ichr.uwa.edu.au/files/user6/RTCHP_Fina
  l_Report_Web.pdf)
• Promising practices in out-of-home care for
  Aboriginal and Torres Strait Islander carers,
  children and young people profiling promising
  programs (http//www.aifs.gov.au/nch/pubs/reports/
  promisingpractices/booklets/menu.html)

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• Dr Fiona Arney
• Senior Research Fellow
• Australian Centre for Child Protection
• 08 8302 4172
• Fiona.arney_at_unisa.edu.au
• http//www.unisa.edu.au/childprotection