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Child Protection as a Public Health Issue

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University of Adelaide Psychology (Honours) Women's and Children's Hospital. Child and adolescent behaviour, physical and mental health, chronic illness ... – PowerPoint PPT presentation

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Title: Child Protection as a Public Health Issue


1
Child Protection as a Public Health Issue
  • Fiona Arney

2
Overview
  • Introduction
  • Child Protection as a Public Health Issue
  • Determinants and outcomes
  • Goals and actions
  • Promising Practice, Programs and Resources

3
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)

4
  • 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

5
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

6
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)

7
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

8
Figure 20 Cumulative percentage of children with
a notification for children born in 1991, 1998
and 2002
9
  • 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.

10
Figure 36 Cumulative percentage children with
Aboriginal or Torres Strait Islander background
with a notification born in 1991, 1998 and 2002
11
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

12
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

13
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.

14
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

15
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

16
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
17
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

18
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

19
Levels of Intervention
  • Primary prevention
  • Secondary prevention
  • Tertiary prevention
  • Individual
  • Family
  • Community
  • Society
  • System

20
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

21
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22
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

23
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)

24
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

25
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

26
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

27
A healthy start to life
  • Anangu Bibi
  • Nganampa Health Council antenatal care program
  • Family Home Visiting
  • Homemaker Services (e.g., in Amata)

28
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

29
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

30
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31
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).

32
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33
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)

34
  • 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
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