Vulnerable Families: evidence-informed possibilities Emeritus Professor Dorothy Scott

Terms over time… Multi-problem families Excluded families Families with multiple and complex needs Evidence-based practice Evidence-informed practice

Vulnerable Families: a conceptual continuum Any family can be vulnerable at times and any child’s wellbeing may be affected Some families are very vulnerable at certain times and their children are at risk of significant harm (“phase crisis” families). Some families are highly vulnerable most or all of the time and their children are at high risk of significant and cumulative harm (“state crisis” families).

Vulnerable Families: a child protection services (CPS) continuum 1.Referral to a non-statutory or statutory service for child welfare concerns. 2.Substantiated by CPS but no court order. 3.Court order under which child remains at home under statutory supervision. 4.Court order under which child is placed in out of home care. 5.Families undergoing reunification.

Referral to CPS yields a massive number of vulnerable children Between one in three and one in five children are notified to statutory child protection services by the age of 18 in those jurisdictions with good retrospective data (NSW, SA) or reliable projections (Victoria). If all of these families were deemed “vulnerable”, the demand pressures for services would be overwhelming.

Cumulative percentage of children with a notification for children born in SA in 1991, 1998 and 2002

New South Wales data The most common issues known in relation to reports to child protection services in : Domestic violence 32.0% Drug and alcohol20.4% Drug issues only11.6% Alcohol issues only10.3% (DoCS, 2007)

Victorian data In of substantiated cases of child maltreatment (mostly neglect and emotional abuse): Domestic violence52% Illicit drug Abuse33% Alcohol abuse31% Psychiatric Disability19% (sums to more than 100% due to parental multiple problems)

SA data In a file sample of 99 children in SA entering care for the first time in 2006, parental substance dependence (most frequently alcohol) was known in 75 cases, and these cases also had a much higher incidence of mental health problems (65.3%) and family violence (69.3%) than the other 24 cases. (Jeffreys, Hirte, Rogers & Wilson, 2009)

Family Characteristics of Children in Out-of-home care in Australia, 2007 Parental substance abuse69.4% Domestic Violence65.2% Parental mental health problems62.6% Delfabbro, Kettler, McCormick & Fernandez (2012), The nature and predictors of reunification in Australian out-of-home care, AIFS Conference, Melbourne.

The challenge… “The challenge of ending child abuse is the challenge of breaking the link between adults’ problems and children’s pain.” (UNICEF, A League Table of Child Maltreatment Deaths in Rich Nations, 2008) We therefore need to ensure all services fulfill their potential to respond to adult problems linked to children’s pain.

Single input services Yet we have a service system largely organised around single input services based on categorical funding. This means that families with multiple and complex needs often end up involved with a large number of organisations and in a revolving door of referrals. Engagement remains a major challenge, and relationship- based practice is greatly diminished.

A wider role for adult services? “The Government should enhance its capacity to identify and respond to vulnerable children and young people by providing funding to support specialist adult services to develop family-sensitive practices, commencing with an audit of practices of adult specialist services that identify and respond to the needs of any children of parents being treated, prioritising drug and alcohol services.” Recommendation 15. Cummins,P.,Scott, D. & Scales, B. (2012) Report of the Protecting Victoria’s Vulnerable Children Inquiry

But what about child and family services? If we were to do an audit of practices of child and family welfare services in Australia, how well might they perform regarding the knowledge and skills necessary to work with the adult problems linked to children’s pain? Have we enabled our workforce to acquire the necessary competencies in parenting in the context of AOD, mental health, family violence and intellectual disability?

And collaboration? And if we were to do an audit of the way in which adult specialist services and child and family welfare services work together to address the adult problems linked to children’s pain, what might we find? What would be the strengths on which we might “scale up” effective inter-sectorial collaboration?

Protecting and Nurturing Children: Building Capacity, Building Bridges The Australian Centre for Child Protection, funded by FaHCSIA under the National Framework for Protecting Australia’s Children, has a major workforce development initiative: 1.Supporting adult services (especially AOD, family violence, mental health andhomelessness services) to be child and family sensitive. 2.Supporting adult services and children’s services to work together effectively.

Family violence Disability Justice and corrections Homeless and housing Alcohol and other drugs Mental Health Children in need of placement Child Protection Intervention Universal Prevention for all Children/Families Targeted Prevention and Intervention for Vulnerable Families

Policy Organisation Service Provider Three levels of change

Role definition: narrow to broad 1. ‘core role only’ (‘it’s not my concern’) 2. ‘core role plus assessment of ‘other needs’, leading to referral’ (‘it’s a concern but someone else’s job – refer on’) 3. ‘other needs incidental but unavoidable’ (‘not my core role but I have to do it’) 4. ‘other needs’ intrinsic part of core role (‘it’s part and parcel of my job’)

Critical factors for implementing evidence-based interventions 1.All parties (researchers, managers, practitioners) need to value one another’s expertise and different perspectives. 2.Challenges to implementation need to be anticipated (eg reasonable caseloads and ongoing clinical supervision). 3.Commitment across systems, and ability to build on organisational strengths. (Toth & Gravener, 2012)

Australian Promising Programs Parenting under Pressure (PuP) program Family by Family

But we need evidence-informed practices, not just programs Evidence based programs typically address a specific problem but we need a family- centred casework practice model which can address a broad range of problems. How might evidence-informed practices (skills, strategies, administrative processes) which reduce risk factors and strengthen protective factors become embedded in services? Barbee et al (2011)

Beyond service solutions The problem of child abuse and neglect will not be solved solely by services for vulnerable families. It requires broadly- based measures to tackle key social determinants, reducing risk factors (eg alcohol misuse) and strengthening protective factors (eg parent-child attachment, social support).

Parental Alcohol Misuse 13.2% of children in Australia live with at least one adult who regularly binge drinks ( Dawe, 2006 ) Effective population based strategies include volumetric taxing, restricted advertising and availability, and possibly social marketing to change social norms Universal ante-natal screening for parental problem drinking??

Social Support first time parent groups via universal services such as maternal and child health schools as nuclei for neighbourhood networks Local sport as “the village well” individually matched mentoring programs

Parent-child attachment Using ultrasound as an opportunity to individualise the unborn child Avoiding threats to parental attachment to the unborn child during pregnancy Promotion of breastfeeding Paid parental leave Reducing disrupted attachments in infancy

“Maltreatment is one of the biggest paediatric public-health challenges, yet any research activity is dwarfed by work on more established childhood ills.” The Lancet Editorial 2003, p. 443 Knowledge building challenge

References Barbee, A., Christensen. B., Wandersman, A., & Cahn, K. (2011) Successful adoption and implementation of a comprehensive casework practice model in public child welfare agency: application of Getting to Outcomes (GTO) model”, Children and Youth Services Review 33: Delfabbro, P., Kettler, L. McCormick, & Fernandez, E. (2012), The nature and predictors of reunification in Australian out-of-home care, AIFS Conference, Melbourne. O’Donnell, M., Scott, D. & Stanley, F. (2008) Child abuse and neglect – is it time for a public health approach? Aust & NZ Journal of Public Health, 32,4, Scott, D. (2009) Think Child, Think Family, Family Matters, 81: Toth,S. & Gravener, J. (2012) Review: Bridging research and practice: relational interventions for maltreated children. Child and Adolescent Mental Health, DOI: /j

Emeritus Professor Dorothy Scott Australian Centre for Child Protection University of South Australia Image source: Istockphoto