1
|
Lanais K, Gnanamanickam E, Maclean M, Segal L. Investigating the impact of Out-of-Home Care on early childhood development. CHILD ABUSE & NEGLECT 2024; 154:106856. [PMID: 38850748 DOI: 10.1016/j.chiabu.2024.106856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Early childhood development is influential for life course capability. Children exposed to child maltreatment and at high risk of harm may be removed for their safety, but the effect on child development is uncertain. OBJECTIVES To assess developmental vulnerability at school commencement across five developmental domains to ascertain whether removal of children with substantiated maltreatment to foster/kinship care is likely protective, or not, of developmental vulnerabilities. METHODS The study drew on linked-data for a South Australian population birth cohort (2003 to 2014) N = 74,751. For children exposed to substantiated child maltreatment meeting study criteria (N = 2011, mean age = 5.7 years, 50.7 % boys), the effect of placement in foster/kinship care (N = 666) on developmental vulnerability was explored using generalized linear models, adjusted for child and family covariates, maltreatment severity and propensity score. RESULTS Children placed in care had a reduced risk of developmental vulnerability on the Physical Health and Wellbeing (aRR = 0.73 [0.64, 0.84]), Language and Cognitive Skills (school based) (aRR = 0.79 [0.68, 0.92]), and Communication Skills and General Knowledge (aRR = 0.81 [0.70, 0.94]) domains, compared to children who were not removed. However, these children had increased risk of vulnerability on Social Competence (aRR = 1.14 [1.01, 1.29]) and Emotional Maturity (aRR = 1.20 [1.05, 1.37]) domains. CONCLUSIONS These findings suggest placement in out-of-home care supported physical health and wellbeing, communication and cognitive but not social and emotional early childhood development. These results highlighting the need for professional therapeutic support for children in care and better attending to the physical development, communication and cognitive skills in maltreated children remaining at home.
Collapse
Affiliation(s)
- Krystal Lanais
- Health Economics and Social Policy Research Group, University of South Australia, Adelaide, Australia.
| | - Emmanuel Gnanamanickam
- Health Economics and Social Policy Research Group, University of South Australia, Adelaide, Australia
| | - Miriam Maclean
- Australian Centre for Child Protection, University of South Australia, Adelaide, Australia
| | - Leonie Segal
- Health Economics and Social Policy Research Group, University of South Australia, Adelaide, Australia
| |
Collapse
|
2
|
De La Sablonnière-Griffin M, Collin-Vézina D, Esposito T, Dion J. Recurrent child protection post-investigation services for First Nations children in the province of Quebec. CHILD ABUSE & NEGLECT 2024; 148:106243. [PMID: 37258368 DOI: 10.1016/j.chiabu.2023.106243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/12/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND The longitudinal trajectory of Indigenous children within child protection (CP) services, including their recurrent involvement, has yet to be documented. OBJECTIVES 1) To document whether First Nations children were at increased risk of a first recurrence of post-investigation CP services compared to children from the majority group. 2) To identify the characteristics associated with recurrence for First Nations children, and to compare these results to those for children from the majority group. METHOD Anonymized CP administrative data (2002-2014; n = 1150) of a region in the province of Quebec were used to conduct Cox proportional hazards modeling, in partnership with an advisory committee. RESULTS The risk of recurrence of First Nations children did not significantly differ from the risk for children from the majority group (HR: 0.980, n.s.) while controlling for covariates. Among First Nations children (n = 459), being under two at the case closure (HR: 2.718, p < .05), having received short-term intervention (HR: 5.027, p < .001) and coming from a family already known to the CP agency (HR: 2.023, p < .001) were associated with an increased risk of recurrence. CONCLUSIONS The findings highlight the importance of studying First Nations children's trajectories within CP services as a group deserving full attention and for First Nations to be able to design or demand appropriate services responding to their population's needs. A family-based research perspective is recommended to understand better the full family history leading to and in relation to CP services, which could provide more sound practice recommendations.
Collapse
Affiliation(s)
- Mireille De La Sablonnière-Griffin
- INRS-UQAT Joint Research Unit in Indigenous Studies, Urbanisation Culture Société Research Centre, Institut national de la recherche scientifique, Val-d'Or, Quebec, Canada.
| | | | - Tonino Esposito
- Canada Research Chair in Social Services for Vulnerable Children, School of Social Work, Université de Montréal, Montreal, Quebec, Canada.
| | - Jacinthe Dion
- Department of Health Sciences, Université du Québec à Chicoutimi, Saguenay, Quebec, Canada.
| |
Collapse
|
3
|
Batty GD, Kivimäki M, Almquist YB, Eriksson JG, Gissler M, Gnanamanickam ES, Hamer M, Jackisch J, Juon HS, Keski-Säntti M, Li C, Mikkola TM, Murray E, Sacker A, Segal L, Frank P. Cardiovascular Disease Events in Adults with a History of State Care in Childhood: Pooling of Unpublished Results from 9 Cohort Studies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.26.24301814. [PMID: 38343845 PMCID: PMC10854358 DOI: 10.1101/2024.01.26.24301814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Background Individuals who were separated from their biological family and placed into the care of the state during childhood (out-of-home care) are more prone to developing selected physical and mental health problems in adulthood, however, their risk of cardiovascular disease (CVD) is uncertain. Accordingly, we pooled published and unpublished results from cohort studies of childhood care and adult CVD. Methods We used two approaches to identifying relevant data on childhood care and adult CVD (PROSPERO registration CRD42021254665). First, to locate published studies, we searched PubMed (Medline) until November 2023. Second, with the aim of identifying unpublished studies with the potential to address the present research question, we scrutinised retrieved reviews of the impact of childhood state care on related adult health outcomes. All included studies were required to have prospective measurement of state care in childhood and a follow-up of CVD events in adulthood as the primary outcome (incident coronary heart disease and/or stroke). Collaborating investigators provided study-specific estimates which were aggregated using random-effects meta-analysis. The Newcastle-Ottawa Scale was used to assess individual study quality. Findings Thirteen studies (2 published, 11 unpublished) met the inclusion criteria, and investigators from nine provided viable results, including updated analyses of the published studies. Studies comprised 611,601 individuals (301,129 women) from the US, UK, Sweden, Finland, and Australia. Relative to the unexposed, individuals with a care placement during childhood had a 50% greater risk of CVD in adulthood (summary rate ratio after basic adjustment [95% confidence interval]: 1.50 [1.22, 1.84]); range of study-specific estimates: 1.28 to 2.06; I2 = 69%, p = 0.001). This association was attenuated but persisted after multivariable adjustment for socioeconomic status in childhood (8 studies; 1.41 [1.15, 1.72]) and adulthood (9 studies, 1.28 [1.10, 1.50]). There was a suggestion of a stronger state care-CVD association in women. Interpretation Our findings show that individuals with experience of state care in childhood have a moderately raised risk of CVD in adulthood. For timely prevention, clinicians and policy makers should be aware that people with a care history may need additional attention in risk factor management.
Collapse
Affiliation(s)
- G David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mika Kivimäki
- Brain Sciences, University College London, London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ylva B Almquist
- Centre for Health Equity Studies, Stockholm University, Stockholm, Sweden
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, Singapore
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, National University of Singapore, Singapore
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Academic Primary Health Care Centre, Region Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Emmanuel S Gnanamanickam
- Health Economics and Social Policy Group, Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Mark Hamer
- Division of Surgery Interventional Science, University College London, London, UK
| | - Josephine Jackisch
- Centre for Health Equity Studies, Stockholm University, Stockholm, Sweden
| | - Hee-Soon Juon
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, USA
| | - Markus Keski-Säntti
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Chaiquan Li
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Peking, China
| | - Tuija M Mikkola
- Folkhälsan Research Center, Helsinki, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Emily Murray
- Department of Epidemiology and Public Health, University College London, London, UK
- Institute of Public Health and Wellbeing, University of Essex, Colchester, UK
| | - Amanda Sacker
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Leonie Segal
- Health Economics and Social Policy Group, Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Philipp Frank
- Department of Epidemiology and Public Health, University College London, London, UK
- Brain Sciences, University College London, London, UK
| |
Collapse
|
4
|
Harrap B, Gibberd A, O'Donnell M, Simons K, Jones J, Lima F, McAullay D, Falster K, Banks E, Eades S. Cumulative incidence of child protection system contacts among a cohort of Western Australian Aboriginal children born 2000 to 2013. CHILD ABUSE & NEGLECT 2023; 143:106297. [PMID: 37352649 DOI: 10.1016/j.chiabu.2023.106297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/05/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Reducing the over-representation of Aboriginal children in the child protection system is a key target for the Australian government. OBJECTIVE We aimed to provide more recent evidence on the population-level cumulative incidence of contacts for Aboriginal children with child protective services (CPS) in Western Australia (WA). PARTICIPANTS AND SETTING Linked administrative data was provided for WA CPS between 2000 and 2015 for 33,709 Aboriginal children born in WA between 2000 and 2013. METHODS Descriptive summaries and cumulative incidence estimates were used to examine changes in CPS contact trends over time and within sibling groups. RESULTS There was an increase in early-childhood contacts for children born more recently, with 7.6 % and 2.3 % of children born in 2000-2001 having a notification and placement in out-of-home care by age one, respectively, compared to 15.1 % and 4.3 % of children born in 2012-2013. Among sibling groups where at least one sibling had a CPS contact, approximately half of children had their first contacts on the same date as another sibling. For children born after one of their siblings had been placed in out-of-home care, 31.9 % had themselves been placed in out-of-home care by age one. CONCLUSIONS Multiple children tend to be placed into out-of-home care when at least one sibling is, which is likely to have a significant impact on families affected. The additional risk of placement also carries over to children born after the first removal in a sibling group, highlighting the need for further support to prevent future removals.
Collapse
|
5
|
Segal L, Dawe S, Nguyen H, Dennison S, Gnanamanickam ES, Bell M, Spittal M, Kinner S, Preen DB. Child protection system involvement in children of incarcerated mothers: A linked data study. CHILD ABUSE & NEGLECT 2023; 139:106126. [PMID: 36889149 DOI: 10.1016/j.chiabu.2023.106126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Women 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. OBJECTIVES Ascertain child protection system contact of children exposed to maternal incarceration. PARTICIPANTS AND SETTING All children born between 1985 and 2011 exposed to the incarceration of their mothers in a Western Australian correctional facility and a matched comparison group. METHODS A 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. FINDINGS Exposure 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. CONCLUSIONS Maternal 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.
Collapse
Affiliation(s)
- Leonie Segal
- Health Economcis and Social Policy Group, University of South Australia, Adelaide, SA, Australia.
| | - Sharon Dawe
- School of Applied Psychology, Griffith University, Brisbane, Qld, Australia
| | - Ha Nguyen
- Health Economcis and Social Policy Group, University of South Australia, Adelaide, SA, Australia
| | - Susan Dennison
- School of Criminology and Criminal Justice, Griffith University, Brisbane, Qld, Australia
| | - Emmanuel S Gnanamanickam
- Health Economcis and Social Policy Group, University of South Australia, Adelaide, SA, Australia
| | - Megan Bell
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Matthew Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
| | - Stuart Kinner
- Justice Health Unit, The University of Melbourne, Melbourne, Vic, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| |
Collapse
|
6
|
Soneson E, Das S, Burn AM, van Melle M, Anderson JK, Fazel M, Fonagy P, Ford T, Gilbert R, Harron K, Howarth E, Humphrey A, Jones PB, Moore A. Leveraging Administrative Data to Better Understand and Address Child Maltreatment: A Scoping Review of Data Linkage Studies. CHILD MALTREATMENT 2023; 28:176-195. [PMID: 35240863 PMCID: PMC9806482 DOI: 10.1177/10775595221079308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND This scoping review aimed to overview studies that used administrative data linkage in the context of child maltreatment to improve our understanding of the value that data linkage may confer for policy, practice, and research. METHODS We searched MEDLINE, Embase, PsycINFO, CINAHL, and ERIC electronic databases in June 2019 and May 2020 for studies that linked two or more datasets (at least one of which was administrative in nature) to study child maltreatment. We report findings with numerical and narrative summary. RESULTS We included 121 studies, mainly from the United States or Australia and published in the past decade. Data came primarily from social services and health sectors, and linkage processes and data quality were often not described in sufficient detail to align with current reporting guidelines. Most studies were descriptive in nature and research questions addressed fell under eight themes: descriptive epidemiology, risk factors, outcomes, intergenerational transmission, predictive modelling, intervention/service evaluation, multi-sector involvement, and methodological considerations/advancements. CONCLUSIONS Included studies demonstrated the wide variety of ways in which data linkage can contribute to the public health response to child maltreatment. However, how research using linked data can be translated into effective service development and monitoring, or targeting of interventions, is underexplored in terms of privacy protection, ethics and governance, data quality, and evidence of effectiveness.
Collapse
Affiliation(s)
- Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Shruti Das
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Anne-Marie Burn
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Marije van Melle
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Mina Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Headington, Oxford, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ruth Gilbert
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Katie Harron
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Emma Howarth
- School of Psychology, University of East London, London, UK
| | - Ayla Humphrey
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Anna Moore
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| |
Collapse
|
7
|
Gnanamanickam ES, Brown DS, Armfield JM, Segal L. Excess hospital costs incurred by individuals with child abuse and neglect history in South Australia: A birth-cohort study. Prev Med 2023; 166:107378. [PMID: 36493867 DOI: 10.1016/j.ypmed.2022.107378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/20/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
Child abuse and neglect is a serious public health issue across the globe, with documented impacts on health, but the impact on hospital costs, at the population level, is unknown. We aimed to estimate the additional public hospital costs for emergency department visits and admitted patient hospitalizations, for persons with reported child protection concerns, from birth to 31 years and modelled to age 65. Using linked hospital data from 2003 to 2017 for a population birth-cohort of all individuals born in South Australia from 1986 to 2017, we estimated costs of public hospital care. Mean cost and cost differences (adjusted and unadjusted) in 2018 Australian dollars (AU$) were calculated for persons with child protection contact vs none, per person and at the population level. Persons with child protection contact had higher annualized mean hospital costs than those with no contact, with cost differentials increasing with age. Unadjusted differential cost per person was AU$338 (95% CI AU$204-AU$473) from birth to 12 years; increasing to AU$2242 (AU$2074-AU$2411) at ages 25 to 31 years, equating to an additional AU$124 (US$100) million for public hospital services from birth to 31 years, an 18% cost penalty (33% from 13 to 31 years). Modelled to age 65 years, excess costs were estimated at AU$415 (US$337, adjusted: AU$365 and US$296) million, a 27% cost impost. There is a considerable hospital cost penalty associated with persons with reported child protection concerns, especially from adolescence into adulthood, highlighting an opportunity for cost savings by preventive investment in effective early-in-life interventions.
Collapse
Affiliation(s)
| | - Derek S Brown
- Institute for Public Health, Washington University in St. Louis, St. Louis, USA
| | - Jason M Armfield
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Leonie Segal
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| |
Collapse
|
8
|
Esposito T, Caldwell J, Chabot M, Blumenthal A, Trocmé N, Fallon B, Hélie S, Afifi TO. Childhood Prevalence of Involvement with the Child Protection System in Quebec: A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:622. [PMID: 36612946 PMCID: PMC9819446 DOI: 10.3390/ijerph20010622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
The goal of this study, the first of its kind in Canada, was to estimate the child lifetime prevalence of child protection involvement in Quebec. Using administrative and population data spanning 17 years, we performed a survival analysis of initial incidents of child protection reports, confirmed reports, confirmation of a child's security or development being compromised, and placement outside the home for one day or more. We found that before reaching the age of 18 years, over 18% of children were reported to child protection at least once, one in every ten children (10.1%) in the province had a report that led to the finding of their security or development being compromised, and over 5% were placed outside the home. We found that neglect was a primary concern in close to half (47.6%) of cases. By using a full population dataset, we obtained a more accurate prevalence estimate than studies using synthetic cohort life tables. These findings only captured initial incidents of involvement with child protection, meaning this study does not show the extent of recurrent involvement for some children. The findings reflect prior results showing that neglect is common in initial child protection involvement but less pervasive than has been shown in incidence studies, suggesting that recurrent child protection involvement is more driven by neglect than initial incidents are.
Collapse
Affiliation(s)
- Tonino Esposito
- École de Travail Social, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Johanna Caldwell
- École de Travail Social, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Martin Chabot
- École de Travail Social, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Anne Blumenthal
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nico Trocmé
- School of Social Work, McGill University, Montreal, QC H3A 0G4, Canada
| | - Barbara Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Sonia Hélie
- Institut Universitaire Jeunes en Difficulté, Montreal, QC H2L 4R5, Canada
| | - Tracie O. Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| |
Collapse
|
9
|
Whitten T, Green MJ, Tzoumakis S, Laurens KR, Harris F, Carr VJ, Dean K. Early developmental vulnerabilities following exposure to domestic violence and abuse: Findings from an Australian population cohort record linkage study. J Psychiatr Res 2022; 153:223-228. [PMID: 35841818 DOI: 10.1016/j.jpsychires.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/11/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
Abstract
Early life exposure to Domestic Violence and Abuse (DVA) is associated with poor psychosocial and cognitive development in childhood. However, most prior research uses mother-reported involvement in DVA as a proxy indicator of child exposure; studies using direct measures of child exposure to DVA are scarce, especially among representative population-based samples. We address this gap by using longitudinal, population-based data from an Australian record linkage study of children to examine the associations between early life exposure to DVA and early childhood developmental vulnerability. Exposure to DVA was measured using police contact records for children involved in a DVA incident either as a victim or witness. Developmental vulnerability at school entry was measured using the Australian Early Development Census, providing indices of five broad domains of function and person-centred classes of developmental risk (referred to as 'mild generalized risk', 'misconduct risk', and 'pervasive risk', each compared to a group showing 'no risk'). Children exposed to DVA showed significantly greater odds of developmental vulnerability on all five domains and were more likely to be members of the three developmental risk classes. Girls who were victims of DVA (OR = 1.65) had significantly poorer developmental outcomes than boys who were victims (OR = 1.26) within the domain of communication skills and general knowledge (d = 0.29 [SE = 0.16], p = .04). No other sex differences were found. These preliminary findings hold important implications for policy regarding the early intervention and implementation of support services for young children exposed to DVA.
Collapse
Affiliation(s)
- Tyson Whitten
- Discipline of Psychiatry and Mental Health, University of New South Wales, Botany Street, Kensington, NSW, 2052, Australia; School of Social Sciences, University of Adelaide, Napier Building, Adelaide, SA, 5005, Australia.
| | - Melissa J Green
- Discipline of Psychiatry and Mental Health, University of New South Wales, Botany Street, Kensington, NSW, 2052, Australia; Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia
| | - Stacy Tzoumakis
- School of Criminology and Criminal Justice, Griffith University, Parkland Drive, Southport, QLD, 4125, Australia; Griffith Criminology Institute, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia
| | - Kristin R Laurens
- Discipline of Psychiatry and Mental Health, University of New South Wales, Botany Street, Kensington, NSW, 2052, Australia; Queensland University of Technology (QUT), School of Psychology and Counselling, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - Felicity Harris
- Discipline of Psychiatry and Mental Health, University of New South Wales, Botany Street, Kensington, NSW, 2052, Australia
| | - Vaughan J Carr
- Discipline of Psychiatry and Mental Health, University of New South Wales, Botany Street, Kensington, NSW, 2052, Australia; Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia; Department of Psychiatry, Monash University, Level 3 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, University of New South Wales, Botany Street, Kensington, NSW, 2052, Australia; Justice Health and Forensic Mental Health Network, Matraville, NSW, 5005, Australia
| |
Collapse
|
10
|
Gnanamanickam ES, Nguyen H, Armfield JM, Doidge JC, Brown DS, Preen DB, Segal L. Child maltreatment and emergency department visits: a longitudinal birth cohort study from infancy to early adulthood. CHILD ABUSE & NEGLECT 2022; 123:105397. [PMID: 34823123 DOI: 10.1016/j.chiabu.2021.105397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Child maltreatment (CM) is a serious global public health issue, with documented impacts on health. OBJECTIVE To examine the association between different levels of CM concern, and Emergency Department (ED) visits from infancy to early adulthood. PARTICIPANTS AND SETTING Individuals born in Adelaide, South Australia from January 1986 to June 2017 (N = 443,754). METHODS Using linked administrative data, we examined frequency and adjusted rate ratios for all-cause and cause specific ED visits among individuals with varying levels of CM concern. RESULTS Cumulative mean ED visits to age 14.5 years were higher for individuals with any CM concern, ranging from 10.2 to 14.8, compared with 6.4 in persons with no recorded CM concern. Adjusted rate ratios for ED visits varied from 1.26 (95% CI: 1.23-1.30) to 1.54 (1.48-1.60) in children (birth to 12 years), 1.98 (CI: 1.92-2.04) to 4.34 (CI: 4.09-4.60) in adolescence and 2.22 (CI: 2.14-3.48) to 3.48 (3.27-3.72) in young adults, increasing with severity of maltreatment concerns. ED visits coded as self-harm or poisoning, injuries, substance use or mental illness were particularly high, with incidence rate ratios mostly 3 to 15 times for mental health/substance related visits and 1.5 to 3.2 for other accidents or injury for individuals with any CM concern versus none. CONCLUSIONS The high rate ratios for ED visits in children with CM concern, especially for self-harm, substance use and mental health during adolescence and adulthood highlights the enduring mental health needs of victims of child maltreatment, providing further impetus for prevention.
Collapse
Affiliation(s)
- Emmanuel S Gnanamanickam
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia.
| | - Ha Nguyen
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia; John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, University of Sydney, Sydney, New South Wales, Australia
| | - Jason M Armfield
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - James C Doidge
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia; Intensive Care National Audit and Research Centre, London, UK; UCL Great Ormond Institute of Child Health, University College London, London, UK
| | - Derek S Brown
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Leonie Segal
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
11
|
Segal L, Doidge J, Armfield JM, Gnanamanickam ES, Preen DB, Brown DS, Nguyen H. Association of Child Maltreatment With Risk of Death During Childhood in South Australia. JAMA Netw Open 2021; 4:e2113221. [PMID: 34110393 PMCID: PMC8193432 DOI: 10.1001/jamanetworkopen.2021.13221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Child maltreatment is a prominent public health concern affecting 20% to 50% of children worldwide. Consequences for mental and physical health have been reported, but population-level estimates of risk of death during childhood that are adjusted for confounders have not been published to date. OBJECTIVE To estimate the association of documented child protection concerns regarding maltreatment with risk of death from infancy to 16 years of age. DESIGN, SETTING, AND PARTICIPANTS This case-control study was nested in a population birth cohort of 608 547 persons born in South Australia, Australia. Case children were those who died between 1 month and 16 years of age (with the death registered by May 31, 2019). Control children were randomly selected individuals from the same population who were alive at the age at which the case child died, matched 5:1 for age, sex, and Aboriginal status. Data were analyzed from January 2019 to March 2021. EXPOSURE Children were assigned to 1 of 4 child protection concern categories (child protection system notification[s] only, investigation[s] [not substantiated], substantiated maltreatment, and ever placed in out-of-home care) based on administrative data from the South Australia Department for Child Protection or were classified as unexposed. MAIN OUTCOMES AND MEASURES Mortality rate ratios for death before 16 years of age, by child protection concern category, were estimated using conditional logistic regression, adjusted for birth outcomes, maternal attributes, and area-based socioeconomic status. Patterns of cause of death were compared for children with vs without child protection concerns. RESULTS Of 606 665 children included in the study, 1635 were case children (57.9% male [when sex was known]; mean [SD] age, 3.59 [4.56] years) and 8175 were control children (57.7% male; mean [SD] age, 3.59 [4.56] years [age censored at the time of death of the matched control child]). Compared with children with no child protection system contact, adjusted mortality rate ratios among children who died before 16 years of age were 2.69 (95% CI, 2.05-3.54) for children with child protection system notification(s) only; 3.16 (95% CI, 2.25-4.43) for children with investigation(s) (not substantiated); 2.93 (95% CI, 1.95-4.40) with substantiated maltreatment; and 3.79 (95% CI, 2.46-5.85) for children ever placed in out-of-home care. External causes represented 136 of 314 deaths (43.3%) among children with a documented child protection concern and 288 of 1306 deaths (22.1%) among other children. Deaths from assault or self-harm were most overrepresented, accounting for 11.1% of deaths in children with child protection concerns but just 0.8% of deaths among other children. CONCLUSIONS AND RELEVANCE In this case-control study, children with documented child protection concerns, who were known to child protection agencies and were typically seen by clinicians and other service providers, had a higher risk of death compared with children with no child protection service contact. These findings suggest the need for a more comprehensive service response for children with protection concerns.
Collapse
Affiliation(s)
- Leonie Segal
- Health Economics and Social Policy Group, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - James Doidge
- Intensive Care National Audit & Research Centre, London, United Kingdom
| | - Jason M. Armfield
- Health Economics and Social Policy Group, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Emmanuel S. Gnanamanickam
- Health Economics and Social Policy Group, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - David B. Preen
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Derek S. Brown
- Brown School, Institute for Public Health, Washington University in St Louis, St Louis, Missouri
| | - Ha Nguyen
- Health Economics and Social Policy Group, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
12
|
Gilbert R, Lacey R. Intergenerational transmission of child maltreatment. LANCET PUBLIC HEALTH 2021; 6:e435-e436. [PMID: 33939967 DOI: 10.1016/s2468-2667(21)00076-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/01/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Ruth Gilbert
- University College London Institute of Child Health, University College London, London WC1E 6BT, UK.
| | - Rebecca Lacey
- Institute of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| |
Collapse
|
13
|
Armfield JM, Gnanamanickam ES, Johnston DW, Preen DB, Brown DS, Nguyen H, Segal L. Intergenerational transmission of child maltreatment in South Australia, 1986-2017: a retrospective cohort study. LANCET PUBLIC HEALTH 2021; 6:e450-e461. [PMID: 33939966 DOI: 10.1016/s2468-2667(21)00024-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The extent of intergenerational transmission of child maltreatment is unclear due to methodological limitations in previous studies. In this study, we aimed to examine factors associated with intergenerational transmission of child maltreatment and quantify its extent in a population sample over a 30-year period in South Australia. METHODS In this retrospective cohort study, we used linked administrative data from the South Australian Birth Registry to identify dyads of mothers and their children both born in South Australia between July 1, 1986, and June 30, 2017. Three child protection system (CPS) outcomes (any CPS involvement, substantiated maltreatment, and time spent in out-of-home care) were computed from data obtained from the South Australian Department for Child Protection. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for child CPS outcomes according to their mother's CPS exposure. FINDINGS 38 556 unique mother-child dyads were included. 458 (2·0%) of 23 437 children whose mothers had no CPS involvement in childhood had a substantiated report of maltreatment and 127 (0·5%) spent time in out-of-home care. By comparison, 970 (22·1%) of 4382 children whose mothers experienced substantiated maltreatment in childhood had substantiated maltreatment and 469 (10·7%) spent time in out-of-home care. After adjusting for potential confounders, children of mothers with any CPS involvement in childhood had an increased risk of CPS contact compared with children whose mothers had no CPS involvement; this risk was greatest for children of mothers who had both substantiated maltreatment and spent time in out-of-home care (HR 6·25 [95% CI 5·59-6·98] for any CPS involvement, 13·69 [10·08-16·92] for substantiated maltreatment, and 25·78 [18·23-36·45] for any time in out-of-home care). Risks of child CPS outcomes were substantially increased for children of mothers who had a first CPS notification under the age of 1 year or who had any CPS notification at age 13-17 years. INTERPRETATION Children are at high risk of maltreatment if their mother experienced maltreatment as a child. Assisting survivors of childhood maltreatment, particularly female survivors, provides a crucial intervention opportunity to help prevent further child abuse and neglect. FUNDING Australian National Health and Medical Research Council; Channel 7 Children's Research Foundation.
Collapse
Affiliation(s)
- Jason M Armfield
- Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
| | - Emmanuel S Gnanamanickam
- Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - David W Johnston
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Derek S Brown
- Brown School, Washington University in St Louis, St Louis, MO, USA
| | - Ha Nguyen
- Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia
| | - Leonie Segal
- Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| |
Collapse
|
14
|
Chikwava F, Cordier R, Ferrante A, O’Donnell M, Speyer R, Parsons L. Research using population-based administration data integrated with longitudinal data in child protection settings: A systematic review. PLoS One 2021; 16:e0249088. [PMID: 33760881 PMCID: PMC7990188 DOI: 10.1371/journal.pone.0249088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/11/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Over the past decade there has been a marked growth in the use of linked population administrative data for child protection research. This is the first systematic review of studies to report on research design and statistical methods used where population-based administrative data is integrated with longitudinal data in child protection settings. METHODS The systematic review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. The electronic databases Medline (Ovid), PsycINFO, Embase, ERIC, and CINAHL were systematically searched in November 2019 to identify all the relevant studies. The protocol for this review was registered and published with Open Science Framework (Registration DOI: 10.17605/OSF.IO/96PX8). RESULTS The review identified 30 studies reporting on child maltreatment, mental health, drug and alcohol abuse and education. The quality of almost all studies was strong, however the studies rated poorly on the reporting of data linkage methods. The statistical analysis methods described failed to take into account mediating factors which may have an indirect effect on the outcomes of interest and there was lack of utilisation of multi-level analysis. CONCLUSION We recommend reporting of data linkage processes through following recommended and standardised data linkage processes, which can be achieved through greater co-ordination among data providers and researchers.
Collapse
Affiliation(s)
- Fadzai Chikwava
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Reinie Cordier
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle, United Kingdom
| | - Anna Ferrante
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Melissa O’Donnell
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia
| | - Renée Speyer
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Lauren Parsons
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
15
|
Segal L, Armfield JM, Gnanamanickam ES, Preen DB, Brown DS, Doidge J, Nguyen H. Child Maltreatment and Mortality in Young Adults. Pediatrics 2021; 147:peds.2020-023416. [PMID: 33318224 DOI: 10.1542/peds.2020-023416] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Child maltreatment (CM) is a global public health issue, with reported impacts on health and social outcomes. Evidence on mortality is lacking. In this study, we aimed to estimate the impact of CM on death rates in persons 16 to 33 years. METHODS A retrospective cohort study of all persons born in South Australia 1986 to 2003 using linked administrative data. CM exposure was based on child protection service (CPS) contact: unexposed, no CPS contact before 16 years, and 7 exposed groups. Deaths were observed until May 31, 2019 and plotted from 16 years. Adjusted hazard ratios (aHRs) by CPS category were estimated using Cox proportional hazards models, adjusting for child and maternal characteristics. Incident rate ratios (IRRs) were derived for major causes of death, with and without CPS contact. RESULTS The cohort included 331 254 persons, 20% with CPS contact. Persons with a child protection matter notification and nonsubstantiated or substantiated investigation had more than twice the death rate compared with persons with no CPS contact: aHR = 2.09 (95% confidence interval [CI] = 1.62-2.70) to aHR = 2.61 (95% CI = 1.99-3.43). Relative to no CPS contact, persons ever placed in out-of-home care had the highest mortality if first placed in care aged ≥3 years (aHR = 4.67 [95% CI = 3.52-6.20]); aHR was 1.75(95% CI = 0.98-3.14) if first placed in care aged <3 years. The largest differential cause-specific mortality (any contact versus no CPS contact) was death from poisonings, alcohol, and/or other substances (IRR = 4.82 [95% CI = 3.31-7.01]) and from suicide (IRR = 2.82 [95% CI = 2.15-3.68]). CONCLUSIONS CM is a major underlying cause of potentially avoidable deaths in early adulthood. Clinical and family-based support for children and families in which CM is occurring must be a priority to protect children from imminent risk of harm and early death as young adults.
Collapse
Affiliation(s)
- Leonie Segal
- Health Economics and Social Policy Group, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia;
| | - Jason M Armfield
- Health Economics and Social Policy Group, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Emmanuel S Gnanamanickam
- Health Economics and Social Policy Group, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Derek S Brown
- Brown School, Institute for Public Health, Washington University in St Louis, St Louis, Missouri; and
| | - James Doidge
- Intensive Care National Audit & Research Centre, London, United Kingdom
| | - Ha Nguyen
- Health Economics and Social Policy Group, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|