Northern Territory research highlights need for standard mandatory reporting methodology and tackling poverty
Children who are vulnerable to abuse could be better protected if procedures for reporting child harm were more standardised across states and territories, and took into account hospital admissions, a study released on Monday says.
Variation in mandatory reporting requirements, changing legislation and differences in child services’ resourcing all make it difficult to compare abuse statistics, the study published in the Medical Journal of Australia says.
Accurate data on child harm is essential for determining the amount, and types, of interventions and services needed to protect vulnerable children, it finds.
The study compared hospital admission data for children between birth and 17 years old who were admitted to public hospitals in the Northern Territory in the 12 years to 2010, and maltreatment data from child-protection services.
The researchers, from the territory’s department of health and the University of Adelaide, found that in contrast to substantial increases in harm of Aboriginal children reported in child-protection data, hospital admissions for maltreatment were, overall, relatively stable during the research period.
Of 313 children admitted to hospital with a confirmed diagnosis of child harm, 275 were Aboriginal children. The average annual hospitalisation rate for confirmed child-harm cases was 8.8 admissions per 10,000 children per year for Aboriginal children, and 0.91 for non-Aboriginal children.
However, child-protection data from the same period revealed that notifications of abuse of Aboriginal children increased by 21%.
While this did not mean cases of abuse were overstated by child-protection agencies, it highlighted the difficulty in getting an accurate depiction of rates across the country, the study’s lead author, Steven Guthridge, said.
“I think we’ve been too reliant on child-protection reports, and we need to look more widely at what’s going on in the community,” Guthridge, the director of the health gains planning division of the Northern Territory’s department of health, said.
“What is constant across all states is hospital data, so it is a valuable additional source we need to be looking at more thoroughly, and more consistently, across the country in conjunction with other data sources,” he said.
In the past, limitations to using hospital data included differences in the way doctors recorded cases of abuse and suspected abuse, Guthridge said. The study finds that emotional abuse is a rare diagnosis in hospitals but it may be better detected by child-protection agencies, highlighting the need to consider more than one source of information to determine the prevalence of child abuse.
A concerning finding from the hospital admission data is that violence against older Aboriginal girls (the cohort with the highest rate of hospital admissions for physical abuse) was 13.5 times the rate for older non-Aboriginal girls.
Paul Bauert is the head of paediatrics at one of the busiest hospitals in the country, Royal Darwin. Speaking in his capacity as the head of the Australian Medical Association in the Northern Territory, he said that regardless of what the statistics said, any case of child abuse was disturbing and its incidence could be reduced by tackling poverty, in particular.
“The problem has always been that the numbers of abuse are too high, particularly among children living in poverty, and the department of children and families is struggling to cope,” he said.
“By the time a child becomes a statistic it is too late, because at the bottom of the iceberg is the psychological damage done to kids living in poverty, particularly in some of the more remote towns in the Northern Territory, where poverty continues to be a national disgrace.”
Bauert said he was frustrated by a lack of political will to address poverty, particularly as there is a growing body of data that shows young children who are subjected to harm could be damaged for life, and could be more prone to chronic diseases in older age.
“The really frustrating thing is there are answers,” he said. “They’re not quick answers. They’re not easy and they revolve around providing a caring and nurturing environment for children in their first few years of life.
“Cycles of domestic violence and child abuse can be broken if we get to these kids early, because that investment in them will pay dividends later on.
“This is hard work at the coalface of poverty that needs to be properly funded and, to me, that would be quickest way of breaking this most vicious cycle, but the three-year political cycle doesn’t lend itself to that, and established programs run out funding with a new wave of government. I guess I’m going to my deathbed frustrated.”
In children younger than five, malnutrition is one of the most common indicators to doctors of maltreatment, he said. Physical abuse and sexual abuse is seen most commonly in children between five and 12, while victims of domestic violence “tend to be the very young ones, who can’t get out of the way”, he said. The statistics are similar across the states and territories, Bauert said.
In a separate piece for the Medical Journal of Australia, Graham Vimpani, professor of family and community health at the University of Newcastle, wrote that the World Health Organisation had recognised that responding to child maltreatment relied on better methods for monitoring it.
Vimpani helped to develop the NSW government’s Keep Them Safe reforms, introduced six months ago, which encourage doctors to fill out a standardised form when they suspect a child-abuse case.
“Let’s audit these reforms properly and examine the data and what it tells us about child maltreatment over a period of time,” he said. “Policy changes affect the definition of cases of child maltreatment, making it very hard to tell what the rate of abuse is.”
Vimpani supports the collection of data from medical, legal and social services to better determine child-abuse rates. “This challenge reaffirms the growing recognition that wicked problems like child maltreatment inevitably require high-level strategic leadership and the good will of many to devise a collective solution,” he said.