Towards prevention - a population health approach to child abuse and neglect: health indicators and the identification of antecedent causal pathways

Melissa O'Donnell

    Research output: ThesisDoctoral Thesis

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    Abstract

    [Truncated abstract] The primary aims of this thesis were to investigate health indicators of child maltreatment, as well as pathways into the child protection system using routinely collected government databases, enabling a preventative health approach to child abuse and neglect. This thesis aims to improve understanding of the trends in child maltreatment and the factors, at the child and family level, which increase or reduce vulnerability to child maltreatment so more effective prevention policies and practices can be developed. This project uses longitudinal de-identified population data from the Western Australian Government Departments of Child Protection, Health and Disability Services. These data contained information on demographic, clinical, social and child protection outcomes of children and their families. Record linkage of administrative data was undertaken to: investigate health indicators of abuse and neglect using Hospital Morbidity data to enable the monitoring of population trends in abuse and neglect; compare proportion of cases obtained using health indicators with the Department of Child Protection data, and describe the physical, psychological and social characteristics of abused and/or neglected children and families. Statistical techniques utilised include logistic and Cox regression to investigate risk of adverse child outcomes, taking into account potential confounding and time to event. The main findings include: There has been an increase in assault and maltreatment related hospital admissions over the last 25 years. ... There has been a marked increase in the birth prevalence of Neonatal Withdrawal Syndrome (NWS) in Western Australia over the last 25 years, from 1 per 10,000 live births in 1980, to 31 per 10,000 live births in 2005. Specific maternal characteristics associated with having a child with NWS are identified and these children have an increased risk of child protection involvement. A population level analysis of child and parental factors determined the estimated increase in risk of substantiated child maltreatment for child intellectual disability, parental admissions for mental health, substance use, and assault, as well as greater socio-economic disadvantage. Conclusions This is the first body of research which has extensively used longitudinal, population level linked health and child protection data to investigate health indicators of child abuse and neglect and antecedent causal pathways. Monitoring injuries and conditions associated with child abuse and neglect in routinely collected data and using multiple sources of ascertainment are important initiatives in child maltreatment surveillance. Health indicators of child abuse and neglect are not subject to the same definitional and policy issues as child protection data and therefore provide a more valid comparison over time and between jurisdictions. The identification of factors which increase vulnerability for children and families to child maltreatment is essential in the implementation of prevention strategies including universal public health approaches as well as the identification of at-risk families for targeted intervention.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Publication statusUnpublished - 2009

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