Trends in child maltreatment in the Northern Territory, using child protection reports and hospital admissions, 1999 to 2010.

Abstract

Through more than a decade there has been ongoing national attention on the vulnerability of Aboriginal children to maltreatment. The concerns have been highlighted through coronial investigations, government inquiries and media attention. Central to these concerns has been the particular focus on sexual abuse of children in the Northern Territory (NT) highlighted through the Little Children are Sacred report released in 2007 and the subsequent intervention by the Australian Government. Associated with this attention there has been rapid increase in reports of suspected child maltreatment which has challenged the capacity of child protection services. This thesis explores changes in the number and characteristics of reports of child maltreatment in the NT, from 1999 to 2010, in the context of continuing public attention. The thesis used two sources of information – child protection activity and hospital admissions. From child protection activity data, annual rates of notifications for Aboriginal children increased by an average of 21% per year (Incidence rate ratio (IRR) 1.21, 95%CI: 1.19-1.24) compared with a more modest increase among non-Aboriginal children of 10% per year (IRR 1.10, 95% CI: 1.07-1.14). The major changes for Aboriginal children were not in reports of sexual and physical abuse but increased reports of emotional abuse and neglect. The leading sources of the increased reports were from police, reporting children exposed to violence, and health professionals reporting neglect. In other settings increases in reports have been associated with more reports of the same children and a decline in the proportion of reports which were substantiated. However in this study, parallel to increased notifications for Aboriginal children, there were increases in both the number of children being reported and the number of substantiated cases. The analysis of hospital admissions, for conditions associated with child maltreatment, provided a second source of information for validating and explaining changes in child maltreatment reports. Hospital admissions are less dependent, than child protection data, on changes in policy and service access and have the additional benefit of being well documented and systematically recorded using an international coding system. The results for admissions were in contrast to the trends reported from child protection data. While the results confirmed the much higher risk of child maltreatment among Aboriginal than non-Aboriginal children, there was only weak evidence for a change in incidence through time (IRR 1.03, 95%CI: 1.00-1.07 and 1.04, 95%CI: 0.96-1.11, respectively). The separate analysis of child protection and admissions data is important in understanding changes in child maltreatment reports and strengthens the interpretation that increases in child protection reports were largely the result of increased surveillance activity, changes in policy and reporting practice, and improved service access and not an increase in underlying incidence of child maltreatment. The study also demonstrates the value of hospital admission data for informing the rational planning of child protection policy and services. After more than a decade of continuous attention, in particular for NT Aboriginal children, we are now better informed of the extent and nature of child maltreatment. Services to protect vulnerable children will need to continue to expand in both scale and scope. This expansion must not only meet the needs of children at immediate risk of danger but also the children with less immediate, but arguably as important, risks associated with neglect and emotional abuse.