Cumulative Incidence of Child Protection Services Involvement Before Age 5 Years in 153 670 Australian Children

Abstract

This study examines the incidence of notifications to and investigations, substantiations, and out-of-home care placements by child protection services for children aged 0 to 5 years in New South Wales, Australia.

Child maltreatment has immediate and lifelong consequences for health and well-being and is costly for governments.¹ Historically, reporting of child protection services (CPS) contacts has offered a system view of child protection based on point incidence. Because CPS data have become increasingly available for research, the scale of the child maltreatment problem across the life span has begun to emerge. In the US, maltreatment is investigated in 37% of children,² confirmed in 13% of children,³ and results in the placement of 6% of children in out-of-home care (OOHC) at least once by the time the child is 18 years of age. In New Zealand, 24% of children born in 1998 had 1 or more CPS notifications, 10% had experienced substantiated maltreatment, and 3% had 1 or more OOHC placements by 17 years of age.⁴ More than one-third of New Zealand children reported to CPS by adulthood were first reported by age 5 years.⁴ This study used cross-sectoral data linkage to quantify the cumulative incidence of CPS involvement before 5 years of age among children in their first year of school in New South Wales, Australia.

Methods

We used linked birth registrations, perinatal records, and CPS data for 153 670 Australian children who started school in New South Wales in 2009 or 2012 and had a birth record in New South Wales. Ethical approval was obtained from the New South Wales Population Health Services and Research Ethics Committee, the New South Wales Aboriginal Health and Medical Research Council Ethics Committee, and the Australian National University Human Research Ethics Committee, which included a waiver of consent to obtain the deidentified, population-level data for this record linkage cohort study. Data on CPS outcomes included notifications that were screened in after meeting the statutory threshold for risk of significant harm, investigations, incidents of substantiated maltreatment, and OOHC placements.

We estimated children’s ages at the first of each CPS outcome using date of birth and the outcome. The numerator for age-specific cumulative incidence was the cumulative number of children with 1 or more CPS outcomes at each age. Because the cohort was defined as children who started school in 2009 or 2012, the denominator was 153 670 children for all incidence estimates from 0 to 5 years. We report the cumulative incidence of primary substantiated neglect and physical, emotional, and sexual abuse. These do not sum to the cumulative incidence of 1 or more records of substantiated maltreatment because children may have experienced multiple notifications for different maltreatment types. The analysis of the data for this study was undertaken between November 2018 and March 2019 using Stata version 12 (StataCorp).

Results

A total of 153 670 children were included. Of these, 79 085 (51.5%) were male, 9625 (6.3%) were Aboriginal and Torres Strait Islanders, 40 480 (26.3%) had a mother who was born overseas, 5638 (3.7%) were born to mothers younger than 20 years; 95 544 (62.2%) lived in major cities, 56 723 (36.9%) lived in regional areas of New South Wales, and 1401 (0.9%) lived in remote areas of New South Wales. The cumulative incidence of screened-in notifications increased from 5.4% (n = 8309) at 1 year of age to 13.8% (n = 21 179) at 5 years of age (Figure 1). Of the children reported to CPS by age 5 years, 8309 (39.2%) were first reported by 1 year of age. By age 5 years, 12 185 of the 21 179 children (57.5%) with 1 or more screened-in notifications were investigated by CPS. The cumulative incidence of substantiated maltreatment was 3.2% (n = 4927 children) by age 5 years. Emotional abuse was the primary substantiated maltreatment type in 2584 children (1.7%) by 5 years of age, neglect in 1936 children (1.3%), physical abuse in 1155 children (0.8%), and sexual abuse in 471 children (0.3%) (Figure 2). The cumulative incidence of 1 or more OOHC placements was 0.5% of children (n = 751) by age 1 year and 1.4% (n = 2177) by age 5 years.

Figure 1. Cumulative Incidence of Child Protection Services Involvement in 153 670 Australian Children Aged 0 to 5 Years .

Notifications include all child concern reports made to the child protection helpline that were screened in by child protection services because they meet the statutory threshold for risk of harm (until January 2010) or risk of significant harm (from January 2010 onward), as defined in the NSW Children and Young Persons (Care and Protection) Act of 1998, No. 157, chapter 3, part 2, section 23. Prenatal notifications account for some of the percentage of children with 1 or more notifications at birth; the Responding to Prenatal Reports Policy was introduced in 2008. Investigations are recorded when a secondary assessment (ie, a face-to-face caseworker visit) of the notification was undertaken. Substantiations include all notifications from which maltreatment has been substantiated by child protection services. The data on out-of-home care (OOHC) placements include placements on care and protection orders, as well as voluntary care, emergency care, and respite placements.

Figure 2. Cumulative Incidence of the Primary Substantiated Maltreatment Type From Ages 0 to 5 Years Among 153 670 Australian Children.

Substantiations include all notifications from which maltreatment has been substantiated by child protection services by 5 years of age. The 4 primary substantiated maltreatment types do not sum to the cumulative incidence of 1 or more records of substantiated maltreatment because children may have been reported to child protection services multiple times for different maltreatment types, including other maltreatment types assessed by child protection services, including parent or caregiver drug and alcohol use or parental or caregiver mental health problems.

Discussion

We found that 1 in 7 children in New South Wales had 1 or more screened-in notifications to CPS by age 5 years, which is comparable in scale with common childhood illnesses, such as asthma. By age 5 years, maltreatment was substantiated in 1 in 30 children and 1 in 70 children were placed at least once in an OOHC placement. Despite differences in the processing of notifications and data recording practices, we found that early-childhood CPS involvement is common in children in New South Wales, similar to other Australian jurisdictions^5,6 and internationally.^2,3,4 Although variation in CPS involvement between jurisdictions may reflect differences in the prevalence of child maltreatment, it also reflects differences in system responses to vulnerable children.

Because 38 480 children (53%) in the cohort starting school in 2009 were born 1 to 22 (median, 4; interquartile range, 2-6) months before notifications were first recorded in the Key Information Directory System (November 1, 2003), the proportion of children with 1 or more notifications may be underestimated in the first year of life. However, a sensitivity analysis using data on children starting school in 2012 suggest that more than 80% of children described in notifications before November 1, 2003, would have been the subject of notifications again by age 5 years.

The scale of CPS involvement and substantiated child maltreatment confirms this is an important public health problem for young Australian children. Given that 2 in 5 children reported to CPS by age 5 years were first reported by age 1 year, an effective public health response may leverage routine health system contacts in the antenatal and postnatal periods to engage and support vulnerable families in a nonstigmatizing way to prevent maltreatment.