Reports indicate that an increasing number of pregnant women are being notified to child protection authorities and infants removed from their families, often permanently. These notifications, substantiations, and removals disproportionately affect certain populations of Australians facing adversity, including Aboriginal and Torres Strait Islander communities and mothers who have previously had children removed. An extensive and ongoing program of work, led by Prof Melissa O’Donnell, Deputy Director, Research, has sought to examine and increase knowledge about the nature, extent, and impact of the removal of infants (<1 year old) and newborns from their mothers. The work aims to identify appropriate early intervention and prevention strategies to help prevent the removal of babies from their families, and to improve services and practices that are involved in child protection responses to perinatal notifications.
There are several projects that have and continue to contribute to this program of work, undertaken with a number of partner organisations highlighted below. The contributions of people with lived experience to this work has also been extensive; you can read more about this here.
Projects
Infants removed by child protection: nature, extent and impact
Funded by Australian Research Council Discovery grant
This project, undertaken in collaboration with Australian Catholic University, Murdoch University, Lancaster University and Chapin Hall at the University of Chicago, used administrative data, case file reviews and interviews with families to investigate the prevalence and incidence of pregnant mothers and infants involved in child protection; examine the processes to which families were subjected; and the extent and nature of services and interventions that families experienced.
Findings
The research determined that across most Australian states we are seeing increasing rates of mothers notified to child protection during pregnancy and increasing rate of infants subsequently removed. All Australian jurisdictions who collect and approved release of prenatal notification data experienced increases in the rates of children with prenatal notifications of 4% per year across Australia. Approximately 33% of children who were notified had a substantiated prenatal notification. Rates of infant entry to out-of-home care in Australia increased by 2% per year.
We also conducted interviews in Western Australia and New South Wales with mothers involved in child protection during pregnancy. Parents predominantly became involved with child protection services during pregnancy through a prenatal report. Parents who had their newborn removed from their care described it as sudden and unexpected, leaving them distressed and unsupported post-removal, with a growing list of requirements for them to see their baby or for restoration to be considered. Domestic violence was a particular issue of concern for some mothers who expressed distress that their partners, perpetrators of violence, were allowed access to their infant with fewer requirements than for them. Improvements recommended by the parents included greater communication and preparation for the removal, better recognition of improvements in their situations and increased supports to be provided to parents both pre- and post-removal.
Our other research findings utilising the New South Wales Pathways of Care Longitudinal Study found that a high proportion (70%) of infants who entered OoHC were assessed as developmentally vulnerable. This highlighted that these infants require comprehensive health and wellbeing assessments. The provision of early intervention services is essential for this group of high-risk infants and will be important in optimising their health, as well as social and emotional outcomes.
More detailed findings can be read in the project’s publications listed below.
Improving practice when child protection intervenes with pregnant mothers and newborns: co-design and evaluation of evidence informed guidelines
Funded by the Stan Perron Charitable Foundation
This project focusses on understanding the experiences of families and practitioners who have been involved with child protection processes and services, and using this feedback to improve practice guidance. Focus groups have been held with 15 service providers to determine the processes in which practitioners have been involved, as well as the services they have provided to families.
Our analysis of national data has also determined that in states where families are notified to child protection during the pregnancy, they are more likely to have a removal in first few months after the birth.
Samantha Burrow, our Perron-funded PhD student, has also conducted an international systematic review of parental views of perinatal support and processes with findings to be published.
Co-design workshops have been conducted with service providers and families to develop principles and leading practice guidance for working with families facing adversity during the perinatal period, many of whom are involved in child protection prior to and following the birth of their child.
Findings
While this work is still underway, the focus groups and interviews undertaken for this project have highlighted the challenges that these mothers face in the complexity of issues, adequacy of service provision, child protection involvement and the development of pre-birth plans to address their health and safety needs.
Future directions
The ACCP and our partners are continuing our work in this important area, with the aim of reducing infant removals and supporting vulnerable families in the perinatal period experiencing child protection interventions. With the findings from our work to date, we are now seeking to embark on the next phase, with the co-design of guidelines to optimise perinatal practice, including care coordination for mothers facing adversity. If you would like to support or partner in this next phase of work, please contact Prof Melissa O’Donnell, Deputy Director, Research.
Publications
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Infant and Pre-birth Involvement With Child Protection Across Australia (June 2023)
This study used a univariate Poisson regression analysis to examine trends in prenatal and postnatal infant child protection notifications, substantiations, and out-of-home care across jurisdictions in Australia (individually for NSW, WA, VIC and QLD, and collectively for SA, TAS, ACT and NT) from 2012 to 2019, using data from the Australian Institute of Health and Welfare. The study aimed to determine increases or decreases in number and timing of reports, substantiations, and removals; quantify the extent to which Aboriginal and Torres Strait Islander families are overrepresented in these actions; and examine associations, similarities, and differences between the jurisdictions. The study found that, while there were individual differences across jurisdictions, overall there was a rise in the rate of infants with substantiated notifications, which was associated with an increase in infants entering out-of-home care. For those states that approved release of prenatal notification data there was an overall 4% increase per year with 33% having a substantiated prenatal notification. Of infants removed, 28% were removed within a week of their birth, and 45% within their first month. This highlights the importance of pre-birth planning and support, and a need for alternative pathways to removals. In addition, the high level of Aboriginal and Torres Strait Islander representation among affected families points to a greater need for community-driven and culturally embedded services, which has also been identified in research among First Nations communities in Canada and New Zealand. There is some complexity in comparing Australian jurisdictions due to the differences in their child protection policies and practices.
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Parents' experiences with child protection during pregnancy and post-birth (November 2022)
Recognised by Wiley as a Top Downloaded Article in Child & Family Social Work
This study, involving qualitative interviews of 13 parents in NSW and WA, undertook a phenomenological approach to understanding their experiences with child protection intervention in the perinatal period. The findings were organised into a thematic timeline, highlighting the global themes which emerged from the parents’ interviews. The themes communicate the consistent concerns of parents dealing with perinatal child protection intervention, and their views on how the system can be improved, including changes within the corresponding government departments, and the importance of support provided by multidisciplinary non-government agency workers.
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Child protection proceedings for infants: Analysis of court files to identify court outcomes and requirements for families in child protection safety plans (February 2024)
This study comprised a court file review of 39 families involved in child protection proceedings in the pre-birth and infancy period (first year of life) in metropolitan WA, making up 19% of cases of infants admitted to care and protection orders in 2014/15. 36% of the families were reported to child protection prenatally, and 64% postnatally. Mixed methods analysis was used to conduct a quantitative analysis of the court file data and a qualitative analysis of safety plan requirements within the court files.
The study highlighted the complexity of the issues impacting the families in question, with families on average having three family issues/service referrals to address the concerns of the Department, with the main areas being drug and alcohol, parenting, mental health, and domestic violence. In some cases, requirements set for multiple families had consistency in wording across files, suggesting they were commonly implemented requirements. In others, there was unexplained inconsistency across the level of financial and logistical support offered to assist families in meeting those requirements. The considerable breadth of issues identified and requiring demonstrable outcomes highlights the need for greater sophistication in strategies to support these families who cross multiple service systems and have a high complexity of needs.
Of particular concern in the findings was significant onus placed on victims of domestic violence, usually the mother of the infant, to protect children from violence perpetrated by others, with reports of domestic violence to authorities potentially being used as evidence against reunification of the non-perpetrating parent and child. In addition, there was a lack of evidence in the files that was used to support families or provide evidence to refute the claims made by the Department. Therefore, the predominant views presented to the court and in the files were in relation to the Department’s child protection concerns.
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Infants entering out-of-home care: Health, developmental needs and service provision (December 2023)
This study used a combination of interview data from the Pathways of Care Longitudinal Study (POCLS), the first Australian large-scale longitudinal study to collect information on the wellbeing trajectories for children who have entered care, and standardised developmental assessments (the Ages and Stages Questionnaire (ASQ) and the Brief Infant Toddler Social Emotional Assessment (BITSEA)), combined with linked longitudinal administrative data from NSW government departments including the NSW Department of Communities and Justice and NSW Health. The study used these sources to determine the prevalence of developmental vulnerability in a sample of Aboriginal and non-Aboriginal children who entered care as infants, and the likelihood of service provision to these children in relation to developmental vulnerability. Among the study findings was that many more children were identified as developmentally vulnerable, compared to the number formally diagnosed with a developmental delay, highlighting the importance of developmental assessment of children who enter care as infants.
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Parents’ experiences of perinatal child protection processes: A systematic review and thematic synthesis informed by a socio-ecological approach (October 2024)
Nationally and internationally, researchers and practitioners are increasingly expressing concerns regarding the number of babies removed by child protection systems soon after birth and how child protection processes in the perinatal period (conception to one year following birth) impact families. This systematic review synthesises qualitative studies to gain an understanding of the experiences and needs of pregnant women, mothers, and fathers involved in perinatal child protection processes that occur in health, welfare, and legal systems. Multi-disciplinary electronic databases (13) were searched for relevant peer-reviewed journal articles written in English and published since 2000. Twenty-four articles met the inclusion criteria. Analysis adopted a socio-ecological approach and thematic synthesis. An expert advisory group comprised of lived experience advisors, service providers, and academics contributed to development of the thematic framework.
Although the reviewed studies were conducted between 2005 and 2023 with diverse participants from six countries, they highlight parents’ similar experiences of perinatal child protection processes. Parents’ experiences were synthesised according to spheres of the socio-ecological model:(i) At the individual level, parents described their love, hope, confusion, fear, agency, and anguish.(ii) Within relationships parents recounted broken parent-baby bonds, limited personal and professional support, and the implications of trauma and trust for parent-professional relationships.(iii) When engaging with organisations parents reported pervasive surveillance and harmful processes, inadequate communication and support, and power imbalances.(iv) At policy and societal levels parents’ experiences pointed to dominant Western norms and values, increased poverty and homelessness, compromised rights, and prejudicial perinatal policies.Also synthesised are parents’, professionals’, and researchers’ recommendations for improving perinatal child protection processes and supporting families. -
Hospital-Based Healthcare Workers’ Experiences of Involvement in Perinatal Child Protection Processes: A Scoping Literature Review (April 2024)
As the number of infants entering Out-of-Home Care at birth internationally continues to rise, Hospital-based healthcare workers (HBHCWs) are increasingly likely to become involved in ethically, morally, and legally complex child protection processes. This scoping review aimed to identify and synthesize qualitative literature pertaining to the perspectives of HBHCWs with experiences of involvement in child protection processes occurring in the perinatal period. JBI Methodology for Scoping Reviews guided this review. Databases Ovid MEDLINE, CINAHL Plus, PsycINFO, ProQuest, Web of Science, SCOPUS, and Informit were searched between March 1 and April 30, 2023. Eighteen sources were identified as meeting the criteria for inclusion following screening by two independent reviewers. Data extracted from the included sources are presented in narrative and tabular formats. Involvement in child protection processes is an inherently conflictual experience for HBHCWs and gives rise to internal, interpersonal, and interorganizational tensions. Involvement can have an enduring impact on the HBHCWs, particularly when an infant is removed from hospital by child protection authorities. Appropriate peer, managerial, and organizational level responses are essential to ameliorate risk to HBHCWs themselves and subsequently their practice with women, infants, and families. HBHCWs can provide valuable insight into the challenges of delivering healthcare at the interface of child protection. Future research should focus on building understanding of experiences across disciplines to ensure that interventions designed to prepare and support HBHCWs are effective and evidence-based.
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Child protection and developmental trajectories of children who entered care as infants (August 2024)
Infants have the highest rate of admission into out-of-home care in Australia,with rising rates of entry to care occurring around the world. Our previous research identified children who entered care as infants as having high levels of developmental vulnerability. The objective of this study was to determine the child protection and developmental trajectories of children who entered care as infants and whether meeting developmental needs through service provision improves trajectories and outcomes for these children. This is a prospective cohort study using three waves (2011–2016) of survey data from the New South Wales Pathways of Care Longitudinal Study which includes standardised assessments (Age and Stages Questionnaire, Brief Infant Toddler Social Emotional Assessment and the Child Behaviour Checklist), as well as linked administrative child protection and health data. Our findings suggest that children who entered care as infants predominantly remained in the care system and had a high level of developmental vulnerability as infants. A large group had positive physical and cognitive developmental trajectories with service provision increasing over time; however, early service provision is needed. Another group was identified as having early social–emotional concerns and displaying worsening social–emotional trajectories. Intervention for this group is an important priority to reduce risk of ongoing poor mental health outcomes.
