In Australia, the proportion of Aboriginal children in out-of-home care (placement of a child with alternate caregivers on a short or long-term basis) is up to 17 times that of non-Aboriginal children in states such as Western Australia.
Data also suggest the rates for Aboriginal children are increasing, and that Aboriginal children are entering out-of-home care at earlier ages and staying for longer durations. Also of concern is that the number of Aboriginal children placed with kinship carers is declining.
A National Health and Medical Research Council funded project, led by Professor Sandra Eades with the ACCP’s Professor Melissa O’Donnell as a Chief Investigator, and supported by ACCP Research Fellow Dr Miriam Maclean and Research Assistant Fernando Lima, aims to identify factors that help to reduce the number of children going into out-of-home care and ways to better support families at risk, children in care, and kinship carers. As part of this project, the ACCP has undertaken linked administrative data analysis and is providing detailed contemporary and integrated data to estimate rates of Aboriginal children entering the child protection system, and identifying the intergenerational health predictors of children and families before they enter the child protection system and health outcomes after they are in care.
Aims
This project, which is co-creating research knowledge through partnerships with Aboriginal communities, aims to:
- Examine contemporary trends, patterns and characteristics of WA Aboriginal children entering the child protection system, particularly the clustering of risk within families and geographic regions.
- Identify the intergenerational demographic, social, and health predictors of out-of-home care among children during their first 10 years of life, their parents, and grandparents.
- Explore the views and narratives from Aboriginal kinship carers about positive and negative experiences of providing out-of-home care to Aboriginal children and their perceptions on how they can be better supported.
- Explore the views and narratives from Aboriginal primary health care staff about how services can be strengthened to support families at risk of having their children removed, to increase kinship carer arrangements and to better support kinship carers
- Work with policy makers and health practitioners to implement the findings into policy and practice.
Aboriginal-led process
The project recognises that addressing the over-representation of Aboriginal children in care will require Aboriginal-led strategies, governments working in partnership with communities and families, and holistic strategies that cross government portfolios and include the voices of families and communities.
Importantly, listening to perspectives from the Aboriginal community through this project is helping to identify a number of support systems for Aboriginal children and families including for kinship carers, so that children going into out-of-home care can stay connected to their culture and community.
Data Findings
Studies taken within the i-CaRe project to this point have resulted in findings including:
There are high rates of child protection involvement
- Among 15,815 Aboriginal children born in WA 2000-2006, 9,269 (59%) children did not have any contact with child protection between one year prior to birth and their 11th birthday. Conversely, 6,546 (41%) Aboriginal children in the study period were involved with child protection, with 1,405 (9%) children placed in out-of-home care. Infants who had a child protection notification were more likely than other age groups to have a substantiated notification of abuse and neglect and placed in out-of-home care.
- Among Aboriginal and/or Torres Strait Islander children born in Western Australia 2000-2013, using child protection data 2000-2015, over 50% had at least one notification to child protection, 27% had a substantiated notification, and 15% had ever had a placement in out-of-home care.
- More than half (56%) of all children were predominantly placed in kinship care; however, only 22% had their first placement with kinship carers.
Alarming trends across time, coinciding with legislative and policy changes
- There was an increase in early-childhood contacts for children born more recently, with 7.6% and 2.3% of children born in 2000–2001 having a notification and placement in out-of-home care by age one, respectively, compared to 15.1% and 4.3% of children born in 2012–2013.
- Among sibling groups where at least one sibling had a child protection contact, approximately half of children had their first contacts on the same date as another sibling. For children born after one of their siblings had been placed in out-of-home care, 31.9% had themselves been placed in out-of-home care by age one.
- When examining by birth cohort, the more recently born the birth cohort, the earlier their first interactions with the child protection system tended to be.
- Increasing interactions occurring at earlier ages coincides with legislative and policy changes.
There may be variation in disability diagnoses across regions, and delayed diagnoses or access to services
- Data linkage indicates that 3.3% of Aboriginal children born in WA 2000-2013 were diagnosed with developmental disability by 18 years. The most common diagnosis (2.5%) was intellectual disability (ID) without fetal alcohol spectrum disorder (FASD). Using NDIS data, 3.1% of Aboriginal children were NDIS participants with development disability in 2021, but only 0.7% of children with ID without FASD. Instead, autism was most common diagnosis. Aboriginal children were more likely than non-Aboriginal children to be NDIS participants with autism, ID without FASD, and ID with FASD. Aboriginal NDIS participants with ID had an older age distribution than non-Aboriginal participants.
ACCHOs see opportunities to improve intersectoral collaboration and strengthen systems to protect children
- Consultation with participants from Western Australian Aboriginal Community Controlled Health Organisations indicates that intersectoral collaboration would be improved by strengthening service resourcing, coverage and availability, addressing high turnover, and increasing emphasis on Aboriginal-led care and aligning approaches between sectors. There is need to review out-of-home and kinship models of care to strengthen the system, including creating more formal and structured modes of collaborating and better resourcing family support and kinship care.
Project Findings
The final stages of the project have been consolidating the findings of the data analysis with the views and perspectives of Aboriginal communities and Aboriginal primary care providers to determine new policy and practice solutions, to better support families at risk of having their children removed. In addition there has been a focus on understanding how to increase kinship care arrangements as the preferred culturally safe out-of-home care option for Aboriginal children, and further support kinship carers providing out-of-home care to Aboriginal children. Identified areas for improvement include improved communication including information sharing and interagency meetings, strengthening service resourcing and availability including geographical coverage, and reducing program turnover. The need for a shift in approach, including more emphasis on Aboriginal-led care and aligning approaches between sectors is another area identified requiring strengthening. In addition, the need to review the out-of-home and kinship care models to strengthen the system, including creating more formal and structured modes of collaborating and better resourcing family support and kinship care were highlighted as key for changing the current trajectory for Aboriginal children and families at risk of coming into contact with child protection.
If you'd like to know more about the study, contact Professor Melissa O'Donnell (below).
Publications
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Intersectoral collaboration for supporting the health and wellbeing of Aboriginal families and children in out-of-home care: perspectives from Western Australian Aboriginal Community Controlled Health Organisations (2024)
Western Australia has one of the highest rates of Aboriginal children entering out-of-home care in Australia. Kinship care is the preferred culturally safe out-of-home care option for Aboriginal children, yet all jurisdictions, including Western Australia, are far from meeting best-practice national standards. Intersectoral collaboration is a key primary healthcare principle and internationally recognized for improving health systems and outcomes. This paper presents findings from a qualitative research project investigating Aboriginal primary healthcare workers’ experiences of intersectoral collaboration challenges and strengthening opportunities. Constructivist grounded theory guided this research involving 55 semi-structured interviews and four focus group discussions with Aboriginal primary healthcare workers. The research was guided by Indigenous methodologies and led by Indigenous researchers Participants were recruited from seven Aboriginal Community Controlled Health Organisations located across Perth metro, Pilbara, Midwest/Gascoyne and Southwest regions in Western Australia. Key themes identified around intersectoral collaboration challenges were communication, including information sharing and interagency meetings, and the relationship with the government sector, including trust and the importance of the perception of Aboriginal health service independence. Key themes around strengthening areas to improve intersectoral collaboration included strengthening service resourcing and coverage, including the availability of services, and addressing high program turnover. The need for a shift in approach, including more emphasis on Aboriginal-led care and aligning approaches between sectors, was another area for strengthening. This study addresses a significant research gap concerning out-of-home care, kinship care, and intersectoral collaboration in an Australian Aboriginal context. Findings highlighted the need to review the out-of-home and kinship models of care to strengthen the system, including creating more formal and structured modes of collaborating and better resourcing family support and kinship care.
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Aboriginal Children Placed in Out-of-Home Care: Pathways Through the Child Protection System (2024)
The overrepresentation of Aboriginal and Torres Strait Islander (respectfully referred to hereafter as “Aboriginal”) children in the child protection system is a concern in Australia, with Aboriginal children placed in out-of-home care at a rate 11 times that of non-Aboriginal children. This study utilised linked administrative data to determine the longitudinal child protection pathways from birth to age 10 years for a cohort of 15,815 Aboriginal children born in Western Australia between 2000 and 2006. In total, 9,269 (59%) children did not have any contact with child protection between one year prior to birth and their 11th birthday. Conversely, 6,546 (41%) Aboriginal children were involved with child protection during the study period, with 1,405 (9%) children placed in out-of-home care. Infants who had a child protection notification were more likely than other age groups to have a substantiated notification of abuse and neglect and placed in out-of-home care. More than half (56%) of all children were predominantly placed in kinship care; however, only 22% had their first placement with kinship carers. Aboriginal-led strategies together with the support and commitment of all levels of government are required to reduce entry into care and improve outcomes for Aboriginal children in care.
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Cumulative incidence of child protection system contacts among a cohort of Western Australian Aboriginal children born 2000 to 2013 (2023)
Reducing the over-representation of Aboriginal children in the child protection system is a key target for the Australian government. We aimed to provide more recent evidence on the population-level cumulative incidence of contacts for Aboriginal children with child protective services (CPS) in Western Australia (WA). Linked administrative data was provided for WA CPS between 2000 and 2015 for 33,709 Aboriginal children born in WA between 2000 and 2013. Descriptive summaries and cumulative incidence estimates were used to examine changes in CPS contact trends over time and within sibling groups. There was an increase in early-childhood contacts for children born more recently, with 7.6% and 2.3% of children born in 2000–2001 having a notification and placement in out-of-home care by age one, respectively, compared to 15.1% and 4.3% of children born in 2012–2013. Among sibling groups where at least one sibling had a CPS contact, approximately half of children had their first contacts on the same date as another sibling. For children born after one of their siblings had been placed in out-of-home care, 31.9% had themselves been placed in out-of-home care by age one. Multiple children tend to be placed into out-of-home care when at least one sibling is, which is likely to have a significant impact on families affected. The additional risk of placement also carries over to children born after the first removal in a sibling group, highlighting the need for further support to prevent future removals.
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Developmental disability among Aboriginal children in Western Australia (WA) (2022)
While Aboriginal Australians are known to be disproportionately affected by intellectual disabilities (ID) and/or autism spectrum disorders (developmental disabilities), true prevalences among Aboriginal children are unclear, with evidence of delayed and missed diagnoses and barriers to services. This study estimated these prevalences and disability service use among WA Aboriginal children. Two cohorts and data sources were used. Firstly, a state-based health and disability data linkage for all WA Aboriginal children born 2000-2013, including hospital, public outpatient mental health, birth and death data and state registries of birth defects, cerebral palsy and ID. The cumulative incidence of diagnosis by age 18 was estimated. Secondly, prevalence of service access was estimated from all National Disability Insurance Scheme (NDIS) WA Aboriginal and non-Aboriginal participants aged 0-17 on 30/6/2021 with a primary diagnosis of ID (with or without fetal alcohol spectrum disorder (FASD)) or autism. Census population counts were denominators. Using the data linkage, 3.3% of Aboriginal children born 2000-2013 were diagnosed with developmental disability by 18 years. The most common diagnosis (2.5%) was ID without FASD. Using NDIS data, 3.1% of Aboriginal children were NDIS participants with development disability in 2021, but only 0.7% of children with ID without FASD. Instead, autism was most common diagnosis. Aboriginal children were more likely than non-Aboriginal children to be NDIS participants with autism (prevalence ratio (PR): 1.16, 95% confidence interval (CI): 1.06-1.26), ID without FASD (PR: 2.06, 95% CI: 1.80-2.35) and ID with FASD (PR: 40.5, 95%CI: 29.9-57.1). For both data sources, prevalences differed by region. Aboriginal NDIS participants with ID had an older age distribution than non-Aboriginal participants. For both cohorts, the prevalence of developmental disability was >3%, though the contributions of ID and autism differed in the two data sources. Variation in diagnoses by region and Aboriginal status may indicate differential diagnosis and variation in age suggests delayed diagnoses or access to services for Aboriginal children.
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Trends in the removal of Aboriginal children in Western Australia (2022)
To understand in greater detail the rates of interaction Indigenous children have with the child protection system in Western Australia and how they vary by birth year, geographic region, and between family units, we used data linkage between the Western Australian Department of Communities (child protection data), the Midwives Notification System, and Deaths Registry. Our cohort consisted of all Aboriginal and/or Torres Strait Islander children born in Western Australia between 2000 and 2013, with child protection data available from 2000 to 2015. We used cumulative incidence curves to visualise the overall rates of interactions with the child protection system and decompose interactions using seven two-year birth cohorts, geographic child protection regions and family units. Overall, the cohort there was a high level involvement of Indigenous children in the child protection system, with over 50% having at least one notification, 27% having a substantiated notification, and 15% ever having a placement in out-of-home care. When examining by birth cohort, the more recently born the birth cohort the earlier their first interactions with the child protection system tended to be. Results for the geographic and family unit analyses will be presented as this work is ongoing. Increasing interactions occurring at earlier ages coincides with legislative and policy changes. The increase in placement in out-of-home care before the age of 1 for the most recently born cohorts warrants further investigation into whether this is occurring across the system or within particular communities or regions.
