Scott Sims

Maternal mental health and risk of child protection involvement: mental health diagnoses associated with increased risk

Background Previous research shows that maternal mental illness is an important risk factor for child maltreatment. This study aims to quantify the relationship between maternal mental health and risk of child maltreatment according to the different types of mental health diagnoses. Methods The study used a retrospective cohort of children born in Western Australia between 1990 and 2005, with deidentified linked data from routine health and child protection collections. Results Nearly 1 in 10 children (9.2%) of mothers with a prior mental health contact had a maltreatment allegation. Alternatively, almost half the children with a maltreatment allegation had a mother with a mental health contact. After adjusting for other risk factors, a history of mental health contacts was associated with a more than doubled risk of allegations (HR=2.64, 95% CI 2.50 to 2.80). Overall, all mental health diagnostic groups were associated with an increased risk of allegations. The greatest risk was found for maternal intellectual disability, followed by disorders of childhood and psychological development, personality disorders, substance-related disorders, and organic disorders. Maltreatment allegations were substantiated at a slightly higher rate than for the general population. Conclusions Our study shows that maternal mental health is an important factor in child protection involvement. The level of risk varies across diagnostic groups. It is important that mothers with mental health issues are offered appropriate support and services. Adult mental health services should also be aware and discuss the impact of maternal mental health on the family and childrens safety and well-being.

Maltreatment risk among children with disabilities

Children with disabilities are at increased risk of maltreatment and this population-based study determines whether risk varies by type of disability. BACKGROUND: Children with disabilities are at increased risk of child maltreatment; however, there is a gap in the evidence about whether all disabilities are at equal risk and whether risk factors vary according to the type of disability. METHODS: A population-based record-linkage study of all children born in Western Australia between 1990 and 2010. Children with disabilities were identified by using population-based registers and risk of maltreatment determined by allegations reported to the Department for Child Protection and Family Support. RESULTS: Although children with disabilities make up 10.4% of the population, they represent 25.9% of children with a maltreatment allegation and 29.0% of those with a substantiated allegation; however, increased risk of maltreatment was not consistent across all disability types. Children with intellectual disability, mental/behavioral problems, and conduct disorder continued to have increased risk of an allegation and substantiated allegation after adjusting for child, family, and neighborhood risk factors. In contrast, adjusting for these factors resulted in children with autism having a lower risk, and children with Down syndrome and birth defects/cerebral palsy having the same risk as children without disability. CONCLUSIONS: The prevalence of disabilities in the child protection system suggests a need for awareness of the scope of issues faced by these children and the need for interagency collaboration to ensure children’s complex needs are met. Supports are needed for families with children with disabilities to assist in meeting the child’s health and developmental needs, but also to support the parents in managing the often more complex parenting environment.

Identifying families most likely to have missing paternal details in birth registrations using linked data

The purpose of this study was to determine the extent of missing paternal data in birth registrations and the characteristics of families most likely to have missing data. We used a retrospective cohort of children born in Western Australia between 1980 and 2005. Results revealed that the characteristics of families associated with missing paternal information included: living in areas of high socio-economic disadvantage; young single mothers; children and mothers of Aboriginal origin; smoking during pregnancy; preterm birth; and low birth weight. We found that the strong association between adverse child health outcomes and the absence of paternal information might be a source of bias in existing data. This bias may be introduced during the analysis of data because records are often excluded due to missing information. Excluding this data could lead to families at highest risk of adverse outcomes being removed from the sample and subsequently introducing bias. Consideration should be given to the collection of paternal details by midwives to aid in the monitoring and evaluation of birth outcomes of at risk mothers.

Visualising linked data using GIS: Western Australian Child Development Atlas

IntroductionWhere people live can strongly influence their level of exposure to health-damaging factors, their vulnerability to poor outcomes, and the consequences of experiencing those poor outcomes. Geographical mapping of child outcomes is therefore an important component of monitoring the health and wellbeing of children and young people. Objectives and ApproachThe Western Australian Child Development Atlas (CDA) maps population-level administrative, census, registry, and survey data, aggregated at various levels of geography. The project utilises geographic information system (GIS) technologies to identify and investigate spatial patterns in key health, social, learning and development indicators, overlaid by service locations. The CDA is an online, interactive platform that provides policy developers, service providers, communities, and government with access to quality and easily comprehendible spatial data on the outcomes of children and young people. This information helps to identify geographic areas of highest need and priority, and patterns in service distribution relative to need. ResultsThe CDA maps linked and non-linked de-identified aggregated data on children and young people (0-18 years) born or residing in Western Australia from 1990 until 2016. Key indicators from health, social, education, and welfare datasets are mapped at various levels of geography. Using a case example of a WA community, we demonstrate how the CDA can enable policy-makers, service providers, and researchers to better identify priority areas for improved child health and wellbeing, and implement place-based approaches to service delivery. Conclusion/ImplicationsMapping population data on children’s health and wellbeing can help identify areas of highest need and priority, and facilitate a targeted focus for service delivery within jurisdictional areas, including rural and remote regions. Outcomes can be monitored over time, enabling evaluation of the effectiveness of changes to service and policy.

Trends in alcohol-related injury admissions in adolescents in Western Australia and England: population-based cohort study

Background Alcohol-related harm in young people is now a global health priority. We examined trends in hospital admissions for alcohol-related injuries for adolescents in Western Australia (WA) and in England, identified groups most at risk and determined causes of injuries. Methods Annual incidence rates for alcohol-related injury rates were calculated using population-level hospital admissions data for WA and England. We compared trends in different types of alcohol-related injury by age and gender. Results Despite a decrease in the overall rate of injury admissions for people aged 13–17 years in WA, alcohol-related injuries have increased significantly from 1990 to 2009 (from 8 to 12 per 10 000). Conversely, alcohol-related injury rates have declined in England since 2007. In England, self-harm is the most frequently recorded cause of alcohol-related injury. In WA, unintentional injury is most common; however, violence-related harm is increasing for boys and girls. Conclusion Alcohol-related harm of sufficient severity to require hospital admission is increasing among adolescents in WA. Declining trends in England suggest that this trend is not inevitable or irreversible. More needs to be done to address alcohol-related harm, and on-going monitoring is required to assess the effectiveness of strategies.