Article: How we could do better for vulnerable children

Young women sitting alone with head down

CEI Directors Dr Vanessa Rose and Dr Melinda Polimeni draw attention to how policymakers might better address child protection in this article published in The Mandarin this week.

The article is reproduced in full below.

The statistics on child maltreatment in Australia make for grim reading.

In the recently released five-year Australian Child Maltreatment Study, 62% of the 8,503 people surveyed (all aged 16 or older) indicated they had been abused, neglected or exposed to domestic violence as children.

Tellingly, this large-scale study found that people who reported experiencing childhood maltreatment were far more likely to have poorer lifelong health outcome – underscoring the continuing impact of negative early life experience.

The darkest end of this picture is the almost 180,000 under-18s across Australia who received child protection services in the latest year-end data. That is, 32 in every 1,000 children – including almost 50,000 kids subjected to substantiated abuse or neglect.

Sadly, despite decades of reform by governments of all persuasions, the number of children in contact with child protection services continues to climb.

This matters. With children and families, receiving the right service at the right time can literally change a life. Whereas ill-informed or poorly implemented services can prolong or even worsen problems, creating potentially life-long harm in traumatised children as they grow into adults.

In the face of this overwhelming challenge, what can governments do?

The challenge of evidence into practice

At a very basic level, we need more action informed by evidence of what works, alongside quality implementation of this evidence relevant to local context. While it sounds simplistic, these two elements have proven very difficult to achieve in child protection.

Weak evidence increases the risk that services or reforms do not improve the lives of vulnerable children and families – or may even do more harm than good. There are numerous examples of this.

An urgent approach to evidence synthesis in the field of child protection – akin to the rapid gathering and review done in public health as Covid-19 swept the planet – could change the game for evidence-hungry policymakers. In response to the pandemic, evidence synthesis reduced the gap between the best-available public health evidence and responsible, actionable, evidence-informed public policy.

Some evidence is already available – such as what child and family early intervention programs and practices work, because their impact has been demonstrated through rigorous testing. But the issue for policymakers is that often this evidence is not ‘generalisable’ to Australian contexts or populations.

Our challenge is then to take heed of this evidence but apply it in locally relevant ways.

The benefit of better implementation

While synthesising evidence can be very useful in helping sort the ‘wheat from the chaff’ – what programs and practices might be effective – it is even more important to look at how programs are implemented.

Research shows that high-quality implementation can even outdo evidence. Ironically, novel or less well-evidenced social programs and practices backed by implementation science can actually be more effective than well-evidenced ones poorly implemented.

This is because local context is vital in tackling the complexities of social issues. Experience shows that a program or practice with good evidence of success in, say, rural England, may not have the same success in suburban Australia or even in rural Australia, if simply transplanted.

Rigorous implementation with regard to the local context makes all the difference to any evidence-based intervention: things like expert coaching and practice adjustments in response to targeted and continuous monitoring, underpinned by high-quality evaluation data.

Alongside all this, an approach termed ‘common elements’ may also be useful. Many evidence-based programs in child and family services consist of different combinations of the same therapeutic elements – so there is benefit to be gained from distilling these practices to their universal core.

The common elements approach is rooted in adaptation. It’s about getting to the essence of what works and using this to empower front-line workers in their local context. Common elements can be employed alongside or form part of other evidence-based programs. They are locally owned and readily available, relatively low-cost to implement and, because they are user-centred, they can target children’s and families’ needs more effectively.

Service and system reform failures in child protection have enormous social and economic costs. Weak or insufficient evidence and poor implementation means that opportunities to improve services and minimise waste are missed, and scarce public resources spent for little or no benefit.

Strong evidence foundations and an emphasis on good implementation can tip the balance toward success. And child protection is a field in which, surely, there is an urgent need for that.

For more on how a common elements approach is being applied in child and family services, read this article on The Response in Victoria.
For more on common elements, see this page and watch our animation.