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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. IMPLICATIONS Aboriginal-led strategies and wholistic responses can reduce the overrepresentation of Aboriginal children reported to child protection systems, and support families and communities. Infancy stands out as a key point of system involvement. This stage offers an opportunity where early intervention and family support strategies may prevent first time involvement with the child protection services and promote kinship placement, reunification with parents, and community-led supportive care. [ABSTRACT FROM AUTHOR]

Globally, Indigenous children have historical and contemporary connections with government child protection services that have caused significant harm to their long-term health and wellbeing. Innovative, culturally secure and recovery focussed service provision is required. This paper describes a research protocol that has been designed by Indigenous researchers led by Indigenous Elders, to explore culturally secure care planning and service delivery in out-of-home care agencies in Australia. Using participatory action research methods, we will collect data using a variety of forums, including focus groups and semi-structured interviews. These data will explore the challenges for out-of-home care agencies in providing culturally secure care-planning, cultural activity and resources, and explore solutions to address factors that influence health and can assist to redress social inequities for Indigenous children. We aim to recruit approximately 100 participants for the qualitative study and 40 participants for the quantitative survey. Study participants will initially be recruited using purposive sampling, and as the study progresses will be recruited using a mixture of purposive and convenience sampling techniques. The rich data that this study is expected to yield, will inform ways to collect cultural information about Indigenous children and ways to provide cultural connections and activities that will have benefit to Indigenous children and families, and a broad range of social services. [ABSTRACT FROM AUTHOR]

Policies aiming to improve educational outcomes are typically based on academic testing data. However, such data only reflect the performance of students who completed the tests. It is possible that students who were absent have shared characteristics. The proportion of students absent out of all eligible school students and whether they have shared characteristics has not been investigated, as this is only possible through the use of linked administrative data. Participants were born in Western Australia in 1994 and 1995, and their birth records were linked to participation status in the Year 9 academic tests to determine the proportion of students who were absent. Logistic regression was conducted to investigate characteristics which predicted absence on test day. A proportion of non-Aboriginal (3.2%) and Aboriginal students (21.9%) were absent on test day. Risk factors which predicted the absence included contact with Child Protection and Family Services, history of maternal mental health problems, and fathers aged below 20 years at the time of their child's birth. A significant proportion of students was absent and therefore not represented in academic achievement information. These students were more likely to have experienced adverse events and therefore are not randomly absent. As these data are typically used to inform policies which aim to improve educational outcomes, they may lack the necessary information to adequately address the complex needs of students who are absent on test day. However, findings suggest that service providers, as well as schools may play an important role in encouraging participation in school.

Background: To investigate associations between interpregnancy intervals (IPIs) and adverse birth outcomes in twin pregnancies. Methods: This retrospective cohort study of 9,867 twin pregnancies in Western Australia from 1980–2015. Relative Risks (RRs) were estimated for the interval prior to the pregnancy (IPI) as the exposure and after the pregnancy as a negative control exposure for preterm birth (< 37 weeks), early preterm birth (< 34 weeks), small for gestational age (SGA: < 10th percentile of birth weight by sex and gestational age) and low birth weight (LBW: birthweight < 2,500 g). Results: Relative to IPIs of 18–23 months, IPIs of < 6 months were associated with a higher risk of early preterm birth (aRR 1.41, 95% CI 1.08–1.83) and LBW for at least one twin (aRR 1.16, 95% CI 1.06–1.28). IPIs of 6–11 months were associated with a higher risk of SGA (aRR 1.24, 95% CI 1.01–1.54) and LBW for at least one twin (aRR 1.09, 95% CI 1.01–1.19). IPIs of 60–119 months and ≥ 120 months were associated with an increased risk of preterm birth (RR 1.12, 95% CI 1.03–1.22; and (aRR 1.25, 95% CI 1.10–1.41, respectively), and LBW for at least one twin (aRR 1.17, 95% CI 1.08–1.28; and aRR 1.20, 95% CI 1.05–1.36, respectively). IPIs of ≥ 120 months were also associated with an increased risk of early preterm birth (aRR 1.42, 95% CI 1.01–2.00). After negative control analysis, IPIs ≥ 120 months remained associated with early preterm birth and LBW. Conclusion: Evidence for adverse associations with twin birth outcomes was strongest for long IPIs. [ABSTRACT FROM AUTHOR]

Infants (<1 year old) are the age group in Australia with the highest rate of involvement with child protection. Many jurisdictions across Australia and internationally are implementing policies focused on prenatal planning and targeted support. This study investigates Australian trends in prenatal and infant child protection notifications, substantiations and out-of-home care; and the extent of over-representation of Aboriginal and Torres Strait Islander infants. Data was provided by the Australian Institute of Health and Welfare for the period 1 July 2012-30 June 2019. Univariate Poisson regression analysis was conducted, reporting the percentage change in the incidence rate ratios. All Australian jurisdictions who collect and approved release of prenatal notification data experienced increases in the rates of children with prenatal notifications, with a 4% (IRR: 1.04(1.04–1.05)) overall increase per year across Australia. Approximately 33% of children had substantiated prenatal notifications. Rates of infant notifications and entry to care in Australia increased overall by 3% (IRR:1.03(1.03–1.04)) and 2% per year (IRR:1.02(1.01–1.03)), respectively. With rising numbers of families reported prenatally and during infancy, greater evidence of the effectiveness of policies, interventions and outcomes for children and families is required. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prevalence, trends, and characteristics of maltreatment and assault related hospital admissions and deaths among children; and identify common injuries and conditions associated with these admissions using routinely collected morbidity and mortality data. Methods: A retrospective cohort study of all children aged 0-17 years in Western Australia from 1980 to 2005 was identified from linked de-identified population level data. Annual trends in prevalence of assault and maltreatment related admissions were calculated and child characteristics were investigated using logistic regression models. Results: Assault admissions more than doubled from 2.8 per 10,000 children in 1981 to 6.1 per 10,000 in 2005 (p less than 0.0001) and maltreatment admissions rose from 0.7 per 10,000 children in 1981 to 1.3 per 10,000 in 2005 (p less than 0.0001). Males aged greater than 12 years were at greater risk of an assault, while children aged less than 6 years were more likely to be at risk of maltreatment as well as those from greater disadvantaged backgrounds. Aboriginal children were more likely to be identified with assault and maltreatment compared to non-Aboriginal children. Common indicators of assault admissions included injuries of the skull and facial bones, intracranial, wrist, hand, and abdominal injuries. Children with maltreatment-related admissions were more likely to have superficial head or abdominal injuries and a high proportion had infectious and parasitic diseases, particularly intestinal infections. Many of these cases were associated with factors influencing health status, particularly socioeconomic and psychosocial circumstances. Conclusions: There has been a steady increase in the prevalence of assault and maltreatment related admissions. Specific child characteristics and injuries associated with child assault and maltreatment-related admissions have been identified using routinely collected morbidity data and may be utilized as potential indicators for identifying and monitoring child abuse and neglect. Practice implications: Broadening child maltreatment surveillance to children's admissions for assault and maltreatment is an important public health initiative which can be improved by the increased use of external cause codes. Health data is collected using international coding standards enhancing comparability across states and countries and has clinical implications in highlighting injuries associated with child abuse and neglect. (Contains 2 figures and 4 tables.)

Limited research has directly sought the input of parents involved in the child protection system during pregnancy and with their infants. As the focus of these policies and practices, parents have a unique and important insight not available to others, so it is vital to obtain their input. As part of a larger Australian study, qualitative interviews were undertaken with 13 parents asking about their views and experiences. Parents predominantly became involved with child protection services during pregnancy through a prenatal report. Parents who previously 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. Parental experiences provide an important guide to improving child protection practice with these families. [ABSTRACT FROM AUTHOR]

The article discusses the results of an exploratory study aimed to provide policymakers with a rapid analysis of the extent of child protection involvement for individual children and their families, and the characteristics of families reported. Topics covered include the sources of data utilized, the research in partnership towards system improvement and the extent and patterns of involvement with child protection over the life of the family.

The aim of this study was to examine the key sociodemographic characteristics of Australian mothers and their children who were victims of family and domestic violence (FDV) that resulted in the male perpetrator being criminally charged for the offense or the mother being hospitalized. A population-based retrospective cohort study using de-identified linked health and police data of mothers with children born 1987–2010 who were victims of FDV 2004–2008 was utilized. Results indicate that mothers who were identified in police data are different demographically from those identified in health data and differed again from mothers identified in both health and police data. Within Western Australia, 3% of the population identify as Aboriginal; however, 44% of mothers identified as victims in police data and 73% within the health data were Aboriginal. Of the mothers identified in police data, 30% were under 25 years of age at their first assault recorded in police data compared with 21% in those identified in both police and hospital data. Most mothers identified as victims of FDV in police data had children present at their assault (60.6%). Prevalence of FDV exposure, identified in police data, was significantly different in Aboriginal children compared with non-Aboriginal children. Aboriginal children had a 19-fold (p <.0001) increased difference in prevalence of exposure compared with their non-Aboriginal counterparts. The study reveals the challenges in identifying victims of FDV when relying on a single data source for research and highlights the need for multiple datasets when investigating FDV. The overrepresentation of Aboriginal mothers and children should be taken in the context of the long-lasting impact of colonization. As such, prevention and early intervention strategies need to be underpinned by Aboriginal communities' cultural authority. [ABSTRACT FROM AUTHOR]

This study aims to determine the prevalence, and trends over time, of Western Australian (WA) mothers who were victims of intimate partner violence (IPV) requiring hospital admission. The study investigated the prevalence of all mothers and the specific prevalence of Aboriginal and non-Aboriginal mothers. A population-based cohort study using de-identified linked health data of mothers of children born from 1990 to 2009 in WA was carried out. The prevalence of hospitalizations for IPV in mothers of children born in the period 1990-2009 (per 1,000 births) was calculated. Results indicate that the overall prevalence of hospital admissions for mothers assaulted 12 months prior to their child's birth month increased in the period 1990-2009, from 2.7 to 7.7 per 1,000 births. There was also an increase in the overall prevalence of hospital admissions of mothers who were assaulted 12 months prior to the birth month and 36 months after the birth month, from 8.9 per 1,000 births in 1990 to 19.4 per 1,000 births in 2009. In addition, being Aboriginal, having a mother <30 years of age, and being of low SES significantly increased the odds of having a mother with an IPV admission. This study highlights that while there has been an increase in the prevalence of IPV admissions for mothers of children born from 1990 to 2009 in WA, the level of prevalence has remained persistent for the last decade for the whole population. However, non-Aboriginal mothers have seen an increase in prevalence in the last decade. This increase is associated with the introduction of the Z63.0 code in International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM). This study highlights the importance of prioritizing groups for targeted early intervention and prevention as well as the need for culturally appropriate strategies to reduce the burden of interpersonal violence. [ABSTRACT FROM AUTHOR]

Undertaking research with young people presents an array of methodological challenges. We report the findings from a qualitative study that took place alongside a fetal alcohol spectrum disorder (FASD) prevalence study among detainees in Australia. Of 38 participants, 27 were Aboriginal youth. Interviews were conducted using "social yarning" and "research topic yarning," an Indigenous research method which allows for data collection in an exploratory, culturally safe way. A complex interplay emerged between social yarning and research topic yarning which provided a space to explore responsively with participants their experiences of FASD assessments. Flexibility, including language adaptation and visual descriptions about assessments, was utilized to assist participants recall and retell their experiences. There were, however, challenges in gathering data on the assessment experiences of some participants. We describe how employing a "yarning" method for collecting data could benefit children and young people undergoing neurodevelopmental assessments in the future. [ABSTRACT FROM AUTHOR]

Data linkage holds great promise for generating new information about people with intellectual and developmental disabilities (IDD) as a population, yet few centers have developed the infrastructure to utilize this methodology. Two examples, from Canada and Australia, describe their efforts in building data linkage capabilities, and how linked databases can be used to identify persons with IDD and used for population-based research. The value of data linkage is illustrated through new estimates of prevalence of IDD; health service utilization patterns; associations with sociodemographic characteristics, and with physical and mental health conditions (e.g., chronic diseases, injury, fertility, and depression); and findings on equity in medical treatments. Examples are provided of findings used for governmental policy and program planning. [ABSTRACT FROM AUTHOR]

The article discusses a study which determine the extent to which children with hospital admissions related to assault, maltreatment or a notified sexually transmitted infection (STI) have contact with child protection agencies in Australia. From 2002-2003 to 2006-2007, rates of notified child maltreatment in Australia has increased by 50 percent. The common injuries and conditions of children who had contact with Australia's Department for Child Protection (DCP) include retinal hemorrhage, rib fractures, multiple injuries and malnourishment.

Children who enter out-of-home care ('care') are at increased risk for low academic achievement. Nonetheless, some children who have experienced out-of-home care achieve highly. Several qualitative studies of academically successful young adults with care histories have highlighted factors that may contribute to positive outcomes; however longitudinal cohort research is needed to identify characteristics and predictors of higher achieving younger children who experienced care. To describe characteristics and circumstances of children with higher reading achievement who had entered care, and predictors of higher achievement. The study included 778 children from the Pathways of Care Longitudinal Study (POCLS) in New South Wales, Australia. Prospective cohort data from interviews and linked administrative child protection and education data were used to identify factors associated with higher Year 3 reading achievement among Aboriginal and non-Aboriginal children that may assist in improving outcomes. Although a lower proportion than the general population, almost half (46 %) of children who entered care were in the higher achievement group. Higher achieving students were a diverse group and faced many adversities commonly found among children who experienced care generally. Multivariable logistic regression showed higher achievement in the cohort was significantly associated with: average or above cognitive ability, low externalizing behaviour, highly-educated carers, and non-Aboriginal students. Several supports and services were associated with higher achievement, but inconsistently across analyses. Results indicate potential interventions could target cognitive ability, wellbeing and environmental factors, and involve interventions directly with children and via carers to improve student outcomes. [ABSTRACT FROM AUTHOR]

Researchers have examined sub-groups that may exist among young people transitioning from out-of-home care (OHC) using various theoretical models. However, this population group has not been examined for trajectories of homelessness risk. To examine whether different subtypes of homelessness risk exist among young people transitioning from care and whether these trajectories of homelessness are associated with mental health and substance use disorders. A retrospective population-based cohort study was conducted from a population of 1018 young people (aged 15–18 years) who transitioned from out-of-home in 2013 to 2014 in the state of Victoria, Australia, with follow-up to 2018. Latent Class Growth Analysis was conducted using linked data from homelessness data collections, child protection, mental health information systems, alcohol and drug use, and youth justice information systems. Three sub-groups of young people were identified. The 'moving on' group (88 %) had the lowest levels of homelessness, with the slope of this trajectory remaining almost stable. The ' survivors' (7 %) group started off with a high risk of homelessness, followed by a sharp decrease in homelessness risk over time. The ' complex' (5 %) group started off with a low risk of homelessness but faced sharp increases in the risk of homelessness over time. Our study demonstrates that subgroups of young people transitioning from care exist with distinct longitudinal trajectories of homelessness, and these classes are associated with different risk factors. Early intervention and different approaches to tackling homelessness should be considered for these three distinct groups before transitioning from care and during the first few years after leaving care. [ABSTRACT FROM AUTHOR]

There are rising numbers of infants entering out-of-home care due to child protection concerns. Research has found that infants entering care are at higher risk of developmental vulnerability and poor health problems. To determine the prevalence of developmental vulnerability for children who entered care as infants, and the extent and likelihood of service provision in relation to their developmental vulnerability. This study includes children who entered care before the age of 1 year for the first time between May 2010 and October 2011 in New South Wales, Australia, and who received final Children's Court care and protection orders by 30 April 2013. This is a prospective cohort study using interview data from the Pathways of Care Longitudinal Study (POCLS) as well as linked administrative child protection and health data. This study used standardised assessments (Age and Stages Questionnaire and the Brief Infant Toddler Social Emotional Assessment) included in the POCLS. Simple and multiple logistic regression analysis was conducted to investigate the likelihood of infants receiving professional services for developmental delays since placement. A high proportion of children who entered care as infants were identified as developmentally vulnerable through health indicators (36 %) and standardised assessments (70 %). Only 17 % of infants in care received services for developmental delay, with 20 % and 15 % of those identified as developmentally vulnerable through standardised assessments and health-related variables receiving services, respectively. The findings point to the importance of developmental assessment of infants in care and the identification of developmental vulnerability and delays. 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. • A high proportion of infants in care were identified as developmentally vulnerable through health and standardised measures. • Only 17.5% of infants in care received services for developmental delay. • The majority of children identified by carers as diagnosed by a health professional were receiving services. [ABSTRACT FROM AUTHOR]

We examined the relationship between a maternal alcohol-use diagnosis, and the timing of diagnosis, and child protection outcomes in a Western Australian population cohort. This analysis made use of routinely collected linked administrative health and child protection data. Those in scope for the study were women who had a birth recorded on the Western Australian Midwives Notification System (1983–2007). Women with an alcohol related diagnosis (ICD 9/10) on relevant datasets formed the exposed group. The comparison cohort were frequency matched to the exposed cohort. Generalized linear mixed models and a proportional hazards model were used to examine the relationship between a maternal alcohol-use diagnosis and subsequent child protection contact. Children of women with an alcohol-use diagnosis were at significantly increased risk of a substantiated child protection allegation (OR = 2.92, 95%CI = 2.71–3.14) and entry into out-of-home care (OR: 3.78, 95% CI = 3.46–4.13). The highest risk of child protection contact was associated with diagnoses received during pregnancy, and in the years immediately pre- or post-pregnancy. Children whose mothers have an alcohol-use diagnosis are at increased risk of contact with child protection services. Despite current public health recommendations, some women continue to drink heavily during pregnancy. Additional work is required to identify effective strategies to reduce heavy alcohol use in this population. Further, women who have been identified to have alcohol use issues require additional support, from multiple agencies, to reduce the potential negative impacts on their child. [ABSTRACT FROM AUTHOR]

Objective: To assess the usefulness of night-time presentations to measure alcohol-related harm (ARH) in young trauma patients, aged 12-24 years, attending Western Australian EDs., Methods: A retrospective longitudinal study examined alcohol-related ED presentations in Western Australia (WA; 2002-2016) among 12- to 24-year-olds. Data from the Emergency Department Data Collection, WA State Trauma Registry Database and Hospital Morbidity Data Collection were used to identify ARH through specific codes and text searches. These were compared to ARH estimates based on presentation time. Statistical analysis involved sensitivity and specificity calculations and Cox proportional hazards modelling., Results: We identified 2644 (17.8%) night-time presentations as a proxy measure of ARH among the 14 887 presentations of patients aged 12-24 years. This closely matched the 3064 (20.6%) identified as ARH through coding methods. The highest risk for an ARH presentation occurred during the night hours between 00.00 and 04.59 hours. During these hours, the risk was 4.4-5.1 times higher compared to presentations at midday (between 12.00 and 12.59 hours). However, when looking at individual patients, we observed that night-time presentations were not a strong predictor of ARH (sensitivity: 0.39; positive predictive value: 0.46)., Conclusions: Implementing targeted interventions during night hours could be beneficial in addressing ARH presentations. However, relying solely on the time of presentation as a proxy for ARH is unlikely to effectively identify ARH in young individuals. Instead, the present study emphasises the importance of implementing mandatory data collection strategies in EDs to ensure accurate measurement of ARH cases., (© 2023 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)

Background: Reducing the over-representation of Aboriginal children in the child protection system is a key target for the Australian government., Objective: 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)., Participants and Setting: Linked administrative data was provided for WA CPS between 2000 and 2015 for 33,709 Aboriginal children born in WA between 2000 and 2013., Methods: Descriptive summaries and cumulative incidence estimates were used to examine changes in CPS contact trends over time and within sibling groups., Results: 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., Conclusions: 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., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: To investigate childhood (0-18 years) hospitalisation and emergency department (ED) contacts for epilepsy in Western Australian (WA) children exposed to family and domestic violence (FDV) pre 5 years of age compared to children with no FDV exposure., Methods: A retrospective, population-based cohort study included children born 1987-2010 who were identified as being exposed to FDV (n = 7018) from two sources: WA Police Information Management System and WA Hospital Morbidity Data Collection (HMDC) and a non-exposed comparison group (n = 41 996). Epilepsy contact was identified in HMDC and ED Data Collection records. Cox regression was used to estimate the adjusted and unadjusted hazard ratio and 95% confidence interval (CI) for epilepsy contact; adjustment was made for a range of demographic characteristics known to impact health outcomes. Analyses were stratified by Aboriginal and Torres Strait Islander status to account for higher rates of FDV and epilepsy hospital admissions in Aboriginal and Torres Strait Islander children., Results: Children exposed to FDV had a 62% (HR 1.62, 95% CI: 1.33-1.98) increased risk of epilepsy contact than non-exposed counterparts. Furthermore, the children exposed to FDV had a 50% longer average hospital stay for epilepsy than non-exposed children (4.7 days vs. 3 days, P = 0.006). When stratified by Aboriginal status, we found that Aboriginal children exposed to FDV stayed (on average) 2 days longer in hospital for epilepsy than their non-exposed counterparts (5.1 days vs. 3.1 days, P = 0.018)., Conclusions: FDV exposure in early childhood is associated with increased risk of requiring secondary health care and longer hospital stays for childhood epilepsy., (© 2022 The Authors. Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Children have a universal right to live free from exposure to family and domestic violence (FDV). Children exposed to FDV can experience long-term effects on their physical and psychological health and their social competencies including social, emotional, and cognitive skills and behaviours that underpin successful social adaptation and academic achievement. The aim of this study was to investigate if children exposed to FDV were more likely to be vulnerable on school readiness measures compared to those children who were not exposed. Our cohort study used de-identified individual-level administrative data of children born during 2002-2010, in Western Australia, who were identified in police and hospital records as being exposed to FDV during 2002-2015. Univariate and multivariate logistic regression was used to estimate the odds of vulnerability in Australian Early Development Census (AEDC) outcomes of children exposed to FDV compared to a non-exposed cohort. After adjusting for demographic characteristics, children exposed to FDV had higher odds than non-exposed children of being vulnerable in all five AEDC domains: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based) and communication skills and general knowledge. Exposed children have an increased likelihood of vulnerability in all five AEDC domains: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based) and communication skills and general knowledge. Comprehensive multiagency early intervention for children exposed to FDV is required to mitigate the impact on outcomes, and ultimately the need to prevent FDV is needed.

Introduction: After a first alcohol-related hospitalisation in youth, subsequent hospitalisations may demonstrate an increased risk of further alcohol-related hospitalisations, but there is no existing data on this., Methods: A retrospective longitudinal study between July 1992 and June 2017 using linked hospital administrative data identified 23 464 Western Australian young people [9009 (38.4%) females and 14 455 (61.6%) males], aged 12-24 years hospitalised for at least one alcohol-related harm (ARH) episode of care. Cox regression was used to estimate hazard ratios (HR) between risk factors and repeated alcohol-related hospitalisation after the first discharge for ARH., Results: Of those admitted for an alcohol-related hospitalisation (n = 23 464), 21% (n = 4996) were readmitted for ARH. This high-risk sub-group comprised 46% (n = 16 017) of the total alcohol-related admissions (n = 34 485). After the first discharge for ARH, 16% (804) of people who experienced an alcohol-related readmission were readmitted within 1 month, and 51.8% (2589) were readmitted within 12 months. At increased risk of readmission were Aboriginal people and those with prior health service contacts occurring before their first alcohol-related hospitalisation, including illicit drug hospitalisations, mental health contacts and, in a sub-analysis, emergency department presentations., Discussion and Conclusions: The probability of a repeated ARH hospitalisation was highest in the first month after initial discharge. There is a high-risk sub-group of young people more likely to have a repeat ARH hospitalisation. This represents an opportunity to provide interventions to those most at risk of repeated ARH., (© 2022 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Background: This study investigated whether the timing of birth of the younger siblings was associated with the risk of the older siblings' developmental vulnerability in early childhood., Methods: Linkage of population-level birth registration, hospital, and perinatal datasets to Australian Early Development Census (AEDC) records (2009-2015), enabled follow-up of a cohort of 32,324 Western Australia born singletons. Children with scores <10th percentile on an individual AEDC domain (Physical Health and Wellbeing; Social Competence; Emotional Maturity; Language and Cognitive Skills (school-based); and Communication Skills and General Knowledge) were classified as developmentally vulnerable. Modified Poisson Regression was used to estimate relative risks (RR) for associations between post-birth interpregnancy intervals (IPIs) and developmental vulnerability., Results: Relative to post-birth IPIs of 18-23 months, post-birth IPIs of <6 and 6-11 months were associated with an increased risk of children being classified as DV1 (aRR 1.21, 95% CI: 1.11-1.31) and DV2 (aRR 1.31, 95% CI: 1.15-1.49); and DV1 (aRR 1.10, 95% CI: 1.03-1.17) and DV2 (aRR 1.21, 95% CI: 1.09-1.34), respectively. Post-birth IPIs of <6 months were associated with an increased risk on four of the five AEDC domains. Post-birth IPIs of 48-60 months were associated with an increased risk of developmental vulnerability; however, the risk was statistically significant for DV1, DV2 and the domains of Emotional Maturity and Language and Cognitive Skills (school-based)., Conclusions: Developmental vulnerability was associated with having a closely spaced younger sibling (<12 months post-birth IPIs). Optimising birth spacing should be further investigated as a potential means for improving child development outcomes., Competing Interests: The authors have declared that no competing interests exist.

Title: Alcohol-related harm in emergency departments: linking to subsequent hospitalizations to quantify under-reporting of presentations., Aims: To quantify the proportion of emergency department (ED) presentations that could be identified as alcohol-related when linking to a patient's subsequent hospitalization, compared with using ED data alone, and to assess that comparison according to the change in alcohol harm rates over time and potential variations within subpopulations., Design: A retrospective study using linked hospital administrative data to identify ED patients who had subsequent alcohol-related hospitalizations., Setting: Western Australia., Participants: A total of 533 816 Western Australian young people (246 866 females and 286 950 males), aged 12-24 years., Measurements: Whether or not presentations of young people to ED could be identified as alcohol-related, and for those that were not, how many had a subsequent alcohol-related hospitalization. Rates and proportions of alcohol-related harm for both methods of ascertainment were estimated by sex and Aboriginality across different age groups., Findings: Alcohol-related hospitalizations that followed an initial presentation at ED allowed the identification of an additional 19 994 alcohol-related presentations (95% increase). Linking to additional hospitalization information also resulted in significant variation in alcohol-related harm trends. In particular, trends in alcohol-related ED presentations for 21-24-year-old males were stable to slightly increasing using only ED data, but decreased after linking with hospitalization data (P < 0.05). Similarly, trends among Aboriginal persons aged 21-24 shifted from increasing using only ED data to being stable in comparison to presentations using subsequent hospitalizations (P < 0.05)., Conclusions: Among young people in Western Australia, twice as many emergency department presentations could be identified as being alcohol-related using diagnosis information from subsequent hospitalizations compared with emergency department data alone. When supplemented with hospitalization data, trends in alcohol-related harm presentations become significantly different within some subpopulations compared with using emergency department presentation data alone., (© 2020 Society for the Study of Addiction.)

Background: Maltreated children are at high risk for low educational achievement, however few studies have accounted for confounding risk factors that commonly co-occur (including child, family and neighbourhood risk factors) and results have been mixed, particularly for adolescents., Objectives: We aimed to 1) examine the relationship between maltreatment and low educational achievement among Year 9 students, taking into account child, family and neighbourhood risk factors; 2) assess subgroup differences in outcomes based on level of child protection involvement and maltreatment type; and 3) identify prevalence and risk factors for low educational achievement., Participants and Setting: A population birth cohort of West Australian children (N = 33,866) who sat national reading achievement tests between 2008 and 2010 was used for the main analysis., Methods: Linked administrative data from Departments of Health, Communities (Child Protection and Family Support), Education, and the Disability Services Commission was used to conduct a series of logistic regression analyses., Results: Maltreatment was significantly associated with low Year 9 achievement, even after accounting for many child, family and neighbourhood risk factors (aOR 1.51, 95 % CI 1.35-1.69). Educational outcomes were consistently poor across subgroups in the child protection system, including those with different levels of child protection involvement and maltreatment types. Other notable risk factors for low achievement included intellectual disability, attendance, parents' level of education, Aboriginality, and being older (indicating possible grade retention)., Conclusions: Adolescents with a history of maltreatment are at risk for poor educational outcomes and need additional support. Multiple contributing risk factors suggest the need for whole-of-government solutions., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Little is known about the significance of cultural differences to how caregivers receive a diagnosis of neurodevelopmental disability. As part of a Fetal Alcohol Spectrum Disorder prevalence study among sentenced, detained youth, our qualitative study explored the experiences of diagnostic assessment among detained young people and their caregivers. We present findings from the perspectives of caregivers. In conversation with the sociology of diagnosis literature, we present vignettes of three Aboriginal and two non-Aboriginal caregivers' experiences of the diagnostic assessment process. We found that Aboriginal caregivers conceptualised their children's diagnosis and ongoing management in the context of their family networks and community. In contrast, non-Aboriginal caregivers focused on how the diagnosis would affect their child and interactions with various institutions including healthcare systems and schools. Caregivers' engagement with diagnostic reports and resources also followed cultural lines. Reflections on intergenerational drinking were voiced by Aboriginal caregivers, who expressed shame at receiving diagnosis. These findings advance our appreciation of cultural difference in receiving a diagnosis, the examination of which is in its nascent stages. We also suggest ways to mitigate harm from a stigmatising diagnosis and soften the well-established effects of medical dominance over the process of defining a person's capacity and status., (© 2020 Foundation for the Sociology of Health & Illness.)

Objective: To investigate factors associated with alcohol use in adolescents, with the focus on analysing the comorbidities between single-occasion harmful-drinking episodes with mental health issues and risk behaviours., Methods: This study used data from the Young Minds Matter survey, designed to inform on the prevalence of the seven most common mental health disorders of children and adolescents. Logistic regression modelling was used to assess the odds of harmful drinking behaviour in young people aged 13-17 years in Australia., Results: We found a strong association between single-occasion harmful drinking and mental health issues, which hold after controlling for sociodemographic characteristics. Young people with severe mental health issues within the past year were four times more likely to have been drinking at harmful levels in the past 30 days., Conclusions: Alcohol use can have adverse health effects among children and adolescents. Research has found a bidirectional association between alcohol use and mental health conditions where the presence of one issue almost doubles the risk of having the other issue. Implications for public health: The comorbidity between these issues suggests the need for strategies to integrate policies addressing mental health and alcohol use disorders in young people., (© 2020 The Authors.)

Australia is seeing an unprecedented increase in the rate of child protection notifications and children being taken into care. The burden of such high levels of notifications and removals impact not only the children and families but also the system which is trying to resource them. The concern is that these increases are unsustainable and overloaded child protection systems can be dangerous for the vulnerable families and children they are trying to protect and support. This paper hopes to raise some alternative thinking as to the overall approaches to child abuse and neglect with a greater focus on prevention. Is it time to consider a public health approach, using population-based measures of child abuse and neglect to accurately describe the epidemiology of population risk and protective factors? Should we investigate the potential of universal health, welfare and education services as platforms for prevention? And should we investigate whether the provision of secondary prevention for vulnerable families which address major contributing factors, such as parental substance dependence and mental health issues are effective in reducing abuse of children in these families?