The early intervention and care of vulnerable infants · the early intervention and care of vulnerable infants 3 chapter also addresses the increased risk of Sudden Infant Death Syndrome

S T A N D I N G C O M M I T T E E O N H E A L T H A N D D I S A B I L I T Y

The early intervention and care of

vulnerable infants

A U G U S T 2 0 0 8

Report 8

T H E E A R L Y I N T E R V E N T I O N A N D C A R E O F V U L N E R A B L E I N F A N T S

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Committee Membership

Ms Karin MacDonald MLA (Chair)

Ms Mary Porter AM MLA (Deputy Chair)

Mrs Jacqui Burke MLA

Secretariat

Grace Concannon Committee Secretary

Demelza‐Rose Gale Research Assistant

Lydia Chung Administrative Support

Contact Information

Telephone: 02 6205 0129

Facsimile: 02 6205 0432

Post: GPO Box 1020

CANBERRA ACT 2601

Email: [email protected]

Website: www.parliament.act.gov.au


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Resolution of Appointment

On 7 December 2004, the Legislative Assembly for the ACT resolved to establish the Standing Committee on Health and Disability to:

examine matters related to hospitals, community, public and mental health, health promotion and disease prevention, disability matters, drug and substance misuse, targeted health programs and community services, including services for older persons and women, housing, poverty, and multicultural and indigenous affairs.1

Terms of Reference

To inquire into and report on the early intervention and care of vulnerable children in the ACT, focusing on the unborn child and infants aged 0–2, with particular reference to:

children of drug affected parents;

antenatal and postnatal care and support services available for vulnerable parents and their children;

early identification of a child at risk;

specific issues related to indigenous parents and children; and

any other relevant matter.

1 Legislative Assembly for the ACT, Minutes of Proceedings No. 2, 7 December 2004, p 12


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TABLE OF CONTENTS

Committee Membership .......................................................................................... i Secretariat ................................................................................................................ i Contact Information.................................................................................................. i Resolution of Appointment...................................................................................... ii Terms of Reference................................................................................................. ii Abbreviations.......................................................................................................... iv

R E C O M M E N D A T I O N S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V

1 I N T R O D U C T I O N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Background ............................................................................................................3 Conduct of inquiry .................................................................................................5

2 V U L N E R B A L E I N F A N T S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Antenatal reporting..............................................................................................12 Sudden Infant Death Syndrome.........................................................................17

3 F A M I L I E S T H A T N E E D S U P P O R T . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 9 Domestic violence ...............................................................................................20 Parental substance abuse ...................................................................................26 Aboriginal and Torres Strait Islander families ..................................................30

4 E A R L Y I N T E R V E N T I O N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1 Barriers to accessing services.............................................................................45 Collaboration between agencies ........................................................................48 What about fathers? ............................................................................................50 Care and Protection Services..............................................................................54

5 C O N C L U S I O N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1

A P P E N D I X A : S U B M I S S I O N S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 3

A P P E N D I X B : P U B L I C H E A R I N G S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 5

A P P E N D I X C : V I S I T T O C H I L D A N D F A M I L Y C E N T R E . . . 6 7


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Abbreviations

CFC Child and Family Centre

C&P Care and Protection

DHCS Department of Disability, Housing and Community Services

FAS Foetal Alcohol Syndrome

OCYFS Office for Children Youth and Family Support

PND Postnatal Depression

NAS Neonatal Abstinence Syndrome

SIDS Sudden Infant Death Syndrome


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RECOMMENDATIONS

R E C O M M E N D A T I O N 1

2.26 The Committee recommends that the ACT Government consider the

promotion of Care and Protection Services through a public education

campaign that aims to improve its status, by explaining the service and

educating the community about the appropriate use of the service.


2.44 The Committee recommends that the ACT Government develop a

targeted antenatal education program for high-risk expectant mothers in

consultation with Child and Family Centres and relevant community

organisations, in particular Women's Information and Resources on Drugs of

Dependency (WIREDD), Domestic Violence Crisis Service (DVCS) and

Women's Centre for Health Matters (WCHM).


3.11 The Committee recommends that ACT Health develop a risk

assessment tool, with guidelines and training, to screen for domestic

violence for pregnant women who access antenatal services through ACT

Government institutions.


3.18 The Committee recommends that the ACT Government work with the

Domestic Violence Crisis Service and women's refuges in the ACT, to

develop mechanisms that would enable women and children to continue to

be supported once they leave the care of the refuge and go back into the

community.


3.27 The Committee recommends that the ACT Government develop an

ACT specific domestic violence campaign for local television and radio.


3.42 The Committee recommends that the ACT Government investigate

ways of utilising the Victorian Government resource Parenting Support

Toolkit for Alcohol and Other Drug Workers in the ACT.


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ways of assisting Winnunga Nimmityjah Aboriginal Health Service with the

transport needs of patients.


3.65 The Committee recommends that the ACT Government resource

Carers ACT to enable delivery of the Service Provider Education Program on

an ongoing basis.


3.69 The Committee recommends that the ACT Government support Carers

ACT to develop strategies to assist in the early identification and support of

young carers.

R E C O M M E N D A T I O N 1 0

3.82 The Committee recommends that the programs available for post

natal depression be better advertised and if necessary be further resourced

to meet demand for services.



ways of better resourcing early intervention services for community based

child and family services.


4.31 The Committee recommends that the ACT Government conduct an

evaluation of its early intervention services to ensure that these services are

adequately and appropriately meeting the needs of parents of vulnerable

infants, and potentially vulnerable infants.


4.40 The Committee recommends that the ACT Government further

enhance the development of collaborative practices across services and

sectors.


4.51 The Committee recommends that the ACT Government consult with

men's support organisations and Regional Community Services to develop

early intervention programs for fathers with complex needs.


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principles of the Father Inclusive Practice Framework in future service

planning.


4.57 The Committee recommends that the ACT Government investigate the

level of unmet need of support services for young fathers post the age of 26.


4.77 The Committee recommends that the Department of Disability,

Housing and Community Services consult with the drug and alcohol sector

to develop cross-sector training to facilitate the exchange of knowledge and

expertise between drug and alcohol and care and protection workers.


4.82 The Committee recommends that the ACT Government investigate the

feasibility of resourcing a group specifically for mothers who have children in

the care and protection system, similar to the NEWPIN model.


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1

1 INTRODUCTION

By their very nature infants are vulnerable.2

1.1 When a child is born its survival is dependant, most often, on the family it is born into. The main carer is usually the mother, and in an ideal situation a secure bond will develop between mother and child. The childʹs father, extended family members, community services and support networks all play an important role in the care and development of the infant.

1.2 An infant becomes vulnerable when its main carer, for whatever reason, is not able to provide the adequate care required to ensure the childʹs safety and wellbeing, including its physical and emotional developmental needs. This is the definition of a vulnerable infant that the Committee has adopted for the purpose of this inquiry.

1.3 There are many circumstances that may impair the main carerʹs ability to provide adequate care for their child. On the one hand, it could be a temporary interruption such as a death in the family, illness, financial stress or relationship problems. With appropriate support networks the child will continue to be cared for until the main carer is able to recover and resume the caring role. On the other hand, the circumstances that may impair the main carerʹs ability to provide for their infant could be much more complex and may require ongoing support and intervention.

1.4 Raising a child is not without challenges for all parents, even for those with the best support networks and the best circumstances. However, the challenges of raising a child are compounded for parents who are also faced with personal life circumstances beyond, what would be considered, the normal course of events.

1.5 These circumstances may include; abused childhoods, substance abuse issues, domestic violence, mental illness, physical and /or intellectual disability, housing stress, and severe financial difficulties (including poverty). While

2 Submission no. 4, Marymead Child and Family Centre, p 2


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none of these on there own are predictors of inadequate parenting, it is often the complex interconnection between them that does impact on a personʹs parenting capacity and ability.

1.6 Evidence to the Committee highlighted a perceived fear by parents with complex issues (mainly mothers) of losing their children to Care and Protection Services.3 Despite their impaired parenting ability, it is clear to the Committee that in most cases parents want to do the best they can for their children. Unfortunately for some parents they are not always able to do so on their own.

1.7 It is a widely held belief that children are best placed in their biological family. The Committee considers that parents with limited parenting ability deserve to be supported to develop and enhance their parenting ability to enable them to provide an appropriate level of care to their child, particularly where they have demonstrated a desire to do so.

1.8 Where a childʹs safety and physical and emotional needs are seriously compromised within the biological family, the Committee supports the intervention of Care and Protection Services. The Committee appreciates that the removal of a child by Care and Protection Services is a traumatic event for all parties involved, but understands that this is only done as the last resort. The Committee also understands that the ultimate decision to place a child on a care and protection order is made in the ACT Childrens Court.

1.9 The focus of this report is on both the families where the caring capacity of the mother and father has broken down, as well as on the supports and interventions available in the ACT to assist them to restore and / or develop their parenting capacity.

1.10 Chapter two discusses the impact of Neonatal Abstinence Syndrome (NAS) and Foetal Alcohol Syndrome (FAS) on the developing child and the effects that abuse and neglect can have on brain development in an infant. This

3 See Womenʹs Centre for Health Matters, Transcript of Evidence, 14 May 2008, p 10 and Womenʹs Information, Resources and Education on Drugs and Dependency (WIREDD) Transcript of Evidence, 14 May 2008, p 21


3

chapter also addresses the increased risk of Sudden Infant Death Syndrome (SIDS) in infants from socially disadvantaged families.

1.11 Chapter three explores the risk factors that place infants in vulnerable situations and in particular focuses on parents with substance abuse issues and Aboriginal and Torres Strait Islander families, as defined by the terms of reference.

1.12 Chapter four explores the benefits of early intervention, examines the services currently available in the ACT, including access to those services and collaboration between the service providers. This chapter also takes an in‐depth look at Care and Protection Services in the ACT.

Background

1.13 This inquiry is informed by the following ACT Government reports addressing the care and protection sector in the ACT.

1.14 The Vardon Report4 of May 2004 introduced the notion of the ‘Territory Parent.’ When the courts take away the parental responsibilities of a child’s biological parents placing the child in the care of the government, a whole government approach is needed. The best ‘Territory Parent’ for a child is one that involves many agencies and departments with clearly defined roles.

1.15 The Vardon Report made 47 recommendations. These recommendations focused on improving child protection and agency efficiency; such as a case‐management system with a child‐focused framework. The recommendations responded to the growing rate of reported child abuse in the ACT and acknowledged the increasing poverty, substance and alcohol abuse, and mental illness contributing to the breakdown in parenting.5

1.16 The Vardon Report also recommended more research be conducted into alternative care models and early intervention and prevention services in the

4 Vardon, C., ‘The Territory as Parent; Review of the Safety of Children in Care in the ACT and of ACT Child Protection Management’, Report, May 2004. (‘Vardon Report 2004’)

5 Vardon Report 2004, p 10


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ACT. It suggested the establishment of a new unit for early intervention and prevention services, and further research into alternative care models.

1.17 The Government agreed with all 47 recommendations6 and devised a 2–3 year reform program. This agenda outlined the direction for the development of future programs for the care and protection of children, young people, families and carers in the ACT and included expanding prevention and early intervention programs.7

1.18 The Murray Report8 by Gwen Murray, an audit on the Vardon Report made 66 recommendations. These recommendations primarily focused ‘on practice, policy, procedures and training within a child‐focused framework’.9 The audit report prepared by Murray raised serious issues concerning the Canberra community and the rise in abuse and neglect. The Murray Report recommended, among other things, the development of effective intervention strategies; expanding the range of intensive family support programs including programs responding to parents with drug and alcohol dependence issues.10

1.19 The Murray‐Mackie Study conducted by Gwen Murray and Craig Mackie looked at the situation revolving around five young children who had either died or nearly died whilst in the care of their biological parents. This study highlighted the difficulties involved in working with vulnerable parents with

6 ACT Government Response to ‘The Territory as a Parent: Review of the Safety of Children in Care in the ACT and of ACT Child Protection Management’, May 2004

7 ACT Government ‘The Territory as a Parent: Review of the Safety of Children in Care in the ACT and of ACT Child Protection Management’, Implementation Strategy, Presented by authority of Katy Gallagher MLA, August 2004, p 10

8 Murray, G., ‘The Territory’s Children: Ensuring safety and quality care for children and young people’ Report on the Audit and Case Review, July 2004.

9 ACT Government Response to ‘The Territory’s Children: Ensuring safety and quality care for children and young people’ Report on the Audit and Case Review, Presented by the authority of Jon Stanhope MLA Chief Minister, August, 2004, p 2

10 ACT Government Response to ‘The Territory’s Children: Ensuring safety and quality care for children and young people’ Report on the Audit and Case Review, Presented by the authority of Jon Stanhope MLA Chief Minister, August 2004, pp 4‐18


5

complex issues and emphasised the need for integrated services. The responsibility for protecting children does not rest with one agency alone.11

1.20 The Murray‐Mackie Study’s recommendations particularly addressed the need for early interventions that responded to the needs of unborn and very young children; antenatal reporting, drug affected babies and domestic violence. The study further found that early intervention should involve the interaction and coordination of agencies and government services.12 The Government agreed with the recommendations made in this study.13

1.21 The Final Progress Report on the Murray‐Mackie recommendations was tabled in the Assembly in April 2008. In her tabling speech the Minister for Children and Young People, Ms Katy Gallagher advised the Assembly that 50 of the 55 recommendations had been completed and the remaining five involved ongoing processes.

Conduct of inquiry

1.22 On 13 February 2008 the Committee resolved to conduct an inquiry into the early intervention and care of vulnerable children in the ACT, with a particular focus on the unborn child and infants aged 0–2. The Committee limited the inquiry to children up to the age of two, due to the shortened timeframe for the conduct of this inquiry.14

1.23 The inquiry was advertised in The Canberra Times on Saturday 15 March 2008 and in The Chronicle on Tuesday 18 March 2008. The Committee also wrote to key stakeholders inviting submissions.

11 ACT Legislative Assembly, Ministerial Statement ‘Murray‐Mackie study‐Recommendations’ Hansard, 21 September 2006 (Ms Gallagher).

12 ACT Legislative Assembly, Ministerial Statement ‘Murray‐Mackie study‐Recommendations’ Hansard, 21 September 2006 (Ms Gallagher).

13 ACT Government ‘Recommendations from the Murray‐Mackie Study and Government Response’ Katy Gallagher, MLA September 2006; ACT Government ‘Recommendations from the Murray‐Mackie Study, Government Response and Current Progress’ Circulated by Authority of Katy Gallagher MLA, April 2008.

14 Standing Committee on Health and Disability, Minutes of Meeting no 73, 13 February 2008


6

1.24 The Committee received 14 submissions and a public hearing was held on 14 May 2008. At the public hearing the Committee heard from the Minister for Children and Young People and representation from eight community based organisations. The list of submissions is at Appendix A. The list of witnesses is at Appendix B.

1.25 As part of the inquiry the Committee also visited the Child and Family Centre (CFC) in Tuggeranong on 16 July 2008.


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2 VULNERBALE INFANTS

The first two years of life are increasingly being recognised as crucial in determining how successfully our children grow up and function as

adults.15

2.1 As discussed in the introduction the survival of babies depends on having their physical and emotional needs met. Without adequate food, water and shelter a baby would not survive. If the babyʹs emotional needs are not met the baby may experience developmental delays that could have long‐term impacts on the child as it grows into an adult.

2.2 There are a range of factors that influence a childʹs development. As noted in the ACT Government submission, these include, but are not limited to the:

birth and pre‐birth experience of the child;

health of the child and the mother;

disability status of the child;

childʹs physical, social and emotional environment; and

skills and wellbeing of the childʹs parents.16

2.3 The health and wellbeing of a child begins at conception. Adequate nutrition before birth (for the pregnant woman) and after birth (for both the mother and baby) are fundamental to the healthy development of the child. The ingestion of substances such as licit and illicit drugs, prescription drugs, alcohol and tobacco can also have detrimental effects on the pregnant woman and the developing foetus.

2.4 Smoking tobacco during pregnancy is associated with poorer birth outcomes and can lead to an increased risk of miscarriage and premature labour. The impact on the developing foetus includes reduced foetal growth, lower birth

15 Dr Sue Packer, Parental substance abuse, parenting capacity and child protection: always a three way tug of war? paper presented at Drug Action Week Public Forum 18 June 2007, ACT, p 4, viewed 21 July 2008, <http://www.ffdlr.org.au/PublicForums/Parental%20substance%20abuse1.pdf>

16 Submission no 10, ACT Government, p 3


8

weight (which is a key indicator of health status) and premature birth. For infants exposed to tobacco smoke there is an increased risk of Sudden Infant Death Syndrome (SIDS), incidences of respiratory infections, asthma and middle ear infection.17

2.5 Children born to alcohol and substance abusing parents may develop Foetal Alcohol Syndrome (FAS) or Neonatal Abstinence Syndrome (NAS). These are discussed in the following section.

2.6 Brain development in infants is also discussed as it is now widely understood that the early years are a crucial time for healthy development. Exposure to abuse and neglect and / or domestic violence can have a significant impact on brain development with long term consequences for those affected.18

Neonatal Abstinence Syndrome (NAS)

2.7 Infants prenatally exposed to addictive substances, such as heroin, methadone and some prescription medications, have a high incidence of NAS. There is no blood test or scan to diagnose NAS and withdrawal syndrome can develop in the baby once the connection between mother and baby is broken at birth.19 The risk of developing NAS and its severity depends on the type of substance the baby has been exposed to, and the amount and frequency of exposure.20

2.8 Symptoms and signs of NAS usually occur within 72 hours of birth and may include:21

irritability and tremor;

increased muscle tone;

gastrointestinal dysfunction including excessive and uncoordinated sucking, vomiting and diarrhoea;

17 Australian Government Department of Health and Ageing, Alcohol and Other Drugs, viewed 7 August 2008, <http://www.aodgp.gov.au/internet/aodgp/publishing.nsf/Content/pregnancy‐5>

18 The effects on children of living with domestic violence are considered, at length, in chapter three of this report.

19 Powell, S, Babies born to substance‐abusing mothers, The Canberra Hospital, 2008 20 Powell, S, Babies born to substance‐abusing mothers, The Canberra Hospital, 2008 21 Australian Government, Department of Health and Aging, Pregnancy: Alcohol & Other Drugs, viewed 28 July 2008, <http://www.aodgp.gov.au/internet/aodgp/publishing.nsf/Content/pregnancy‐1 > and Powell, S, Babies born to substance‐abusing mothers, The Canberra Hospital, 2008


9

respiratory disease indicated by nasal flaring; and

autonomic symptoms including excessive yawning, sneezing and mottled colour and fever.

2.9 Unless treated, a newborn baby with NAS is at risk of serious health consequences. Treatment at this early stage usually involves the oral administering of an aqueous solution of morphine.22 The long term effects of NAS on infant development are unclear, however there is an increased incidence of SIDS in infants with NAS.23

Foetal Alcohol Syndrome (FAS)

2.10 Alcohol can be toxic to the developing foetus. The severity of the effects on the developing foetus is related to the amount ingested, the stage of the pregnancy and the general health of the woman.24

2.11 FAS is the major cause of intellectual disability not caused by genetics.25 There is no cure for FAS and there is no treatment other than supporting care.26

2.12 A child born with FAS may:

be born small and have a slow rate of growth;

have anomalies of brain structure and functioning resulting in developmental delay and disability;

have heart defects;

have physical characteristics such as small eyes and flat lips and other limb deformities;

have problems eating and sleeping; and

22Australian Government, Department of Health and Aging, Pregnancy: Alcohol & Other Drugs, viewed 28 July 2008, <http://www.aodgp.gov.au/internet/aodgp/publishing.nsf/Content/pregnancy‐1>

23 Australian Government, Department of Health and Aging, Pregnancy: Alcohol & Other Drugs, viewed 28 July 2008, <http://www.aodgp.gov.au/internet/aodgp/publishing.nsf/Content/pregnancy‐1>

24 Australian Government, Department of Health and Aging, Pregnancy: Alcohol & Other Drugs, viewed 28 July 2008, <http://www.aodgp.gov.au/internet/aodgp/publishing.nsf/Content/pregnancy‐1>

25 Childs Health Centre Foetal Alcohol Syndrome, viewed 28 July 2008, <www.virtualmedicalcentre.com.au>



1 0

have problems seeing and hearing. 27

2.13 Children born with FAS usually have a lower IQ and will usually require ongoing medical care. The long term effects of FAS may include:28

trouble following directions and learning how to do simple things;

trouble paying attention and learning in school; and

aggressive and anti‐social behaviour that can lead to attention deficit disorder (ADD) in teenage years.

Brain development in infancy

2.14 ‘The environment experienced by a young child sculpts the brain and establishes the trajectory for long term cognitive and social‐emotional outcomes.’29 To provide children with the best possible future, there needs to be a focus on the critical early years of development.30

2.15 Child brain development can be understood and summarised into the following five points:

1. The brain is organised in a hierarchical fashion; all incoming sensory input first enters the lower parts of the brain.

2. The brain develops sequentially.

3. The brain develops fastest in early life.

4. The design of neurons and neural systems is such that they change and develop as they are used.

27 Childs Health Centre Foetal Alcohol Syndrome, viewed 28 July 2008, <www.virtualmedicalcentre.com.au> ; See also Australian Government, Department of Health and Aging, Pregnancy: Alcohol & Other Drugs, viewed 28 July 2008, <http://www.aodgp.gov.au/internet/aodgp/publishing.nsf/Content/pregnancy‐1>


29 Oberklaid, F., ‘Brain development and the life course‐ the importance of the early caretaking environment’ Extract from Putting Children First, the Newsletter of the National Childcare Accreditation Council (NCAC) Issue 24 December 2007, viewed 25 July 2008,<https://ncac.gov.au/pcf/Brain_Development_Life_Course_Dec07.pdf >

30 Oberklaid, F., ‘Brain development and the life course‐ the importance of the early caretaking environment’ Extract from Putting Children First, the Newsletter of the National Childcare Accreditation Council (NCAC) Issue 24 December 2007, viewed 25 July 2008 <https://ncac.gov.au/pcf/Brain_Development_Life_Course_Dec07.pdf >


1 1

5. Neural systems can be changed, but some are harder to alter then others.31

2.16 The early days of infancy to approximately three years of age are when the child’s brain grows and develops fastest. 32 The central and peripheral nervous systems, which are controlled by the brain, develop at a phenomenal rate in child’s first years of life.

2.17 The Central Nervous System (CNS), comprised of the brain and spinal cord, coordinates a range of activities from breathing to body movements and emotion. The Peripheral Nervous System (PNS) coordinates other body functions and actions such as; voluntary activities, involuntary functions for example blood pressure and every aspect of the digestive system.33 Good health care, including nutritious food and stimulation is critical for normal healthy development of the brain and the body systems that it controls.34

2.18 Unnecessary stresses can impact on brain development resulting in permanent complications, such as disordered brain circuits. This can ultimately result in problems in adult life. An example is ‘toxic stress’ which is caused by a prolonged activation of the body’s stress response.35 This stress may be caused by poverty, physical or emotional abuse, and family violence and is exacerbated when there is an absence of ‘buffering protection of supportive relationships with caregiversʹ.36

31 Bruce Perry, cited in Snow, P., ‘Child abuse and neglect: Is Speech‐Language Pathology missing in action?’ School of Psychology, Psychiatry and Psychological Medicine, Monash University, May 2008.

32 ChildFund Australia, ‘Child Development’ Fact Sheet 4 <http://www.childfund.org.au/static/8/4/ec7d017f7e43c821152e4b1d9ead31ee.pdf>

33 Kids Health Centre, ‘Your child’s neural (nerve) development’, May 2008, viewed 25 July 2008, <www.kidshealth‐central.com/child‐development.html> 34 ChildFund Australia, ‘Child Development’ Fact Sheet 4, viewed 25 July 2008, <www.childfund.org.au>

35 Oberklaid, F., ‘Brain development and the life course‐ the importance of the early caretaking environment’ Extract from Putting Children First, the Newsletter of the National Childcare Accreditation Council (NCAC) Issue 24 December 2007, viewed 25 July 2008, <https://ncac.gov.au/pcf/Brain_Development_Life_Course_Dec07.pdf >

36 Oberklaid, F., ‘Brain development and the life course‐ the importance of the early caretaking environment’ Extract from Putting Children First, the Newsletter of the National Childcare Accreditation Council (NCAC) Issue 24 December 2007, viewed 25 July 2008, <https://ncac.gov.au/pcf/Brain_Development_Life_Course_Dec07.pdf >


1 2

Antenatal reporting

2.19 Following the Murray Mackie Review amendments were made to the Children and Young Peoples Act 1999 to include provisions for antenatal reporting of a child considered to be at risk of abuse or neglect after birth. Section 362 of the Children and Young People Act 2008 deals with prenatal reporting of anticipated abuse and neglect.37

2.20 The Act reads:

(1)This section applies if, during a pregnancy, a person believes or suspects that a child who may be born as a result of the pregnancy may be in need of care and protection.

(2) The person may report (a prenatal report) the belief or suspicion, and the reasons for the belief or suspicion, to the chief executive.38

2.21 The report is made to the chief executive, who may with the consent of the woman, take action in relation to the report (section 362 (3)). This could include: providing a voluntary assessment on the needs of the child after birth (section 362 (4)a); providing or arranging support services for the pregnant woman and other family members (section 362 (4)b); or seeking advice from government or community‐based services in relation to the matters raised (section 362 (4)c).

2.22 The chief executive may also give prenatal information to a prenatal information sharing entity or seek prenatal information from a prenatal information sharing entity with the consent of the woman. 39 However, if the

37 Children and Young People Act 2008, p 278 38 Children and Young People Act 2008, p 278 39 As defined in the Children and Young People Act 2008: prenatal information means information that is relevant to the safety, wellbeing and development of a child after the child is born; and prenatal information sharing entity means any of the following: (a) a person who would be involved in the care of the child after the child’s birth; (b) a Minister; (c) a health facility; (d) a police officer or a member of a police service or force of a State; (e) an entity established under a law of a State or the Commonwealth; (f) the holder of a position established under a law of a State or the Commonwealth; (g) any of the following entities that would, after the child’s birth, provide a service to, or have contact with, the child or a person who would be involved in the care of the child: (i) an administrative unit; (ii) a territory authority (other than the legal aid commission); (iii) a territory instrumentality; (iv) a


1 3

woman does not consent to this, the chief executive can still do this if it is believed, ʹon reasonable grounds that the child may be in need of care and protection after the child is bornʹ (section 362 (7)).

2.23 This provision for prenatal reporting of anticipated abuse and neglect enables any person, who knows the pregnant woman, to raise concerns on her and her babyʹs behalf. The Committee considers this to be a useful mechanism for the early identification of an infant at risk and a mother in need of support, particularly for pregnant women who are not receiving antenatal care through an appropriate antenatal care provider. However, the Committee is concerned that most community members would not be aware of the Children and Young People Act 2008, let alone this provision that allows for the reporting of anticipated abuse and neglect and the mechanisms for early invention that could benefit both mother and child.

2.24 There is no doubt that there is significant community concern about child abuse and neglect. Despite this concern, there is little public discussion about child protection matters and the majority of information is sporadically provided though mainstream media reports that tend to focus on the most severe cases. Most people in the community would have little knowledge about the role of Care and Protection Services, the Children and Young People Act 2008 and the myriad of services that are currently operating in the community to provide support to parents from all backgrounds, to assist them to be better parents.

2.25 This report highlights the perception Care and Protection Services have, particularly by those parents that have had contact with the system, as one of fear and mistrust (see chapter four). On the other hand, community perception about Care and Protection Services is often also negative, particularly when severe cases are reported in the media. The Committee acknowledges the difficult job that is conducted by care and protection workers and considers that raising the profile of Care and Protection Services within the ACT would not only be of benefit to the workers in the sector, but could also educate the

public employee (other than a judge or magistrate); (v) a community‐based service, Section 362 (10) Children and Young People Act 2008, pp 280–281


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community on how to be vigilant to ensure vulnerable infants and children and their families have access to appropriate supports.



promotion of Care and Protection Services through a public education

campaign that aims to improve its status, by explaining the service

and educating the community about the appropriate use of the

service.

2.27 Antenatal care is essential for the wellbeing of the mother and baby and provides ʹcomprehensive preventative care, promotion of normal pregnancy, detection and treatment of existing diseases and early detection and management of complicationsʹ.40 It also provides a pathway for the early identification of a mother and baby that may be benefit from support and early intervention and care.

2.28 The Womenʹs Centre for Health Matters expressed concern regarding the 5.7 per cent of women in the ACT that had no contact with antenatal services and the 12.4 per cent of women that did not report having an ultrasound during their pregnancy.41 The Committee shares these concerns about the figures as it is often the women most in need of support that are the ones not receiving it.

2.29 The need for antenatal care is heightened when the unborn child is at risk of being harmed by the intended or unintended actions of the mother. However, research has shown that women who use drugs or alcohol during their pregnancy often do not receive adequate antenatal care, due to isolation and increased fear of professional support.42

2.30 Drug dependent women also tend to present late for antenatal care. Interviews conducted with pregnant women from low socioeconomic backgrounds, in a

40 Submission no 1, Womenʹs Centre for Health Matters, p 4 41 Maternal and Perinatal Health in the ACT 2000–2004, cited in Submission no 1, Womenʹs Centre for Health Matters, p 4

42 M. Hudoba and others, Substance Use in Pregnancy and Parenting Service (SUPPS): Preliminary Evaluation Data, Centre for Research & Education in Drugs & Alcohol, Illawarra Institute for Mental Health, University Of Wollongong, NSW , June 2002 pp 4–5


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study examining perceived barriers to accessing antenatal care, found the greatest barriers to be:

…transportation, waiting too long for appointments, having too many other problems (e.g. housing, legal), the belief that prenatal care is unnecessary, fear of medical examination, no childcare for other children, and fear of judgemental staff.43

2.31 Other reasons that may result in women presenting late for antenatal care could be that they have had bad experiences with health care professionals in the past, feelings of guilt and shame about their behaviour, particularly if they are continuing to use illicit drugs, they may have had previous experiences with child welfare agencies and are fearful of consequences.44

2.32 In other cases women may not disclose their drug use to their general practitioner or antenatal care providers and as such, her drug use will go unnoticed. This can present problems at the time of birth for the child.

2.33 With the serious complications associated with the misuse of alcohol and other drugs, it is imperative that women with substance addictions engage with health professionals and other support workers to ensure the best outcomes for their babies and themselves, but unless these women have access to support networks either formally through antenatal care and other health support services or informally through family and friends, they are unlikely to get the care they need for themselves and their children.

2.34 A report45 examining the isolation and marginalisation of women in the ACT found that the risk factors prevalent among these women included, among other things, homelessness, poverty, drug and alcohol misuse, mental health

43 Mikhail, B. & Curry, M. A. (1999). Perceived impediments to prenatal care among low‐income women. Western Journal of Nursing Research, 21(3), 335‐355, cited in M. Hudoba and others, Substance Use in Pregnancy and Parenting Service (SUPPS): Preliminary Evaluation Data, Centre for Research & Education in Drugs & Alcohol, Illawarra Institute for Mental Health, University Of Wollongong, NSW, June 2002, p 5 44 M. Hudoba and others, Substance Use in Pregnancy and Parenting Service (SUPPS): Preliminary Evaluation Data, Centre for Research & Education in Drugs & Alcohol, Illawarra Institute for Mental Health, University Of Wollongong, NSW , June 2002 pp 5

45 Sarah Maslen, Marginalised and Isolated Women in the Australian Capital Territory Risk, Prevalence, and Service Provision, Womenʹs Centre for Health Matters, February 2007, p 4


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issues, disabilities, culturally and linguistically diverse backgrounds and violence. The report states:

Often women experience these risk factors concurrently, increasing the risk of their marginalisation and isolation.46

2.35 The report defines marginalisation as ʹa process of social exclusion that results in individuals and / or groups experiencing deprivation, either of resources or social linksʹ. The report goes on to define social isolation as ʹan aspect of marginalisation, and refers specifically to a lack of social networks, limited social participation, and limited access to services and support dimensionsʹ.47

2.36 It is clear from the research and the evidence presented to the Committee that, despite the best intentions of health care professionals and other support workers, the perception and fear of many women with complex issues is of judgement and mistrust of the system that is supposed to support them. It is this barrier that must be broken down to enable pregnant women or women with young children to seek out the support they require, without fear of reprisal, and disclose their drug use and other issues with honesty, in a safe place, free from judgment.

2.37 It is imperative to develop strategies that facilitate the engagement of families and the uptake of supports, particularly where children are most at risk. As noted in the submission from the Public Advocate:

Developing realistic strategies so that families do not feel stigmatised and fearful of engaging with services is therefore paramount in ensuring the welfare, wellbeing and protection of infants.48

2.38 The Committee addresses the issues of access to services for marginalised women in chapter four of this report which deals with service delivery in the ACT.



48 Submission no 12, Public Advocate of the ACT, p 4


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Sudden Infant Death Syndrome

2.39 It was brought to the Committeeʹs attention that families experiencing social disadvantage are also at an increased risk of losing their child to Sudden Unexpected Death in Infancy (SUDI) and also at an increased risk of losing an infant to a stillbirth.49 In itʹs submission to the inquiry, SIDS and Kids ACT stated:

…a significant percentage of families that experience a death due to Sudden Infant Death Syndrome (SIDS) or other Sudden Unexpected Death in Infancy (SUDI) have chaotic, itinerant lives, characterised by social problems such as sub standard housing, unemployment, illicit drug use, multiple partners and domestic violence.50

2.40 SIDS and Kids ACT did note that the risk factors associated with SUDI are modifiable. Therefore educational programs around safe sleeping practices are essential for families where there are increased risk factors as recommended by the Murray‐Mackie Review. As SIDS and Kids ACT noted in their submission:

The social conditions of these families make them difficult to reach through traditional public health education strategies. They may require more direct intervention to ensure that messages are understood and implemented.51

2.41 The Committee was advised that SIDS and Kids ACT had received funding from the ACT Government to develop a low literacy, safe sleeping brochure. However, SIDS and Kids ACT is of the view that behaviour change will not be achieved with a single brochure and considers that it is essential that health professionals, including midwives, working with high‐risk families are fully versed in sleep safe practices and are vigilant about relaying this message to high‐risk families with infants.52

49 The two major sub categories of SUDI are sudden infant death syndrome and other sudden deaths with no known cause. (Submission no 2, SIDS and Kids ACT, p 4 and 7)

50 Submission no 2, SIDS and Kids ACT, p 3 51 Submission no 2, SIDS and Kids ACT, p 3 52 Submission no 2, SIDS and Kids ACT, p 6


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2.42 The Committee was advised that effective and accessible bereavement support is further complicated for families with complex needs associated with their social disadvantage, including coexisting drug and alcohol problems and mental health problems. SIDS and Kids ACT considers that the best response for these families would be through interagency partnerships. The Committee supports collaboration between agencies and discusses this further in chapter four.

2.43 SIDS and Kids suggested the implementation of antenatal education programs aimed at high‐risk women to teach sleep safe practices. The Committee supports this recommendation but further considers that antenatal education programs targeted at high‐risk women, experiencing complex issues, could go much further than delivering sleep safe messages, and could improve access to antenatal programs for expectant mothers that are currently not receiving appropriate antenatal care and information.53


2.44 The Committee recommends that the ACT Government develop a

targeted antenatal education program for high-risk expectant mothers

in consultation with Child and Family Centres and relevant

community organisations, in particular Women's Information and

Resources on Drugs of Dependency (WIREDD), Domestic Violence

Crisis Service (DVCS) and Women's Centre for Health Matters

(WCHM).

53 The Committee notes the newly established IMPACT program (see page 55 of this report).


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3 FAMI L IES THAT NEED SUPPO RT

The family is the natural and basic group unit of society and is entitled to be protected by society.54

3.1 Families come in all shapes and sizes and it is the family environment that has the greatest impact on the childʹs development and future growth into adulthood. This chapter examines the factors that impair parenting capacity and leave infants at risk of abuse or neglect in the family.

3.2 Keeping children in their biological family, where this is deemed appropriate, is the current practice of Care and Protection Services in the ACT.55 Where a family is experiencing parenting difficulties the Committee considers that the best response is a multi agency approach that ensures that the child is cared for while the parents are supported to enhance and develop their parenting skills.

3.3 There are a number of well recognised risk factors experienced by the main carer and other significant adults that can contribute to poorer outcomes for children or put children at an increased risk of abuse and neglect. These include, but are not limited to: parental substance abuse; domestic violence; financial difficulties; mental and/or physical disabilities; mental illness; limited social support networks; and lack of appropriate housing. As mentioned earlier these factors rarely occur in isolation and thereby exacerbate the problems faced by some families.56

3.4 Less well recognised factors that may place infants at risk have also been brought to the attention of the Committee. These include parents of children with a disability (particularly on receipt of an unexpected diagnosis at birth or in the early days of life), young carers, refugee families and families where the

54 ACT Human Rights Act , section 11, p 6 55 See for example general principles of the Children and Young People Act that states ʹThe primary responsibility for providing care and protection for the chid or young person should lie with his or her parents and other family membersʹ, cited in DHCS, Keeping Children and Young People Safe, August 2006

56 Australian Government, Australian Institute of Health and Welfare, Australiaʹs welfare 2007, p 49


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mother may experience postnatal depression.57 These are discussed briefly at the end of this chapter.

Domestic violence

The impact of violence between parents and caregivers on a child’s inner world is complex.58

3.5 Domestic violence is not easy to define. The Domestic Violence Crisis Service (DVCS) describes it as more than conflict or arguments in a relationship and:

…typically involves a range of behaviours to control, intimidate or do harm to another person, including: emotional, verbal and psychological abuse, bullying, withholding and controlling finances, harassment, intimidation, damage to property, cruelty to pets, threats, stalking and coercion.59

3.6 This report does not attempt to analyse the nature of domestic violence nor the prevalence but is concerned with the impact on infants and children who live with domestic violence.

3.7 Pregnant women and women with infants and young children are particularly vulnerable in domestic violence situations. As noted in the submission from the DVCS:

While anyone subjected to domestic violence is confronted with a range of concerns and vulnerabilities, it is widely understood that women with children aged 0‐2 and women who are pregnant face particular and heightened vulnerabilities on account of domestic violence.60

3.8 Women with infants or young children in domestic violence situations can be‐ isolated with limited financial resources and lack of support networks. Domestic violence cannot be viewed in isolation and the situation is further

57 Submission no 6, Carers ACT, Submission no 3, Companion House and Submission no 5, Canberra Mothercraft Society Inc.

58 J. McIntosh, Children Living With Domestic Violence: Research Foundations For Early Intervention, Journal of Family Studies, Vol. 9, No. 2, October 2003, p 219

59 Submission no 11, Domestic Violence Crisis Service, p 2 60 Submission no 11, Domestic Violence Crisis Service, p 4


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exacerbated by the complexity of factors that contribute to situations of domestic violence. As noted by DVCS:

These are structural/social and interpersonal in nature and typically intersect across a range of fronts including those associated with: mental health and well‐being, substance abuse, post‐partum and maternal health needs, unemployment, poverty, housing, community supports and so on.61

3.9 Most women at some stage throughout their pregnancy will have contact with health professionals. Women do not freely disclose domestic violence to health professionals for the reasons mentioned above. According to the Canberra Mothercraft Society (CMS) this could be improved if health professionals, particularly those working with pregnant women, asked about domestic violence or screened for domestic violence. From the experience of CMS, the major barrier for this is the lack of effective training of health professionals and the ʹlack of effective coordination between hospitals and community based services to ensure womenʹs safety and confidentialityʹ.62

3.10 The Committee considers that a risk assessment tool to screen for domestic violence, coupled with appropriate training would be valuable for the early identification of a mother and child that may be in need of support.


3.11 The Committee recommends that ACT Health develop a risk

assessment tool, with guidelines and training, to screen for domestic

violence for pregnant women who access antenatal services through

ACT Government institutions.

3.12 The impact of living with domestic violence for infants and very young children is profound. The understanding of the impact of traumas on the neurobiological, psychological, cognitive and social functioning of developing children was advanced by significant research that occurred during the 1990’s.

61 Submission no 11, Domestic Violence Crisis Service, p 4 62 Submission no 5, Canberra Mothercraft Society, p 5


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Prior to that time it was considered that children were detached and unaffected by the violence they witnessed.63

3.13 The effects on children living in households where there is domestic violence can be social, psychological and developmental. This may include experiencing physical harm, poor health, learning and developmental delays and other behavioural and emotional problems.64

3.14 Children in these households are also at an increased risk, up to 15 times more likely, of being physically abused or neglected. 65 Young children, up to the age of five years, are over represented in households where domestic assaults have occurred.66 While the violence may not be directed at the child, a further study found that almost a quarter of children hurt in domestic violence assaults were hurt as a result of them intervening in the parental conflict ‘usually trying to stop, intercept, or protect their mother’.67

3.15 For children living with domestic violence the impact will depend on the severity and frequency of the violence and the age of the child. Major developmental impacts on children from violent homes compared to non‐ violent homes, as noted by Dr McIntosh68 include: psychological and behavioural disturbances; impact on their social world; intergenerational transmission of violent patterns of relating; and co‐occurring stresses that increase the likelihood of post‐trauma difficulties.69 A study by Mertin and Mohr found that 20 per cent of children of mothers that had gone to a refuge


64 Submission no 11, Domestic Violence Crisis Service, p 5 65 Osofsky, cited in J. McIntosh, Children Living With Domestic Violence: Research Foundations For Early Intervention, Journal of Family Studies, Vol. 9, No. 2, October 2003, p 221


67 Fantuzzo & Mohr, cited in J. McIntosh, Children Living With Domestic Violence: Research Foundations For Early Intervention, Journal of Family Studies, Vol. 9, No. 2, October 2003, p 222

68 Dr Jennifer McIntosh is a clinical child psychologist, family therapist and research & training consultant. 69 J. McIntosh, Children Living With Domestic Violence: Research Foundations For Early Intervention, Journal of Family Studies, Vol. 9, No. 2, October 2003, pp 224–225


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after a violent incident, 20 months later, met the criteria for Post Traumatic Stress Disorder.70

3.16 It is not just behavioural problems that children develop from homes where there is chronic violence:

Domestic violence, severe and protracted, which begins very early in a child’s life and continues through childhood, disrupts the very organisation of the child’s sense of self, and the way he or she is able to think about and process the world around them.71

3.17 Children who present at a refuge with their mother, following a serious domestic violence incident may require ongoing support. The Committee understands that the DVCS and refuges have dedicated child‐focused workers that work with the children while they are in their care. The mothers are also supported and provided with appropriate referrals to community supports and services. However, once women leave the refuge or cease to have contact with DVCS there is no follow‐up, that the Committee is aware of, to ensure that women and children continue to be supported. The Committee acknowledges the work conducted by the refuge workers, but does not consider that ongoing involvement with clients is the role or responsibility of this sector.


3.18 The Committee recommends that the ACT Government work with the

Domestic Violence Crisis Service and women's refuges in the ACT, to

develop mechanisms that would enable women and children to

continue to be supported once they leave the care of the refuge and

go back into the community.

3.19 Despite the best intentions of mothers subjected to domestic violence to care for and protect their children, it has been shown that parenting capacity can be affected. Research conducted across all socioeconomic groupings found that mothers who had been victims of domestic violence showed: reduced levels of

70 Mertin & Mohr, cited in J. McIntosh, Children Living With Domestic Violence: Research Foundations For Early Intervention, Journal of Family Studies, Vol. 9, No. 2, October 2003, p 225



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psychological functioning; less effective social supports; poorer parenting; and higher rates of depression and psychological distress and lower levels of self‐esteem.72

3.20 The concern about the effects of domestic violence on young children, either as witness to or direct recipient of, is reflected in the Children and Young Peopleʹs Act that includes in its description of emotional (psychological) abuse, the following:

(i) the child or young person has seen or heard the physical, sexual or psychological abuse of a person with whom the child or young person has a domestic relationship, the exposure to which has caused or is causing significant harm to the wellbeing or development of the child or young person.73

3.21 As noted by Dr McIntosh:

There are few legitimate avenues for reaching children other than via protective intervention, which itself can mitigate against the seeking of support and often protects without healing.74

3.22 The DVCS is the first port of call for many people in the ACT experiencing domestic violence. In its submission to the inquiry DVCS reported that, for the period 2006‐07, the service had 938 requests for ‘on site’ crisis support and that children were present in 68 per cent of the crisis visits.75 Further figures provided by DVCS show that up to 50 per cent of clients accessing the service for the first time are accompanied by children.76

3.23 Police attending a domestic violence crisis call are mandated to report the incident to Care and Protection Services. The Committee understands that, while DVCS is not mandated to report incidents of domestic violence where


73 Children and Young People Bill, Part 10.2, p 255 74 J. McIntosh, Children Living With Domestic Violence: Research Foundations For Early Intervention, Journal of Family Studies, Vol. 9, No. 2, October 2003, p 230

75 Submission no. 11, Domestic Violence Crisis Service, p 4 76 Information provided by the Domestic Violence Crisis Service. The figures provided are for first time clients only and do not reflect the number of ongoing contacts DVCS has with established clients.


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children are involved, they will do so when there are serious concerns for the welfare of the child/ren. Not all reports made to Care and Protection Services are acted upon. Action following a report to Care and Protection Services is discussed in chapter four.

3.24 Women in domestic violence situations are often reluctant to seek support. International research suggests that women can experience violence for years or up to 10–35 separate incidences before they come to the attention of the police or other supports services.77 Factors that influence this include:

threats;

fear of reprisal and harm, including fear of services such as care and protection and police;

lack of supports/alternatives including lack of resources;

family and societal/cultural pressures;

personal beliefs around family, marriage and children; and

hostile and judgemental community attitudes.78

3.25 Despite numerous national campaigns aimed at reducing domestic violence, it is still a largely hidden problem in our communities and one that causes significant harm to infants and children. The challenge is to engage women to seek support earlier. Engaging women with complex needs is discussed further in chapter four.

3.26 The Committee considers that the best form of early intervention for vulnerable infants and children living with domestic violence is to reduce the occurrence of domestic violence in the first instance. This is a long process that all governments can assist with, by ensuring community campaigns are frequent and consistent. Further, resilience training for school children aimed at developing strong, healthy young people armed with the confidence to make their own decisions and choices is another way to begin to break the

77 Amnesty International, cited in Submission no 11, Domestic Violence Crisis Service, p 2 78 Submission no 11, Domestic Violence Crisis Service, p 7


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cycle of intergenerational violence and social disadvantage that impacts so negatively on growing children.79


3.27 The Committee recommends that the ACT Government develop an

ACT specific domestic violence campaign for local television and

radio.

Parental substance abuse

For adults with substance misuse issues who are also parents, one of the greatest fears that comes with accessing support services is that their

parenting capacity may be called into question.80

3.28 In recent times there has been a growing interest in the needs of children of drug dependent parents. It is difficult to ascertain the extent of parental alcohol and substance abuse in Australia but it has been estimated that around 10 per cent of Australian children live in families where there is parental substance abuse.81

3.29 Parental substance abuse is often implicated in cases of children who come to the attention of care and protection services. The Child Protection Australia Report states:

Departmental analysis across the states and territories indicate that children are being admitted to orders for increasingly complex factors associated with parental substance abuse, mental health and family violence.82

79 The Standing Committee on Health and Disability made a recommendation regarding resilience training for young people in its report The use of crystal methamphetamine ʹiceʹ in the ACT, April 2008, p 48

80 C. Cousins, ʺBut the parent is trying…ʺ The dilemmas workers face when children are at risk from parental substance abuse, Australian Institute of Family Studies, p 3

81 Dawe et al, Drug use in the family impacts and implications for children, Australian National Council on Drugs Research Paper 13, November 2006, p vii

82 Victorian Department of Human Services, cited in Australian Institute of Health and Welfare, Child Protection Australia, 2006–2007, AIHW Child Welfare series No 43, p 43


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3.30 Families Australia has also noted the increasing number of children in the child protection system as a result of substance abuse stating that:

This issue and, in particular, the fact that increasing numbers of women are now engaged in substance abuse, has changed the face and dynamics of child abuse and neglect in Australia.83

3.31 While parental substance abuse is implicated in many child protection cases ʹfew of these cases actually involve harm as a result of intent to injure or through violenceʹ.84 It is not the drug use itself that creates the problems in most cases, but rather the substance using life style such as being intoxicated, anti social behaviours, social isolation, poverty and neglect. However, there is also a correlation between substance abuse and domestic violence.85

3.32 It has been noted that the impact of environment and parental capacity on the child from the prenatal period have a more significant impact on developmental outcomes than the actual maternal substance use.86

3.33 Research conducted by Odyssey House Victoria regarding the needs of children with substance dependent parents found that 55 per cent of children of drug dependent parents were similar to other Australian children in that they experienced minor emotional or behavioural problems.87

3.34 The Committee notes that parental substance abuse on its own is not a predictor of a child at risk of abuse or neglect and acknowledges that there are many families living fulfilling and socially responsible lives, while also living with an addiction. Families and Friends for Drug Law Reform (FFDLR) directed the Committee to evidence to support this view, particularly in cases of heroin addiction where appropriate maintenance programs have been established.88

83 Families Australia, Our Children, Our Concern, Our Responsibility, 2003, p 11 84 Scott, cited in C. Cousins, ʺBut the parent is trying…ʺ The dilemmas workers face when children are at risk from parental substance abuse, Australian Institute of Family Studies, p 4

85 Submission no 11, Domestic Violence Crisis Service, p 7 86 Kay Berry, Drugs and the Aftermath. Children who live with Substance Use–Early Intervention in Utero to Permanency Planning, viewed 28 July 2008, <<http://www.acwa.asn.au/Conf2004/acwa2004papers/26_kerry_kay.pdf>

87 Odyssey Institute of Studies, The Nobodyʹs Client Project Identifying and Addressing the Needs of Children with Substance Dependent Parents, Summary Report, December 2004, p ii

88 Submission no 13, Families and Friends for Drug Law Reform, p 15


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3.35 FFDLR considered the maintenance treatment program in the ACT to be family unfriendly. The location of the Opioid Treatment Program (OTP) at the TCH can make it difficult to access for many people, particularly for those with young children, who were also reliant on public transport, coming from further away. In the initial stage of assessment and stabilisation, clients admitted to the program may be required to attend the clinic daily, over a number of weeks. However, once clients are stabilised at the OTP they are then able to receive their treatment at a local community pharmacy.89

3.36 While the Committee notes these concerns it welcomes the recommendation made by the Siggins Millar Review to ʹincrease the system capacity to provide more integrated care for pharmacotherapy clients by supporting the development of a GP led expanded and enhanced community‐based multidisciplinary team to provide pharmacotherapy servicesʹ.90 The Committee understands that the OTP is currently working to increase the number of GPs in the community that can manage patients on the maintenance program, thereby relieving the pressure on OTP and making the maintenance program more accessible.

3.37 While there is a strong link between substance abuse and child protection matters, FFDLR warned against the ʹinsistence of abstinenceʹ in drug dependent parents that exists in child protection policy.91 This is often a recipe for failure and can exacerbate the problems for drug dependent parents. As noted in the FFDLR submission:

Drug dependency is a chronic relapsing mental health condition recognised as such by the International Classification of Diseases (ICD‐10) of the World Health Organisation and the Diagnostic and Statistical Manual (DSM‐IV) of Mental Disorders of the American Psychiatric Association.92

89 Submission no 13, Families and Friends for Drug Law Reform, p 15 90 Siggins Millar, External Review of the ACT Alcohol and Other Drug Service System, A report to ACT Health, September 2007, p iii

91 Submission no 13, Families and Friends for Drug Law Reform, p 15 92 Submission no 13, Families and Friends for Drug Law Reform, p 15


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3.38 It has long been argued that drug addiction is a health problem and should be treated as such.93 However the stigmatisation and marginalisation of drug dependent people, and in particular drug dependent mothers, contributes to the reluctance of them seeking out support services and makes it harder to assist these parents to improve their parenting capacity. The report by the National Council on Drugs noted that women are deterred from engaging in treatment out of concern that their children will be removed. The report noted:

Although drug treatment is regarded as a way of keeping children ʹout of careʹ women are less likely to engage with drug treatment services due to anxiety that discovery of their drug problem will lead to the removal of their children.94

3.39 This fear of, for mothers particularly, losing their children to care and protection has been highlighted throughout this inquiry. Despite the parenting capacity of these mothers, the fear of losing their children demonstrates the love and bond that they have for their children. FFDLR argues in favour of strengthening the capacity of drug dependent parents to fulfil their responsibilities as parents rather than focusing on abstinence issues. The Committee agrees that these mothers must be supported, to not only strengthen their parenting capacity, but to address the other issues in their lives that may be contributing to their ongoing substance abuse problems.

3.40 Drug and alcohol treatment services are ideally placed to work with their clients on parenting issues as most clients accessing drug and alcohol agencies are in some way affected by parenting, ʹeither as current parents, future parents, or parents who donʹt currently have contact with their childrenʹ.95 People access treatment services when they have a desire to address their drug and alcohol problems. Children can often be the catalyst for prompting change in their parents.

93 see for example, G. Fulde and A Wodack, Ice: cool drug or real problem?, MJA, Volume 186 Number 7,

2 April 2007 94 Australian National Council on Drugs, cited in Submission no 13, p 10 95 Victorian Government Health Information, A Parenting Support Toolkit for Alcohol and Other Drug Workers, viewed 7 July 2008, <http://www.health.vic.gov.au/drugservices/downloads/pst‐overview.pdf>


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3.41 However, it is not always easy for drug and alcohol workers in an adult‐focused drug and alcohol agency to engage with their clients as parents. In response to this the Victorian Parenting Centre and Odyssey House Victoria, with funding from the Victorian Department of Human Services, developed a specific tool kit, Parenting Support Toolkit for Alcohol and Other Drug Workers to assist drug and alcohol workers to address the role that parenting plays in the lives of their clients.96 The Committee considers this to be a useful resource for drug and alcohol workers that could be utilised in the ACT.



ways of utilising the Victorian Government resource Parenting

Support Toolkit for Alcohol and Other Drug Workers in the ACT.

Aboriginal and Torres Strait Islander families

3.43 One of the terms of reference for this inquiry was to look at the specific issues related to Indigenous parents and their children. While Aboriginal and Torres Strait Islander people are subject to the same vulnerabilities as previously discussed throughout this report, matters are further exacerbated when coupled with issues of racism, cultural oppression, access to culturally appropriate services and poorer health outcomes. Aboriginal and Torres Strait Islander people are over represented in the criminal justice system, rates of unemployment, lower levels of education and teenage pregnancies. Aboriginal and Torres Strait Islander children are over represented in care and protection matters, out‐of home care and in the youth justice system.97

3.44 The Committee was not successful in its attempts to seek input to the inquiry from Aboriginal and Torres Strait Islander representatives and workers and acknowledges the time pressures placed on services such as Winnunga Nimmityjah, that make it difficult to respond to such inquiresat short notice.

96 Victorian Government Health Information, A Parenting Support Toolkit for Alcohol and Other Drug Workers, viewed 7 July 2008, <http://www.health.vic.gov.au/drugservices/downloads/pst‐overview.pdf>

97 Steering Committee for the Review of Government Service Provision, Overcoming Indigenous Disadvantage Key Indicators 2007 Report, Commonwealth of Australia, pp 1–4


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However, the Committee is pleased to note the establishment of the ACTʹs first Indigenous Elected Body. The role of the new body is to advise the Government on policy and services for Canberraʹs Aboriginal community.98

3.45 While it is difficult to determine the population of Aboriginal and Torres Strait Islander people living in the ACT, in 2006, it was estimated to be 4 000, or 1.2 per cent of the overall population.99 Aboriginal and Torres Strait Islander people in the ACT have better health outcomes than in other parts of Australia despite two in five people considering their health to only be fair to poor and more than one in three having a disability.100

3.46 From 2000–2004 there were 338 babies born to 330 women who identified as being Aboriginal and Torres Strait Islander, in the ACT. The majority of these women were ACT residents (240 or 72.7 percent) while the rest were NSW residents (90 or 27.3 per cent).101 Aboriginal and Torres Strait Islander women tend to have their babies at an earlier age than non Aboriginal and Torres Strait Islander women ʹwith 64.4 per cent less than 30 years of age at the time of birth compared with 40 per cent of non Aboriginal and Torres Strait Islander womenʹ.102

3.47 Over 40 per cent of ACT resident Aboriginal and Torres Strait Islander women reported smoking during their pregnancy compared with 13.9 per cent for non Aboriginal and Torres Strait Islander women. Of those Aboriginal and Torres Strait Islander women who reported smoking, more than 70 per cent smoked 10 or more cigarettes per day.103 The correlation between low birth weight and smoking is well known. While Aboriginal and Torres Strait Islander women are more likely to have child of low birth weight (21.9 per cent compared to 7.5

98 The Canberra Times, ACTʹs inaugural indigenous body, Media Release, 2 July 2008 99 Australian Bureau of Statistics, 4705.0 ‐ Population Distribution, Aboriginal and Torres Strait Islander Australians, 2006, viewed 9 July 2008, <http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/4705.0Main+Features12006?OpenDocument> 100 2002 National Aboriginal and Torres Strait Islander Social Survey, cited in ACT Health, A New Way: The ACT Aboriginal and Torres Strait Islander Health and Family Wellbeing Plan 2006–2011, p 7

101 ACT Health, Maternal and Perinatal Health in the ACT 2000–2004, Health Series Number 44, Population Health Research Centre, Population Health Division, November 2007, p 56




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per cent of babies from the non Aboriginal and Torres Strait Islander population, weighing below 2500 grams) the majority of low birth weight babies born to Aboriginal and Torres Strait Islander women in the ACT during 2000–2004 were not resident in the ACT.104

3.48 Aboriginal and Torres Strait Islander children are significantly over represented amongst the number of children on care and protection orders in the ACT. In 2006‐2007 there were 113 Aboriginal and Torres Strait Islander children on care and protection orders, equating to just under 20 per cent of all children on care and protection orders in the ACT in that year. When comparing the rate of Aboriginal and Torres Strait Islander on care and protection orders it is 58.9 children per 1000 Aboriginal and Torres Strait Islander children compared to 6.2 children per 1000 children for non Aboriginal and Torres Strait Islander children.105

3.49 While these figures appear alarmingly high the Committee notes that the small population of Aboriginal and Torres Strait Islander children in the ACT (1,920 as of March 2007106) contribute to the high figure. As a percentage of all children on care and protection orders in the ACT, Aboriginal and Torres Strait Islander Children make up 19.68 per cent. This is comparable (but by no means acceptable) to figures for the remaining states and territory that range from 10 per cent in Victoria to 66 per cent in the Northern Territory.107

3.50 There is no easy explanation for the over representation of Aboriginal and Torres Strait Islander children in the care and protection system. Some of the underlying causes, as noted by the HREOC report Bringing them home (National inquiry into the separation of Aboriginal and Torres Strait Islander Children from their families) include:

the legacy of the past policies of the forced removal of Aboriginal and Torres Strait Islander children from their families;

104 ACT Health, Maternal and Perinatal Health in the ACT 2000–2004, Health Series Number 44, Population Health Research Centre, Population Health Division, November 2007, pp 59–60

105 Australian Institute of Health and Welfare, Child protection Australia 2006–07, AIHW Child Welfare Series No 43, January 2008, p 50

106 Australian Bureau of Statistics cited in, Australian Institute of Health and Welfare, Child protection Australia 2006–07, AIHW Child Welfare Series No 43, January 2008, p 80



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intergenerational effects of previous separations from family and culture;

poor socioeconomic status; and

perceptions arising from cultural differences in child‐rearing practice.108

3.51 The Committee notes the changes made to the Children and Young People Act 1999 that require the development of cultural plans for all Aboriginal and Torres Strait Islander children on care and protection orders requiring out‐of‐home care.109 The cultural plans are developed in consultation with the parents, Care and Protection Services, the Aboriginal and Torres Strait Islander Servicesʹ Family Support program and aim to preserve and enhance the childʹs cultural identity.110

3.52 The Committee further notes section 513 of the Children and Young People Act 2008, Priorities for placement with out‐of‐home carer—Aboriginal or Torres Strait Islander child or young person outlines a preference for the placement of Aboriginal and Torres Strait Islander children to be with the child’s extended family, within the childʹs community, and/or placement with other Aboriginal and Torres Strait Islander person and must be consistent with the childʹs cultural plan.111

3.53 The Committee notes that the ACT Government has a number of specific strategies for Aboriginal and Torres Strait Islander families but was disturbed with this high rate of children on care and protection orders. The Committee further notes that these programs are new and hopes that this will lead to a reduction in the number of Aboriginal and Torres Strait Islander children placed on care and protection orders in the ACT.

3.54 One of the priority areas of the A New Way: The ACT Aboriginal and Torres Strait Islander Health and Family Wellbeing Plan 2006‐2011 is maternal and child

108 Human Rights and Equal Opportunity Commission cited in, Australian Institute of Health and Welfare, Child protection Australia 2006–07, AIHW Child Welfare Series No 43, January 2008, p 29


110 ACT Government, DHCS, Service Brochure, our mob and care and protection services, p 7

111 Children and Young People Act 2008 p 392


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health. Beginning life as a healthy child will lead not only to better health outcomes into adulthood but also better social outcomes. The Plan states:

Premature and underweight babies have a significantly higher likelihood of poor health as they grow through childhood and into adulthood. By assisting mothers to have a normal, uncomplicated pregnancy and give birth to a health baby, it will be possible to reduce the rates of early childhood sickness, hospitalisation and even death.112

3.55 Winnunga Nimmityjah Aboriginal Health Services has a nurse/ midwifery program that provides holistic antenatal care from an early stage that also includes information and referral to other services such as contraception and nutritional advice. The pregnancies supported though this service are often complicated and include issues such as anaemia, cultural and social wellbeing, and substance misuse. As noted on the Program website:

Many of these clients require intensive support and care in a culturally appropriate and friendly environment. Personal and socio‐economical problems, cultural differences, transport problems, and communication problems, mean that there is often a reluctance to access relevant mainstream services, including hospital‐based services as well as support services such as Nursing Mothers or the post natal depression support group. This lack of access to services can of course result in complications for both mother and baby.113

3.56 The Committee notes the pilot program for Aboriginal and Torres Strait Islander families operating at the Gungahlin Child and Family Centre. The program is coordinated by the ACT Government Indigenous Unit and supports families that have been identified to be at risk. The Committee was advised that the program provided support to six families, representing 28 children in the previous year and that additional funding provided in the current budget will allow the program to cater for up to 25 families. The Committee was further advised that the Government was pleased with the

112 ACT Health, A New Way: The ACT Aboriginal and Torres Strait Islander Health and Family Wellbeing Plan 2006–2011, p 11

113 Winnunga Nimmityjah, Nurse / Midwifery, viewed 9 July 2008, <http://www.winnunga.org.au/services/midwife.htm>


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response to the program and that it was expected to be evaluated in the coming year.114

3.57 The ACT Government also has a program called ʹengaging our mobʹ that is a series of workshops facilitated through the Child and Family Centres. This program is about ensuring staff of ACT Health interact with Aboriginal and Torres Strait Islander families in a respectful and culturally appropriately way.115

3.58 The Committee understands that transport is a key issue for Aboriginal and Torres Strait Islander people in the ACT accessing the Winnunga Nimmityjah Health Service and that professional staff spend a lot of their time transporting people to their appointments. This is of significant concern as the time of health professionals and social workers engaged with the service could be much better utilised. The Committee is of the view that the ACT could play a greater role in assisting Winnunga Nimmityjah with its transport needs.



ways of assisting Winnunga Nimmityjah Aboriginal Health Service

with the transport needs of patients.

Parents of children with disabilities

A significant number of Australian parents face a learning curve beyond all usual imagining when they discover that their child has a disability.116

3.60 The emotional responses of parents who learn that their child has a disability would be difficult to comprehend, for those who have not had this experience. Carers ACT describes overwhelming feelings of grief and loss, confusion, stress associated with the time taken to determine a diagnosis, particularly when parents know there is something wrong, parents distress at having to subject their child to invasive treatments or learning to conduct medical procedures themselves such as tube feeding or giving injections, and the huge

114 DHCS, Transcript of Evidence, 14 May 2008, p 49 115 DHCS, Transcript of Evidence, 14 May 2008, p 50 116 Submission no 6, Carers ACT, p 4


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adjustment in personal expectations when parents begin to realize the full implications for the future of their child and their family.117

3.61 These experiences do not, in themselves, make the infant vulnerable, but it is an important time when parents need the knowledge and support of people with experience and expertise in this field to help them to deal with and adjust to their situation.

3.62 Carers ACT was particularly concerned that appropriate support is not always made available to these families when it is most required. As noted in their submission:

The catastrophic impact of such news is largely unrecognized and unsupported in our society. It is a sad fact that many parents in such circumstances still get offered little more support than being told to ʺgo home and try to get on with your lives as best you canʺ.118

3.63 Carers ACT stressed the need for long‐term strategies to educate service providers about providing direct referral for parents, at the point of diagnosis, to support services such as Carers ACT.

3.64 The Committee was advised that the ACT Government provided a one‐off funding grant for the development and delivery of a comprehensive Service Provider Education Program under the Carers Recognition Grant program for the 2006–2007 year.119 However, due to the high turnover of staff in the health sector, Carers ACT considers that an education program about the needs of families with a child with a disability and appropriate referral strategies must be comprehensive and ongoing.120


3.65 The Committee recommends that the ACT Government resource

Carers ACT to enable delivery of the Service Provider Education

Program on an ongoing basis.

117 Submission no 6, Carers ACT, pp3‐4 118 Submission no 6, Carers ACT, p 3 119 Submission no 6, Carers ACT, p 4 120 Submission no 6, Carers ACT, p 5


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Young Carers

3.66 Carers ACT also brought to the Committeeʹs attention the plight of young carers who are providing care for a parent or other family members due to disability, mental illness, chronic conditions or illnesses, and drug and alcohol problems. While this falls outside the scope of this inquiry the Committee would like to acknowledge this group of young people and makes the following comment.

3.67 There are approximately 130 young carers in the ACT supported through Carers ACT. The most common age of young carers is 12–15 years of age. The youngest carer currently receiving support through Carers ACT is 7 years of age. Most young carers (74 per cent) provide care for a parent of guardian and 25 per cent provide care for a sibling. Carers ACT makes the point, that children born to a parent with a disability, chronic condition or drug and alcohol problem are at risk of becoming a young carer themselves.121

3.68 The Committee considers that the issues raised by Carers ACT are of significant concern. Early identification of these families, particularly where a young carer is caring for an infant or young sibling, would greatly assist these young people to be supported, not only in their role as carer but also in their educational and social requirements.


3.69 The Committee recommends that the ACT Government support

Carers ACT to develop strategies to assist in the early identification

and support of young carers.

Refugee and Asylum Seekers

3.70 The ACT is home to a small population of refugee and asylum seekers. Companion House is a community based organisation in the ACT and is the main provider of services to these communities of people, who have been affected by torture and trauma. Companion House provides medical services, counselling, advocacy and community development services.122

121 Submission no 6, Carers ACT, p 6 122 Submission no 3, Companion House, pp 1–2


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3.71 In its submission to the inquiry Companion House provided two case studies ʹwhere medical practitioners believed a loss of life was imminentʹ.123 The first case study highlighted the lack of trust in service providers, particularly in relation to Care and Protection Services, communication issues, the lack of outreach support and care coordination. The second case study highlighted the need for culturally appropriate parenting support and information, specifically around appropriate nutrition for the child.124

3.72 Other concerns raised by Companion House for refugee and asylum seekers included; lack of affordable housing, the need for greater antenatal care, postnatal outreach services and case coordination for women with vulnerable infants and young children. Domestic violence was also raised as a concern for these women, particularly in relation to culturally accessible messages about domestic violence to new and emerging communities.125

3.73 These issues outlined above are also of concern to other marginalised women in the community with complex needs. In the report on isolation and marginalisation of women in the ACT, (discussed in chapter two) women from cultural and linguistically diverse backgrounds were also identified of being at an increased risk of isolation and marginalisation.126

3.74 Companion House notes their role in working to provide solutions for the identified issues, but also considers that mainstream health and family support services have a role in responding to the needs of culturally and linguistically diverse communities through the provision of multilingual and culturally sensitive services.127

3.75 The Committee is pleased to note the 2008‐2009 funding allocation for primary care services at Companion House. This initiative will enhance:

…the current medical program for refugees and humanitarian entrants operating from companion house, by providing a part‐time registered

123 Submission no 3, Companion House, p 3 124 Submission no 3, Companion House, pp 5–9 125 Submission no 3, Companion House, p 11 126 Sarah Maslin, Marginalised and Isolated Women in the Australian Capital Territory Risk, Prevalence, and Service Provision, Womenʹs Centre for Health Matters, February 2007, p 4

127 Submission no 3, Companion House, p 11


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Nurse (3 days per week) to better meet the increasingly complex needs of existing and future clients.128

3.76 Issues relating to accessible service provision are discussed in the next chapter.

Postnatal depression

3.77 Children of parents with postnatal depression (PND) are at an increased risk of developing behaviour problems. Research suggests that up to 30 per cent of preschool aged children whose parents had PND symptoms experienced mild to severe behaviour problems.129

3.78 Postnatal depression is a form of clinical depression that can affect up to 15 per cent of women after childbirth.130 While it is less common for men to experience, up to 50 percent of partners of women with postnatal depression will also develop depression.131

3.79 The severity of PND will depend on the number of symptoms, their intensity and the effect they have on the normal functioning of the person. Symptoms of PND can include: sleep disturbance, (unrelated to the baby’s sleep needs); appetite disturbance; crying without apparent reason; inability to cope with daily chores; chronic exhaustion or hyperactivity; irritability; anxiety; negative obsessive or morbid thoughts; fear of being alone; fear of social contact; memory difficulties and loss of concentration; feeling guilty and inadequate; loss of interest in sex; loss of confidence and self‐esteem; and feelings of self harm and suicide; and harm to the baby.132

3.80 Although PND can affect all women, known risk factors that make some women more vulnerable include:

previous experience of PND;

family history of psychiatric illness (bipolar disorder, schizophrenia, PND);

128 ACT Government, Budget Paper 3, p 76 129 J. Marshall and P. Watt, cited in Submission no 5, Canberra Mothercraft Society Inc, p 5 130 J. Najman and others, cited in Submission no 5, Canberra Mothercraft Society Inc, p 5 131 M. Areias, cited in Submission no 5, Canberra Mothercraft Society Inc, p 5 132 raising children network the australian parenting website, What is postnatal depression?, viewed 5 August 2008, < http://raisingchildren.net.au/articles/what_is_postnatal_depression_‐_panda.html>


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stressful life events, for example, a recent death in the family, financial problems, moving house;

history of pre‐menstrual tension; and

difficult marital or family relationships.133

3.81 These risk factors assist with the early identification of women that should be encouraged to talk with their doctor before the birth of their baby. PND is treatable and with the early intervention services in place postnatal depression should be screened for routinely to identify women that may be at risk and to ensure that appropriate support mechanisms are in place to ensure the needs of the parents and children are being met.


3.82 The Committee recommends that the programs available for post

natal depression be better advertised and if necessary be further

resourced to meet demand for services.

133 raising children network the australian parenting website, What is postnatal depression?, viewed 5 August 2008, < http://raisingchildren.net.au/articles/what_is_postnatal_depression_‐_panda.html>


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4 EARLY INTERVENTION

4.1 Public interest in policy about the wellbeing of children has grown over recent years. The Australian Institute of Health and Welfare attributes this to:

….a growing awareness that effective support for children, young people and families, is vital for the stability and future productive capacity of society in a rapidly changing social, educational and economic environment.134

4.2 Early intervention can refer to a stage early in the life of the child or early in the life of the problem.135 This report is concerned with early childhood intervention that has been described as:

…programs that attempt to improve child health and development during the period from conception to six years of age with the expectation that these improvements will have long‐term consequences for child development and well being.136

4.3 Raising children is a complex process and a long learning curve that often requires support and education, particularly for first time parents. This support and education can come through family and extended family members and friends, educational material such as books on raising children, as well as a range of early childhood and family services. These services can include any of the following objectives:

enhancing the parent‐child relationship;

developing parental knowledge and parenting skills;

developing social support networks;

focusing on the childʹs cognitive, language and social development;

school performance; and

134 Australian Institute of Health and Welfare, Australiaʹs Welfare 2007, p 66 135 Submission no 7, Families ACT, p 3 136 Sarah Wise and others, The efficacy of early childhood interventions, Research report no 14 2005, Australian Institute of Family Studies, p 1, viewed 16 July 2008, <www.aifs.gov.au/institute/pubs/resreport14/2.html>


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broader community and social conditions.137

4.4 There are many such services operating in the ACT including ACT Government services and community based services that are funded through the ACT Government. Community based services also receive funding through the Australian Government, and in particular through the Department of Families, Housing, Community Services and Indigenous Affairsʹ program of Stronger Families and Communities Strategy. The Program provides an opportunity for families, their children and communities to build better futures.138

4.5 The Committee does not intend to review all these services, but rather focus on those early intervention services that provide services to parents with complex needs whose children are vulnerable and at an increased risk of abuse or neglect.

4.6 This report is also concerned with the collaboration between agencies for families with complex needs.

4.7 In its submission to the inquiry, Families ACT (FACT) advised the Committee that current contracts under the ACT Government Family Support Grants Program (FSGP) are being reviewed and that the sector has been informed that that the FSGP is going to be targeted towards families with complex needs. While FACT supports this approach it was concerned, that without additional resources, this could be at the expense of early intervention services.139

4.8 Without the final details of the review the Committee is not in a position to comment. The Committeeʹs position is clear however, that any reduction in the delivery of early intervention services would be detrimental to those families that seek the support for the wellbeing of their children.

4.9 Family Support services, like most community organisations have limited resources. The need for investment in early intervention cannot be overstated.

137 Sarah Wise and others, The efficacy of early childhood interventions, Research report no 14 2005, Australian Institute of Family Studies, p 1, viewed 16 July 2008, <www.aifs.gov.au/institute/pubs/resreport14/2.html>

138 Australian Government Department of Families, Housing, Community Services and Indigenous Affairs, Stronger Families and Communities Strategy (SFCS) 2004–2009, viewed 5 August 2008, <http://www.facs.gov.au/internet/facsinternet.nsf/aboutfacs/programs/sfsc‐sfcs.htm>

139 Submission no 7, Families ACT, p 3


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The only state that has recorded a reduction in child protection notifications is Victoria, which has tripled its investment in early intervention family services.140

4.10 The Marymead Child and Family Centre is a local community‐based child and family service that works to preserve and support families, and care for children and young people who canʹt live at home with their biological family. Marymead has been operating in Canberra for 40 years and supports up to 800 children and families through a diverse range of programs.141

4.11 As Marymead Child and Family Centre noted in their submission:

Infants cannot be discussed in isolation. Because infants are so highly dependent upon their main caregivers for their very survival, services and care of infants must really focus on the needs and care of families and communities. When needs of families and communities are supported, the needs of infants will also be supported.142

4.12 Figures provided by Marymead for this inquiry showed that 25 infants and very young children (0–2) had been referred to the Marymead Fostercare program for placements in the preceding 6–8 months. Marymead was able to place 15 of those children in foster families.143 Of the 15 placed with foster carers just over half were returned to their family (including kinship care). The pathway for the children not returned to families is unclear but as Marymead noted:

Some may return to their parents. Others may experience sporadic return to their motherʹs care. Some will not return to their families and indeed may experience a succession of carers by the time they are five years old, thus compromising their attachment potential and the development and wellbeing.144

140 Submission no 7, Families ACT, p 5 141 Marymead Child and Family Centre, viewed 1 August 2008, <http://www.marymead.org.au/about_us.html>

142 Submission no 4, Marymead, p 2 143 Submission no 4, Marymead, p 3 144 Submission no 4, Marymead, p 3


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4.13 Marymead is of the view that these figures could have been reduced if these families had access to high quality early invention before reaching crisis point. Marymead also discussed their Families Together program that provides in‐home visits to families with drug and alcohol related issues to assist the family with parenting and relationship issues. The families are referred to this program by Care and Protection Services. As noted in their submission:

It is Marymeadʹs preferences to provide these services earlier in the life of the problem i.e. before they have contact with OCYFS.

However, the demand on the program from OCYFS limits its capacity to accept self‐referrals (which is the best time for an early intervention service) and referrals from community based organisations.145

4.14 The Committee considers that better resourcing of early intervention services is required to ensure that services are able to deliver to those families that require it and, in particular, considers that greater focus on targeted interventions aimed at those families with complex need is required to reach those families that are most in need.



ways of better resourcing early intervention services for community

based child and family services.

4.16 The Committee notes the Universal First Home Visit program whereby everyone who has had a baby in the ACT will receive a home visit from a Maternal and Child Health nurse. The program is designed to identify any potential problems for the baby and the family. This is more than a self identification of problems. The nurses:

…have quite a defined process that they go through to identify what the needs and possible risk factors are for those families. And they will talk with them about them and make an assessment as to whether that family either needs more regular visits—that is part of the PEP [Parenting

145 Submission no 4, Marymead, p 2


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Enhancement Program] program possibly—or referral to other services.146

4.17 The Committee notes that there are many programs, both at the community and government level operating in the ACT. The Committee is concerned however, whether these programs are being accessed by those parents with complex needs, when they require them most.

Barriers to accessing services

4.18 Research has shown that people with complex issues are the least likely to access services to seek support. As discussed in chapter two, for example, there are many reasons that contribute to women with substance abuse issues presenting late to antenatal care. For these women, and other marginalised and isolated women such as migrant and refugee and Aboriginal and Torres Strait Islander women,147 the barriers that impact upon them presenting late to antenatal care do not leave them when their child is born.

4.19 ACT Health is the major provider of antenatal and postnatal care and support services in the ACT. In their submission WCHM cited a number of reasons that prevent women with complex issues from accessing these services. These include:

a womanʹs perception that she did not fit the target group;

women feeling uncomfortable mixing with women who do not have complex needs; and

difficulty in accessing information about available services.148

4.20 Outreach services are beneficial for people in the community who are unable or unlikely to access support services. This is particularly so for the parents with complex needs that have been discussed throughout this report. The Committee heard that outreach services are currently provided through a number of organisations in the ACT including, the Universal Home Visit

146 DHCS, Transcript of Evidence, 14 May 2008, p 44 147 See report, Sarah Maslen, Marginalised and Isolated Women in the Australian Capital Territory, February 2008

148 Submission no. 1, Womenʹs Centre for Health Matters, p 4


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program for all new parents, WIREDD and Marymead. The Committee was advised that outreach is a crucial component of Marymeadʹs Family Support and Families Together programs as it helps workers to develop a trusting relationship between the worker and the parent in their own environment.149

4.21 Transport was also identified as a major barrier to accessing services, particularly for families experiencing social disadvantage who are reliant on the public transport system.150 It was further noted that outreach services are particularly important to help combat the problems people have with transportation.151

4.22 The Committee was advised that young parents have very specific needs and often feel marginalised by mainstream services catering for more mature parents. The Committee was informed that most youth services in the ACT run young parents groups.152 The Committee notes the directory of youth services for people who work with young people, The Big Red Book, developed by the Youth Coalition of the ACT provides, among other things, comprehensive information about resources and parenting groups available to young parents.153

4.23 The Committee is of the view that targeted programs are essential to engage with the diversity of families with complex needs. To ensure that services are adequately targeting these families most in need the Committee supports the suggestion from the Public Advocate of the ACT to:

…conduct research and service evaluations to ensure the quality outcomes are assessed and that services are effectively meeting the needs of vulnerable infants in the ACT.154

4.24 The Committee notes the targeted programs run by the ACT Government such as; Learn, Giggle and Grow playgroup for families with multiple and complex issues; the Poppy Play Group for children of parents with a diagnosed mental

149 Marymead, Transcript of Evidence, 14 May 2008, p 55 150 WCHM, Transcript of Evidence, 14 May 2008, p 14 151 Youth Coalition for the ACT, Transcript of Evidence, 14 May 2008, p 80 152 Youth Coalition for the ACT, Transcript of Evidence, 14 May 2008, p 79 153 Youth Coalition for the ACT, The Big Red Book, viewed 23 July 2008, <http://www.youthcoalition.net/public/Projects/BRB.html>

154 Submission no 12, Public Advocate of the ACT, p 4


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health illness, and the Children of Parents with a Mental Illness (COMPI) group.155

4.25 As part of this inquiry the Committee visited the Child and Family Centre at Tuggeranong. The Committee considered the centre to be well equipped with a range of excellent programs for parents with infants and young children.

4.26 The ACT Government Child and Family Centres offer a multidisciplinary, needs‐led approach to service delivery. There are two centres currently operating in the ACT at Tuggeranong and Gungahlin. The Committee is pleased to note that the 2008‐2009 budget included funds for forward planning for a centre to be built in Belconnen.

4.27 The Committee notes the targeted programs that cater for parents with complex needs but was concerned that the mainstream programs could be perceived as inaccessible by parents from lower socioeconomic backgrounds and those with complex needs. Unless these parents were referred to the Centre, the Committee considered it unlikely that they would choose to attend many of the parenting groups and other programs.

4.28 The Alcohol and other Drug Foundation ACT (ADFACT) provides a residential program for parents who have alcohol or other drug issues. ADFACT advised the Committee that the service utilises the Child and Family Centres primarily for parenting education programs. ADFACT identified that amongst their clientele of parents with young children there was a significant ʹlack of awareness of basic things like hygiene, food and basic care of a small childʹ.156

4.29 However ADFACT advised the Committee:

…the problem is that the Triple P programs or the PET programs are pitched at a high level of education, so we are having to do a lot of that stuff in house where we can really lower the level for people to be able to understand it on their terms.157

155 Submission no 10, ACT Government, p 8 156 ADFACT, Transcript of Evidence, 14 May 2008, p 70 157 ADFACT, Transcript of Evidence, 14 May 2008, p 71


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4.30 The Committee also considered that more flexible hours of operation, particularly extended hours during week days, could make the centre more accessible for fathers and working mothers who are often unable to attend during work hours.


4.31 The Committee recommends that the ACT Government conduct an

evaluation of its early intervention services to ensure that these

services are adequately and appropriately meeting the needs of

parents of vulnerable infants, and potentially vulnerable infants.

Collaboration between agencies

4.32 The families that have been the subject of this report require a multi‐agency response to deal with the complexity of issues that they face. As noted in this report, and in many of the submissions received these issues cut across a number of sectors including; drugs and alcohol, domestic violence, mental health and housing.

4.33 This has been recognised in the ACT with a number of programs operating in the ACT that work from a collaborative model, at both the Government and community level.158 The Committee was particularly impressed with the ACT Governmentʹs new IMPACT project.

4.34 The Integrated Multi‐agencies for Parents And Children Together Program (IMPACT) is an example of a multi‐agency program that began in February 2008. This program caters for families expecting a baby or who have a child under two years of age. To be eligible for the program one must be a client of Mental Health ACT and / or be receiving Opioid Replacement Therapy.

4.35 The Committee would like to see this program expanded to include all families with drug and alcohol issues. The Committee was advised that pending the outcome of the first 12 months, the possibility to expand the program would need to be considered by the next government. The Minister

158 See for example, Submission no 9, ADFACT Family and Children Program


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advised that limitations on entry were required to ensure the service was not inundated. The Minister advised:

We had to control the entry, in order to make sure we did a good job; otherwise there would be referrals from everywhere for every difficult family or someone they had a concern over. With this one, because it is the first time we have done a program like this, we will watch how it goes for the first 12 months. If we need to expand it then that is a question that the government of the day will have to look at in terms of further funding.159

4.36 While there are many good government and community based services operating in the ACT, consultations conducted by WCHM for this inquiry found that ʹthere are insufficient resources, lack of collaboration across the sectors and a service system mainly confined to the working weekʹ.160 WCHM advocated for an overarching collaborative body funded specifically to develop collaborative partnerships between services.161

4.37 The Domestic Violence Resource Centre suggested that collaboration between agencies could be promoted through mechanisms such as:

the development of Memorandums of Understanding;

the development of more joint partnerships and projects between services;

enhancing cross‐sector communication through the development of interagency networks and meetings; and

incorporating collaborative practices that reflect cultural awareness and sensitivity.162

4.38 The Committee also heard that women are often concerned about their personal information being shared between agencies. This was particularly so for sensitive information that women feared would be reported to Care and Protection Services.163 The Committee was advised that this is not the case, but whilst it remains a concern for women it needs to be addressed.

159 Minister for Health, Ms Katy Gallagher, Transcript of Evidence, 14 May 2008, p 49 160 Submission no 1, Womenʹs Centre for Health Matters, p 4 161 WCHM, Transcript of Evidence, 14 May 2008, p 13 162 Submission no 11, Domestic Violence Crisis Service, p 9 163 WCHM, Transcript of Evidence, 14 May 2008, p 12


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4.39 The Committee considers that collaboration between agencies would require the sharing of some information and considers that the concerns of women could be addressed by clearly defined processes and guidelines. The Committee supports the development of collaborative practices across services and sectors.


4.40 The Committee recommends that the ACT Government further

enhance the development of collaborative practices across services

and sectors.

What about fathers?

4.41 Fathers play a vital role in the care and development of their infants and their families. The Committee was concerned at the lack of specialist services available for men in the ACT.

4.42 The Canberra Menʹs Centre (CMC) is a community service organisation that provides support to men living in the ACT and local region. The Manager of the Centre, Mr Greg Aldridge, advised the Committee that while the service is not specifically funded to deal with issues related to the safety of children, the service assists many men with issues of anger and violence and who have posed a risk to their partners and / or children.164 As a menʹs organisation this was only one aspect of their work.

4.43 Mr Aldridge raised a number of concerns in relation to the supports currently available to men, including limited expertise that exists around working with menʹs issues. He was of the view that child and family support services tend to overlook the needs of fathers. The focus is on the mother and child, and men were not given the choice or encouraged to access services. This is perpetuated by the cultural idea that men donʹt typically ask for help and that the needs of the mother and child should come before their own.165

164 Mr Greg Aldridge, Transcript of Evidence, 14 May 2008, p 27 165 Submission no 8, Canberra Menʹs Centre, p 2


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4.44 The support often provided to men through child and family services is ʹin terms of propping them up to support the familyʹ.166 CMC was supportive of seeing more male practitioners and support workers as currently, community services are mostly staffed by women, who are not always best equipped to understand a male point of view.167

4.45 The Committee understands there are a number of parenting groups operating in the ACT to help men with their parenting skills. However, these groups are not always available for men whose children are at risk through violence or neglect.168 The Committee considers that men need more than parenting groups and is supportive of more male focused services and programs.

4.46 The Committee heard that to best address the needs of men, a combination of services was required. That is, specific services for men as well as more male inclusive practices in the family and relationship services currently available.

4.47 Of particular concern to the Committee was the lack of early intervention support services for ʹmen as menʹ and ʹmen as fathersʹ. As Mr Aldridge noted:

They may have drug and alcohol problems, intellectual disabilities or mental health problems; they could have grown up in abusive families. But as soon as the stresses of being in a relationship with children start to get too much and they react badly to that and start becoming aggressive, controlling or violent, there is nowhere even to refer them in the early stages.169

4.48 The Committee was pleased to note that the ACT government had allocated additional funds to CMC to employ a menʹs counsellor. CMC reported that this would enable the Centre to make greater connections with the Child and Family Centres (CFCs). The Committee visited the Tuggeranong Child and Family Centre and noted that most of the activities did focus around women and their babies apart from an evening Triple P (Positive Parenting Program) that was well attended by fathers.

166 Mr Greg Aldridge, Transcript of Evidence, 14 May 2008, p 29 167 Submission no 8, Canberra Menʹs Centre, p 4 168 Mr Greg Aldridge, Transcript of Evidence, 14 May 2008, p 31 169 Mr Greg Aldridge, Transcript of Evidence, 14 May 2008, p 29


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4.49 The Committee noted that the majority of programs offered through the CFC were held during regular business hours. The Committee considers that the opening hours between 8.30 am ‐ 5.00 pm restrict access to men who are otherwise engaged with work. The Committee understands a trial of extended hours of operation at the Gungahlin CFC on a Saturday morning was not successful. The Committee considers, however, that extended hours of operation on week days, either earlier mornings or later evenings once or twice per week, would open up the service to enable men to access the service to seek support and guidance in matters concerning their children. The extended opening hours would also be of benefit to full‐time working mothers. The Committee also believes that the Saturday morning trial would not have been a success given that this is a typical time for family activities.

4.50 Despite the best intentions of family services the Committee considers that there is a lack of male focused early intervention services to support men, particularly those with complex issues, to become better fathers. The Committee considers that a significant investment in a targeted early intervention program addressing life skills and parenting skills for men with complex needs, would be a valuable addition to current family services and would go a long way to supporting those vulnerable infants that are the subject of this inquiry.


4.51 The Committee recommends that the ACT Government consult with

men's support organisations and Regional Community Services to

develop early intervention programs for fathers with complex needs.

4.52 In relation to gender specific services the Committee heard that there was a need for gender specific services for both men and women, particularly in the area of substance and dependency issues. Evidence from Womenʹs Information, Resources and Education on Drugs and Dependency (WIREDD) supported a similar service for men that addressed issues specific to drug dependency for men, such as domestic violence, gambling issues and sex addiction.170

170 WIREDD, Transcript of Evidence, 14 May 2008, p 24


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4.53 The Committee notes the Father Inclusive Practice Framework developed by the Family Action Centre at the University of Newcastle.171 The framework is based on nine principles which are: father awareness; respect for fathers; equity and access; father strengths; practitionersʹ strengths; advocacy and empowerment; partnership with fathers; recruitment and training; and research and development.172



principles of the Father Inclusive Practice Framework in future service

planning.

4.55 The Committee also heard that young men / fathers have limited access to mainstream child and family services. Youth services cater for young people 12–25 years of age and engage with young men on a number of different levels, such as relationship enhancements, parenting skills and drug and alcohol issues. However, once young men reach the age of 26 they no longer have access to youth services which can leave them without support.173



the level of unmet need of support services for young fathers post the

age of 26.

171 University of Newcastle, Family Action Centre, Father‐Inclusive Practice Framework, viewed 22 July 2008, <http://www.newcastle.edu.au/centre/fac/efathers/includingfathers/index.html>

172 University of Newcastle, Family Action Centre, Principles for Father‐Inclusive Practice in Early Intervention and Family Related Services, viewed 22 July 2008, <http://www.newcastle.edu.au/centre/fac/efathers/includingfathers/framework‐principles.html>

173 Youth Coalition of the ACT, Transcript of Evidence, 14 May 2008, p 81


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Care and Protection Services

The care and protection system can be seen as adversarial, punitive and judgemental.174

4.57 ACT Care and Protection Services receives a high number of reports, on a daily basis, that must be processed. In 2006–2007 the Department received 8,710 notifications.175 Early intervention services, targeting these families where infants and children are at risk of becoming vulnerable, have the potential to reach these families before they are brought to the attention of Care and Protection Services. Reducing the number of initial reports made to Care and Protection Services would not only relieve pressure on an already overloaded service, but it would reduce the stress placed on families that are the subject of such reports.

4.58 The Committee considers that reaching families before they have come to the attention of Care and Protection Services is a desirable outcome.

4.59 The care and protection of children in Australia is the responsibility of state and territory governments. The Australian Government, however, has recently begun the process of developing a national child protection framework. Consultations on the discussion paper closed on 30 June 2008 and the final framework is expected to be completed by the end of 2008.176

4.60 With increasing cases of child abuse and neglect across the country a national response to dealing with child protection issues is long overdue. Statistics cited on the Government website of particular concern include:

58,563 findings of children either being or likely to be harmed, abused or neglected per year;

the prevalence of abuse and neglect five times higher among Indigenous children than other children;

174 Submission no 1, Womenʹs Centre for Health Matters, p 5 175 Australian Institute of Health and Welfare, Child Protection Australia 2006–07 AIHW Child Welfare Series NO 43, p 18

176 Australian Government, Department of Families, Housing, Community Services and Indigenous Affairs, Australiaʹs children: safe and well, viewed 17 July 2008, <http://www.facsia.gov.au/internet/facsinternet.nsf/family/parenting‐child_protection_discussion_page.htm>


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65 per cent of children in the child protection system are under the age of 10; and

the largest proportion of children admitted to care and protection orders are between one and four years of age.177

4.61 ACT Care and Protection Services is located in the Deparment of Disability, Housing and Community Services (DHCS) and is responsible for facilitating coordination across the government for the care and protection of children and young people as prescribed by the Children & Young People Act 2008. The role of care and protection workers is to ensure quality outcomes for children and families, in accordance with government policy and departmental practice standards and procedures.178

4.62 Care and Protection Services are very clear that their client is first and foremest the child.179 The Committee accepts that the childʹs safety and needs are paramount; but is pleased to observe that care and protection workers also work extensively with families.180

4.63 In 2007 there were 574 children in the ACT on a care and protection order.181 This included 435 guardianship or custody orders/arrangements, 59 supervisory orders, and 111 interim and temporary orders.182 For those children on orders 18 were less than 1 year old, 123 were aged between 1–4 years, 164 were aged between 5–9 years and 269 were aged between 10 and 17 years of age.183 The rate of children on care and protection orders in the ACT for 2007 was one of the highest at 7.5 per 1000 children, second only to

177 Australian Government, Department of Families, Housing, Community Services and Indigenous Affairs, Australiaʹs children: safe and well, viewed 17 July 2008, <http://www.facsia.gov.au/internet/facsinternet.nsf/family/parenting‐child_protection_discussion_page.htm>

178 ACT Government Staff Bulletin, Prepared and Produced by Publishing Services, No 29‐ 08, 24 July 2008 (PS 08/1043), p 12 179 Minister for Children and Young People and DHCS, Transcript of Evidence, 14 May 2008, pp 37–39 180 DHCS, Transcript of Evidence, 14 May 2008, p 37 181 Australian Institute of Health and Welfare, Child Protection Australia, 2006–07, AIHW Child Welfare Series No 43, p 43

182 Australian Institute of Health and Welfare, Child Protection Australia, 2006–07, AIHW Child Welfare Series No 43, p 44



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Tasmania that recorded 7.6 per 1000 children. The national average for children on protection orders was 6 children per 1000.184

4.64 Children and their families come to the attention of the care and protection system through a report (notification) being made. The voluntary and mandatory reporting of children at risk of abuse and neglect is governed by Part 11.1 of the Children and Young People Act 2008.185

4.65 Notifications received by Care and Protection Services in the ACT come from a range of different sources, including mandated and non mandated reporters. Notification for 2006–2007 came through school personnel (19.5 per cent), the police (17.5 per cent), and non‐government organisations (16 percent). For non‐mandated reporters parent/guardian accounted for 9.1 per cent, other relatives 5.7 per cent and friend or neighbour 8.3 per cent. Combined these non‐mandated reporters accounted for 23.1 per cent.186

4.66 Once a notification has been received by Care and Protection Services a Risk Assessment187 is conducted to determine whether the report requires an appraisal. The appraisal of a report determines ʹthe level of harm or risk to the child and the nature of any further intervention requiredʹ.188 Less than seven per cent of reports made to Care and Protection Services result in the child being placed in out‐of‐home care. When a child has been identified as being at risk within the family, Care and Protection Services may work with the family on a voluntary basis or may seek court orders if the family does not cooperate.189 Interventions may include referral to child and family support services and drug and alcohol agencies.

4.67 There have been a number of systemic changes in the care and protection services in the ACT, particularly with the implementation of the


185 Children and Young People Act 2008, pp 269–274 186 Australian Institute of Health and Welfare, Child Protection Australia, 2006–07, AIHW Child Welfare Series No 43, p 32

187 ʹA Risk Assessment is a professionally guided framework that leads to a judgement based on the available information regarding the risk to the child or young person and the timeliness of a response if required.ʹ DHCS, Keeping Children and Young People Safe, August 2006, p 16

188 DHCS, Keeping Children and Young People Safe, August 2006, p 17 189 DHCS, Keeping Children and Young People Safe, August 2006, p 17


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recommendations from the Murray‐Mackie Report. The Committee considers that it is still too early to determine the impact of these changes on children in the system. Despite these changes however, the Committee heard that the perception of Care and Protection Services in the community, particularly amongst those likely to be affected by the service, was one of fear and mistrust.190

4.68 The Committee heard that one of the reasons women were fearful of care and protection workers was that they lacked information about the process and expectations on them, particularly in relation to the ʹrestoration plansʹ. Women were also fearful of their information from other agencies being shared with Care and Protection Services and of losing their children, as discussed earlier.191

4.69 It was reported that this fear was compounded for women who where already known to Care and Protection Services and who were having another child. The perception for some of these women was that once they had been identified and were in the system, it was difficult to reverse the status.192 DHCS did confirm that for families that had had a child previously removed, the birth of any additional children was treated by the Department as an alert. The Committee was further advised by the Department that the removal of a child did not lead to the removal of future children and that the Department did work with parents to develop appropriate parenting skills.193

4.70 The Committee does not consider it unreasonable that infants born to parents who had previously had a child removed, to be on alert. However, the Committee considers that better communication between parents and care and protection workers could assist in alleviating the perceived fear experienced by many of these women.

190 Womenʹs Centre for Health Matters, Transcript of Evidence, 14 May 2008, pp 11–12 191 WIREDD, Transcript of Evidence, 14 May 2008, p 21 192 Womenʹs Centre for Health Matters, Transcript of Evidence, 14 May 2008, pp 12–13 193 DHCS, Transcript of Evidence, 14 May 2008, p 37


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4.71 It was also reported that responses from care and protection workers were not consistent. Women who had supportive care and protection workers reportedly had better outcomes.194

4.72 The Committee was pleased that care and protection workers are now situated at the Child and Family Centres to work with those families that have been identified through the system as requiring support.195

4.73 Another concern raised by drug and alcohol workers was that women with drug and alcohol dependency issues were having unrealistic expectations placed upon them by care and protection workers, due in part to their limited understanding of addiction. Likewise, the Committee was advised that drug and alcohol workers, who have frequent contact with women in the care and protection system have limited knowledge and access to information regarding critical development stages in childhood and indeed the processes and procedures involved in the care and protection system. 196

4.74 The Committee considers that community organisations, particularly drug and alcohol services would benefit from access to comprehensive information about care and protection processes and procedures. This would enable the workers, who have established relationships with their clients, to be able to convey the information in an nonthreatening way to their clients.

4.75 The Committee also considers that care and protection workers would benefit from spending more time in community agencies, particularly drug and alcohol agencies to learn more about the consequences of substance abuse and addiction.


4.76 The Committee recommends that the Department of Disability,

Housing and Community Services consult with the drug and alcohol

sector to develop cross-sector training to facilitate the exchange of

knowledge and expertise between drug and alcohol and care and

protection workers.

194 Toora, Transcript of Evidence, 14 May 2008, p 22 195 DHCS, Transcript of Evidence, 14 May 2008, p 39 196 Submission no 14, WIREDD, p 2


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4.77 WIREDD advised the Committee that there was significant need in the ACT for a gender specific reference group to support women who have children in the care and protection system. The reference group would not only provide a safe space where women could share their feelings, such as shame, in an understanding environment but could also be a source of ʹinformation, validation and mentoringʹ.197

4.78 The Committeeʹs attention was drawn to a successful self‐help early intervention family program run by UnitingCare Burnside aimed at breaking the cycle of destructive family behaviour and enhancing parent‐child relationships. The intended outcomes of the program, NEWPIN, are to:

break the cyclical effect of destructive and negative family behaviour;

prevent child abuse, with a particular focus of emotional abuse;

encourage self‐help and lasting change;

inspire good parenting and encourage the valuing of positive parent/child relationships; and

raise the self esteem of every individual.198

4.79 NEWPIN works from a strengths‐based approach where participants are able to develop an awareness ʹof their own intrinsic value as a person, a parent and a fulfilled member of the communityʹ.199

4.80 The Committee considers that breaking the cycle of intergenerational disadvantage is essential to prevent todayʹs vulnerable infants from becoming tomorrowʹs parents with complex needs and impaired parenting capacity, the very parents that have been the main subject of this report. The NEWPIN model, with its strengths based approach would be a welcome program on the ACT landscape for parents with complex needs.

197 Submission no 14, WIREDD, p 4 198 UnitingCare Burnside, NEWPIN, viewed 28 July 2008, <http://www.burnside.org.au//content/NEWPIN%20Internet%2Epdf >

199 UnitingCare Burnside, NEWPIN, viewed 28 July 2008, <http://www.burnside.org.au//content/NEWPIN%20Internet%2Epdf >


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the feasibility of resourcing a group specifically for mothers who

have children in the care and protection system, similar to the

NEWPIN model.


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5 CONCLUSION

5.1 There are many circumstances that can leave an infant in a vulnerable situation. The focus of this inquiry has been on parents with complex needs and their infants that become vulnerable when the parenting capacity of their main carer has broken down.

5.2 The Committee considers that the best way to help vulnerable infants in this situation is to restore or develop the capacity of the main carer and, where this is not possible, to ensure that the child is placed in a caring secure environment as soon as is practically possible.

5.3 The Committee commends the work of the ACT Government and community based agencies who work in this difficult field of child protection and supports the ongoing development of collaborative practice between the sectors to address the complex needs of parents to best equip them to care for their children.

5.4 The Committee acknowledges the work done by the ACT Government in relation to enhancing its Care and Protection Services but is of the view that greater investment in early childhood intervention programs is required to reduce the number of notifications made to Care and Protection Services in the first instance.

5.5 The Committee is mindful that the parents that have been the main subject of this report were, in many cases, themselves the vulnerable infants that child and family services are trying to protect today.

5.6 Breaking the cycle of intergenerational disadvantage requires a whole of community response that treats these parents with complex needs with respect and compassion.

5.7 The Committee wishes to thank all those who gave their time for this inquiry.

Karin MacDonald Chair 21 August 2008


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APPENDIX A: Submissions

1. Womenʹs Centre for Health Matters (WCHM)

2. SIDS and Kids ACT

3. Companion House

4. Marymead Child and Family Centre

5. Canberra Mothercraft Society Inc (Queen Elizabeth ll Family Centre)

6. Carers ACT

7. Families ACT (FACT)

8. The Canberra Menʹs Centre

9. ADFACT Family and Children Program

10. ACT Government

11. Domestic Violence Crisis Service (DVCS)

12. Public Advocate of the ACT

13. Families and Friends for Drug Law Reform (FFDLR)

14. WIREDD & Lesleyʹs Place


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APPENDIX B: Public Hearings

Families and Friends for Drug Law Reform (FFDLR)

Mr John Ley, President

Mr Bill Bush, Member

Ms Joan Westaway, Member

Womenʹs Centre for Health Matters (WCHM)

Ma Kiki Korpinen, Executive Director

Ms Robin James, Senior Project Worker

Toora Women Inc

Ms Anna Stewart, Coordinator, Lesleyʹs Place

Ms Natalie Liosatos, Counsellor, WIREDD

The Canberra Menʹs Centre

Mr Greg Aldridge, Manager

Department of Disability, Housing and Community Services

Ms Katy Gallagher, Minister for Children and Young People

Ms Sandra Lambert, Chief Executive

Mr Martin Hehir, Deputy Chief Executive

Ms Megan Mitchell, Executive Director, OCYFS

Ms Denise Lamb, Senior Manager, OCYFS, Care and Protection Group,

Mr Frank Duggan, Senior Manager, OCYFS


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Marymead Family Relationship Program

Ms Suella Jarvis, Manager

Domestic Violence Crisis Service (DVCS)

Ms Dennise Simpson, Manager

Ms Kylie Cocking, Children and Young People Focus Worker

ADFACT Child and Family Program

Ms Kerry Fitzroy, Manager

Ms Kerrianne Abbott, Psychologist

Youth Coalition of the ACT

Ms Carrie Fowlie Deputy Director


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APPENDIX C: Visit to Child and Family Centre

The Committee visited the Child and Family Centre in Tuggeranong on 16 July 2008 and met with the following officials from the Department of Disability, Housing and Community Services:

▪ Ms Helen Pappas, Early Intervention and Prevention Services, Senior Manager

▪ Mr Frank Duggan, Office for Children, Youth and Family Services, Senior Manager

Documents

The early intervention and care of vulnerable infants · the early intervention and care of vulnerable infants 3 chapter also addresses the increased risk of Sudden Infant Death Syndrome