Early in life outcomes of children of mothers with child protection system involvement. What factors are protective and what factors predict poorer infant outcomes?
Chief Investigator: Professor Leonie Segal
Funding Amount: $99,997
Recipient: University of South Australia
Child maltreatment in SA is unacceptably high; ~25% of children have some child protection system (CPS) contact and >4% substantiated maltreatment. Little is known about early-in-life health and social outcomes (low birth-weight, neonatal mortality, infant CPS contact, education etc.) of children of mothers with CPS involvement. The proposed study will ascertain how maternal maltreatment affects their offspring and predictors of better/worse outcomes, informing policy targets to disrupt inter-generational pathways into child maltreatment and associated disadvantage. The aim is to re-imagine a predicted future of entrenched disadvantage, characterised by mental illness, welfare dependency, homelessness to one of promise and potential fulfilled.
Researchers: Professor Leonie Segal, Dr Jason Armfield, Professor David Johnston, Dr Jackie Amos, Ms Leanne Haddad
Research Completed: 2021
Research Findings: The children of mothers who were victims of child abuse or neglect, are considerably more likely to experience abuse or neglect themselves, and other negative early-life outcomes. These high-risk mothers, with their infants/children, are typically identified by maternity and other services. But what is missing is a comprehensive service response, that reflects a deep understanding of relational trauma, to heal the mother’s trauma and build her capacity to provide a nurturing environment for her child.
Aim: The focus of this research was twofold:
- Child protection involvement during early childhood: Are the children of mothers with child protection system (CPS) contact – indicating suspicion of or substantiated child maltreatment (CM), more likely to be the subject of documented child protection concerns ..
- Early birth outcomes: Do the children of mothers with child protection system contact have poorer birth outcomes.
Compared with the children of mothers with no documented child protection concerns.
Based on our cohort of 38 556 mother–child pairs born in SA from 1986, just 458 (2·0%) of the 23 437 children of mothers with no CPS contact had a substantiated CM report and 127 (0·5%) had spent time in out-of-home care (OOHC). In comparison, 970 (22·1%) of the 4382 children whose mothers were exposed to substantiated CM had substantiated CM themselves and 469 (10·7%) had entered OOHC. After adjusting for socioeconomic status and pertinent maternal and child factors, the children of mothers with documented child protection concerns were at much higher risk of child protection contact than the children of mothers with no CPS involvement. Relative risk was greatest for the children of mothers who’d been the subject of substantiated CM and entered OOHC; at >6 times risk for any CPS involvement, >13 times risk for substantiated CM, and nearly 26 times risk of removal from family and entry to OOHC. Where mothers had CPS contact before reaching 1 year of age and/or any CPS notification as a teenager, their children were at highest risk of CPS contact. ThIs study found intergenerational transmission of CM is the dominant pathway into child abuse and neglect.
In terms of birth outcomes, we found that children of mothers with substantiated CM were 75% more likely to die in infancy/early/middle childhood than the children of mothers with no CPS contact, after adjusting for potential confounders.
Children are at higher risk of CM and other negative early-life consequences if their mother has experienced serious abuse or profound neglect as a child. This is consistent with evidence for the disturbing impact of CM on the developing brain and relational patterning. Knowing the very high risk for the child of parental child abuse or neglect underlines the importance of identifying and helping infants, children, adolescents, adults who have been exposed to serious abuse or neglect in childhood. Our findings show that implementing effective interventions that address the past trauma of child maltreatment, distressing parent–child relationships are crucial in preventing intergenerational transmission of child maltreatment and other negative early-life outcomes for the child. Effective interventions will require cross-agency collaboration, skills development (especially in infant mental health) and extra funding – based on social and political will.
J. Armfield, E Gnanamanickam, D Johnston, D Preen, D Brown, H Nguyen, L Segal: ‘Intergenerational transmission of child maltreatment in South Australia, 1986–2017: a retrospective cohort study’, The Lancet Public Health, published on-line April 30, 2021; doi.org/10.1016/S2468-2667(21)00024-4
PRESENTATIONS – this research has been presented at:
- Flinders University Grand Round, Department of Psychiatry, April 2021
- Healthy Development Adelaide/Aust. Assoc. of Infant Mental Health forum, Adelaide June 10th 2021
World Association of Infant Mental Health Congress, Brisbane June 23rd 2021