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It Takes a Community: Preventing Child Abuse and Neglect
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Hello, I'm Norman Swan.
Welcome to this program -
It Takes A Community: Preventing Child Abuse And Neglect.
On the behalf of everywhere here, I'd like to acknowledge
that we're meeting on the land of the Wangal people.
The Wangal people are part of the wider Aboriginal nation known as Eora.
We acknowledge the elders and descendants of the Wangal people.
We're coming to you across Australia
through the Rural Health Education Foundation's satellite network.
In the past ten years, the number of substantiated cases of child abuse
and neglect of children in this country has more than doubled,
and it's overwhelming child-protection services.
Tonight's program focuses on prevention,
and taking opportunities to support families
before child abuse or neglect occurs.
We'll talk about intervening early before damage has been done.
Tonight's panellists all agree on the importance of stronger communities
to the functioning of families,
and therefore reducing the incidence of abuse and neglect.
We're also happy tonight to introduce a new way
of asking questions or making a comment.
It's via instant email. The email address is:
Let's meet our expert panel.
Dorothy Scott is the Foundation Director
of the Australian Centre for Child Protection
at the University of South Australia.
- Welcome, Dorothy. - Thank you, Norman.
Adam Tomison is an expert in the field of child abuse,
and has a long history in research and policy development.
He is Acting Director of Family and Children's Services
for the Northern Territory.
- Welcome, Adam. - Thanks, Norman.
Judy Atkinson is Chair of the College of Indigenous Australian Peoples
at Southern Cross University in northern New South Wales.
She identifies as a Jiman/ Bundjalung woman
who also has Anglo-Celtic and German heritage.
Judy has worked with Indigenous communities across Australia
in the area of violence and trauma.
- Welcome, Judy. - Hi.
Jodi Burnstein is the Senior Manager of Barnardo's Australia's
Orana Far West Centre, overseeing a range of programs
in Central and Far Western NSW.
- Welcome, Jodi. - Thank you, Norman.
Liz Cuninghame is a GP working in private practice in Berry
and at Crossroads Youth Health in Nowra, both in New South Wales.
Liz is actively involved in encouraging and assisting young parents
in their challenging task of parenting. You'll hear more about that later.
- Welcome, Liz. - Thank you.
Welcome to you all.
Dorothy, set the scene for us. It's not a pretty picture.
It's not a pretty picture, and we've got a serious problem.
If we look at the number of children brought into State care,
the number of children for whom a court has deemed it unsafe
for them to remain at home,
we see a doubling in the number of children at any one time,
on any one night, over the last decade.
That is a very serious figure.
NORMAN: Is that a reporting number?
No, these are children in the care of the State.
Is that a phenomenon of reporting or is it their true rise?
It's both. If we look at the number of reports,
we can see that there's been a doubling of those in just four years,
a very high level of notifications
to statutory child-protection services across Australia.
If we look a little more closely, we see this is a system under siege.
In some States we now have one in five
children before the age of 18
being the subject
of a child-protection notification.
NORMAN: One in five?
One in five.
20% of those will be substantiated
as cases of child abuse and neglect.
We are seeing an increase in reporting,
we're seeing an increase
in substantiation.
If we look at what's happening
in the wider community,
particularly around parental alcohol
and drug abuse,
we'll see we have got a seriously increasing problem.
We've got 13.2% of Australian children, or approximately 450,000,
living in a household with at least one adult who's binge drinking.
Not all of those children will be abused or neglected,
but the dice are weighted in that direction.
If we look at children in the child-protection system,
say, being investigated, we're talking about 50% of those
involving parental alcohol abuse.
If we look at children who are actually in State care,
up to two thirds of those will have a parent
with an alcohol and/or drug dependence.
It's not just an artefact of more reporting. The problem is more serious.
There's also an implication that not everybody who is reported
is truly child abuse.
There's an element of unnecessary reporting
because of being risk-averse, or what have you.
Yes, there's an element of that.
Not all children who are being abused and neglected are being reported,
and not all children who are being reported are abused and neglected.
It's probably worth adding that of those reports that aren't substantiated
or aren't accepted for investigation,
a good proportion of those families still need assistance.
They may not be abuseful or neglectful but they need assistance
to help with daily life struggles, parenting skills.
In Aboriginal communities, Judy, the problem is acute because of poverty?
More than that. There's trans-generational trauma as well.
The reporting is higher, the substantiated cases are much higher.
Whole communities can be in crisis.
That's the case with Kalumburu that we're looking at tonight -
21 arrests on child sexual assault.
That's the tip of the iceberg
in the issues that are part of that community's pain.
- Dorothy, there are long-term effects? - Very serious long-term effects.
Some of the best data we have on that comes from the US,
that examined children living in adversity in childhood,
which could be child abuse and neglect, incarceration of the father,
maternal mental illness, a range of risk factors.
Long-term increased risk, both
physical and mental-health problems,
and of course an increased risk
of being unable to effectively parent
their own children.
It isn't automatic that there's
an intergenerational process occurring,
but the risk
of intergenerational transmission
of a pattern of child abuse and neglect in families is higher.
Jodi, is there evidence that you can deload the system?
Every jurisdiction in Australia, this is front-page headlines,
when DoCS, or the equivalent of DoCS, fails in the case of care of one child,
which is not surprising when you have this huge volume of stuff,
can you truly unload the system through prevention?
If you work at an early intervention and preventative level,
you can prevent some of those cases escalating,
particularly if you're focusing on things like early-childhood education
and following through to education at school.
Some people, Adam, might say, it's all just hopeless.
When you hear Dorothy or Judy talking about the statistics,
you say, this is trans-generational, it's cultural,
it's the history of Aboriginal people in this country,
it's socio-economic.
What's the poor GP, social worker, whoever else, going to do?
From my perspective running a statutory child-protection system
in the Northern Territory,
it's well recognised that without the support of a prevention infrastructure
around a statutory child-protection service,
we're not allowing the circumstance to prevent, as Judy said,
children and their families coming to the notice of child-protection services
and/or requiring statutory intervention.
The GP has quite a strong role, as do other professions,
in the universal level, and also in targeting groups in the community
who may be at more risk or are struggling,
and trying to do early work to prevent those struggles from getting worse.
NORMAN: Liz?
I agree. GPs are seeing children,
seeing the parents of children every day.
If we're mindful of prevention, we have a role to play.
NORMAN: Judy?
It's deeper than that.
In communities I work in, there's no GP.
There's no health service, there's no early-childhood program.
But in every community I've been in,
there are people who want to make a difference.
There's skills, there's creativity, there's commitment.
It's finding them and bringing that out.
Is this soft and fuzzy, or are there reliable, reproducible ways
of intervening which we know will make a difference? Dorothy?
There's a long way to go in our research base,
but we have a growing body of knowledge which tells us
that some interventions are effective.
We know that antenatal engagement of vulnerable mothers,
following up with a sustained nurse home-visiting program
for two years after birth of the child, can have a range of gains,
not just a reduced risk of child abuse and neglect.
We know that very high-quality early-childhood education care
which has a strong outreach component to the parents
can be a very effective intervention for children at risk of neglect.
There are a number of community-level interventions, too,
that have been shown to be effective.
NORMAN: Judy?
When we start to talk about an issue publicly,
then we get people at community level speaking out, saying, we want change,
and demanding the government deliver the services
the government legally has to deliver, then we're seeing change happen.
When mothers and young dads also demand
that they get early-childhood programs, they get maternal and child health
which they do have in their communities, then we see change happen.
Have we covered the risk factors?
You talked about parental substance abuse.
What other risk factors are there?
What's interesting is that child abuse and neglect
go along with a range of other problems,
which is why prevention is so cost-effective.
So, low birth weight, child-behaviour problems, low literacy,
non-completion of school, juvenile crime, drug use, teenage pregnancy,
they travel together.
If we understand that they have
a common set of risk factors,
our prevention strategies can be
those underlying risk factors.
The underlying risk factors would be
poor parent-child attachment -
a very critical one.
Low peer-group connectedness.
Diminished social support
and social isolation.
And of course, poverty.
Adam, to what extent can the community be the remediating factor?
I take the view that child protection is everybody's business,
for a range of reasons.
There is good evidence that just impacting on social connectedness
or reducing social isolation in communities can have a strong impact
on the amount of child abuse and neglect that gets reported
and is then substantiated.
Tony Vinson and others did studies looking at different neighbourhoods
and matching them on certain characteristics,
including levels of child abuse and neglect.
He found that communities that were higher
in child abuse and neglect had lower social connectedness.
People were more isolated unless connected to their wider community.
You can do a lot of work around addressing that.
The National Association for the Prevention of Child Abuse and Neglect,
NAPCAN, which I'm a board director of,
they've done a lot of work around creating child-friendly communities
to address how children are perceived in communities
and how children and families can interact more in local environments.
Does that make a difference when it works?
Yeah. A friend of mine has what she calls the Balloon Theory -
it can start very small but expand over time.
You can move from a family fun day,
and move to creating parenting resources and child-friendly spaces
that can reduce isolation and allow access by professionals
to provide support to people that can start to engage.
That can reduce a range of issues including child abuse and neglect.
NORMAN: Do you agree, Jodi? - One key factor of those events
is the engagement of families
and the focus of a community on child-friendly spaces.
By engaging families, you hook them in to other programs,
such as antenatal classes or parenting programs,
or for young children, maybe a social-skills program
where they learn better communication skills.
Liz, you've been trying to do this in general practice.
One of the interventions you presumably can do in general practice
is on positive parenting.
I certainly can deal with positive parenting,
but GPs have a greater role as well.
Listening to the discussion of the incidence of child abuse,
it's easy to feel overwhelmed, and think, what can you do as an individual?
But if what you listen to what Dorothy was saying about risk factors,
they are things that GPs in their everyday consultation
can make a contribution towards.
If you think about treating depression,
so each time you look out for postnatal depression,
treat depression in mothers and in fathers.
If you look at dealing with prevention and treatment of substance abuse,
those things contribute.
Dorothy was talking about the spacing of children and teenage pregnancy.
Thinking about contraception in those areas
will be making a contribution indirectly.
NORMAN: Dorothy, it's a multi-faceted approach, prevention?
Absolutely, particularly strengthening parent-child attachment.
The role of midwives, maternal and child health nurses,
GPs, obstetricians - a fascinating one.
I'm pleased Dorothy mentioned that.
That's one thing that has changed in my practice.
I came across research that said if an ultrasoundographer
doing an antenatal ultrasound spends an extra five or ten minutes
showing the mother and father the baby in more detail
and connecting to the baby and beginning attachment,
that correlates with reduced smoking and substance abuse in pregnancy.
Hearing that has made me change the way I'll deal with promoting attachment
of the mother to the foetus in my ordinary consultation.
NORMAN: You're nodding, Judy.
We showed my students, young Aboriginal men and women,
an ultrasound of a baby in-utero.
There was a scenario of the father coming in and yelling,
and the baby jumped.
Then the mother yelled back and the baby jumped again.
The boys went back and told the girls, the mothers of their babies,
that they had to behave themselves.
They also said they had to stop drinking and smoking
because they had to look after the baby.
There was a consciousness in the young dads
that moved on to the young mums.
I've had people walking in saying, can I take this and show it in my community?
A changeable moment, or whatever they call it.
Back to parenting, there's strong evidence
coming out of the University of Queensland, the Triple P program.
Can you take us through some principles behind that positive parenting?
We have used Triple P and trained GPs in our region in the Triple P program.
That does provide an evidence base.
It gives GPs and other service providers trained in Triple P
a framework they can use when dealing with parents in everyday consultations.
The principles of Triple P are around providing a safe
and interesting environment,
in creating a positive learning environment,
seeing parents as being able to be teachers,
using assertive discipline, having realistic expectations.
Also the important thing of taking care of yourself as a parent.
By being trained in Triple P or having people in your community
trained in an evidence-based parenting program,
it needn't necessarily be Triple P,
you've got a resource that, if a GP feels they've got the capacity
to deal with that in consultation, that can happen.
Or they can be aware of the referral pathways
that they can engage parents to increase their capacity of parenting.
Primarily, you're changing the way you interact with the child.
You're reinforcing the positive rather than yelling about the negative.
It's more than that too.
It's looking at enhancing the capacity of parents to be preventing problems
rather than just managing misbehaviour when it occurs.
Triple P has an element of self-sufficiency,
which is trying to provide as much intervention as they need and not more.
So I think it is quite a powerful thing.
A lot of parents that I will see, if you give them more tools,
it can reduce a lot of problems that might be occurring.
In our experience, when programs like that are run in the community,
you're also creating a social network and a culture focused on children.
This in itself can be a protective factor.
Is good physical health a protective factor?
Indeed. Good health is critical. That's where GPs are so important.
That's one of the questions that came in from country New South Wales.
There's another question from a general practitioner in Victoria -
'Is there a greater incidence of child abuse in blended families?'
DOROTHY: I wouldn't be able to say.
There is an over-representation of blended families
in the child-protection system.
There's a range of reasons for why,
including the special issues of creating that new family unit.
It's also true that how we report in the community
is influenced by who we're reporting about.
It's often harder to report a biological family member
than a person who's joined the family.
NORMAN: A bias in reporting? - There's evidence of that.
There are also special stresses attached to being a blended family
that can lead to increased need.
This is a question from a general practitioner in Queensland -
'How much benefit would there be
with a greater link between rural health services and schools?' Dorothy?
That would be of enormous significance.
Again, we want to start with health services
around the antenatal period and early childhood,
then move on to schools.
Schools are universal services, they are not stigmatised.
To see schools as a platform
from which one can reach out to vulnerable families and children,
then maximise that, is one of the most important strategies
in the prevention of child abuse and neglect.
Schools can be a hub or a nucleus in the community
around which people gather.
We've got a long way to go in fulfilling that potential.
NORMAN: Judy?
Absolutely. In Aboriginal communities
there often aren't the other health programs there should be,
but there's always a school.
The school becomes the place people go.
If we encourage the mums to come where the kids are,
and the dads and grandparents are there
wanting to talk about cultural issues,
you've got the potential to do important work.
That's what I say to Government all the time.
Some of the best research we've got, Dorothy talked about this,
like Aboriginal Head Start and Head Start more broadly
and Perry Pre-School-type programs, they're all school-based programs
that worked because they could engage with at-risk families,
parents and children in a non-stigmatising way.
There have been Australian versions of those.
Schools as community centres,
the idea of using that centre to get in and engage,
as we've been talking about, is important.
In tonight's program, we'll look at some case studies.
Some are focused on what you can do as a primary health-care practitioner,
whether you be a general practitioner
or another part of the primary health-care team in rural Australia.
We're talking about primary intervention, secondary intervention
and, indeed, to some extent, tertiary intervention.
We'll tease that out as we go.
Liz, we'll look at one of your programs to begin.
Why don't you lead us into this case study?
We're looking at a small part of our program
called the Young Parents Early Intervention Program
that the Shoalhaven division of general practice has been running since 2001.
Tonight, we'll look at the Fathers Fishing component.
I would like to set it in the context of the rest of the program.
I've mentioned training GPs in Triple P.
That is the beginning part of the program.
We also established in our community
a network of people interested in parenting
who were workers in any way connected with looking after young parents.
We have 35 members on our network now.
This has informed a large part of our program
and allowed our community to know what each other are doing.
We'll have early-childhood teachers, early-childhood nurses, mental health,
youth workers et cetera network together.
We're much better informed about what's happening.
With the support of the network-developed
parenting program for young parents,
it was through running workshops for young parents
that we'd discuss in the network the difficulty of engaging fathers.
As a result, someone came up with an idea of using something different.
That's what we'll see tonight.
NORMAN: Let's have a look.
I'm Liz Cuninghame.
I'm a GP working in Shoalhaven on the South Coast of New South Wales.
Grab your packs.
There's hooks and sinkers and everything in the pack.
Fishing Fathers came about through the Shoalhaven division of general practice.
They have a youth-health program that's been going for a decade.
We've been looking at how we could engage fathers
in attending parenting workshops.
Somebody came up with the bright idea of doing something such as fishing.
It came from there.
I'm going to teach you guys a little bit more about fishing,
but with a strong slant about how to take your kids fishing -
to make sure they stay safe, make sure they have a good time
and to make sure they'll want to do it again.
I was approached by Southern Area division of general practice
and asked if I'd be willing to lend my expertise on the fishing front.
They'd never had problems getting mothers to come to parenting groups,
but when they advertised for fathers, they got poor attendance.
They decided they needed a hook, and the obvious hook was fishing.
Most guys like to go fishing.
Because I've got a profile in the fishing game,
a lot of them wanted to learn it from me.
We were knocking people back the first time.
This is the third one.
It's a model that could be used in other areas in well.
Do people find it difficult
to work out how much risk to allow their kids to take?
My child has no fear.
She'd go headlong into that water without thinking about it.
There's a perception that men have difficulties
talking about emotional issues and softer issues like parenting.
They're probably either embarrassed or not motivated enough
to go to something just advertised as a parenting workshop.
But fishing gives them an excuse to go.
You could do the same thing with sailing or bushwalking
or four-wheel driving or whatever worked in your area,
and get fathers in that way, then talk about parenting.
I thought it would be a good, skilful thing to meet other men,
whether they be single or just parents.
Just meet other people, talk about the kids,
learn some positive parenting skills, which I certainly did learn.
A lot of women have got their own outlets,
but the majority of the time, men, we work full time.
It's very hard to get out and talk to other men
going through similar circumstances with their children.
You go to the pub, but you don't talk about the kids.
It's been a roller-coaster ride.
It's been a huge roller-coaster.
Since we moved here from Tasmania, my wife contracted cancer.
She's been through a rough period with that.
She only recently passed away about six weeks ago.
I'm left now with three young kids.
I've been the main breadwinner, now I'm thrust into the single-parent role,
having to learn what's the right thing to do and what's the wrong thing.
How do we set limits, and how do we make those limits effective?
You kind of just know what's the right thing to do,
whether you ground them, whether you smack them on the bum,
whether you lock them in their bedroom.
I don't agree with any of these things.
My 12-year-old, I smacked her three times when she was between 2 and 4.
With my two-year-old now, my voice just doesn't work.
We're really well-placed as GPs to be doing this type of work.
People see us as a credible source of information.
I learn a lot about what fathers think of fathering from doing the workshop
that makes you respond differently in consultation as well.
Part of what came out of the workshop
was what I could be doing to be a better dad.
Instead of raising your voice
all the time to the children, talking to them.
Show me your eye.
Nothing's in there. All clear. Probably salt water.
Trying to think about when you were a child yourself.
The idea of prevention underpins the basis of our program,
that every parent has the intention of being the best parent they can,
but some parents don't have the training, the education,
the assistance, the background
to be able to fulfil their potential as a parent.
You would hope that if you improve people's capacity to parent,
that will result in a reduction of problems that you might see,
such as child abuse.
Nice program.
Thank you.
I'd be interested to know how that program
changed some of your practices in the consultation room.
It made me more aware of fathers,
more aware of their role and the need to be including them.
We'll often sideline fathers inadvertently.
I've found that I make a better effort to include fathers.
If I send information home, I make sure I send it to the mother and the father.
I'll suggest to the mother
that the father reads the immunisation sheet I give them.
If you're phoning someone at home and the father answers,
you might talk to them, not just ask for comments from the mum.
It's made me more aware.
Not everybody watching has a river running by.
What are the key take-away messages
that emphasise one small element of the whole program?
The biggest thing is about engagement.
What this program says is that you can engage fathers if you get creative,
and that they do want to be involved.
NORMAN: They're not just coming for the fishing?
No. When we started this, I thought they would be coming for the fishing.
I thought the parenting, they wouldn't be interested in.
But when we did an exercise at the beginning,
and asked the dads to interview each other
about what they wanted out of the workshop,
nobody mentioned fishing. Starlo was a bit disappointed.
- He thought they'd come for the star. - They all said, parenting.
In terms of a take-home message from this,
it would be easy for this to be reproduced
with something different from fishing that might be relevant to the community.
I do think it has to be part of a networked community program.
If you just went out and did a four wheel-drive thing and parenting,
unless you had the support of people in the community
working with the group that you want to target,
you might have trouble making it happen.
Judy?
I think it's about cultural safety for all people.
If you have a man involved in something where he feels comfortable,
he's more open to talk about it and be open to a change in thinking.
Also feeling safe in the sense that, I'm not a good dad all the time,
I'm not a good person all the time,
I'm not a good mum all the time, but I can learn more.
I think that for me, in bringing up my own kids too.
In that film clip, you saw how relaxed the men were
and how easy it was for them to then talk about parenting issues.
There must be a transition from what is clearly primary prevention -
you're trying to prevent problems and sort things out before they start.
But you must get to a situation, also in Aboriginal communities,
where things might be more on the edge and it's got to be therapeutic.
This is a very brief intervention that you've seen.
It could be strengthened and extended.
But once you've got people engaged,
you've then got something you can be working with.
Certainly, there are times in the workshops
when you may come across things
that you'd feel needed to be addressed in more detail.
We have made referrals from people who have attended the workshops.
We've had people referred into our workshops from other organisations
where they think they would benefit from fathers being engaged.
If it's therapeutic, there's a discipline here.
It's not just soft and fuzzy -
let's engage and get them telling their narratives -
you've got to do assessment and plan and work things through
and make sure people follow a pathway.
Where's the line here?
We heard Liz refer to the skills in picking up
that there might be something else going on
where you might need to follow through with a one-on-one assessment.
From there, you refer to a specialist.
Unless it's a frankly therapeutic approach,
it's the engagement of a clinician, whether that be a nurse,
a physiotherapist or a social worker.
Their engagement is part of that assessment process.
JUDY: In Aboriginal communities, we don't have that luxury.
What we do have, for example, Greg Telford in the Northern Rivers area
has week fathers-and-sons fishing camps.
They do a lot of therapeutic work, and sometimes they do refer on.
In Kalumburu, we certainly didn't have the luxury.
We went fishing when I was up there,
and I heard a lot of stories beyond the warm and fuzzy,
some very, very painful stories.
It was about giving people the skills to do something for themselves.
We do not have the luxury of having clinicians on the ground.
DOROTHY: That would be true in many rural parts of Australia.
The other issue is that often referrals don't work.
It's often through the relationship-based practice
with the competent generalist,
be that a public-health nurse, a GP, another health professional,
it's the relationship which is based on trust.
We need to rethink whether, when we identify a more complex problem,
the solution always is referral.
It may be that the clinician needs to be part of a strong network of services
with expert secondary consultation that enables them to stay on working
in ways that I don't think sometimes the specialist clinician
is able to engage with some vulnerable young people and families
that we've talked about.
Picking up on what Judy and Dorothy are saying,
that's a reality in a lot of remote areas.
You may only have a health nurse or a GP if you're lucky
or a primary-school teacher.
That person is on the ground.
There might be 800km to the nearest secondary service,
family-support service or larger clinic.
That person has to do what they can, and we've got to back that up
by providing fly-in-fly-out support and training and other support.
A referral can be, for example, an email to me,
a phone call to me from a doctor in the Territory
or a nurse in a community saying, I've got this problem. Can you help me?
We talk something through.
There's no specialisation in that,
but we're responding to a crisis at the time.
There are many doctors on the ground in Aboriginal communities in particular
who feel despairing because they don't have the answers.
We have to respond to that.
Which is why I asked that first question. Liz?
It is important that you do something with an evidence base
in a small program.
It's hard to evaluate an individual program, and say, is this effective?
But if you use something, in our case we use Triple P,
which has sound evidence behind it,
has been tested over bigger populations,
and I'm sure there are other things that are evidence-based,
which prevents it being just a warm, fuzzy thing,
that helps direct what you're doing.
Tell me about your work with young, first-time mothers.
I had a long relationship
with the Maternal and Child Health Service in Victoria.
I think it's no coincidence that Victoria has the lowest rate
of children in out-of-home care in the country.
So, something's working in Victoria.
There are different factors.
It's hard to make comparisons across jurisdictions.
Victoria has taken a different policy direction in child protection
and put a lot of emphasis on diversion and prevention.
Probably the jewel in the crown of prevention
is the universal maternal and child health service,
in which 98% of families with an infant is enrolled.
Those nurses offer first-time parent groups to all first-time parents.
NORMAN: Not just teenage mums?
No. Two thirds of all first-time parents actually join these groups.
The nurse runs them for, say, eight sessions.
My study followed them up two years later
and found that 80% of those groups were still in contact informally.
They'd evolved into self-sustaining social networks -
one of the most protective factors for child abuse and neglect.
The classic thing - by having a child, you meet new people.
That's right. Sometimes fathers join.
Some of the nurses ran groups based on parenting in a new land
for refugee families.
With young mothers,
they often feel alienated from the normal first-time mother group.
As one young mother said to me,
the women talk about mortgages and marriages.
Some nurses have been very creative in reaching out to very young mothers
and giving them a different type of group experience.
That's what we now see in Mildura,
where a youth worker and a maternal and child-health nurse
have joined together, again, forging a partnership between organisations,
to run a pretty special group.
Let's have a look.
I'm Robyn Flett. I'm a maternal and child-health nurse
with the Mildura Rural City Council.
Mildura is a country town in the north-west corner of Victoria,
bordering on New South Wales.
The town itself is around 60,000.
In Mildura, we have the second- or third-highest rate
of teen pregnancies in the State.
Is that it? Thank you.
The young mums' program started with Maternal and Child Health
five years ago.
This year it's being run at the youth centre
as a partnership with Youth Services with the Connections program.
We found we were having a lot of young mothers.
They were accessing maternal and child-health services,
but not mothers' groups.
They felt intimidated to attend mothers' groups
with older-aged women.
They felt they were looked down upon.
We decided to tap into maternal and child-health services
and ask if we could run a joint program
where I could help build upon young people's skills and confidence.
Each week, Robyn and I alternate.
One week, Robyn will do maternal and child-health stuff,
and I will do more about the young mums on my weeks.
Dealing with their needs might be housing, counselling,
drug and alcohol or just general support on how they're going.
We're getting a bottle.
She has panic attacks, like her mother.
Definitely, isolation plays a big part
in... child abuse and neglect,
not so much that we're rural, but there isn't a lot to do in small towns.
It's good to meet other mums that are around your age.
Your children get to play with other kids too.
I don't see my friends very often, from school,
so I like to come here and talk to the girls
and see what they're up to, what's new.
Coming here, I'm able to make some new friends and talk to people -
actual people that are alive, and not constantly a baby or a cat.
Those mums do have a lot of particular needs.
They are different to deal with and work with.
I'm really talking about mums from about 14, 15 to 19 or 20.
She's beautiful. What happened here? A little scratch.
- I think her cousin did that. - That's all right.
It's helped me grow.
You have to grow mentally with your child.
I'm still very childish.
I like Winnie the Pooh, and my daughter has Winnie the Pooh.
Mentally, I've grown up more.
You've got to be able to teach your children stuff,
and if you don't grow up, you can't teach them.
It's not just skills, it's emotionally and mentally
and all other ways.
So, yeah, it's a good group.
A lot of the things that we do with young mums is related to life skills.
They need to learn these life skills while their babies are growing
and while they need parenting skills.
Don't stress over stuff that's just the normal run-of-the-mill.
Only stress about the big stuff.
I feel that the program we offer to the mums
is helping make a difference with child abuse and neglect
because we're educating the mothers of what to expect.
Some of the things we cover in the program
are safety for children, care of your baby when they're unwell,
anything to do with breastfeeding or bottle feeding.
We talk about times of stress and how to manage that stress
so that they don't get cross with the baby.
They tend to know how to deal with problems.
Last week, we were talking about teething.
Often that's a time when babies are crying a lot.
Mothers, if they know it's going to happen,
are able to deal with it better.
We're only two hours a week that they come and see us,
but they can call in any day if they need assistance
or they're feeling down or just need someone to chat to.
- ..do what I need to do. - Yeah, yeah.
I feel if the mums are supported, then when she does get into a crisis
with either her baby or herself, she at least was able to come to me.
That's happened several times.
When things were hard at home for various reasons,
partners and things, stressed,
we talked about about not shaking babies.
From the very first time we see them, we talk about, never shake a baby,
and tell them strategies not to do in those early days.
The group work certainly does not stop post-natal depression,
but it helps to lessen the severity of it.
It's about making time for yourself, making time to look after your babies
and having some fun in your life.
A lot of them don't have transport, given that they're young,
don't have a licence or don't have money to buy a car.
It's a big thing, transport,
a majority of the young mums... (Speaks indistinctly) ..program.
He only gets 400.
It's a positive program, because it's teaching them that they are worth it.
Yes, you have got a baby, but, oh, well, we'll deal with it now.
There is still time in life. You're only young.
There's time for you to go to school, get an education
and make something of life.
Just 'cause you've had a baby, it doesn't hold you back.
What are the take-away messages for people wanting to get things going?
What do we extract from that program?
There are five elements in that.
One is that it uses a non-stigmatised service
to reach out to adolescent women,
and uses the peer norms - changing things through the peer group
rather than a one-to-one authoritarian relationship with a service provider.
The second thing is that
that group's focus is both on the needs of the young mother and the child.
We're not splitting between adolescent service and children's service.
It's a beautiful integration of those.
The third thing is how flexible it is
in responding to that multiplicity of needs.
NORMAN: It goes with the flow. - Around housing,
around drug and alcohol, transport
and also birth control to increase the spacing before the next baby.
The fourth thing is, you get a sense
that these young women trust the people facilitating that group.
There's warm, trusting, non-judgemental relationships.
That leads to the last point, the fifth, which is, when there's a crisis,
when things start to fall apart in these young women's lives,
they can turn around to someone they trust and ask for help.
Liz, that ties in with programs you've been involved with
as a general practitioner.
Yes, it does. What came across to me was the connectedness,
that these were people not feeling in isolation anymore.
Yet potentially they are vulnerable people who could easily be isolated.
You can expand what happens there
when you're talking about the flexible approach.
You could easily see that GPs could come in and be involved
so you could expand the reach of the program.
NORMAN: Jodi, tell me the programs you're involved with at Barnardo's.
I work in the central-west of New South Wales.
It's a mixed community.
A lot of towns we work in are fairly small, from 400 up to 8,000.
We've deliberately worked in towns that are not regional centres.
They're all within an hour or two hours of a regional centre,
but they aren't regional centres as such.
We find with some older children we're working with
that one of the most important protective factors
is attending and remaining at school and school achievement.
We've developed a range of strategies or interventions
aimed at encouraging school attendance.
NORMAN: After you've handcuffed them to the desk, what do you do?
No, much more fun than that.
For example, at Warren, we had a group of girls who were on suspensions
or at risk of suspension because of behaviour, attitude, talking back,
spitting, swearing, fighting, et cetera.
The school came to us and asked, what can we do with these girls?
We decided to work with the girls,
initially by engaging them in some circus skills.
We were fortunate to have a worker
who had been with the Flying Fruit Fly Circus.
She did hula-hooping with them as a bit of fun,
then started to work to build a human pyramid.
To achieve that, they literally had to learn how to work together,
how to include everyone and make sure everyone participated,
because it wouldn't work if they didn't all participate,
and build trust amongst one another.
Having done that, we were able to move on to a program
that combined art channelling and scrapbooking
to explore more themes around identity and articulating feelings.
So just as with the men and fishing,
you're trying different keys to unlock that safety box.
It's about engagement skills and building a sense of trust
and that it's OK to do what we're doing.
It's that cultural safety Judy was talking about.
This is an OK environment to talk in, that we saw in the fishing program.
Likewise with the young mums, they felt safe
and that this is an environment where they could talk about their needs.
How important is the health-care team in this?
If I was watching as general practitioner
or a pharmacist or community nurse,
I might think, interesting, but I don't see my role in this.
Amongst this group of girls, one had a hearing problem.
The school was not able to get her to a hearing specialist.
But having worked with the girls and developed a sense of trust,
our youth workers were able to work with the whole family
and get that girl to a hearing assessment two hours away.
There were other problems around logical things, transport.
But until that time, the school was aware there was a hearing problem,
it was impacting her education, but they hadn't been able
to engage with the family to get to the specialist.
Liz, it's knowing, if you're a GP, that there is such a group
that you can start to have a relationship with them.
That's what I was going to say
when you said it might not directly relate to a GP.
I'm thinking, if I'm in that town and I've got a kid who's a bit tricky,
you look at what you can get them engaged with.
That's really helpful if you're working on something else,
like managing depression or trying to engage them in contraception,
if they're actually becoming more positive and agreeable.
Another program we have is a breakfast program out at Narromine.
Kids come to the breakfast program in the morning.
The program is a combination of having something to eat,
so getting a good start to the day,
and doing exercise with a load of gym equipment.
That sets children up in a more positive frame of mind for the whole day -
having fed, exercised, offloaded any problem
that might have come up from the night before or at home that morning.
Then they're ready to go to school.
What about community strengthening, Adam?
What sort of programs can you quote there,
and the principles you might take away from that?
This applies across communities.
I like what we've heard so far in terms of the idea of engagement,
then building on that engagement over time
with other professionals into a multifaceted approach.
As families get more comfortable and issues come up,
we've got ways of engaging them.
Some of the keys are, individuals in the community have to want to be engaged,
have to want to be part of something.
It might be something innocuous to start with, then build on that.
Here's my question - what's implicitly underlying this
is you're trying to build up resilience -
resilience in communities, resilience in individuals.
My understanding of the resilience literature is, it's quite a hard task.
The kids who'll do better already have a bit of resilience.
They're more open, more sociable, they're more willing to ask for help.
Can you really teach resilience, Jodi?
That's a tricky one.
That's what you're trying to do, isn't it?
Using a strengths-based approach,
you can build the factors that contribute towards resilience.
If I could interrupt,
because some of those factors are around if you're in school,
you're getting life skills as well as academic skills
to allow you to cope better with the things that life throws at you.
The second point I'd make... I've lost that point.
LIZ: I've got one. - I've lost it, sorry.
If you're dealing with people who aren't very resilient -
I find that with young parents we work with -
you have to assist them to be able to engage.
NORMAN: So you model behaviour.
Also you have to provide really structural things.
Like, we will provide transport and feed people at our workshops well
and give them good resources.
If we just said, come, they probably wouldn't.
We recognise it's hard for them to get there,
but when they do get there, you can build on things you want to.
Have you seen in your area of Shoalhaven in New South Wales
a reduced rate of notification of child-protection orders?
I can't answer that. I don't know.
NORMAN: Dorothy?
Notifications tell us a lot more about activity in a child-protection system
and the degree to which people feel obliged
to report to a statutory authority.
We don't have good prevalence data in this country.
The Institute of Child Health in Western Australia
is working on developing proxy measures
for the prevalence of child abuse and neglect.
At the moment, we're relying on reports, which are a very problematic measure.
What I can say about resilience is,
if we go back to the classic resilience studies of Werner and Smith,
yes, there are constitutional factors in the temperament of some children,
but they found that resilient children,
that is, children exposed to a high level of adversity
but with fewer problematic outcomes in adolescence and adulthood,
had far fewer separations in the first year of life
with their primary caregiver.
NORMAN: Their pathway through life was different?
One significant adult who was very committed to them,
who may not even have been a relative, and greater spacing between births.
So we shouldn't always assume
that resilience is an innate quality in children.
There are factors in the social environment that enhance resilience.
I don't want to spend the rest of the program on resilience,
but my understanding was that the significant adult wasn't that important,
that it was the hiatus, that these children
had some interruption of the adversity, which could be a program like this.
Yes, indeed.
Some of the programs we've heard described, Jodi's for example,
are providing mentoring-like relationships ,
and the before-school program, so you're helping significant adults
into the lives of children in a safe way.
Judy, tell me how it works in Indigenous communities.
Resilience in an Indigenous community would not be looked at from outside
as something of real value.
In an Indigenous community, you may have one house where one woman,
a grandmother, provides a safe place for kids.
The kids will congregate there.
The kids feel safe there.
It looks chaotic at one level, and she's struggling to do things,
- but they feel happy and safe. NORMAN: This heroic aunty.
I've recently had a situation with a woman living in a remote community
who's got six kids.
She's subject to high levels of domestic violence.
We've been trying to get her out.
But if she comes out, she doesn't have the network in her community
that supports her in times of crisis.
When she comes out, she won't be subjected to domestic violence, but...
NORMAN: There's good things as well.
The other thing I wanted to say is,
I'm interested in moving beyond resilience into resonance.
NORMAN: Into? - Resonance.
The ability to empathise, to relate to another person,
another child who's in pain.
Sometimes kids can be resilient and end up in a prison system.
I've worked with kids who, when they're feeling with another child,
they understand why the other child is hurting,
then they can feel how they're hurting themselves.
To explain for people who don't know the resilience literature,
that notion of empathy and being able to empathise
is a key feature of a resilient child or person.
The thing that worked really well for us was,
my students, in the middle of all the arguments
about what was happening in the Territory,
decided they wanted to do something.
So they ran something with NAPCAN called Stomp It,
which has been amazing because it's taken off across Australia.
Communities want to do Stomp It.
We had one day when, on campus -
we were going to run it in Sydney then we decided not to -
on campus, we focused on how we could have a lot of fun,
celebration, around children.
We had GPs, we had the government departments, the NGOs on campus,
and a big celebration with a load of musicians, artists and activities.
We had more children and their parents and their grandparents
on that campus than I've ever seen.
I'd never seen Aboriginal people come
onto a university campus site like we had.
They went away and talked about it for a long time.
Out of that, we didn't have a lot more reports,
but we had people saying, we want this service. We've not got this service.
This is northern New South Wales. We want the Government to do something.
We're seeing communities turn themselves around by demanding.
The New South Wales Government has not been on top of things,
particularly after Breaking The Silence -
the report on child sexual assault in NSW.
the communities I'm working with are saying, come on.
The Western Australian Government has just said to us,
they are seeing changes in a couple of communities in NSW
that they want to have in Western Australia because of this work.
Talk us into the next case study.
I got an email from a community called Kalumburu.
If I ever get a crisis request for help, I say yes straightaway.
I don't worry about the money. Put it on my credit card.
I'm glad I'm not your bank manager.
I've got a good husband.
21 arrests on child sexual assault.
I did two things I always do.
NORMAN: This is a community in crisis? - Yes.
We have what we call ICERT -
the Indigenous Crisis Educaring Response Team.
Immediately I get a call, I either get my students to go out
or somebody else in our multiskilling team, or I go myself.
In this case, I rang the Commonwealth Government and said,
I will make a commitment to this community,
but I want you to commit me to two years of funding and I will go, so I went in.
I found a community that was in incredible pain.
It didn't have any words, any sense of positivity.
I had to work with what was negative first.
I asked them to tell me the things that weren't good. They painted it for me.
NORMAN: So it was almost like narrative therapy?
A kind of a narrative approach, yeah.
It's working from story in a very organic way.
I often get people to find parts of the nature around them
to make the story they want to tell me.
After they had started to name the pain they were feeling
and the shame they were feeling, I said, there are some really good things.
Tell me what's good in this community.
I watched them start to talk
as they named the positive things in the community. It was beautiful.
They started to paint a canvas. I use art a lot, and music and theatre.
They started to paint a canvas, and suddenly stopped
and repainted the canvas, and painted the flag.
On the flag, they painted hands,
and in the hands, they painted the good things in their community.
Then I knew. Then they took us fishing.
LIZ: Fishing? - Just like Liz.
They took us fishing, and we caught fish.
The young boys took us out.
They took the mums and the bubs out,
and we did work with the bubs and the mums went fishing,
and we sat beside different people while they told us how they were feeling.
It was kind of organic, it was therapeutic. I call it educaring.
Let's have a look.
When the community first contacted me, I responded immediately.
When there's a crisis and people want things to change and they ask for help,
a successful outcome is more likely.
Today, we're creating a safe place around the mango trees,
an open space where everyone can come.
The water round the circle symbolises creating the safe place
within the circle, which is really important,
providing a safe place for people to come in and share their stories.
It allows them to talk about their feelings
knowing that no-one else will know about it,
it doesn't go outside the circle.
I'm the director of the healing circle at Gnibi.
CIRCLE stands for the collaborative Indigenous research centre
for learning and educare.
There was a pain here, confusion and shame.
Historically, many in the community
were themselves abused by Europeans they trusted.
People feel safe working with us, here, outside, under the mango trees.
That's where we create the human circle.
Community rebuilding is about helping people to tell their own stories
and to listen to each other.
I call this community healing.
The best way to do this work is holistically, of course.
We have to include the elders - the old grannies and the old grandfathers.
Then you've got the aunties, then young mums,
then the teenagers, then the little kids.
That's six different layers of people.
We work with the elders first, gain their trust,
let them know what we're here for.
JUDY: Trauma recovery is a journey towards healing.
This can begin when people feel safe enough to ask the hard questions,
like, why were the children abused? Who brings in the grog?
Who's behind the supply of the drugs and pornography?
Through painting, dancing, story maps, you help people to find the courage
to first describe their pain
and then discover, and this is important, their hope and resilience.
First, they tell themselves what's wrong,
then they tell each other what they have to do about it.
That's what we teach at Gnibi - how to encourage people to tell their story
and to help the community build solutions.
Aunty, do you want me to take that damper?
We were invited to come to this beautiful community
to see if we could come up with a program of solutions
to help get the community back on its feet,
and families be happier again
and relationships start to work again
and people to understand the dangers of drugs
and alcohol - that they aren't the answer to dealing with problems.
JUDY: Circle work links communities to the university.
It's supported by the Government.
It's educational, or as I call it, educaring.
Community change starts with those who want to change.
If this community has the courage to do the work,
we'll sit in the circle with them and we'll learn with them.
It doesn't happen all at once.
People come to the circle of healing when they're ready.
It teaches education appropriate to their lifestyle.
At this community,
education should be based around the strong culture they have.
The fact that they live on the land, they're still well connected.
It's paramount that we teach our kids the old ways so we can survive.
As the old people, the elders, they share their stories,
they're reclaiming the traditional law.
That says that all children are sacred.
We need to honour the courage of the elder who listened
when she heard her grandchild's cry for help.
She helped her community see there's something wrong,
and she began to do something about it.
Now they're helping themselves, and we have a commitment to be there with them.
When I came here, there was a community in crisis,
a shattered community,
a community that wants to heal and go forward
and get out of all those things that are hurting this place.
A part of that, in particular, is the men of this community.
There's been different levels of support for women and children,
but there was hardly anything here for the men.
We decided when we got here that I'd start a men's group.
Once a week we get together and talk about our problems,
then we work out ways of, how do we address them?
I was offered a job here with the Kalumburu Aboriginal Corporation.
I supervise a small mowing crew.
That has helped me to work in every yard in the community,
which in turn helped me to get to know the people in that household
and what kind of problems they were facing, family issues or whatever.
Young Ian, when I first came here, a very friendly young man,
very proud of his culture here.
This is a bush apple tree.
Always involved in putting together activities
for the youth of his age, boys and girls.
A lot of kids go mad over this.
These things that look like a kangaroo -
(Speaks Indigenous language) ..flying fox.
Ian has been accepted at Southern Cross University Lismore.
With him completing his studies,
the rest of the youth in this community will see that,
and say, I'd like to step up like Ian did.
That's where the strength will come from - from themselves.
The strength that we have inside of us, we share it.
We learn from our elders, it gets passed to us, we pass it to our young people,
and the cycle goes on.
JUDY: It takes a community to rear a child.
It takes a strong, healthy community to raise healthy, strong kids.
If we help the parents to love and protect their kids,
even in ways they've not been protected themselves,
we're building a generation of strong and happy kids,
and then they'll be loving and caring parents themselves.
That's all we can ask for.
The Kalumburu community.
What are the take-aways here that could be generalised elsewhere, Judy?
That it does take a community, that there's no magic wand,
that we have to be in it for the long haul,
that we have to engage across the community to all levels -
with the children, the people at the school, the health workers.
There's a couple of nurses in Kalumburu.
With the old people, who really want change.
I've never yet been anywhere and sat with anybody
who's sitting in pain who doesn't want change.
That's really important.
I totally believe, and what this does, is show...
We've built a program around education -
education for early childhood, education for life-long learning,
education for healing.
Well, impressive.
Thank you very much to you all.
It's been a moving and important program.
What are your take-away messages? Liz?
For me, on a clinical level,
it would be to bear in mind the risk factors Dorothy so clearly identified,
and keep them at the back of your mind.
But rather than feeling overwhelmed by them,
don't underestimate your capacity as a GP
to be assisting parents by reducing those risk factors.
NORMAN: Picking off the pieces you can manage.
I'd also say, if you're a GP like me,
who has the luxury of not working full-time in clinical practice -
and I know lots of rural GPs are so overwhelmed,
they don't have time for something else.
But don't be afraid to team up with somebody,
like my fantastic program coordinator Kim Oliver,
and have a go at applying for some funding
and do something in the community that's incredibly rewarding.
It's completely different from the work you do in your consultation room.
It's definitely worthwhile having a go.
There's often money if you look for it.
Jodi?
For me, in the rural context, where we often have very limited resources,
the key message is - work collaboratively.
Make the most of what we've got in the community.
Know your community resources and refer early when you can.
That's not just a workaround.
That's what I've heard again and again - that's what you've got to do.
Even if you had all the money in the world,
you actually want to build up from the community,
not parachute something shiny in that's new and alien.
- Judy? - Take from what we already know
and build on it.
Don't try to make something new.
We already know a lot, and we need to build on that.
We need to work collaboratively.
And we need to get government to work with us.
Now you're getting ridiculous, Judy.
You were practical up to that point.
No, seriously - Adam, government?
I absolutely support the working-with.
We're trying to do that in the North.
My point would be, finding the right hook is really important.
We've heard that clearly tonight in the programs presented.
Finding the right hook, getting that key relationship with individuals
so they feel support and can ask for more support.
There's more interest in communities that we recognise.
We get overwhelmed sometimes by how much interest there is.
Even in struggling communities, you'll get that interest.
We have to walk with them to create opportunities
for the community to take further action,
putting that system around them to support that work.
Dorothy?
I'd say, developing trusting relationships
with children and families and nurturing hope in communities
and looking after yourself.
I hope you've enjoyed tonight's program -
It Takes A Community: Preventing Child Abuse And Neglect.
If you're interested in obtaining more information
about the issues raised, there are a number of resources available
on the Rural Health Education Foundation's website:
Don't forget to complete and send in your evaluation forms.
They help us constantly improve our service to you.
And please register for CPD points by completing the attendance sheet.
Our thanks to Perpetual Trustees, the Ian Potter Foundation,
the Mary Potter Trust Foundation and the Milton Corporation Foundation
for making this program possible.
Thanks also to you for taking time to attend and contribute.
I'm Norman Swan. I'll see you next time.
Captions by Captioning & Subtitling International
Funded by the Australian Government Department of Families, Housing,
Community Services and Indigenous Affairs.
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