6 November 2009
Protecting children: Where to from here?
Dr Adam M. Tomison
Director, Australian Institute of Criminology
Abstract, slides and audio of presentation
Edited transcript
The following audio presentation is brought to you by the Australian Institute of Family Studies as part of our monthly seminar series in which we showcase national and international research related to the family.
The seminars are designed to promote a forum for discussion and debate. They are open to the public and free of charge.
Seminar facilitated & speaker introduced by Professor Alan Hayes.
Dr Adam Tomison:
Now, today while I'm going to talk about systems failures, to some extent, and the need for change, I don't want this to be taken as a criticism of the individual front line workers who are working in Child Protection Services, police or a range of other professionals who work in addressing child abuse and neglect.
I know it's a hard, thankless job, at times. I know how difficult it can be to do this sort of work, so in no sense at all am I scapegoating, or providing a negative impression of those people. It's more about, how can we improve our system, where might we go in the future? So that's my intent and I hope you all take it that way.
So, I'd like to start with a few brief vignettes, variations of real cases or real matters that I've come across, and I'll use them to set the scene, and to highlight some of the themes I want to cover.
Okay, in the first one, community members in a remote Aboriginal town identified they have a sexual abuse issue going on. When you actually asked what they mean by sexual abuse, they say, oh it's swearing at your kids, it's using the F word. So what does this tell us? Well, I think the first one is, whether it be families and communities, different professions and agencies, let's not assume that everyone has the same understanding as what you may have, on what child abuse and neglect actually is.
In this particular case, this misunderstanding doesn't mean there wasn't sexual abuse - as might be understood by a child protection service - going on in the community. We can't really know from that comment whether anything was happening, or if there was lots of stuff happening.
What we do know is, that that person who was making the response or the community that was making that response has a very different interpretation of sexual abuse. It raises issues of how we educate others to understand the Australian legislative definitions of what we currently believe child abuse and neglect to be.
There is a need for us all to be on the same page, because how can community or professionals respond if they don't know what to focus on, or they have a different interpretation of what the issue is?
In the second matter, parents arrested for beating a child with a stick and slapping a child across the face. When questioned, the parent notes, this is how children in her family have always been disciplined, that she loves her kids, it's never done her any harm to be hit or disciplined in the same way.
What this case says for me is, what is appropriate or accepted behaviour is determined partly by family and community norms. This may change over time and across cultures, and a lack of exposure to wider community norms and wider community views, and a range of parenting strategies, will affect how parents care for their children.
So the point here might be, the need for community education around what we think is an appropriate standard for behaviour, and also to teach people good ways, or alternative ways of actually disciplining their children, that we find acceptable as a community. I'm going to return to these sorts of points later.
Okay, the case of Mary. Mary's reported to Child Protection Services because of concerns she's being seriously beaten by her father. She's been seen with bruises. Police and a child protection worker visit the home together. The father explains the bruises away, there is an excuse for how Mary got hurt. There isn't enough evidence for police or social workers that the father's been doing the harm, or that the child is at imminent risk of harm at that particular point, so they'll leave to continue investigating the matter. Unfortunately, Mary's left in her father's care and is subsequently assaulted again, and dies.
In the media, this system failure results in calls for increased mandatory reporting of suspected child abuse and neglect. Okay, so in this case, there would appear to have been a failure by professionals to determine the extent of risk to the child and unfortunately, to decide the child could be left with her father until further information could be found to give a clearer indication of the concerns.
What might this sort of case highlight? Well, firstly, child protection workers and police are faced with such decisions every day. Unfortunately, you might get a number of cases that look very similar to this, and only one of those cases may the outcome be so negative and so tragic. In other cases, doing the same sorts of actions, taking the same sorts of decisions, may result in a much more positive outcome or an outcome that's quite acceptable for a community and for the services.
Sometimes workers get it wrong, and tragic things happen. Whilst there may be training and supervision needs for these workers, maybe they've done exactly the right thing based on the information they had. Maybe we just have to accept sometimes things go wrong, and you can't always predict that. It's not a perfect system, you can't always work out what's going to happen in the future.
Second point, such tragedies are usually picked up by the media, as you would expect. Is the coverage helpful? Does it produce a better system? The answer is, sometimes it does and sometimes it doesn't. For example, in recent times - driven by comments by some senior academics - the focus taken in cases like Mary's is this idea of increasing mandatory reporting of child abuse by the professions to ensure Child Protection Services are aware of the concerns that a child might be harmed.
So mandatory reporting - for those who are new to the field - is essentially the legislated requirement that people, especially professionals, will actually report suspicions of child abuse and neglect to Child Protection Services. It varies across the country, as to who's mandated to report and how you do that reporting. But it's essentially what it's about.
Now, is it actually an issue of mandatory reporting, in this case? Is this the right thing we should be focussing on? In this particular case, the child protection worker and the police office knew about the matter because they went and did the investigation. So is it a mandatory reporting issue we should be looking at, and a push for extending mandatory reporting requirements is what's required, or is it about something else? Is it about our assessment processes, is it a about how we triage or assess cases?
Okay. Another less frequent outcome arising from these sorts of cases is the idea of punishing offenders, especially non-familial offenders. So the classic one is a sexual abuse case where the stranger's assaulted a young person, and there's calls for hangings and throw away the key, et cetera, et cetera.
Often we still get these punitive approaches or this promotion of punishment, even in cases where family are involved. That's quite understandable, given some of the tragic cases that are seen by society, and seen by workers.
Again, though, is it the approach we really want to be taking? Will it improve our system? Will it lead to better responses? I'll talk about this a bit later. In the case of Jack - Jack's been assessed by our Child Protection and Family Support Services, and they've been assisting Jack's family to try and care for him. He's a 13 year old boy, he ends up being removed from his home because of continued episodes where his parents are failing to feed and care for him adequately, failure to send him to school, and also because they're regularly verbally abusing Jack.
Both the parents are long-term alcoholics and drug users. Unfortunately, there's no foster care available for Jack and he has a few short term placements in Out-Of-Home Care before he ends up in a Family Group Home with a range of other young people who've been removed from their families. Over a period of a year, he ends up dropping out of school, he tries some hard drugs, he's binge drinking and he gets arrested for committing criminal damage.
What might we take from this? There's an assumption that child protection interventions will always lead to greater safety and a better outcome for children removed from their homes. This is not always the case, despite the best of intentions. Decisions to remove a child in the real world may also, in reality, come down to which outcome is least harmful, rather than, 'is this the best?' of two great options.
How decisions pan out will also depend on what care options are available. Even in large urban environments, there's no guarantee that a long-term placement in a family home, if you like, through foster care, will actually be available for kids like Jack.
Second, what can adult services do in this sort of case? If Jack's parents were being treated for their addictions, was the service focused enough on ensuring that Jack's needs were also being met, while they worked with the parents to address their drug and alcohol usage? In other words, was an adult-focused service prepared to - and funded to support - the parenting needs of the adults and the specific needs of Jack, as a child? Was work being done to ensure the parental care was adequate? Were Jack's needs being addressed at all?
Taken together, with the case of Mary, the cases highlight the fact that child protection workers may be damned if they remove a case from home - and the outcomes aren't positive for the child or for the child's family - and damned if they don't remove the child and she or he is harmed.
Often you get both criticisms appearing in the media at once. If you're really unlucky you get both in the same paper, at the same time, in the same jurisdiction. It makes life a bit difficult if you're actually doing the hard work on the ground.
Now thankfully, most families will never be referred to Child Protection Services and fewer still will need to have their child removed from their care or be placed under supervision. However, these sorts of cases highlight what academics, social workers and others who work in the sector know, it's an all round better outcome if you can avoid, or prevent children and families from ever reaching the statutory situation in the first place.
So my questions today are going to be around: what is the best child protection approach, and maybe tease out some ideas on where child protection might be going - where might we take it? I'll pose some ideas for further consideration. That's the plan.
Okay, the History of Western Child Protection. Look, throughout recorded history, in most societies you'll identify the fact that children have been killed, maimed, starved, abandoned, neglected and chastised with cruelty. Okay, that's pretty much every cultural group, over time. You see a similar pattern of sexual exploitation of children, of both females and males, at different times, through history, as well.
But it really wasn't until the Industrial Revolution that child neglect became recognised as a societal concern throughout much of the western world. Initial concerns were around the abandonment and physical neglect of children, and it resulted in the first formation of child protection societies, and then later, the first child protection legislation.
In the 16th Century, legislation was enacted in England that began the process of protecting children from sexual abuse. Boys were protected from forced sodomy and girls, under the age of 10 years, from forcible rape. You can see, they started somewhere, but there was a long way to go, in terms of how we now conceptualise child abuse - sexual abuse in particular - and how we should respond.
This, led to the modern societal level discovery of child abuse, and it really wasn't until the 1960s, when the media picked up on the issue of battered child syndrome, which Henry Kempe and colleagues in the United States had identified. Essentially, Henry and his colleagues were paediatricians working in hospitals, and they identified through x-ray processes, spiral fractures, a particular form of physical abuse and that led to a media pickup of the issue. All of a sudden we had society interested in addressing child physical abuse.
Over time, then that interest developed into the creation of the first statutory Child Protection Services as we now know them. If you like, 'the welfare' as it's called by some. That is, the government services that do the investigations, the assessments, the case management work and also look after kids when they're taken into care or where a court order is organised to protect the child.
From the 70s and beyond is really where I'm going to focus a lot of my presentation. It's probably worth noting, what we actually mean by child protection. If you take a holistic view then child protection would be a comprehensive system of protecting children, which some people would say is actually a child abuse prevention system or a child welfare system.
Over time, however, the term 'child protection' has become more closely linked in meaning to the statutory Child Protection Services - to the government services that do the investigations, the forensic responses, as they're sometimes called.
As we'll discuss later, since initial set up, these services have been focused more and more on doing the assessment and the investigations, taking the court action, managing children in Out-of-Home Care, and have had less and less time to focus on doing the in depth, therapeutic work that families often require to actually make a difference. This work is being done by others. That may be quite okay, but I'm just identifying where things have gone.
The other point I'd make about the historical elements of western child protection practice, often it's revisiting the past - it's all that is old, is new again. Often we have what are called pendulum swings, were you go from on one side of an equation to another. So, for example, at some points in our history we've looked at the importance of investigation driving our systems, much more than perhaps actually counselling and supporting families.
We've looked at preserving families, and not removing children, and having that as our very strict policy, to a policy of actually removing as many children as we can, because we think that's the best approach. Within Out-of-Home Care we've looked at services where kids should be placed in residential care, and orphanages or Group Homes. We've also had the other - the flip side of that is all kids should be in family based care, working with/living with foster carers or with their kin.
Of course, we've had the pendulum swing between 'prevention' - stop abuse and neglect before it even starts, to 'protection' - respond after the fact, respond to the incidents that you actually receive through the system. These things are driven by economics, by policy and also by scandals that actually inform a lot of the development of new systems.
It's probably worth very briefly, given my vignettes before, that I try and define the main forms of child abuse and neglect, as I see them - try and get you on the same page as me before we move forward.
Now, it's worth noting that there are cultural and regional differences in definitions of child abuse and neglect, but essentially the more severe the maltreatment, pretty much you're going to find it in every definition that you would come across in most jurisdictions. So, for example, if we're talking about physical abuse, some might question whether smacking is physical abuse or just good punishment, or disciplining strategies. Most people would say if you're actually breaking bones and harming children to that extent, that's abuse, you shouldn't be doing that.
So, as I've got on the screen, child abuse is the umbrella term for a range of ill treatment of kids. There are four main forms - sexual abuse, any act that which exposes the child to, or involves the child in sexual processes beyond his or her understanding, contrary to accepted community standards. It goes from exposure, sexual activity, voyeurism, to indecent assault and then penetrative sex on kids.
Physical abuse - hitting, kicking, shaking, strangling, all those sorts of nasty, physical assault type injuries. Really, physical abuse - that was our focus in the 60s. Sexual abuse was really the focus in the 70s and 80s and onwards. What we found at the late 80s and into the 90s was the focus on emotional abuse. So, over time, our definitions have been changing, and increasing, as we've expanded the range of behaviours we think are abusive.
What we've got with emotional abuse is an act - usually it's a pattern of acts - which has a severe adverse effect on the emotional and behavioural development of a child, caused by persistent or severe emotional ill treatment or rejection. So things like verbal abuse, scapegoating a child, telling him you don't love them, but as a pattern, rather than a once-off type activity.
One of the key elements of what some people consider emotional abuse to be, and certainly it's in the official figures, is, exposure to domestic violence. Children who are psychologically harmed by witnessing or hearing intimate partner violence between their parents. Others think that should be the fifth form of maltreatment – and have its own separate name, but often when you see it in the child protection figures, you find it under the 'emotional abuse' label or by the 'physical abuse' label.
Neglect has always been with us in Australia, even when the First Fleet arrived, we had colonisation, very quickly afterwards we had groups taking kids off the streets because they were in danger and were living rough, and were at risk. Neglect has been with us ever since. There's always been an attempt to ensure that families look after their kids and provide adequate food, fluid, clothing, safety.
There's a recent focus which you might be interested in around educational neglect. This was also partly driven by episodes in the Northern Territory which sparked the Intervention and other government responses. The idea is that if you don't - if your child isn't going to school - it's a form of abuse or neglect, and that in fact you may need to get Child Protection Services involved to address that issue.
It's said, mainly because of the abuse in Indigenous communities, that it (educational neglect) has been rising as a community wide issue. It's recognised the fact there is a protective effect in being schools, the importance of a good education also, to actually assisting young people to have a good start in life.
But when you're trying to send, maybe a thousand, two thousand cases into a child protection system without having done any initial work to see why they're not going to school, to follow up in an educational sense, is that the best response to these sorts of matters? Do we want to send these cases into the statutory child protection system to be dealt with there? Do we want Child Protection Services as a first responder? Is it helpful? Will it work?
Might it make things worse for the children who really do need protection, and may actually be missed because we're dealing with more and more cases that would be considered to be less severe concerns, and that wouldn't actually require a legal response?
Very briefly, the causes of abuse and neglect - there's no single cause. Maltreatment usually results from a variety of issues, problems, situations that interrelate. Just because you have a risk factor in your family doesn't mean you're actually going to become an abusive or neglectful parent. We know the majority of families aren't abusive and aren't neglectful.
Some of the key causes we looked at initially - maybe parents had to be mad to be abusive or neglectful? Maybe it was the child? Maybe the child was difficult? The child cried a lot as an infant and therefore, provoked abuse or neglect. Early on, we also looked at the sociological and structural factors like poverty, unemployment, attitudes to children and violence, access to supports, that would also potentially lead to incidents of child abuse and neglect.
This is one I actually want to come back to later, because I think it's an important one and I think there's been evidence now of the importance to make sure we don't forget about structural factors as an important element of the causation of child abuse or neglect.
One of the important lessons that's been driven home when investigating maltreatment in Indigenous communities, and its lesson can be applied more broadly - is a renewed recognition that communities in which we live have significant effects on our health and wellbeing.
Communities with few professional services, high unemployment, poverty, where people maybe aren't connected well to their families, and to neighbours. Where the physical and social infrastructure is poor, in other words, you haven't got access to good drinking water, your house is a wreck, electricity is a bit variable - those sorts of things. Where violence has become an accepted dispute resolution mechanism, these communities are more likely to produce a range of social ills - whether it be violence, child maltreatment, substance abuse, health concerns.
So for these reasons, when I was involved with the 'Little Children are Sacred' report, I coined the phrase, that perhaps sexual abuse could be seen as a 'marker' for wider community dysfunction. What I meant by that was, often where you've found fairly high rates of child sexual abuse, it was because when you looked behind the scene a little bit, more in depth into the community, you found this whole constellation of negative things that were going on.
Really, sexual abuse was just the tip of the iceberg. So to get lots of sexual abuse in a community, maybe what it meant was the community itself had many problems. It was so toxic, that in fact, there was a whole range of things that were going on that also needed to be addressed, not just the sexual abuse - that was the tip of the iceberg.
For much of the last 20 years, however, mainstream child protection and other helping professions have often seen such structural issues as being beyond them. They're the big issues. They require a whole of government approach, a cross-agency approach. When you're working in disadvantaged communities - the really toxic neighbourhoods as Garbarino talks about them - you get a much stronger reality check of the need not to divorce individual families from their community and social context - the need to intervene holistically to fix the big ticket items in order to make a difference with children and their families.
For me, when I was in the Northern Territory, the big one was unemployment. Coming from a social welfare background, the big shock and realisation for me was around - maybe we need to actually be addressing unemployment as a child protection or a child welfare issue.
The impact of unemployment isn't just about the financial stuff, the lack of resources, the difficulties in finding money to pay for food and clothing. It's about giving people a reason to 'get up in the morning'. It gives them exposure to social supports through mixing with other people. It's about community norms and being exposed to what other people think is appropriate behaviour.
It became for me, a real argument for joined-up services, and a coordinated case management approach, such that a range of agencies, including employment agencies, became part of the solution to addressing child welfare and child protection concerns.
Just briefly, I'll just give you an idea of the size of the problem we're talking about. Now, there isn't great Australian data on the prevalence of how much child abuse and neglect is going on in Australia, at the moment. The research hasn't been done. A couple of overseas studies maybe give us an idea of the size of the problem. I mean, what we use is typically the child protection statistics, which I'll show you in a sec.
But essentially here, there are two examples – in the UK, a survey done in 1998 showed that 21 per cent of almost 3,000 young people had experienced physical abuse as a child under the age of 18. Eleven per cent had experienced sexual abuse and 6 per cent had experienced neglect or emotional abuse.
The other classic study which is quoted a lot in the literature around sexual abuse - it's an American study - is that one in four girls and one in 10 boys will experience sexual abuse in some form. Thus, it varies from seven to 36 per cent in women, and three to 29 per cent for men. Again, the intent here is to give you an idea of how big the problem might be.
What we use in this country to actually identify the size of the problem is typically the child protection statistics that are put out by the Australian Institute of Health and Welfare each year. In the most recent stats we found that almost seven per cent of Australian children get reported to child abuse and neglect services, because of concerns they might be abusing or neglecting their child.
This has basically doubled since 1999/2000. We also know that approximately one per cent of Australian children have been confirmed or substantiated by Child Protection Services as having been abused or neglected in 2007-8. In other words, about 17 per cent of all the reports that come in were substantiated. So, in other words, for the majority of the reports that come in, the cases, the matters aren't substantiated. They may include various concerns, but they're not actually, formally, seen as a substantiated child protection matter.
Again, there's been a big jump in substantiations from 1999-2000 to 2007-8, not as big as the number of reports, but still a fairly big jump. It (number of substantiations) has started to go down a little bit in the last year, but that's a separate issue - I won't get into now - it becomes complicated.
In children in care - again, big increase in the last 10 years for the number of children in care. This is one of those pendulum swings. If you look back at the data you find that at certain points, the number of kids in care decreases and then it starts to increase again. At the moment we seem to be on one of the increases.
We also know Indigenous children comprise about three per cent of the Australian population of children, but about 30 per cent of those in Out-of-Home Care. They're much more likely to be in Out-of-Home Care. They're much more likely to found throughout any part of the child protection system.
So that's just a quick summary of the some of the key issues as background that I wanted to provide for you, and what I'll do now is talk about some of the child protection practice trends.
Okay, child protection systems in Australia are typically based on, or adapted from, US and UK innovations and directions. We take advice and support and the research from other jurisdictions, as well. But the two big ones we often look to are the US and the UK. Because Child Protection Services are run by the states and territories, you've basically got a whole range of different service models to look at across the country, which is good for looking at how things might work, doing comparisons and perhaps doing things the same, or differently.
Unfortunately, often it's doing things differently, which makes it a bit more - harder to get a national cohesive picture. So these different models have similar underlying roles, they all sort of try to take reports, do investigations, substantiate or not substantiate child abuse or neglect, take legal action if they have to and look after kids in Out-of-Home Care in some sense. But they all do that in different ways. So the specific service models that might be employed might differ a bit: you might have joint teams, you might a whole range of different ways of doing it (child protection practice). But the reality is, it's all pretty much the same sort of model.
So, how does change occur in the system over time? Well as Axford and Bullock summarised for us, there are probably five basic models of service development that have been used in the child protection area.
The first one is achieving change by legislation and guidance. Legislation underpins all the work that gets done in a statutory sense. If legislation changes and you have a different focus, obviously that's going to drive some practice changes as well. It can be a highly effective thing, but it can also be sometimes influenced by political agendas rather than practice agendas.
You can also make incremental change by looking at gaps in your services, looking at your evaluation research and identifying, okay, we could just tweak this a little bit and we'd get a better result. So there's some small changes you can do on the ground to maximise the base service that you're offering.
You can also look much broader into new evidence and practice wisdom. In the bigger studies that come out, the evidence based studies if you like, even though they might take a bit longer to get going, you can use some of those big studies that demonstrate very clearly preventative benefits or some effectiveness, and implement those.
Some of the classics in the child protection area are really about child abuse prevention, with things like home visitation services, early intervention programs with young people, and with the parents of infants. Its Headstart type programs, which are like preschool based programs, which work with families and kids to try and give them a 'head start' in life - it's those sorts of things, rather than drivers around child protection practice around investigations and assessment. It's a lot harder to find clear evidence of what works (for child protection practice).
The fourth big way that we make service change, and one of the big ones in this country, has been scandals. The child death reviews, inquiries that take place, like Little Children are Sacred, the Gordon Inquiry in Western Australia. There's a whole range of them, they go on and on and on, and often they say similar things.
The results may not always be evidence based, they may not actually address the actual needs or the concerns raised by a particular case, and if I can take you back to Mary, it may be a that a focus on mandatory reporting in that case of Mary who was killed by her father, may be the wrong way to go. Maybe for other reasons - political reasons or because of pressure, (that is, certain lobby groups may push certain agendas), we may be taken away from where we need to be when we look at these cases.
So some argue that child death reviews for example, actually take outlier cases, if you like, the worst of the worst, that don't happen that often, and they take the lessons from those cases and sort of apply them more broadly - and in fact, perhaps they shouldn't. Maybe they're not actually reflecting usual practice? Others would argue the opposite, that in fact child death reviews identify poor practice - in a very broad sense - and we should actually take those lessons and apply the lessons very broadly back into our system.
Unfortunately, in the last 20 years, most of the reports that have come out have said pretty much the same sorts of things - most child deaths and severe harm cases identify that Child Protection Services have known the family in some way, prior to the death or severe harm. Whilst there has been a failure to report by some professionals or other people at some points, the bigger issue seems to be the failure to share information between professional groups, or to assume information's been shared effectively and it hasn't. So often, the whole case picture's not known when we're making our decisions.
There's been a failure to recognise the danger signals in some matters and that has led to things like the Mary case, where people are doing assessments, or workers are doing assessments and the outcomes aren't as good as one would hope. Now this is often a post hoc assumption, which assumes that you can actually predict things, and always get it right and I don't actually think that's a fair assumption to make.
These inquiries and reviews always show there's poor inter-agency and inter-professional communication issues. The more people you involve in a case, the more likely you are to have a communication breakdown. It's almost like a law of physics, in some ways. You can put in place different models to improve your communication, and how you coordinate and work together as agencies and professionals to actually minimise, if you like, opportunities for failure. But you're always going to get some (failures) - it's like any relationship, it requires good maintenance to keep it going.
Finally, often these cases identify poor case assessment, poor case management practices,a failure to review cases when you're meant to, a failure to do a 30 day follow up and poor case record keeping or information keeping. These are things you see time and time and again, and attempts are made to fix them yet though the services change, the systems change, and despite that we still get the same sorts of issues coming up.
Each of the four approaches has its strengths and weaknesses. They've got to balance competing interests - for example, policy makers might want to make sure we try not to spend too much money. They may be concerned with service efficiencies, getting consistent services. Practitioners may focus more on professional competence, being culturally sensitive, how are we going to do our cooperative work with other people?
Researchers are going to be concerned with the use of evidence. How we discover the causes of 'need' and howdo we actually get the input of individuals involved in the system?
Now, a fifth model of service development is a bit more radical and it starts looking at the needs of the children themselves. Actually creating a system around what the children's needs are, rather than having a system in place and trying to fit the children into the system. It moves from an emphasis on intervention and treatment to a balance between prevention, early intervention, treatment and social prevention.
It lifts the focus on process and outputs, to services that prevent harm and social exclusion, and improve children and families' lives. A good example of this is the development and the implementation of a public health model, which I'll get to in a second.
A public health model is a three tiered system, where you've got universal services at the big end of the triangle, which are services provided for all children and families to actually support child development, health and wellbeing and also to improve supports to families.
In the middle levels you've got really, targeted services that look for vulnerable families - kids who might be in vulnerable families or in particular at-risk groups, and you intervene early to actually assist those families to, again, avoid becoming child protection concerns.
At the top end of the pyramid we've actually got the statutory system. That's the hard end - the crisis-driven stuff - the doing the investigations and the Out-of-Home Care. Now, it's been argued that in fact what we've got at the moment is the reverse pyramid, where, at the moment, we've got everything directed towards our crisis end of the spectrum, and not enough down towards the targeted services or the universal services.
Others say it's an hourglass - we've got plenty at the crisis end, plenty at the universal level and not much in the middle. You can take whichever model you want. Essentially, what we're all saying, is we need to do more to invest in prevention services and to avoid too much of a focus on the crisis system.
So the climate we've got at the moment is basically that we've got increased reports of child abuse and neglect. We've got a large proportion of reports as we've seen that really aren't child abuse and neglect in the sense that they aren't cases that Child Protection Services wish to investigate. Of those cases that are investigated, and of the total number of cases in our 'pool', only about 20 per cent of families are going to end up substantiated or as a confirmed child abuse or neglect concern.
Some might argue we're actually missing some cases, and that would be, I think, a reasonable thing to say. But the reality is most cases that Child Protection Services are currently seeing aren't going to need the statutory response. So we've got to do something else with them.
This situation has arisen partly because of mandatory reporting, the desire to see professionals' obligation as being one about reporting suspicions and that's pretty much the main obligation they have. So as a result of that, community members who are interested and keen on protecting kids, along with a lot of professionals, do report their suspicions to Child Protection Services, which then have to try and triage or assess all those reports and deal with them appropriately.
There's also the societal expectation that Child Protection Services is like a panacea. It's like the place you go which is going to solve all the problems of child abuse in the world. So, one service in each jurisdiction, essentially - plus police, to be fair - is going to be tasked to solve the child protection problem.
The reality is, that's not going to be the case. The reality is, if you're going to do good practice, what you need to do is involve a large number of agencies in creating a solution, and again, if possible, you try and do that in a preventative sense, rather than wait until the case has come into the child protection system, in the first place.
There's also a push, again, for this idea of increased police or criminal justice sanctions against families and offenders who harm children. So, again, the solution is - let's just charge them and chuck them in gaol, where the reality is, most families aren't going to end up in the criminal system. But most families are going to need support to deal with their parenting issues and their maltreatment issues. Maybe that's where we should have our focus.
We also know the current system can't necessarily always 'fix' families. Often families get re-notified or re-reported into Child Protection Services. Often concerns get re-substantiated and sometimes we have to remove kids, as well.
We know that Out-of-Home Care is - even though it's a last resort in most jurisdictions at the moment - it's not an easy solution, and sometimes the outcomes aren't that great. So, whilst some kids will certainly do better in Out-of-Home Care than what they would in their family environment, for some kids it's not a great solution, like Jack who we talked about, who may actually have more issues to deal with.
So we need to be careful how we use these approaches, and the reality is, if we can avoid the families coming into child protection in the first place it makes it a lot easier - to try and get in early with families, to actually try and prevent child abuse and neglect.
In the 90s what happened was, because of mandatory reporting and a few other decisions that were taken, policy shifts, and also greater community interest, we got lots and lots of cases reported into Child Protection Services across the country. This is a phenomena of most western democracies really.
What happened was systems went into crisis. Child Protection Services couldn't respond to all the matters they needed to respond to. They spent a fair bit of time sorting the 'wheat from the chaff'. So, in other words, trying to identify those hard-core, severe cases that needed to be addressed by a statutory service - and separating those from the families that really just required family support. What happened was, the system went into overload. A lot of families couldn't get supports, and attempts were made to try and look at a better solution to try and address these sorts of issues.
A 'differentiated response' system was developed in various parts of the world, as it's now become known. Essentially what that was about was changing the balance between child protection and family support. So that whilst you want to maintain a focus on investigating serious matters, the investigation process itself, wouldn't drive child protection any more. It would actually become one facet of a broader approach, which is really about trying to help families.
So again, re-emphasising this idea of family support, rather than investigation, where the aim would be to deflect most of your cases - all those but the very severe ones that would require the legal response - to Family Support and the other helping professions.
The benefits of this approach would be, you get a service system that could be better able to cope with the demand, and to provide effective services. Only those families that really needed to be at the 'hard end' of things, and be investigated by police and child protection - they would be the ones that would get that experience. You wouldn't be traumatising people unduly by sending everyone through that process. As a result, families - when they were actually facing issues might actually be more willing to seek assistance themselves.
It was also linked to trying to provide a comprehensive assessment process through Family Support Services, so that all the families' issues would be dealt with and assessed, if you like, and responded to effectively. You do that through an enhanced interagency communication and coordination approach. It relies on resources to make it work. If you haven't got the resources in the system to allow for all the great family support work that's required, then there will really not be much difference compared with what is already in place in the existing system.
Now, Victoria is probably the best example of what can happen when you take this sort of differential response, this sort of deflecting away of all but the most severe. In the mid 1990s Victoria was having a lot of child deaths. It was having a lot of crisis situations arising, a lot of media reports - bad media reports.
Essentially, Victorian Governments decided to do it tough and to invest over a long period of time, in strengthening early childhood and parenting support services, taking on a differential response service, deflecting out all but the most severe cases from the forensic services. Essentially, by investing in those supportive agencies that could do that therapeutic work that actually would make a difference to most families.
They spent millions and they've spent over 10 years doing this. Have they actually made any differences? Well, again to some extent, it's up for debate. The reality is - in looking at Victoria's child protection stats - whilst every other jurisdiction has had a significant increase in the number of substantiations, in the last few years Victoria has had a seven per cent decrease in substantiations.
So, in other words, the number of confirmed cases that are being seen in Victoria is dropping. Some would argue that's due to the greater service infrastructure that Victoria's put in place. Others would say maybe it's due to a way that we actually count these cases - maybe there's a bit of playing around with the data? Maybe we aren't looking at enough cases seriously enough and are actually deflecting too many out of our system, and therefore we're missing cases that should have come in (to child protection).
These are questions we can't answer here today, but overall, the investment that's been made in preventative services, in Maternal and Child Health, Early Intervention and in Family Support, and coordinated Family Support Services, I would argue is probably the way to go and the benefits of this investment is probably reflected in some of this data.
To our current strategic drivers - we have this renewed focus now on prevention and support. We've got this idea that child protection is everybody's business, which has been the NAPCAN National Child Protection Week motto for the last two or three years, I think. We also have the Council of Australian Governments signing up to a National Framework for Protecting Australia's Children 2009-2020. For the first time in over 20 years, we've actually got a national approach to looking after or protecting Australia's kids, which is great. It's taken a while, but we got there.
This prevention focus is actually based on the public health model we've already talked about. It (the Framework) also spends a lot of time looking at cross-government agency engagement, embedding a range of Family Support and Child Protection Services in a broader system of health and education. So again, it's very much preventative, and it's a huge investment that's being planned across a whole range of areas.
Again, just to remind you, the public health model is that triangle. The aim is to have that particular triangle where we've got most of our investment at the lower end, and we're actually diverting resources away from a total focus on families at the 'pointy end' of the system - the crisis response.
So again, you're going to use the child protection system only for those cases where the child can't remain at home. It should be used for a minority of cases, not the majority, and we should be deflecting less severe issues back to the support services.
The framework does actually also incorporate an attempt to address some of these structural factors - the big things - unemployment, the housing concerns, that impact on family vulnerability - through linking to other government national frameworks on homelessness, on violence against women and children, a few other frameworks, as well. The Government's primary health care agenda is another big one it's linked to.
It's also about developing accessible, non-stigmatising family support, through universal services for all families, but also developing targeted services for those who are vulnerable in some sense, whether it be young mums, or new migrants, or drug affected families, or those families where there is a disability or a mental illness. It's also about investment in rehabilitation recovery services, so in other words, trying to stop violence happening again, if it's already happened.
It also promotes community engagement and action. Again, this idea that 'child protection is everybody's business', not just one particular agency. I think that's a very important point.
Okay, what are some of the barriers to why it's taken so long for us to get the public health model working - because it's been around for about 20 years. I'm a bit of an old cynic. I've been promoting this sort of model for quite some time. It's great to actually see it in writing with the Government backing.
To actually do it now is going to be a big task. There's a lot of money been poured into these systems and we have to make sure we get it right, because the opportunity won't happen again for another 20 years, because these things take a fair bit of time and effort to get them going.
One of the things is to make sure we actually use the evidence base, make sure we actually do use it to inform our investments, so when we put the big money into things, we aren't doing it in programs that aren't going to work.
When we do invest though, and we do try and use the evidence base, we need to give programs a chance to settle down, to get the job done, and actually - if you like - start showing a difference by working with families, and over time demonstrate success or failure. In other words, there's a tendency sometimes, with governments, to fund things for 18 months. This is often too short to enable a program to make a difference.
You need to invest a bit of time and energy to actually allow services to get entrenched where they are, to develop a way of working - if you like - to tailor their services to meet their conditions, and then see how they're going. If they're working, fund them more broadly, and then fund them in other jurisdictions in other parts of the country as well. So use your evidence base, but once you've actually got it, use it properly.
We've still got this idea of the crisis response and 'putting out the fires'. We can't ignore the fact that we've got people - we've got children who are at risk right now. We need to keep assessing those matters and providing support, (and also taking legal action sometimes), to protect Australia's kids. We can't wait 20 years and just sort of hope that that's going to go away.
At the same time though, we've got this big prevention push, we've also got this continuing law and justice focus on getting tough on child abusers, which I think, in some ways, actually sends a different message. So, whilst we're encouraging families to come forward, we're also - if you like - having to deal with the fact that some will be scared of coming forward, because they think they're going to be in trouble, which they may be.
We've also got this continuing push to assign more and more issues to child protection, this idea that it's a panacea, that it will actually 'fix' all related child abuse matters in the country – though it's one small agency. So we have educational neglect, where education services may wish that Child Protection takes on all school refusals or school non attendance matters, rather than trying to deal with them themselves, and then only send those cases where there really is a child protection concern to Child Protection.
We've got to address these sorts of barriers, to change the view that child protection covers everything. We have to make it, again, very much the view that child protection is everybody's responsibility. Every agency has a role in it and they must take that role seriously, not just refer on (to child protection).
Maybe we should be thinking more radically. I'm going to pose a few little points here, which - and they're really just points for discussion, I'm not suggesting we have to necessarily do them, but we'll see how they look.
Maybe we should extend our prevention focus a bit further. Maybe we should separate out the forensic investigatory arm of child protection, away from the therapeutic arm a bit more, to make that distinction clearer. At the moment there are at least two services in this country which have joint investigations teams of police and social workers. In other words, the child protection services are co-located with police and they go off and do investigations of physical and sexual assault, as a joint team, one on one, and off they go - one 'copper' and one social worker. That's in the Northern Territory and also in New South Wales.
Maybe we need to do what America tried to do and actually say, okay if it's an investigatory, forensic service that we want to look at the hard core cases, do the investigations, collect the evidence,and manage the cases when they become a court matter - maybe we should put them with police, in criminal justice land. Make it very clear that it's their role (forensic response) and keep all the therapeutic work over here in the welfare side of things, and the human services side of things.
Maybe we should make it a much clearer distinction as to what people's roles are and reduce some of the role confusion for the public but also for social workers. As I said, the US tried this approach in the late 1990s. I haven't been able to find evidence of its success, or if whether it's still going on. There are only a couple of mentions online for it. But maybe we should do that, maybe we should make that clearer distinction as to how we actually frame our investigatory services?
There'd be issues to look at around professional cultures, the mismatch and how this co-location might work, about the management of the social work team in a police service, career paths - all that sort of stuff. These issues have been dealt with in these joint teams already. For example, in theNorthern Territory there are two teams, one that works in Alice Springs, one that works in Darwin. One is based in the police headquarters at Berrimah in Darwin, and one in the police headquarters in Alice Springs.
Essentially it's a social work team, with a social worker who heads that team, who works with a group of police officers, who has a police senior sergeant involved, and they co-manage those teams together. It (joint teams) can be done, and the response that we get is that the investigatory arm, the investigatory response is much stronger and much better. We get a better, clearer outcome in terms of whether it's child abuse or neglect or not, and if you want to take legal action, you're much better prepared to do it. It's not about the therapeutic work, that's farmed off, back to the main Child Protection Branch. This model is something to consider.
The next one's going to be even a bit more controversial. We've talked about this shift away from just doing investigations and trying to get families into family support. There's been a big push - and again Victoria's one of the leader here - in actually investing a lot in family support infrastructure.
Now, if I can just digress for a second, back in the 80s, when I was young and had long hair, as a Victorian I used to spend a lot of time looking at how the systems worked then. It was almost like 'rosy days' where everything worked fairly well, even though there were still children dying, and controversies, tragedies and enquiries.
What was happening was, certainly in the areas that I was working in, there were a lot of services that were actually 'backing up' the Child Protection Service, and this was in the days before mandatory reporting. Essentially, what was happening quite often was that families could self refer themselves into the child protection system or into a family support service, and they could be dealt with in a therapeutic way, rather than having to go to Child Protection first to be screened and assessed.
There were certainly a lot of matters that still ended up as a Child Protection matter. There were investigations, there were still kids who were taken way from families for a short period of time or a long period of time. There was still a need to actually do rehabilitation or treatment with those families and also for those children, but there was also this inbuilt part of the system, preventative work to stop these families actually becoming child abusing families or neglecting families in the first place.
In some ways this is a bit of a shift back. I mean, Victoria spent 10 years trying to recreate that system in a much harsher world. We've got many more reports, we've got mandatory reporting and we've also got a huge amount of demand in the sector. So they've put a lot of money into try and create services so families can get help.
Now, I'm sure that's the case in all parts of the country, there are still more resources required to give people access, as much as they would need, to these services. There's always going to be a wait list.
One extension of that work though, that idea of a family support focus, that therapeutic focus is, is maybe we should do what Europe's been doing in some ways for years. Rather than actually having a focus on enforcing the legal sanctions, maybe we should offer a non-punitive, therapeutic pathway for families where they actually get to speak to a practitioner in confidence, with the understanding that they'll work with that practitioner to resolve maltreatment concerns?
With a team of people to address any concerns they've got about whether they've been harming their child, or the risk they may harm their child. Making sure the child is safe but actually not with that threat that 'the welfare's' going to come and take my kid, or the police are going to arrest me because I've just given my kid a hit.
Now, I'm not suggesting you don't want to address some violence issues, or we don't want to have the normal forensic pathway. What I am suggesting is, though, that given that many cases don't end up in the legal system at any rate, would we be encouraging more families to come forward without too much fear if we set up this confidential service, perhaps based around the confidential doctor service of Belgium. This is where a doctor is authorised to take confidential reports, and works with families intensively to try and address child abuse and neglect issues and vulnerabilities.
Would that be a way to go? Should we look at that sort of system? In Belgium, how it works is, those systems are very much separated from the classic sort of forensic legal response. They will refer to statutory services if they have to, if the matter is too severe or if the parents won't cooperate, or the child isn't safe. They try and give families a go, those who are willing to come to these services, and try and work with them intensively, to avoid the need for that legal response.
The service is based around a medical practitioner who is trained for the role, who is supported by a multi-disciplinary team of people who come in to work on the various bits and pieces that may affect families. These services are tailored to meet the needs of the community that they're based in - the local conditions of the community that they're based in - so this determines what services you can bring in to actually assist with that work. The key thing is, the services have to be well resourced, and have to have plenty of services or programs they can draw upon to do that therapeutic work.
Maybe one of the issues for us is going to be, at this point we still haven't reached the threshold where we've got enough services in place to allow us to do this sort of confidential work with success, because we haven't got enough services who are willing to, or are able to participate in this sort of model. But I think it's worth considering.
The third area is the role of community. Programs focused solely on the individuals seem destined to failure, if they don't take into account the community context. If you work in the Northern Territory or in any rural or remote community, the importance of community is very much in your face. Much more than urban environments in a lot of ways, because in urban environments, you've got other services you can draw upon. In remote areas, it's often you and the community.
Another quote, "Child abuse and neglect will not be overcome through administrative, legal, technical and professional measures which leave social values, structures and dynamics unchanged". The third point I'd therefore make is that in developing partnerships between professionals and the local community, looking at what works in Indigenous communities may actually have something to teach the wider community.
Creating partnerships, again, as I said, if you're actually out at a remote community, 900km from Alice Springs, that's pretty much you, it's the community and you might have, if you're lucky, a health nurse, maybe a police officer, maybe a preschool teacher. That's pretty much it. You might also have some Aboriginal Corporation workers.
So, really it is going to be, what can you do on the ground there, working with community. Because your service is going to be a 'fly in, fly out' or a 'drive in, drive out' service. You're going to be in and out for a day or two at most, and you're going to be gone again. What's left is what you've got to work with.
So it becomes very clear, very quickly, that you have to work with the community in partnership, to try and make some differences. I'm hopeful - I'm not 100 per cent hopeful - but I'm hopeful that Little Children are Sacred, some of the Intervention stuff and also the other Closing the Gap agendas in the National Framework, will actually try and look at this engagement of community in much more detail.
I'm sort of emboldened by the fact that in the UK, [Michael Little] has been talking about very similar things, about engaging community as part of his work of reforming child protection, as well. So why would you do it? Why would you create a partnership?
Firstly, you can give the education of 'what is child abuse'? What is appropriate parenting? What does our society, as a whole, think is the appropriate standard? That's important. As we heard from the very first case about - 'what is sexual abuse? Oh, it's swearing at your kids'.
It enables you to provide information also, on what sort of supports are available for you to access, and sometimes in remote areas, there aren't any. But you can also get in there and change community attitudes by working with people, change how they perceive children and adolescents, their attitudes to violence and what's appropriate behaviour. You can address some social issues, like power, domination, patriarchy and of course, try and improve community connectedness as well.
You can work on cross cultural issues - and this is not just for Aboriginal communities, it's for all communities. Because community engagement also means you get the community to tell you what the problems are from their perspective. What are their needs? What are their priorities as well, because if you go in there and you say, do you want a new swing, people say 'yep'. Do you want a new GP clinic, people say 'yep'. You need to actually get in there and see what are the real needs and what priorities people might have so when you're actually asking questions, you can say, look we've got a certain amount of money, what do you think are the things we should be investing in? You can inform that with expert opinion, but the experts on the ground are the community. They also know what they need.
It also helps to develop culturally appropriate and tailored solutions, so you might have a great home visiting package; it's not going to work in Lara, for example, because of some particular local condition. It may be that the home visiting program requires mums to be at home and the nurse goes and visits those mums, where in fact what the community might want is a community health centre, where the nurse is actually sitting at a desk and mum gets to go visit.
It may be things like that, so by talking to people you can actually tailor a solution. You want to try and develop the solutions that are both community based and professionally based. So you want your experts to advise, but you want your local expertise built in too.
If you invest in the time, as well in the education and training, the other real benefit you can get is you can actually develop a local workforce, and again in remote communities this is particularly important. One of the things I was really heartened about with the aftermath of Little Children are Sacred was, communities that identified they had problems, there were individuals in those communities - men and women - who were standing up and saying, 'I want to be part of the solution', 'I want a job working in anti-violence work', or in anti-drug and alcohol work.
It was up to the governments, then, to actually harness that interest, that motivation, to provide training and real jobs, and get active with those people as fast as possible, while they were still - if you like - still motivated to do so. Striking while the iron was hot.
I think that's a really important element, where you're looking at that issue of employment in a very high unemployment communities, providing a real job, but providing a real job that actually provides - if you like - a level of professional support, or lay person support to families, when no one else may be present or able to do anything.
So the four key factors to success, which I think probably relate to all communities: You've got to have the community willing to address the issues. You want to have some degree of ownership or self-determination, so you move from ownership to self-determination over time, most likely.
Again, these are lessons from working with Indigenous communities, but I think they apply across the board. You want to have that ownership, you want to have communities participating, being involved, and you want to build on that.
You want to have ongoing professional mentoring, and support and training though, for those people. You don't just give them money and say, 'okay you're ready to rock, there's your community plan, go for it'. You have to work with people, to walk alongside them.
You also, you need to have created an infrastructure, if you're going to this – perhaps including some of the more radical family support models like confidential doctors - you need to have an infrastructure that actually supports a statutory response that actually enables you to do the more intense work. Without that, it becomes much more difficult.
Last two slides. So what else - we've got the joint investigations teams based with police, we've got our 'confidential doctor', we've got communities being more actively involved in a partnership, in a meshing with professional services to get a better local, tailored response. What else might we do to actually get a better, long-term response to the issue of child abuse and neglect?
Resisting the pressure of bad outcomes and maintaining a strategic focus is really important. Now, Victoria, as I said, spent about 10 years investing in early intervention and prevention, and changing the way it does it's child protection business. I think over that time, especially in the late 90s it had to resist a lot of calls for radical change for more enquiries, because things weren't always going right. We were having child deaths, we were having tragedies, we were having concerns about practice, and we were also having those cases where workers were damned for removing kids and damned for not removing kids.
They (Victoria) managed to push through that, put in place more accountability, but kept moving on the basic agenda of 'let's change our system'. I think that's got to be admired. I think it's a really strong thing. It's hard to do it but it has to be admired and I'd probably suggest to other governments they need to do the same sorts of things.
As I've said before, we need to invest in programs for the long term. Use the evidence base. Get the ones that are working and put them in. Give them a real go at working, though. Don't just put them in for five months and hope to change the world with them. That won't happen. Give them a bit more time. Incorporate an evaluation of that project up front, so when we know it works, then we can actually say, okay this works, and we can start extending it out into other areas.
While you want to maintain your program integrity, you want to have core facets that shouldn't change, like this is a home visiting service, this is about home visiting. You also want to be able to be a bit flexible about some of the mechanisms, so you can work with your local communities on how you might run that service. Again, it's that engagement issue. As I've said here, if something's working with good evidence, roll it out.
What else could be done? I've said this a number of times, interagency coordination is very difficult to achieve. Like any relationship, you've got to maintain it to keep it strong. There are a range of models that we can draw on to show different ways of working together.
One thing I'm interested in exploring is the idea of changing the way we actually fund our services. One of the big problems we've got is silo funding. We've got our police funding, we've got our child protection worker funding, our social worker funding. The services need to come together with some of the money they've got to actually work together.
Within the bounds of that money or funding, these agencies are going to do what they can do to work with you on your agenda of fixing child abuse or improving child welfare for a particular local area.
Maybe what we have to do is actually take that agency money and pool it in some sense. Have a steering committee made up of these agencies and allocate pooled funding according to need in that particular community. Rather than just saying, 'well I've got my bit'; 'all I can do is my key role with this particular amount of funding', and that's it.
There are two examples I draw upon for ways in which we could do that. One in Tasmania I heard about recently was a domestic violence response model which involved the Department of Justice, Tasmania police, women's refuges and also other anti-violence services. They had a steering committee that was given government funding, an allocation of funding which they could then choose to use in whichever way they wanted to, to actually bring in services. They might fund a police response team, they might fund a women's refuge service, they might fund a particular counselling service.
They could work together to actually find the best way to use that money, and it meant that people weren't coming in saying, 'this is my chunk, I'm going to do my thing with it'. They actually got to go beyond their own theoretical perspective, beyond their own particular departmental perspective, and look at the issue as a whole, rather than try and stick in their own little area. That was one way of doing it.
Victoria again - I'm giving Victoria a big plug today. They invested in a range of coordinated family support agencies in the late 90s, which I think were called Strengthening Families, where they have an agency that was given lead agency status in each region of the state.
They had funding to actually broker - to call a coordination meeting, and to broker services across a network of services that were already in existence. In other words, they'd receive a case, and they could then put in the services they needed to make sure that family were going to be treated and supported appropriately. That's another way of doing it - having a lead agency service; and that's been tried in other parts of the country, too, including the Northern Territory.
Finally, the last two comments - I think it's important we invest in the core competencies that underpin our professional work. So, we've got all these professionals involved, we've got doctors, we've got nurses, teachers, social workers, police officers. In the professional training at university, you don't find that much on child abuse and neglect. Sometimes you don't find that much on child development either, depending on what course you're doing.
A few years back there was an Australian Government AHMAC-funded project which looked at creating core competencies around child welfare and child development that could be taught to all those different professions. So that when you're going out in the field, you've got all this core grounding of how you should work with families, how kids develop, those sorts of things.
I think that's a really important area and I'd certainly be pushing that we actually create those core competencies in our work force, so we are closer to developing our 'shared understanding' of what is required to prevent child maltreatment.
Finally, getting back to the case of Jack, we have to ensure that our adult services are funded and supported to have a focus on children's issues as well. Often the adults that our mental health services are going to see, or that the alcohol and drug services are going to see - they're actually parents as well. They've actually got kids.
We need to make sure those kids don't fall off the agenda, and to actually look at the parenting issues as well as the substance abuse issues, or the mental health issues. So parenting becomes a priority in that service, as well as the treatment or support of the adult for that particular issue.
Finally, to continue this presentation, I'll put in a plug. I'm organiser of the 8th Asia Pacific Conference on Child Abuse and Neglect, which is taking place in Perth this year. We're going to have a diversity of speakers from across the region, and I'm hoping that these sorts of ideas that I've talked about today, will actually stimulate some discussion around where we should be going. Taking perspectives beyond the UK and beyond the US, and seeing where we end up. So, if you're interested, I'd urge you to come along to the conference - thanks for your time.
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