Child Abuse Prevention Newsletter

vol.12 no.1 Winter 2004

Published by the Australian Institute of Family Studies
ISSN 1447-0039 (Print); 1447-0047 (Online)
Manager and Senior Research Adviser: Adam Tomison
Newsletter compiled and edited by Nick Richardson

Contact the Australian Institute of Family Studies for a copy of this newsletter, or access articles as listed below in HTML or PDF format. The full newsletter can be downloaded in PDF format (442K) or in sections as listed below. You will need an Acrobat Reader which is free from the Adobe Systems Web site .

In this Issue

Introduction

Adam Tomison

Welcome to the first National Child Protection Clearinghouse Newsletter for 2004. In this edition we are pleased to feature overviews of the Queensland Inquiry into the Abuse of Children in Foster Care (by Katie Kovacs), and treatment programs for sexually abusive young people in Australasia (by Karen Flanagan), as well as articles on the Parents Under Pressure Program (by Paul Harnett, Sharon Dawe and Vanessa Rendalls), and the links between animal abuse and family violence (by Nicola Taylor).

We would like to remind readers that the Clearinghouse welcomes contributions for publication. Authors can submit articles that describe current initiatives or policies, discuss aspects of child abuse and neglect, or highlight issues in preventing, or responding to, child abuse and neglect.

Staffing changes

There have been a number of staffing changes at the Clearinghouse this year. Dr Janet Stanley resigned in January to take up the position of Research and Policy Manager with the Brotherhood of St Laurence (Melbourne), while Katie Kovacs resigned in March 2004 to take up a position managing offender rehabilitation programs in the Victorian Department of Justice. Both Janet and Katie joined the Clearinghouse in 2001 and since that time they both have made significant contributions to the Clearinghouse. We wish them well in their new endeavours.

In March 2004, Nick Richardson joined the Clearinghouse team as a research officer. With a psychology background, Nick has previously been working at the Australian Institute of Family Studies as a researcher on the Australian Temperament Project, and specifically, as part of a collaborative project with Crime Prevention Victoria that has been exploring a range of issues around adolescent antisocial behaviour. Nick has also worked as a volunteer telephone counsellor and is already well-versed on the issues of child abuse and other family violence.

Tom Fooks has also been employed to provide administrative support for the Clearinghouse. As this issue goes to press, we are also recruiting additional research staff.

Finally, after nine years with the Clearinghouse, I (Dr Adam Tomison) will also be leaving at the end of May 2004. I have recently accepted an offer to be the Director of Research (Population and Evaluation) in the Northern Territory's Office of Aboriginal Health, Family and Social Policy, and have therefore resigned from the Clearinghouse and the Australian Institute of Family Studies. A key part of this role is to address the issue of child abuse and other family violence in Indigenous communities. Thus I will continue to remain active in the child abuse and family violence field. I am also pleased to continue to have an ongoing involvement with the Clearinghouse, via a position as Honorary Research Associate for the Australian Institute of Family Studies.

From modest beginnings ...

From modest beginnings, the National Child Protection Clearinghouse has developed into a centre for excellence with a national and international reputation in the field of child abuse prevention and child protection. I am very proud of all that has been achieved by staff members and it is with a heavy heart that I am leaving.

With the current Clearinghouse contract extended for a further three years to June 2007, the Clearinghouse is poised to develop its services further to better meet the research and informational needs of stakeholders. I would encourage you to make the most of this valuable national resource, and to contact Clearinghouse staff if you have any ideas or opportunities that you feel might enable the Clearinghouse to better meet your needs or those of the child protection and child welfare/family support sectors.

I wish you well with your endeavours.

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Protecting children

Katie Kovacs

In January 2004, the report of the findings of the Queensland Crime and Misconduct Commission Inquiry into Abuse of Children in Foster Care was published. The Queensland Inquiry was instigated following allegations made by a woman who claimed that while she was in foster care with 'family X' she was subjected to sustained and serious abuse by foster family members and others. The allegations included a complaint that she was sexually abused by one family member who had been an approved foster carer, as well as by visitors and friends of the family.

The alleged sexual abuse included acts of sodomy and indecent dealing and of procuring the woman (then a child) to commit indecent acts with other children. The alleged abuse was said to have happened over a period of 13 years. The woman stated that other children in care with this family had also been subjected to sexual and physical abuse, and that some of these children still resided with the family.

Subsequently, documents relating to allegations of abuse involving other children placed with this family were made public. The material suggested apparent failures on the part of the Department of Families to deal with these allegations. Media interest was generated, and questions were also raised as to the extent to which successive ministers responsible for the Families portfolio at the relevant times were aware of the situation and took action.

Who undertook the Inquiry?

In August 2003, the Queensland Crime and Misconduct Commissioner commenced Operation Zellow which made investigations into allegations that employees of the Queensland Department of Families had failed in their statutory duties to protect children they placed in the care of family X. It also investigated the claim that successive ministers and director-generals of the department had failed to act appropriately to protect children placed with family X.

During the Inquiry's public hearings an independent consultant was appointed by the Department of Families to audit abuse notifications made against current foster carers in Queensland.

What were the terms of reference?

The Commission resolved to inquire into and report on: (a) any systemic factors contributing to the incidence of any abuse of children in foster care; (b) the suitability of measures to protect children in foster care from abuse, in particular the adequacy of systems and procedures to prevent and detect abuse, and the adequacy of measures to respond to and deal with suspected abuse including abuse reported by foster carers; and (c) any recommendations as may be considered appropriate in relation to (a) and (b), including recommendations for any necessary changes to current policies, legislation and practices.

What were the recommendations?

A total of 110 recommendations for reform were made; some of which are outlined below.

Restructuring

Prevention

Staffing

Complaints mechanisms

External accountability

Child deaths

Multi agency relationships

Mandatory reporting

Out of home care

Indigenous children

Child protection reform implementation

In response to the findings of the Inquiry into Abuse of Children in Foster Care, the Queensland Government has initiated a number of reforms to state child protection systems. This reform process has the support of both the Labor and Liberal/National parties.

Peter Forster was appointed by the Queensland Government on 6 January 2004 to implement the recommendations of the Inquiry into Abuse of Children in Foster Care, and the Final Report on Phase One of the Audit of Foster Carers Subject to Child Protection Notifications.

The Child Protection Implementation Unit, led by Peter Forster, will deliver the reform implementation program in three phases. Phase one will see the development of a project plan to deliver recommendations; phase two will see the development of the blueprint for the new Department of Child Safety; and phase three will see the implementation of the blueprint.

The Unit released an Implementation Blueprint on 22 March 2004, which outlines the strategy, plans and processes to improve the child protection system in Queensland. This includes an implementation strategy for the new Department of Child Safety. This department was created following the re-election of the Queensland Labor Government on 7 February 2004, to focus exclusively on the needs of children at risk from harm, neglect or abuse.

Copies of the full report Protecting Children can be downloaded at www.cmc.qld.gov.au/FCINQUIRY/ To request a printed copy, contact: The Crime and Misconduct Commission, Queenslaqnd. Phone: (07) 3360 6060. Copies of the Implementation Blueprint can be downloaded at www.premiers.qld.gov.au/childprotection/blueprint.html

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Australian Child Protection Statistics

The latest Child Protection Australia 2002-2003 report has recently been published by the Australian Institute of Health and Welfare. A summary of the latest statistics are provided below.

Between 1 July 2002 and 30 June 2003:

 NSWVICQLDWASATASACTNT
Notifications 2002-2003109,49837,63531,0682,29313,4427412,2141,554
Percentage of notifications where child abuse and neglect were substantiated in 2002-200315%19%39%39%18%29%15%21%
Number of substantiations per 1000 children7.56.310.11.95.81.83.63.9

The maltreatment involved in the substantiated cases of abuse or neglect was classified as follows:

There is broad variation in the rate of substantiated child abuse and neglect among children aged between 0-16 years of age (per 1000 children) between the states and territories. This broad range is influenced by differences in the way jurisdictions both define and deal with notifications and investigations.

In Victoria, for example, the definition of a notification is very broad and may include family issues that are responded to without the need for a formal investigation process. In contrast, in Western Australia and Tasmania, reports to the departments are screened before being classified as a notification. Only those reports where maltreatment is indicated are classified as a notification and the majority of these cases are subsequently investigated. In addition, in Western Australia, the disproportionately low number of notifications and rate of substantiation (per 1000 children) is likely to be due to the fact that reporting of child abuse and neglect is not mandatory.

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Child abuse in Australia: plotting future directions for NAPCAN

Adam Foster
Executive Officer NAPCAN

The release by the Australian Institute of Health and Welfare (AIHW) of the latest child abuse and neglect statistics has confirmed concerns for the welfare for Australian children - child abuse and neglect reports are on the rise. For the 2002-2003 year, there were 198,000 notifications, which amounts to one report for every 25 children in Australia, and one report of child abuse and neglect every two minutes (AIHW 2004).

Even more alarming is the substantiation figure, which indicates that one child was confirmed by child protection services as having been harmed every 13 minutes - 40,000 children for the one year period. It is important, however, to take into account the difficulties in drawing conclusions from these statistics. On the one hand, many notifications are re-notifications (the same children being reported two or more times); on the other hand, not every instance of child abuse or neglect is reported. (In truth, we have no firm knowledge of the prevalence of the problem.) There are also differences in definitions and systems across each state and territory of Australia.

Irrespective of how we count and interpret these numbers, child abuse and neglect is one of Australia's most significant and alarming social problems. At its recent Summit on Child Abuse and Neglect, the Australian Medical Association described the problem as a pandemic.

With child abuse and neglect reaching pandemic levels, it is critical that we invest wisely across the entire continuum of prevention, protection, and support.

Investing wisely in prevention, protection and support

So how well are we addressing the entire continuum? Without effective investment into prevention, the number of child protection reports may continue to rise as a number of families continue to struggle to raise their children.

With increased demand and need for child protection services, as well as intervention and support at the secondary ('at risk') level and the tertiary level (where maltreatment has already occurred), it is critical that the overall investment into children's welfare is increased and balanced - including appropriate and strategic investments in primary prevention.

A growing evidence base is demonstrating the benefits of primary-level early intervention programs. For example, research in the United States on the cost savings of the Perry Preschool Early Intervention Program showed significant savings from early intervention (primary level) initiatives, with $7 saved for every $1 spent (Zigler and Styfco 1996). Savings were measured in the areas of health, welfare, criminal justice, and social security expenditure.

The role of NAPCAN

The National Association for Prevention of Child Abuse in Australia (NAPCAN) has recently completed a long-term evaluation of its primary prevention activities and role, and has now agreed upon a new strategic direction. These changes are possibly NAPCAN's greatest challenges since it began in 1987.

It has long been understood that 'it takes a village to raise a child' (an African proverb). This was echoed in the 2003 theme for National Child Protection Week, 'Child Protection is Everybody's Business', and is now reflected in NAPCAN's new vision:

By 2008 there will be courageous and inspired communities protecting children from abuse and neglect.

NAPCAN's new vision reflects a 'whole of community' approach. The National Child Protection Clearinghouse's work on community-based approaches in preventing child maltreatment provides a good summary of the evidence base in this area (Tomison and Wise 1999). This approach has most recently been demonstrated as highly successful in the Windale community which was part of the New South Wales State Government's Hunter Community Renewal Scheme. In 1999, Windale was rated in the worst one per cent of New South Wales postcodes for child abuse. Today, Windale rates in the best 25 per cent (Vinson 2004).

There are also parallels from other areas of social concern that echo similar primary prevention solutions. For example, the National Crime Prevention (1999) Report, Pathways to Prevention, argued that the solution to crime was a local, community-based approach to prevention. The Report advocates whole-of-community approaches to the long-term prevention of crime.

Taking a 'whole of community' approach to NAPCAN'S work is going to create some new and different challenges. As part of its response to this, in 2004 NAPCAN plans to create a national committee to oversee the development and implementation of National Child Protection Week. The committee will comprise key national leaders from business, government, the community, and the child welfare sector. This approach reflects the goal and need to engage the whole community in order to prevent child abuse and neglect. Over the next six months NAPCAN will be developing a strategic plan outlining how it will achieve its vision. This too will be created openly with collaboration from the wider community. A survey has been circulated to more than 5000 'friends of NAPCAN' to invite their views on how NAPCAN can best achieve its vision.

No one denies the challenges that come with working collaboratively. However NAPCAN has worked collaboratively since its inception. It was originally formed to open up lines of communication across the child welfare sector, and increase collaboration and cooperation.

Working together for a child-safe world

The other key piece of NAPCAN's work this year, will be the biennial 15th International ISPCAN Congress on Child Abuse and Neglect, auspiced by NAPCAN, to be held in Brisbane from 19-22 September 2004. The theme for the Congress is 'Working Together for a Child-Safe World'.

The Congress has been fortunate in securing these pre-eminent keynote speakers, Professor Fiona Stanley AC, Dr Astrid Heger, MD FAAP, and Professor Geraldine MacDonald. The congress organising committee has worked to ensure that children and young people have the chance to take part in the Congress. In addition to the 1200 delegates expected to attend the Congress, 40 children and young people from Australia will also be invited to attend.

The Congress will provide a forum for international experts to canvas opinions on how best to shield children from harm, bringing together professionals from around the world to enhance their knowledge, discuss the issues surrounding child abuse and neglect, and network with people from a range of disciplines. It aims to facilitate education and training in prevention and promote and facilitate research and the dissemination of academic and practical materials for exchange of information and action.

To register or for further information, visit the Congress website at www.congress2004.com. Or contact the ISPCAN 2004 Congress Secretariat on 1800 335 413 or registration@icms.com.au.

References

AIHW (2004), Child Protection Australia 2002-2003, Child Welfare Series no. 34, Australian Institute of Health and Welfare, Canberra.

National Crime Prevention (1999), Pathways to Prevention: Developmental and Early Intervention Approaches to Crime in Australia, Commonwealth Attorney-General's Department, Canberra.

Tomison, A.M. & Wise, S. (1999), Community-based Approaches in Preventing Child Maltreatment, National Child Protection Clearinghouse Issues Paper no.11, Australian Institute of Family Studies, Melbourne.

Vinson, T. (2004), Community Adversity and Resilience: The Distribution of Social Disadvantage in Victoria and New South Wales and the Mediating Role of Social Cohesion, Jesuit Social Services, Sydney.

Zigler, E.F. & Styfco, S. (1996), 'Head Start and Early Childhood Intervention: The changing course of social science and social policy', in E.F. Zigler, S.L. Kagan & N.W. Hall (eds) Children Families and Government: Preparing for the Twenty-first Century, Cambridge University Press, New York.

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Program profile: The Parents Under Pressure program

Paul H Harnett, Sharon Dawe and Vanessa Rendalls

It is becoming increasingly recognised that high-risk families require intensive interventions targeting multiple dimensions of functioning (Catalano, Gainey, Fleming, Haggerty and Johnson 1999; Dawe, Harnett, Rendalls and Staiger 2003; Dawe, Harnett, Staiger and Dadds 2000; Luthar and Suchman 2000). For example, Dawe, Harnett, Straiger et al. (2000) summarise a range of risk and protective factors across ecological domains that influence the developmental outcomes of children raised in families with substance abusing parents. The literature on child abuse and neglect has documented the diverse causes of child maltreatment (Belsky 1993; Cicchetti and Carlson 1991; Dawe, Harnett, Staiger et al. 2000; Milner 1998).

The Parents Under Pressure program has been recently developed specifically to address the multiple needs of high-risk families (Dawe, Harnett and Rendalls 2000). This article provides an overview of the program, theoretical influences on its development, and preliminary evidence of efficacy and effectiveness.

The Parents Under Pressure (PUP) program was developed in response to the literature clearly indicating that in addition to parenting skills, high-risk parents have a number of areas of vulnerability that, if left unaddressed, may impede their ability to protect and care for their child (Dawe, Harnett, Staiger et al. 2000). The most salient aspects include the ability to regulate emotions, combating negative views of self and negative mood, problems in parent-child and marital relationships, managing life crises and daily hassles, and the lack of social support.

These problems can lead to a lowered sense of personal efficacy and an avoidant style of problem solving. Thus, the PUP program targets problems of the individual parent(s), the parent-child relationship, family functioning more generally, and the social context and life style of the family, including drug and alcohol use.

Structure and content of the program

A description of each module making up the Parents Under Pressure program is presented in Table 1. The format of the program is conceptualised as structured but non-sequential (SNS) - that is, interventions are structured insofar as each identified problem area is addressed by a manualised intervention. However, the program is non-sequential in that the problems targeted vary from family to family, with the order of presentation determined by the salient presenting problem for the family, as determined in an initial assessment and ongoing monitoring of the family.

In the early stages of intervention, it is common for high-risk parents to report a life crisis or stressor of such magnitude that their attention to a structured intervention is minimal, reducing the likelihood they will derive any benefit from the session. In order to respond appropriately to such crisis situations, the therapists begin each session with an enquiry about immediate concerns. Where they exist, therapists determine whether the issue can be solved or not. If solutions are possible, therapists develop action plans with the dual aim of specifying small manageable steps that will help alleviate the program, and teaching the parent problem solving skills. For crises with no immediate solutions, the aim is to help the parent tolerate the distress associated with the crises sufficiently to enable the parent to meet the emotional needs of the children. In this way the crisis presented by the family becomes a therapeutic opportunity without undermining the integrity of the intervention program.

The PUP program is delivered in families' homes and consists of 12 sessions. The content of the early part of the program addresses the parents' view of themselves as parents, which is typically negative, by encouraging them to acknowledge their parenting abilities. Similarly, parents are encouraged to acknowledge their child's positive attributes. This component of the program highlights the importance of regular child focused play times, and praising their child's pro-social behaviour.

The middle sections of the program typically shift focus to psychological problems and difficulties of the parents - in particular, low mood, anxiety, and emotional regulation. Enhancing coping skills and finding alternatives to drug use are incorporated into sessions and, within the context of a harm minimisation approach, the need to plan instances of illicit drug use to ensure the safety and wellbeing of the children is emphasised.

The latter part of PUP focuses on helping parents acquire and consistently employ non-punitive methods for dealing with problem behaviours, including effective limit-setting and non-punitive consequences for unacceptable child behaviour. Finally, parents are encouraged to extend their social supports by recontacting non-drug using friends and engaging with community agencies such as playgroups and child care centres.

Parents Under Pressure: Therapist manual unit topics and purpose

Unit topicPurpose
Unit 1: AssessmentTo obtain quantitative and qualitative information to provide content for the development of a treatment plan.
Unit 2: Assessment feedback and checking outTo develop a shared understanding of the major areas of strengths and areas of difficulties, which leads to a treatment plan and shared goals to work towards.
Unit 3: Challenging the notion of an ideal parentTo help bring about change in the view of self as an inadequate or hopeless parent.
Unit 4: MoreTo provide parents with skills that will increase parental attending to good behaviour and, in turn, increase their children's good behaviour.
Unit 5: LessTo provide parents with skills to decrease their child's undesirable behaviour to an acceptable level, and decrease the use of highly punitive discipline or physical punishment procedures.
Unit 6: How to under pressureTo help parents to become aware of the relationship between their own emotional state and their parenting practices, and to learn how to regulate emotions and tolerate distress.
Unit 7: Coping with lapse and relapseTo ensure that clients have skills and confidence to minimise lapses to the use of drugs and alcohol, avoid relapse and remain in methadone treatment. Harm minimisation approaches incorporated.
Unit 8: Social support networksTo help parents extend their support networks by modelling social interactions and helping parent(s) prepare for social events that may have been avoided in the past.
Unit 9: Life skills To develop practical life skills including budgeting, nutrition, health care, obtaining housing etc.
Unit 10: RelationshipsTo help improve effective communication with current partner and to identify past unproductive relationship patterns.

Theoretical influences

At the level of the individual functioning of the parents, the PUP program uses cognitive behavioural techniques that have been well documented as effective interventions (Beck 1995). The program has also been influenced by Dialectical Behaviour Therapy (DBT) that has been successful in intervening with individuals displaying extreme behaviours, including Borderline Personality Disorder and substance misuse problems (Linehan 1993).

While not specifically developed for high-risk parents, this intervention is relevant in targeting individuals displaying severe problems with impulsivity and emotional regulation, manifesting in behaviours such as substance abuse and self-harm, as well as deficits in interpersonal relationships (Linehan et al. 2002; McMain, Korman, and Dimeff, 2001; van den Bosch, Verheul, Schippers, and van den Brink 2002). Such individuals have enormous difficulties in problem solving and tolerating distress in their lives - characteristics displayed by many substance abusing and child maltreating parents (Whipple and Webster-Stratton 1991).

The emphasis on the individual functioning of the parents is consistent with other parenting programs for high-risk families. For example, Luthar and Suchman (2000) describe a multifaceted parenting intervention, the Relational Psychotherapy Mothers' Group (RPMG), with standard care in a sample of mothers on a methadone program with a child under 16 years. In acknowledgement of the high rates of co-morbid psychopathology in substance misusing women, and the impact that this has on the ability both to acquire and then implement parenting strategies, the RPMG intervention emphasises techniques aimed at decreasing the psychological distress of the parents.

At the level of the family, PUP has been influenced by the literature describing the efficacy of behavioural family interventions (Sanders, Markie Dadds, Tully and Bor 2000; Webster-Stratton and Reid 2003). Behavioural family interventions are based on the premise that parent-child interactions, particularly the coercive family processes described by Gerald Patterson (1982), maintain child behaviour problems. Interventions are aimed at interfering with the dysfunctional patterns of behaviour through parent training, including the importance of positive interactions (Forehand and McMahon, 1981), and techniques for non-punitive discipline, such as effective limit settings and time-out.

Parent-Child Interaction Therapy (PCIT) includes a powerful and direct intervention through delivery of instructions via an earphone worn by the parent while the parent is playing with their child in an adjacent room. This allows the therapist to guide the parent's interactions with their child and experience the immediate impact of the new interactional style on the dyad relationship (Herschell, Calzada, Eyberg and McNeil, 2002; Urquiza and McNeil 1996). While it is not possible to provide feedback via an ear-bug in the families' homes, PCIT does emphasis the importance of working directly with the parents and the children in play situations. Rather than guiding parents through a microphone, PUP therapists adapt the technique by modelling, prompting and providing feedback on the parent's performance during play sessions with their child in the home setting.

Case example

A case example is presented here to illustrate that, for high-risk parents, parenting interventions should not assume family problems are the inevitable result of deficits in child management skills, but rather that problems can exist across ecological domains.

A mother on a methadone maintenance program who had been referred to the PUP program had been working as a prostitute for two years while the father had been the primary care giver. The child had a good relationship with the father and showed no serious behavioural problems until the mother gave up prostitution and went on methadone.

Following the decrease in income that ensued, the father carried out a burglary, was caught, and sent to prison. The mother became the sole parent and approached services for help in developing her relationship with her child and confidence as a parent. A major focus for her was a concern that she would relapse to heroin use which was, in turn, related to problems in her ability to regulate her emotions. She had limited social contact and support as she was avoiding friends who were continuing illicit drug users. The emphasis on the intervention was on emotional regulation, extending social support networks, and preventing relapse.

Empirical support for the program

To date, empirical evidence of the Parents Under Pressure program is drawn from a pilot study, a randomised control trial, and a dissemination study. The pilot study (Dawe, Harnett, Rendalls et al. 2003) was undertaken to determine the feasibility of delivering the PUP program. Twelve families were recruited from methadone clinics. Nine of the families were assessed and completed the 12-session program; eight were recontacted at three months. All families reported significant improvements in three domains: parental functioning, parent-child relationships, parental substance use and risk-taking behaviour (Dawe, Harnett, Rendalls et al. 2003). The families reported high levels of satisfaction with the program. The results were encouraging and provided the impetus to evaluate the treatment program as a randomised controlled trial.

A randomised controlled trial commenced in January 2000, funded by the NH&MRC. This study aimed to determine the relative effectiveness of the intensive, multidimensional approach of the PUP program compared to a brief behavioural parenting intervention and standard care in families in which either or both parents are currently enrolled in a methadone maintenance program.

The intensive program, PUP, was delivered in families' homes and consisted of up to 12 sessions focusing on parental functioning (including psychopathology and proactive problem solving), the parent-child relationship, beliefs about parental adequacy, and life style issues (including engaging support, problem solving and reducing drug abuse). The brief behavioural parenting intervention consisted of two sessions and was delivered in the clinic. Standard care consisted of the current treatment program of once monthly contact with a caseworker. Using measures sensitive to child behaviour (including behavioural observation of parent child interactions), parental functioning and parental substance abuse, pre and post assessment data were consistent with findings obtained in the pilot study with a substantial decrease in problems in all domains in the intensive condition compared to no change in either the Brief or Standard Care condition. These data have been presented at recent conferences (Dawe, Harnett, and Rendalls 2003; Harnett, Dawe, and Rendalls 2002, 2003).

In 2002, NSW Health funded an evaluation of the dissemination of the Parents Under Pressure program in four NSW Health methadone clinics, allowing an evaluation of the effectiveness of the program under real-world conditions. Evaluation of the dissemination process has focused on the real-world factors that can potentially limit the efficacy of the PUP program. These include diversity in the professional background and level of experience of clinicians in these settings, relaxed exclusion criteria resulting in a greater diversity in the client group, organisational and resource constraints, and models of ongoing supervision and support for clinicians. This study is currently in progress, thus outcome data are not currently available. However, the emerging picture is that the program is having some success with retaining parents in the program.

Application of the program

The application of the PUP program to families involved with child protective services has been approached with caution. Our research team is concerned that parents may be mandated to attend parenting programs if it is argued that they are 'evidence-based' or 'empirically supported' (Chambless and Hollon 1998).

No parenting intervention can claim to be effective with all families, and when working with high-risk families it must be assumed that some will fail to respond to even intensive interventions and ongoing support. Simply attending a parenting program is no guarantee that a parent will benefit from the intervention and is better able to meet the needs of the child. Thus, the PUP program includes ongoing assessment of the parent's response to the program as a core component of the intervention.

An assessment first specifies clear behaviourally defined goals for change and then monitors the motivation and ability of parents to achieve these goals. The assessment of potential to change is carried out to determine the additional and ongoing support the family will require to meet the needs of their children. It should be emphasised that the aim is not necessarily to achieve some minimal level of adequate parenting (Budd 2001), but rather to clarify the strengths and deficits in the family and to gather evidence that can be used to estimate the family's potential to eventually meet the needs of their children.

For families who have little potential to change, clarifying that change is not possible may be as important a goal for the welfare of the children. For families who do make changes, parenting interventions targeting high-risk familles will have made a significant contribution in this difficult area of work.

References

Beck, J. S. (1995), Cognitive therapy: Basics and beyond, Guilford Press, New York, NY.

Belsky, J. (1993), Etiology of child maltreatment: A developmental-ecological analysis. Psychological Bulletin, 114(3), 413-434.

Catalano, R. F., Gainey, R. R., Fleming, C. B., Haggerty, K. P.   Johnson, N. O. (1999), 'An experimental intervention with families of substance abusers: One-year follow-up of the focus on families project', Addiction, 94(2), 241-254.

Chambless, D. L.   Hollon, S. D. (1998), 'Defining empirically supported therapies', Journal of Consulting and Clinical Psychology, 66 (1), 7-18.

Cicchetti, D.   Carlson, V. (1991), Child maltreatment: Theory and research on the causes and consequences of child abuse and neglect, Cambridge University Press, New York.

Dawe, S., Harnett, P. H.,   Rendalls V. (2000), The Parents Under Pressure Program: Facilitator's Manual, Griffith University, Brisbane.

Dawe, S., Harnett, P. H.,   Rendalls V. (2003), 'Evaluation of a parenting program in methadone maintained families', Paper presented at the Helping Families Change conference, Sydney.

Dawe, S., Harnett, P. H., Rendalls, V.,   Staiger P. (2003), 'Improving family functioning and child outcome in methadone maintained Families: The Parents Under Pressure program', Drug and Alcohol Review, 22, 299-307.

Dawe, S., Harnett, P. H., Staiger, P.,   Dadds M. R. (2000), 'Parent training skills and methadone maintenance: Clinical opportunities and challenges', Drug and Alcohol Dependence, 60, 1-11.

Harnett, P. H., Dawe, S.   Rendalls, V. (2002), 'Improving family functioning and child behaviour in methadone maintained families: The Parents Under Pressure program', Paper presented at the Queensland Health and Medical Scientific Meeting, Brisbane.

Harnett, P. H., Dawe, S.   Rendalls, V. (2003), 'Dissemination of the Parents Under Pressure program', Paper presented at the Helping Families Change conference, Sydney.

Herschell, A. D., Calzada, E. J., Eyberg, S. M.   McNeil, C. B. (2002), 'Parent-child interaction therapy: New directions in research', Cognitive and Behavioural Practice, 9(1), 9-16.

Linehan, M. M. (1993), Cognitive-behavioural treatment of borderline personality disorder, Guilford Press, New York, NY.

Linehan, M. M., Dimeff, L. A., Reynolds, S. K., Comtois, K. A., Welch, S. S.   Heagerty, P. et al. (2002), 'Dialectal behaviour therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder', Drug and Alcohol Dependence, 67(1), 13-26.

Luthar, S. S.   Suchman, N. E. (2000), 'Relational Psychotherapy Mothers' Group: A developmentally informed intervention for at-risk mothers', Development and Psychopathology, 12(2), 235-253.

McMain, S., Korman, L. M.   Dimeff, L. (2001), 'Dialectical behaviour therapy and the treatment of emotion dysregulation', Journal of Clinical Psychology, 57(2), 183-196.

Milner, J. S. (1998), 'Individual and family characteristics associated with intrafamilial child physical and sexual abuse', in P. K. Trickett   C. J. Schellenbach (eds) Violence against children in the family and the community, American Psychological Association, Washington, DC. Patterson, G. R. (1982), Coercive family processes. Castalia, Eugence, OR.

Sanders, M. R., Markie Dadds, C., Tully, L. A.   Bor, W. (2000), 'The Triple P-Positive Parenting Program: A comparison of enhanced, standard, and self-directed behavioural family intervention for parents of children with early onset conduct problems', Journal of Consulting and Clinical Psychology, 68(4), 624-640.

Urquiza, A. J.   McNeil, C. B. (1996), 'Parent-child interaction therapy: An intensive dyadic intervention for physically abusive families', Child Maltreatment: Journal of the American Professional Society on the Abuse of Children, 1(2), 134-144.

van den Bosch, L. M. C., Verheul, R., Schippers, G. M.   van den Brink, W. (2002), 'Dialectical Behaviour Therapy of borderline patients with and without substance use problems: Implementation and long-term effects', Addictive Behaviours, 27(6), 911-923.

Webster-Stratton, C.   Reid, M. J. (2003), 'The incredible years parents, teachers and children training series: A multifaceted treatment approach for young children with conduct problems', in A. E. Y. U. S. o. M. Kazdin   C. Child Study (eds) Evidence-based psychotherapies for children and adolescents, Guilford Press, New York, NY.

Whipple, E. E.   Webster-Stratton, C. (1991), 'The role of parental stress in physically abusive families', Child Abuse and Neglect, 15, 279-291.

Paul H. Harnett BA MA(Hons) PhD, is from the School of Psychology, University of Queensland. Sharon Dawe BA MA(Hons) PhD and Vanessa Rendalls BBehSc (Hons) are from the School of Applied Psychology, Griffith University, Mt Gravatt Campus, Brisbane.

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Intervention with sexually abusive young people in Australia and New Zealand

Karen Flanagan

This article is a summary of one of three invited papers commissioned for a special issue of the Journal of Sexual Aggression, that focused on current interventions with sexually abusive young people.

The journal issue was prompted by an event in the United Kingdom where an 11-year-old boy was murdered by an 18-year-old (DM) who was subsequently convicted of his murder and rape. The rape conviction was subsequently overturned on appeal. The 18-year-old had a long history of time in care and had received specialist residential treatment for sexually aggressive behaviour problems. The case had a very high profile and led to a review of services in the UK for young abusers (see 'Childhood Lost' 2001). The review and subsequent report raised, amongst other issues, questions about the progress or lack of service provision for young abusers in the United Kingdom.

The author (Karen Flanagan) was asked by the editors of the Journal of Sexual Aggression to read the review report and draw out similarities with the issues faced in Australia and New Zealand, to comment on her experiences of working with young people with sexually abusive behaviours, and to review progress in this developing area of practice.

At the time of writing the article, the author was the Manager of the Sexual Abuse Counselling and Prevention Program (SACPP), run by the Children's Protection Society in Melbourne, Victoria. The program, established in 1993, is one of only a few working with victims of sexual abuse and young sexual abusers in a holistic and integrated manner. That is, the service works with all family members and the relevant professional systems that may be involved with the family, such as the education sector, mental health and child protection services. Further, the program takes an integrated approach such that sibling victims and perpetrators are both assessed and treated. This is in contrast to some programs that refer the victims for support elsewhere, focusing attention on the sexually abusive young person.

Overall, the article provides a review of the development and current state of treatment programs for young people with sexually abusive behaviours in Australia and New Zealand (as of 2003). To ensure the accuracy of the assessment, personal contact was made with every relevant service provider in Australian and New Zealand. Each operational program was summarised according to the nature of the program, their target client group, and preferred methods of therapeutic intervention. Evaluation and program outcomes were addressed where information was available.

The main findings of the service review were that in the last decade a growing number of programs have been independently developed and established across Australia and New Zealand. This development can be characterised as relatively uncoordinated and involving limited collaboration between states and countries. This is in part due to geographical challenges and the differing policy agendas operating in different jurisdictions. Further, there was some evidence from the programs that practitioners in this still-emerging field are developing greater confidence as to what works with adolescents engaging in sexually abusive behaviours. However, a number of significant gaps in service delivery were also identified. These included a lack of services for younger children (aged ten years and under) with sexualised behaviours, Aboriginal and Torres Strait Islander youth, females, and adolescents with an intellectual disability who engage in sexually abusive behaviours.

The most pressing need articulated by most service providers was for young people to be able to access programs in a timely manner when sexually abusive behaviours are discovered (a resourcing issue), together with the need for the earliest possible identification and intervention with children who engage in sexualised behaviour.

The complexities of the various legal systems were also identified as hindering practice. This related specifically to the issue of mandated versus voluntary clients. While some practitioners take the view that sexually abusive young people should be prosecuted and provided treatment as mandatory clients, others see the need to cater for the needs of voluntary, non-convicted perpetrators. For example, the Children's Protection Society takes both voluntary and involuntary clients, and has had many children and families seek assistance voluntarily. This fits with an early intervention preventative approach to reduce the risk of further abuse/harm being perpetrated. One problem for voluntary clients is that it is more difficult to access services, with mandatory clients taking precedence.

Finally, the need for effective evaluation and ongoing research was noted as a means of accurately determining what works with specific client groups, including both voluntary and non-voluntary clients.

With regard to therapeutic approaches, it was recommended that a holistic approach to the treatment of children and young people engaging in these behaviours be employed, where there is active involvement not only of the young person, but also of their parents and caregivers, in order to sustain change.

Further, the benefits reportedly derived from New Zealand's recent development of a national strategy led to the recommendation that Australian programs should collaborate more effectively in order to drive a national strategy for the ongoing development of programs for children and adolescents with sexually abusive behaviours. It was argued that such a strategy, involving all existing service providers active in the field, could better address the identified service gaps and lead to the development of prevention and early intervention programs that can reduce the incidence of sexual abuse in Australia.

The incentive to work towards this is driven by the knowledge that tragedies such as the DM case can be avoided if young people are identified early and are supported to cease their sexually abusive behaviours in a systematic and holistic manner.

The full paper, entitled 'Intervention with sexually abusive young people in Australia and New Zealand', by Karen Flanagan, was published in the Journal of Sexual Aggression, vol. 9, no. 2, pp. 135-149, November 2003, published by Brunner Routledge, Taylor & Francis Health Sciences.

Karen Flanagan is the Program Manager for the Choose With Care program, run by Child Wise, PO Box 451, South Melbourne, Victoria 3205. Email: choosewithcare@ecpat.org

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Child abuse, domestic violence and animal abuse: considering the links

Nicola Taylor

Research has found that companion animals may be used in a number of ways in the context of family violence.

It is well documented that child abuse often occurs within a web of violence in the home which may include domestic violence. However, it is also becoming increasingly apparent that there are clear links between other forms of violence in the home and the abuse of companion or pet animals. Despite this evidence, until recently there has been a great deal of resistance from all sides to accepting the idea that when addressing family violence there is a need to consider violence which is directed towards the family's companion animal.

Research has found that companion animals may be used in a number of ways in the context of family violence. Cruelty to companion animals may be used to ensure the silence of the victim, to maintain power over the victim, to coerce the victim to do something against her will and/or to punish the victim (Adams 1994; Ascione 1998; Ascione Weber and Wood 1997). Studies report many different types of violence being directed towards the animals of those living in violent family situations: from cats being smacked and kicked; to dogs being thrown off porches; to burying pet dogs alive; and even the sexual abuse of companion animals (Flynn 2000).

Furthermore, it has been shown that companion animals provide emotional comfort to both women and children during psychologically traumatic times and that women will often remain in violent and dangerous situations rather than leave their pet behind with their abuser. One woman explained how she would rather stay in a violent relationship than risk her pet's welfare or hurt her children any further:

I was a victim of domestic violence for seven and a half years as were my children. We have always had pets and lots of them - they were and still are part of our family. In my case, staying at home and suffering beatings on a daily basis became more acceptable to me than leaving with the children without their pets, for doing that would have broken their hearts, and I would have felt it was my decision to hurt them. (Paws for Kids, unpublished)

Children are often caught up in this conundrum, with threats to their pets being used to maintain their silence. In a 1999 study in the United Kingdom, 50 women entering a refuge (after experiencing violence) were asked about their experiences of harm to their companion animals (Paws for Kids, unpublished). Of the 50 women, 66 per cent indicated that their partners had threatened to harm their pets, and 38 per cent indicated that their partners had actually harmed their pets. Further, 74 per cent of the respondents had children and 40 per cent of the children had witnessed threats to, or actual harm to, their pets. In addition, 88 per cent of the women said they had problems sorting out their pet(s) when they were going into a refuge; 58 per cent of the women said that they had had to give up a pet in the past when entering a refuge; and 40 per cent of the women said that they had stayed in a violent relationship because they did not want to leave their pet.

One woman in the the study explained how this affected both her and her children: 'On previous occasions I have had to leave my pets behind, which has broke both mine and my children's hearts.'

These UK findings mirror those in the United States. For example, Ascione and Weber (1998) surveyed 38 women entering a refuge to escape violence and found that of the 28 who had pets, 71 per cent had experienced their partner either threatening to harm or actually harming their pet. Flynn (2000) found that approximately one-fifth of women significantly delayed leaving their relationship and seeking a place in a shelter because of concern for their companion animal's health and welfare.

In Australia, studies show similar patterns. Twenty-eight women entering a refuge in the outskirts of Melbourne were surveyed, with 44 per cent of them indicating that their abuser had harmed and/or threatened to harm their pet, and 48 per cent said that worry over the fate of their pet was a significant factor in delaying them taking up a refuge place (Fawcett, Gullone and Johnson 2002).

Children who are exposed to violence in the home may also begin to abuse companion animals. The abuse of animals by a child can be a significant indicator that a child has been a victim of abuse themselves (Adams and Donovan 1996). There is also evidence that children who exhibit cruel behaviour toward an animal may go on to abuse humans in adulthood (Flynn 2000). Research has also found that juveniles who admit to having sexually abused animals report more sex offences against humans than other sex offenders their same age and race (Fleming, Jory and Burton 2002).

What are the implications for practice?

The findings outlined above have significant implications for those who work in the field of animal, family and child welfare.

Internationally there has been recognition of the need to assist women and children entering domestic violence refuges to have their pets fostered until they are able to care for them again. There are a number of innovative projects currently dealing with this issue such as Paws for Kids in the United Kingdom and Feminists for Animal Rights in the United States. Such programs are important for women and children who can make the decision to leave a violent relationship with the knowledge that their pets will also be safe from violence.

If the links between animal abuse, domestic violence and child abuse are recognised, work can be done towards the development of a collaborative framework where animal protection officers, including veterinarians, report suspicions of child abuse, and where child abuse investigators report suspicions of animal abuse. In California, there are a number of cross-training and cross-referral programs in operation and animal control officers are forced by law to report any suspicions of child abuse (Arkow 1996).

If Australia introduced a cooperative and multi-agency response to family violence and animal abuse, this may go some way towards early detection and intervention in the cycle of family violence, and the prevention of further violence to the family and the family's companion animals.

References

Adams, C. (1994), 'Sheltering companion animals of battered women', Feminists for Animal Rights Newsletter, vol. 8, no. 1-2, pp. 1-8.

Adams, C. & Donovan, J. (eds) (1996), Animals and Women: Feminist Theoretical Explanations, Duke University Press, Durham and London.

Arkow, P. (1996), 'The relationships between animal abuse and other forms of family violence', Family Violence and Sexual Assault Bulletin, vol. 12, pp. 29-34.

Ascione, F. & Weber, C. (1998), Battered Partner Shelter Survey, Utah State University, Logan.

Ascione, F. R., Weber, C. V. & Wood, D. S. (1997), 'The abuse of animals and domestic violence: A national survey of shelters for women who are battered', Society & Animals, vol. 5, no. 3, pp. 205-218.

Ascione, F. R. (1998), 'Battered women's reports of their partners' and their children's cruelty to animals', Journal of Emotional Abuse, vol. 1, pp. 119-133.

Fawcett, N., Gullone, E. & Johnson, J. (2002), 'The relationship between animal abuse and domestic violence: Implications for animal welfare agencies and domestic violence orgnisation', Australian Domestic and Family Violence Clearinghouse Newsletter, no 10, pp. 4-7.

Fleming, W., Jory, B. & Burton, D. (2002), 'Characteristics of juvenile offenders admitting sexual activity with non-human animals', Society and Animals, vol. 10, no. 1, pp. 31-45.

Flynn, C. (2000), 'Battered women and their animal companions: Symbolic interaction between human and non-human animals', Society and Animals, vol. 8, no. 2, pp. 99-127.

Paws for Kids (unpublished) http://www.pawsforkids.org.uk/

Dr Nicola Taylor is a sociologist at Central Queensland University where she is currently researching the additional service needs of those living in violent relationships who have companion animals, in collaboration with the Queensland Centre for Family Violence Research

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Two campaigns aim to prevent child abuse

Every Child is Important Campaign

The Australian Childhood Foundation launched its Every Child is Important campaign in Sydney on 15 March 2004.

This is an innovative parenting education initiative which works to prevent child abuse through eliciting a social commitment to children. It uses multi-modal strategies to strengthen positive relationships between parents and children through the provision of parenting information, resources and support at a national level. It also encourages help seeking behaviour by parents through promoting the view that all parents need information and support at some point in their child's development.

The campaign has been funded through the Australian Government's National Agenda for Early Childhood, to be implemented nationally until the end of 2005.

The launch included the release of a report entitled The Concerns of Australian Parents based on interviews with a sample of 500 parents nationally. The research was undertaken as a joint project between the Australian Childhood Foundation and the National Research Centre for the Prevention of Child Abuse at Monash University.

Analysis of the findings highlighted that three in four parents struggled to balance work and family, more than half lacked confidence in their parenting, and approximately 80 per cent wanted more information and support on parenting issues. A significant proportion of parents appeared to associate asking for help with a high degree of stigma which, in turn, acted as a strong deterrent to actually seeking necessary support.

The results also highlighted that parents have a poor understanding of the extent and nature of child abuse in Australia. They appeared to not consider it an issue of concern for them or their children. They needed reminding to place child abuse on a list of community concerns.

The campaign uses a health promotion model to enhance developmental outcomes for children through resourcing parents. It features creative television, radio and print advertising using the evocative Van Morrison song, Have I told you lately that I love you.

It includes the following key elements:

Information about the campaign can be found at www.kidscount.com.au. Requests for campaign resources can also be made by phoning the Every Child is Important national campaign helpline on 1800 176 453.

Child Abuse Hurts Us All Campaign

The Australian Childhood Foundation, in conjunction with the National Research Centre for the Prevention of Child Abuse, has launched the Child Abuse Hurts Us All campaign.

The campaign, launched at Parliament House, Hobart, on Wednesday 5 May 2004, is a major new community education and awareness initiative, funded and supported by the Tasmanian Government for implementation in Tasmania in 2004-2005.

The campaign uses innovative advertising elements and education strategies to deepen the commitment by the general community to the prevention of child abuse and the protection of children from harm associated with abuse and family violence.

Information about the campaign can be found at www.stopchildabuse.com.au.

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Program Profile: Women's Safety after Separation Project

Marie Hume

The Women's Safety After Separation Project is a joint effort between the National Council of Single Mothers and Their Children and the Australian Coalition of Women Against Violence.

Research by the Family Court of Australia and the Family Law Council, as well as a number of other researchers, has highlighted concerns that the intersection of federal and state jurisdictions in matters in the Family Court involving allegations of violence and abuse fails to recognise the serious risks to the safety of women and children (Brown, Sheehan, Frederico and Hewitt 2001; Rhoades, Graycar and Harrison 1999).

This research indicates that women who leave relationships where they have been subject to abuse and violence are at risk of escalated violence. Some women may experience difficulty in achieving safety for themselves and their children in negotiating children's matters after separation in the context of current system provisions. While the Family Court, counselling and mediation agencies, and state child protection departments provide some services for families, the research confirms that abuse and violence of women and children can continue post-separation (Brown et al. 2001; Rhoades, Graycar and Harrison 1999).

The consequences for women may be numerous, adverse and severe. They include: higher risks of continuing violence and abuse of themselves and their children; the high cost of legal action; the significant time demands required to undertake legal action and to respond to other relevant agencies; greater health risks arising from exposure to violence and abuse; anxiety and depression from being unable to protect their children; and the added stress and concern for their distressed children (Rendell, Rathus, and Lynch 2000).

Survivors of violence and abuse begin recovery when they are in a safe and secure setting, when their rights to safety are recognised, and there is an absence of danger. However, women who are continually being re-exposed to danger both directly, and through their children, are in the difficult position of being unable to recover or to achieve safety (Rendell, Rathus and Lynch 2000).

What is required is the development of more effective and accessible resources and approaches by the criminal justice and family law systems in order to better meet the needs of women and their families subjected to violence and abuse.

Project aims

The Women's Safety After Separation Project focuses on cases involving violence and abuse and aims to:

Anticipated project outcomes

The anticipated outcomes of the Women's Safety After Separation Project are as follows:

Consultation

Consultation has been underway between NCSMC and the Australian Coalition of Women Against Violence in developing the project proposal. The proposal draws on continuing discussions between other groups - including the National Women's Justice Coalition, the Women's Services Network, the Abuse Free Contact Group (Qld), community health and family support services, women's legal services, the Family Court of Australia, the Family Law Council, legal services commissions across Australia, and the Office for the Status of Women at both state and federal levels, which have enabled the development and extension of the National Abuse Free Contact Campaign.

These consultations have further highlighted the importance of developing an initiative that would better enable women to express their needs in relation to Family Law Court matters involving children. In sum, it is argued that the family law system does not adequately recognise the risks to the safety of women and children who have been subject to violence and abuse, potentially putting women and children at further risk.

References

Brown, T. Sheehan, R. Frederico, M. & Hewitt, L. (2001), Resolving Family Violence to Children Family, Violence and Family Court Research Program, Monash University, Victoria.

Rhoades, H., Graycar, R. & Harrison, M. (1999), The Family Law Reform Act 1995: Can Changing Legislation Change Legal Culture, Legal Practice and Community Expectations? Interim Report, University of Sydney, NSW.

Rendell, K, Rathus, Z. & Lynch, A. (2000), An Unacceptable Risk, Women's Legal Service Inc, Brisbane, Queensland.

For further details, contact: Coordinator Marie Hume. Email: marie@ncsmc.org.au. Project worker Heather Joy. Email: heather@ncsmc.org.au. National Council of Single Mothers and their Children, Torrens Building, 220 Victoria Square, Adelaide 5000. Phone: (08) 8226 2505.

The hidden dynamics of domestic violence

A commonly held community myth is that domestic violence is only physical abuse. Through New Eyes: Exploring the Hidden Dynamics of Domestic Violence is a new resource that aims to increase awareness of the non-physical violence, such as emotional abuse, that is also a facet of domestic violence. In homes where domestic violence occurs, children exposed to it are also at risk of suffering psychological and emotional abuse, which can happen without actual physical abuse.

Supported by the New South Wales Department of Urban Affairs and Planning, Through New Eyes is designed to 'open Australia's eyes to the insidious nature of emotional abuse as a core component in domestically violent relationships,' says Carol Skye, Project Manager, Hunter Women's Centre.

Through New Eyes consists of four videos, a CD ROM and detailed facilitator handbook. The video package explores the emotional, verbal, psychological, social, financial and sexual aspects of domestic violence. It is a generic resource designed for use across a range of human services, education and business, including universities, TAFEs, welfare, health and police.

The Through New Eyes Video Package comprises: Video One - 'More than just physical'; Video Two - 'Barriers to leaving'; Video Three - 'Wising up; Video Four - 'Continuous play'; CD ROM - Video One and Two. A 'Facilitator handbook', which discusses the aims of each section, step-by-step strategies, learning outcomes, and possible discussion questions and answers, is also included.

The cost (including GST) of the Through New Eyes resource is: For-profit organisations: $385. Not-for-profit organisations: $275. Postage and handling is $15.

For further information, contact: Nadine Tisdell, Through New Eyes Project Worker. Phone: (02) 4968 2511 Fax: (02) 4968 2975. Email: hwc_nt@yahoo.com.au.

Childhood sexual abuse and women's experiences of pregnancy, birth and mothering

A report has been published by the South Australian Women's Health Statewide entitled: For the first time somebody wants to hear: Adult survivors of childhood sexual abuse. Written by Tanja Stojadinovic, the report is designed to be used as an information resource for health professionals who work with women during pregnancy, birth and mothering.

This report shares the stories about the experiences of pregnancy, birth, mothering and the health system of women survivors of childhood sexual abuse across South Australia. These experiences and the issues raised were compared with those documented in the literature and a set of recommendations were developed.

Medical and health workers were also consulted about their opinions about what resources and information they would need in order to assist them work more effectively with women survivors of child sexual abuse.

Copies of the report can be downloaded from: http://www.whs.sa.gov.au/pub.php
For more information contact Women's Health Statewide. Phone: (08) 8239 9600. Email: info@whs.sa.gov.au