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Are our child protection policies causing more harm to our most vulnerable children?

In Australia, there were 43 399 children in out-of-home care (OOHC) on 30 June 2015 (Box).1 Over the past 18 years, the rate at which Indigenous children have been placed in care has more than tripled and more than doubled for non-Indigenous children.1-3 This is disturbing, and particularly so for Indigenous children where one in 19 are in OOHC.1 A recent review of child maltreatment across various countries, including Australia, concluded that 40 years after contemporary child protection policies were introduced in the 1970s, there has been “no clear evidence for an overall decrease in child maltreatment”.4 Despite the call by this review for more evidence,4 there have been no studies planned to assess the effectiveness of our current OOHC policy in Australia.

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Bond University, Gold Coast, QLD

Correspondence: pejones@bond.edu.au

Competing interests:

No relevant disclosures.

1. Australian Institute of Health and Welfare. Child protection Australia 2014–15 (AIHW Cat. No. CWS 57; Child Welfare Series No. 63). Canberra: AIHW, 2016. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129554973 (accessed Nov 2016).
2. Australian Institute of Health and Welfare. Child protection Australia 2006–07 (Cat. No. CWS 31; Child Welfare Series No. 43). Canberra: AIHW, 2008. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442455311 (accessed Nov 2016).
3. Australian Institute of Health and Welfare. Child protection Australia 1997–98 (AIHW Cat. No. CWS 8)Canberra: AIHW, 1999. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442455176 (accessed Nov 2016).
4. Gilbert R, Fluke J, O’Donnell M, et al. Child maltreatment: variation in trends and policies in six developed countries. Lancet 2012; 379: 758-762.
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6. Tarren-Sweeney M, Hazell P. Mental health of children in foster and kinship care in New South Wales, Australia. J Paediatr Child Health 2006; 42: 89-97.
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8. NSW Department of Community Services. Mental health of children in out-of-home care in NSW, Australia. July 2007. http://www.community.nsw.gov.au/__data/assets/pdf_file/0019/321715/researchnotes_mentalhealth_oohc.pdf (accessed Nov 2016).
9. Child Family Community Australia. Child deaths from abuse and neglect. CFCA resource sheet — May 2016. https://aifs.gov.au/cfca/publications/child-deaths-abuse-and-neglect (accessed Apr 2017).
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11. Osborn A, Delfabbro PH. Research article 4: an analysis of the social background and placement history of children with complex and multiple needs in Australian out-of-home care. Communities, Children and Families Australia 2006; 1: 33-42.
12. Townsend S, Hignight A, Rubovits D. Factors affecting permanency outcomes for foster children before and after passage of the Adoption and Safe Families Act of 1997. Illinois Child Welfare 2008; 4: 59-73.
13. Fernandez E, Atwool N. Child protection and out of home care: policy, practice, and research connections Australia and New Zealand. Psychosocial Intervention 2013; 22: 175-184.
14. Population Statistics New Zealand. http://maps.stats.govt.nz/apps/StatsMaps324/index.html?webmap=map_config.txt&viewer=July2015_EstimatedResidentialPopulation.txt (accessed Nov 2016).
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16. Parliament of Australia. Senate Community Affairs References Committee. Report: out of home care. 19 Aug 2015. http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Out_of_home_care/Report (accessed Oct 2016).
17. Australian Council of Social Service. Poverty in Australia in 2016. Sydney: ACOSS, 2016. http://www.acoss.org.au/wp-content/uploads/2016/10/Poverty-in-Australia-2016.pdf (accessed Apr 2017).
18. Greenhalgh EM, Bayly M, Winstanley MH. 1.3 Prevalence of smoking — adults. In: Scollo MM, Winstanley MH, editors. Tobacco in Australia: facts and issues. Melbourne: Cancer Council Victoria, 2015. http://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-3-prevalence-of-smoking-adults (accessed Apr 2017).
19. Federal Office of Road Safety. The history of road fatalities in Australia. (Monograph 23, 1998). Canberra: FORS, 1998. https://www.tac.vic.gov.au/__data/assets/pdf_file/0005/66407/History-of-Road-Fatalities-from-1925.pdf (accessed Apr 2017).
20. National Road Safety Strategy 2011–2020. Implementation status report. November 2015. http://roadsafety.gov.au/performance/files/NRSS_Implementation_report_Nov2015.pdf (accessed Oct 2016).

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Research

Premature deaths of nursing home residents: an epidemiological analysis

Joseph E Ibrahim, Lyndal Bugeja, Melissa Willoughby, Marde Bevan, Chebiwot Kipsaina, Carmel Young, Tony Pham and David L Ranson

Med J Aust 2017; 206 (10): . || doi: 10.5694/mja16.00873
Published online: 5 June 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Diagnostic techniques and procedures

Gerontology

Ethics and law

Abstract

Objectives: To conduct a descriptive epidemiological analysis of external cause deaths (premature, usually injury-related, and potentially preventable) of nursing home residents in Australia.

Design: Retrospective study of a cohort of nursing home residents, using coronial data routinely recorded by the National Coronial Information System.

Setting and participants: Residents of accredited Australian nursing homes, whose deaths were reported to coroners between 1 July 2000 and 30 June 2013, and determined to have resulted from external causes.

Main outcome measures: Causes of death, analysed by sex and age group, and by location of incidents leading to death and location of death. Rates of death were estimated on the basis of Australian Bureau of Statistics population and Australian Institute of Health and Welfare nursing home data.

Results: Of 21 672 deaths of nursing home residents, 3 289 (15.2%) resulted from external causes. The most frequent mechanisms of death were falls (2 679 cases, 81.5%), choking (261 cases, 7.9%) and suicide (146 cases, 4.4%). The incidents leading to death usually occurred in the nursing home (95.8%), but the deaths more frequently occurred outside the nursing home (67.1%). The annual number of external cause deaths in nursing homes increased during the study period (from 1.2 per 1000 admissions in 2001–02 to 5.3 per 1000 admissions in 2011–12).

Conclusion: The incidence of premature and potentially preventable deaths of nursing home residents has increased over the past decade. A national policy framework is needed to reduce the incidence of premature deaths among Australians living in nursing homes.

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1 Monash University, Melbourne, VIC
2 Victorian Institute of Forensic Medicine, Melbourne, VIC

Correspondence: Joseph.Ibrahim@monash.edu

Acknowledgements:

This work was supported by the federal Department of Social Services, the Victorian Department of Health and Human Services (Ageing and Aged Care Branch), and the Department of Forensic Medicine, Monash University. None of the funders influenced the design, methods, subject recruitment, data collection, analysis or preparation of the paper.

Competing interests:

We are affiliated with or employed by the Department of Forensic Medicine, Monash University, which was also a funding source.

1. Ibrahim J, Murphy B, Bugeja L, Ranson D. Nature and extent of external-cause deaths of nursing home residents in Victoria, Australia. J Am Geriatr Soc 2015; 63: 954-962.
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