The Health of Aboriginal Children born in Western Australia in the Context of Out-Of-Home Care
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2024-06
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Melbourne Authors
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Melbourne School of Population and Global Health
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PhD thesis
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Open Access
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© 2024 Benjamin Jack Allam Harrap
Abstract
Aboriginal and Torres Strait Islander children continue to be over-represented in child protection statistics and have an inequitable burden of disease, a consequence of the historic and ongoing colonisation of Australia. There is considerable research on Aboriginal children’s health and interactions with child protective services (CPS) as separate topics, but little that explores their health in the context of CPS involvement. By centring the perspectives of Aboriginal researchers and community reference group participants, my research connected their qualitative findings and conversations we had to population-level quantitative findings using a data linkage for all Aboriginal children born in Western Australia between 2000 and 2013.
First, mothers with prior child removals felt ‘written off’; that removal of their future children was inevitable. This informed my analysis of family relationships and child protection data, which identified children born to mothers with a previous child removal were 16 times more likely to be removed themselves by age one. Also, among sibling groups where at least one sibling was placed in out-of-home care (OOHC), 64.7% of siblings were placed in OOHC on the same date. In addition, carers suspected children in their care had mental and neurodevelopmental health conditions but struggled to get a diagnosis. I drew on hospital admissions and several sources of health data to compare the prevalence of mental and neurodevelopmental health conditions. Children ever-placed in OOHC had a three-times greater prevalence of neurodevelopmental (6.2%) and mental health (14.8%) conditions compared to never-placed children (2.0% and 5.0% respectively). Ever-placed children whose first placement occurred before the age of one had a higher prevalence of neurodevelopmental conditions (9.0%) compared to children first placed after the age of one (5.2%), while mental health conditions were similar (13.3% and 15.3%, respectively).
Further, carers reported difficulty accessing primary healthcare services to meet the health needs of the children in their care. To explore this, I examined potentially preventable hospitalisations (PPHs), an indicator of inadequate primary healthcare. Diagnoses for PPHs were similar for ever- and never-placed children, however the rate of bed days for PPHs was overall 2.3 times higher for ever-placed children, with the rates being highest during the first year of life. The rate of PPH bed days for ever-placed children on average reduced by 11% following first placement in OOHC, however, the rate did not reach parity with that of never-placed children.
In summary, these quantitative findings support the qualitative research and experiences of the community reference group and demonstrates how widespread their experiences are for Aboriginal children and families across Western Australia. To reduce the concurrent and future risk of removal for children and their siblings, meet the increased mental and neurodevelopmental healthcare needs of children in OOHC, and lower rates of PPHs, greater support is needed for Aboriginal children with experience of OOHC and their parents and carers. This support must be culturally safe, which includes funding service delivery through Aboriginal community-controlled organisations, building a culturally competent child protection and healthcare workforce, and decolonising state operated systems of child protection and healthcare.
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Aboriginal, Torres Strait Islander, First Nations, Indigenous, Child health, Mental health, Neurodevelopmental health, Potentially preventable hospitalisations, Western Australia, Child removals, Out-of-home care, Child protection, Data linkage