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Child protection and child health: A shared future

Health professionals, particularly those practising in the field of where interest and motivation are high, but there is little evi-
population health and paediatric medicine, have long been dence of effectiveness. Professional education is necessary but
aware of the ecology of child abuse and neglect. The impact of insufficient. Wills et al. suggest that we look to the business sector
adversity on child health was appreciated well before authors for lessons about change management if we are to be successful.
such as Diana Jolly summarized current knowledge on behalf of They suggest that local champions have a key role to play in
the Australian College of Paediatrics in 1990,1 and Fiona Stanley modelling desired work practices. They also emphasise the
and others suggested a new way forward in 2002.2 The paper by importance of systems monitoring and feedback to promote a
Wills et al. 3 in this edition of the journal advances the idea that continuous quality improvement cycle; a principle unquestion-
child protection and child health are inextricably linked and ably enshrined in good health care across our countries.
highlights the obligations of health professionals working We look overseas for inspiration from our British and Ameri-
within all areas of the health sector to better recognise and can colleagues. The recommendations contained in Lord Lam-
respond to family violence, child abuse and neglect. They dem- ing’s report into the death, as a result of child abuse, of Victoria
onstrate how health professionals can successfully enquire Climbie serve to remind us of the multisystemic failures that
about family violence, increase the detection rate and respond contributed to her death. We would do well to emulate the
in a collaborative manner with statutory agencies. It is an idea United Kingdom’s ‘Every Child Matters’:4 a well-funded, whole-
whose time has come. of-government response to safeguard children and reduce the
incidence and impact of child abuse. The US model (Child Advo-
See related article by Wills et al. on pp. 92–98. cacy Centers5) also advocates for strong multisystem linkages
but has taken a slightly different path in strengthening linkages
Across Australia and New Zealand, many health and child pro- with the criminal justice system. In particular, professionals in
tection bureaucracies are exploring ways of formalising linkages these community-based centres aim to increase, and improve,
between the child protection and health sectors. Child Protec- the investigation and prosecution of child sexual abuse cases.
tion Liaison Officers, interagency guidelines and project officers Arguably this has resulted in negative unintended conse-
charged with the responsibility of fostering linkages across the quences, reducing the connection between health care provided
child protection and health sectors all contribute to this process. within Child Advocacy Centers and centers providing main-
New Zealand’s Te Rito Family Violence Prevention Strategy stream paediatric health care.
takes these ideas further by recognising that attitudinal and In the current sociopolitical climate, few would dare argue
behavioural change requires partnerships with non- against collaborative interprofessional and intersectorial work.
governmental organisations and local communities. Theoreti- Governments and communities alike express enthusiasm for a
cally, these seem to be wise ideas. Empirically, the benefits of whole-of-government approach to matters pertaining to chil-
close working relationships between the sectors are starting to dren. The link between child abuse and other forms of interper-
emerge. As scientists we hunger for evidence of effectiveness. sonal violence, including family violence, is well established, yet
The data presented by Wills et al. is welcome evidence of the many intervention services are stratified according to victims’
success of a training strategy for health professionals that age and gender. Opportunities for cross-fertilisation of ideas and
increased their confidence to enquire about family violence inspiration are limited when special interest groups focus on the
resulting in an increased number of reported cases. needs of abused children, or abused women, or abused men
Furthermore, Wills et al. identified the key components of an rather than the broader ecological and interpersonal variables
effective intervention strategy. As they point out, programmes contributing to aggression. It makes good sense to share knowl-
aimed at reducing family violence and child abuse can fail when edge and effort. For governments and organisations such as New
the strategies, for a variety of reasons, do not successfully change Zealand’s Area Health Boards it also makes good economic
professionals’ work practices. Political good will is necessary but sense, although this is difficult to prove!
often insufficient to effect change. Who does not remember Bob The next challenge before us is to educate and increase the
Hawke’s pledge, ‘no Australian child shall live in poverty by skills of child protection workers, particularly in relation to
2000’? Similarly, policy and clinical practice guidelines are nec- intervening with children who have complex medical needs and
essary but insufficient. Public health physicians carefully con- children who experience ‘medical neglect’. The child protection
sider how best to translate policy into practice in an area of study industry is plagued by controversy and intense media scrutiny,
high rates of ‘burnout’ and high staff turnover. Educating and
maintaining the child protection workforce presents a consider-
Correspondence: Dr Anne Smith, Victorian Forensic Paediatric Medical able challenge. Like health professionals, child protection
Service, Royal Children’s Hospital, Parkville, Vic 3052, Australia. Fax: workers need to be aware of the importance of reducing child-
+61 9345 4105; email: anne.smith@rch.org.au
hood adversity because it has such negative impacts on chil-
Accepted for publication 6 December 2007. dren’s health, growth, development, psychological well-being,

Journal of Paediatrics and Child Health 44 (2008) 85–86 85

© 2008 The Author
Journal compilation © 2008 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Child protection and child health A Smith

behaviour and relationships. Experts in child development and Australian Institute of Family Studies, 2002. Available from: http://
behaviour have much to offer professionals working within child www.aifs.gov.au/institute/pubs/resreport8/main.html.
protection and it is timely that some governments are employing 3 Wills R, Ritchie M, Wilson M. Improving detection and quality of
child psychologists and child health experts in the same way that assessment of child abuse and partner abuse is achievable with a
formal organisational change approach. J. Paediatr. Child Health 2008;
child protection bureaucracies employ expert educationalists and
44: 92–98.
lawyers. Perhaps ‘embedding’ child protection workers within
4 Every Child Matters: Change for Children. Cross-Government working
key organisations such as children’s hospitals will advance this with local partners to achieve better outcomes for children and young
process and increase child protection workers’ and child health people. Available from: http://www.everychildmatters.gov.uk/
professionals’ acceptance of a shared responsibility for child publications [accessed 27 November 2007].
protection as well as a shared responsibility for children’s health, 5 The National Children’s Advocacy Center. Putting Standards into
development and well-being. I commend Wills et al. for taking us Practice: A Guide to Implementing NCA Standards for Children’s
a step closer to this shared future. Advocacy Centers, 2000. Available from: http://www.nationalcac.org/
professionals/model/cac_model.html [accessed 27 November 2007].

References Dr Anne Smith

1 Jolly DL. The Impact of Adversity on Child Health – Poverty and
Medical Director
Disadvantage. Sydney: Australian College of Paediatrics, 1990. Victorian Forensic Paediatric Medical Service
2 Stanley F, Sanson A, McMichael T. New ways of causal pathways Royal Children’s Hospital
thinking for public health. In: Sanson A, ed. Children’s Health and Melbourne, Victoria
Development: New Research Directions for Australia. Melbourne: Australia

86 Journal of Paediatrics and Child Health 44 (2008) 85–86

© 2008 The Author
Journal compilation © 2008 Paediatrics and Child Health Division (Royal Australasian College of Physicians)