doi:10.1111/j.1440-1754.2007.01274.
EDITORIAL COMMENT
Child protection and child health: A shared future
Health professionals, particularly those practising in the field of
population health and paediatric medicine, have long been
aware of the ecology of child abuse and neglect. The impact of
adversity on child health was appreciated well before authors
such as Diana Jolly summarized current knowledge on behalf of
the Australian College of Paediatrics in 1990,1 and Fiona Stanley
and others suggested a new way forward in 2002.2 The paper by
Wills et al. 3 in this edition of the journal advances the idea that
child protection and child health are inextricably linked and
highlights the obligations of health professionals working
within all areas of the health sector to better recognise and
respond to family violence, child abuse and neglect. They dem-
onstrate how health professionals can successfully enquire
about family violence, increase the detection rate and respond
in a collaborative manner with statutory agencies. It is an idea
whose time has come.
See related article by Wills et al. on pp. 92–98.
Across Australia and New Zealand, many health and child pro-
tection bureaucracies are exploring ways of formalising linkages
between the child protection and health sectors. Child Protec-
tion Liaison Officers, interagency guidelines and project officers
charged with the responsibility of fostering linkages across the
child protection and health sectors all contribute to this process.
New Zealand’s Te Rito Family Violence Prevention Strategy
takes these ideas further by recognising that attitudinal and
behavioural change requires partnerships with non-
governmental organisations and local communities. Theoreti-
cally, these seem to be wise ideas. Empirically, the benefits of
close working relationships between the sectors are starting to
emerge. As scientists we hunger for evidence of effectiveness.
The data presented by Wills et al. is welcome evidence of the
success of a training strategy for health professionals that
increased their confidence to enquire about family violence
resulting in an increased number of reported cases.
Furthermore, Wills et al. identified the key components of an
effective intervention strategy. As they point out, programmes
aimed at reducing family violence and child abuse can fail when
the strategies, for a variety of reasons, do not successfully change
professionals’ work practices. Political good will is necessary but
often insufficient to effect change. Who does not remember Bob
Hawke’s pledge, ‘no Australian child shall live in poverty by
2000’? Similarly, policy and clinical practice guidelines are nec-
essary but insufficient. Public health physicians carefully con-
sider how best to translate policy into practice in an area of study
Correspondence: Dr Anne Smith, Victorian Forensic Paediatric Medical
Service, Royal Children’s Hospital, Parkville, Vic 3052, Australia. Fax:
+61 9345 4105; email: anne.smith@rch.org.au
Accepted for publication 6 December 2007.
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)
where interest and motivation are high, but there is little evi-
dence of effectiveness. Professional education is necessary but
insufficient. Wills et al. suggest that we look to the business sector
for lessons about change management if we are to be successful.
They suggest that local champions have a key role to play in
modelling desired work practices. They also emphasise the
importance of systems monitoring and feedback to promote a
continuous quality improvement cycle; a principle unquestion-
ably enshrined in good health care across our countries.
We look overseas for inspiration from our British and Ameri-
can colleagues. The recommendations contained in Lord Lam-
ing’s report into the death, as a result of child abuse, of Victoria
Climbie serve to remind us of the multisystemic failures that
contributed to her death. We would do well to emulate the
United Kingdom’s ‘Every Child Matters’:4 a well-funded, whole-
of-government response to safeguard children and reduce the
incidence and impact of child abuse. The US model (Child Advo-
cacy Centers5) also advocates for strong multisystem linkages
but has taken a slightly different path in strengthening linkages
with the criminal justice system. In particular, professionals in
these community-based centres aim to increase, and improve,
the investigation and prosecution of child sexual abuse cases.
Arguably this has resulted in negative unintended conse-
quences, reducing the connection between health care provided
within Child Advocacy Centers and centers providing main-
stream paediatric health care.
In the current sociopolitical climate, few would dare argue
against collaborative interprofessional and intersectorial work.
Governments and communities alike express enthusiasm for a
whole-of-government approach to matters pertaining to chil-
dren. The link between child abuse and other forms of interper-
sonal violence, including family violence, is well established, yet
many intervention services are stratified according to victims’
age and gender. Opportunities for cross-fertilisation of ideas and
inspiration are limited when special interest groups focus on the
needs of abused children, or abused women, or abused men
rather than the broader ecological and interpersonal variables
contributing to aggression. It makes good sense to share knowl-
edge and effort. For governments and organisations such as New
Zealand’s Area Health Boards it also makes good economic
sense, although this is difficult to prove!
The next challenge before us is to educate and increase the
skills of child protection workers, particularly in relation to
intervening with children who have complex medical needs and
children who experience ‘medical neglect’. The child protection
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-
able challenge. Like health professionals, child protection
workers need to be aware of the importance of reducing child-
hood adversity because it has such negative impacts on chil-
dren’s health, growth, development, psychological well-being,
85
Child protection and child health
behaviour and relationships. Experts in child development and
behaviour have much to offer professionals working within child
protection and it is timely that some governments are employing
child psychologists and child health experts in the same way that
child protection bureaucracies employ expert educationalists and
lawyers. Perhaps ‘embedding’ child protection workers within
key organisations such as children’s hospitals will advance this
process and increase child protection workers’ and child health
professionals’ acceptance of a shared responsibility for child
protection as well as a shared responsibility for children’s health,
development and well-being. I commend Wills et al. for taking us
a step closer to this shared future.
References
1 Jolly DL. The Impact of Adversity on Child Health – Poverty and
Disadvantage. Sydney: Australian College of Paediatrics, 1990.
2 Stanley F, Sanson A, McMichael T. New ways of causal pathways
thinking for public health. In: Sanson A, ed. Children’s Health and
Development: New Research Directions for Australia. Melbourne:
86
Journal compilation © 2008 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
A Smith
Australian Institute of Family Studies, 2002. Available from: http://
www.aifs.gov.au/institute/pubs/resreport8/main.html.
3 Wills R, Ritchie M, Wilson M. Improving detection and quality of
assessment of child abuse and partner abuse is achievable with a
formal organisational change approach. J. Paediatr. Child Health 2008;
44: 92–98.
4 Every Child Matters: Change for Children. Cross-Government working
with local partners to achieve better outcomes for children and young
people. Available from: http://www.everychildmatters.gov.uk/
publications [accessed 27 November 2007].
5 The National Children’s Advocacy Center. Putting Standards into
Practice: A Guide to Implementing NCA Standards for Children’s
Advocacy Centers, 2000. Available from: http://www.nationalcac.org/
professionals/model/cac_model.html [accessed 27 November 2007].
Dr Anne Smith
Medical Director
Victorian Forensic Paediatric Medical Service
Royal Children’s Hospital
Melbourne, Victoria
Australia
Journal of Paediatrics and Child Health 44 (2008) 85–86
© 2008 The Author