Prevention and early intervention

The abuse and neglect of children has far reaching consequences for society. Investing in prevention and early intervention is a well recognised evidence based approach that offers the best long term outcomes for children and families. Key prevention and early intervention policy and evidence frameworks emphasise the need to disrupt the social conditions most likely to foster child abuse and neglect and the importance of early brain development, healthy parent child relationships, and strengths based, trauma informed approaches.

As a sector we are committed to helping children and communities thrive. This means providing programs and services that address the root causes of child abuse and neglect, and supporting children and families early to prevent harm.

There is extensive research on the long term health and social outcomes of child abuse and neglect for individuals, including increased risk of chronic disease, poorer mental health and wellbeing, homelessness or involvement in the criminal justice system. There are substantial economic and social costs to families, communities and society that can be prevented through effective prevention and early intervention approaches.

Prevention

Prevention refers to programs and services designed to build protective factors, and prevent risk factors for child abuse and neglect from emerging in the first place. Prevention programs are usually universal or primary interventions in that they are offered to entire communities or community groups. Examples include social wellbeing programs offered to school students, antenatal services available to all families, or public awareness campaigns that target whole communities.

Early intervention

Early intervention refers to activities, programs and services designed to support families who show signs of needing support or vulnerabilities that may escalate into child abuse or neglect. Early interventions provide families with resources and skills designed to interrupt the growth of emerging problems, and encourage positive child development.

Examples of issues targeted by early intervention services include parenting stress, caring for a child with disability, social isolation, poverty, parents living with disability, mental health or alcohol and other drug issues. Without support, issues like these can become overwhelming and less manageable for families over time, and impact on parenting. Each family will have a unique mix of risk and protective factors, including strengths they have already developed to deal with problems.

There is no general, one size fits all answer. Whether prevention or early intervention meets a family’s needs will be unique to each situation. Working in partnership with families is the best way to understand their circumstances and the outcomes they want to achieve. Many prevention and early intervention services work with specific groups or have specific goals, it is critical to find the right fit for each family and family member.

The needs of families change over time. Changes in circumstances can rapidly increase or decrease need, and families are likely to share more about their world as trust builds with services and professionals. Being prepared to change our approach as things evolve is a core part of working in the child protection and wellbeing sector.

The Mandatory Reporter Guide (MRG) is an important tool that supports decision making about the needs of children and families, including the most appropriate response. In Part 6: Reporting and responding to child wellbeing and safety concerns, further information is provided about how to use this tool.

Our sector sits on a spectrum of service delivery, often referred to as the public health model. There are three layers of service delivery in the public health model: Primary or universal services, secondary services, and tertiary services.

A text alternative to the Public Health Model diagram is available.

Primary or universal services

Primary or universal services target whole communities or populations to strengthen protective factors and diminish risk factors that might contribute to child abuse and neglect. Prevention programs are generally primary or universal. Examples include:

• The National Association for Prevention of Child abuse and Neglect (NAPCAN) promotes evidence based public awareness of child abuse and neglect, and promotes child safety through public events and advocating for child safe policies and strategies.

• The ‘There’s no excuse for abuse’ campaign, developed by Our Watch, aims to challenge public assumptions about domestic and family violence through television and other public campaigning. By shifting public attitudes, social awareness becomes a protective factor that mitigates violence.

Other examples of universal services that contribute to prevention are mainstream education and health care services, such as antenatal services and quality child care.

Secondary or targeted services

Secondary or targeted services support children and families with certain vulnerabilities or who are at greater risk of experiencing violence, abuse and neglect. Early intervention services are generally secondary or targeted. Some examples of these services include supported playgroups that offer family worker support for families who need it, or targeted parenting support for families with specific risk factors.

Tertiary services

Tertiary services are specialised intensive services working with children and families where some form of child abuse or neglect is already happening. Statutory child protection services and intensive family based therapeutic services are in this group.

People often move between layers of service fluidly

In reality, the children and families we work with often experience all three of these service types, separately, or sometimes all at once. Prevention and early intervention is key to the long term reduction of child abuse and neglect, and tertiary services do absolutely essential work with families with more complex problems. Risk factors families are experiencing change over time, and families’ needs change. A coordinated approach that involves services working together has the best possible chance of reducing child abuse and neglect.

Our frameworks

There are several key policy frameworks and evidence guides that inform prevention and early intervention work in NSW:

• The NSW Human Services Outcomes Framework (HSOF) is a cross agency framework that specifies seven wellbeing outcomes for the NSW population, and links these outcomes to evidence on how to achieve them. The Department of Communities and Justice (DCJ) has also applied the HSOF to specific early intervention evidence.
• Brighter Beginnings - the first 2000 days of life is a whole-of-government initiative to give children the best start in life. It is a strategic policy framework developed by NSW Health that outlines the importance of the first 2000 days of a child’s life and guides service delivery priorities to ensure that all children have the best possible start in life.
• The Australian Research Alliance for Children and Youth (ARACY) Better systems, better chances report is an extensive 2015 review of the prevention and early intervention evidence designed to highlight the core components of an optimal prevention and early intervention service system.
• The National Framework for Protecting Australia’s Children is a long term approach to deliver a substantial and sustained reduction in levels of child abuse and neglect over time. The Framework identifies 6 evidence informed outcomes intended to achieve this goal.
• The US Centers for Disease Control and Prevention have collated research and resources on the impact of childhood ‘Adverse Life Experiences’ (ACE’s) on life outcomes. The ACE’s model examines opportunities for prevention by identifying specific childhood experiences and their relationship to health, wellbeing, and opportunity.
• Closing the gap is a national agreement designed to achieve equality in health status, life expectancy and life outcomes for Aboriginal and Torres Strait Islander people, and eliminate the gap between Indigenous and non-Indigenous Australians.
• The Australian Institute of Family Studies has published an evidence review and recommendations for the prevention of child sexual abuse. The review highlights the need to address the underlying causes of child sexual abuse with sustainable prevention efforts.
• The Australian Centre for Child Protection has published an evidence review on improving service responses to vulnerable families during pregnancy and infancy.
• In response to the Royal Commission into Institutional Responses to Child Sexual Abuse, the NSW Government is developing a framework for the prevention of and responses to children with problematic and harmful sexual behaviours.

Key messages from the evidence

The policy and evidence frameworks highlight key prevention and early intervention service delivery and practice lessons.

Key messages for service delivery

The evidence has some clear messages about targeting service delivery for outcomes:

• Prevention matters. A strong foundation of universal services and initiatives that address the broader systemic causes of child abuse and neglect are important sites of investment.
• The prenatal period is a critical time for early intervention. Brain development begins during pregnancy, and this can be a period of high motivation for parents.
• Brain development in early childhood is a key window of opportunity for prevention and early intervention that shapes long term trajectories, particularly in the first 2000 days of a child’s life.
• Brain development during adolescence is another window of opportunity due to the transition to peer influence and increased exposure to risky behaviors.
• Parents, play and home environments matter. Quality of relationships with family is a protective factor from social and economic disadvantage.
• There is no one driver or point of intervention that ensures positive outcomes for all children. A complex mix of risk and protective factors is unique for each family, and requires flexible service delivery that can adapt to individual need.
• An effective system must take into account the specific needs of communities and use responsive approaches, particularly when working with Aboriginal communities, children and families.

Key messages for practice

The evidence has also generated some core practice principles:

• Being strengths based matters for prevention and early intervention as much as for work in tertiary services. Work with families, communities and groups to recognise and build upon strengths. A strengths based approach operates on the assumption that all people, even if they are experiencing problems, have some strengths and resources from which they can draw on to make positive change. A strengths-based approach does not ignore problems and always holds the safety of the child or young person as paramount. It focuses on utilising personal strengths to inform strategies to support individuals.
• Being trauma informed matters. Trauma-Informed Practice is a strengths-based framework grounded in an understanding of and responsiveness to the impact of trauma, that emphasises physical, psychological, and emotional safety for everyone, and that creates opportunities for survivors to rebuild a sense of control and empowerment. Don’t assume being trauma informed is less important in a prevention or early intervention context. Understanding the early experiences of adults and children is critical to being effective.
• Work in partnership with families, communities and other agencies. This is important at each stage of the spectrum.
• Culturally safe approaches are critical to safe and respectful engagement, particularly for Aboriginal children, families and communities.

For more information on evidence informed practice approaches see Working with children and families

A wide range of prevention and early intervention initiatives are available in NSW, delivered by non-government organisations and by NSW Government and Australian Government agencies. This section offers a summary of the some of the key programs and services and provides links for further information.

Children’s services

Children’s services include long day care, early childhood education and preschools, occasional care, vacation care, toy libraries, supported playgroups, family day care, mobile children’s services and after school care. High quality children’s services can increase children’s experiences of positive interactions, support brain development, and provide families with social connections and opportunities to access support. Quality preschool makes a significant, long-term difference to educational and other development outcomes, particularly for children experiencing disadvantage.

Communities for Children supports children and families in 52 disadvantaged communities across Australia through building on local strengths to meet the needs of individual communities and creating capability within local service systems. It does this using strong evidence of what works in early intervention and prevention. Communities for children collaborate with other organisations to provide a holistic service system for children and families.

You can search for local children’s services using HS Net.

Prevention and Early Intervention in NSW schools

For many students, schools are one of the safest places in their day to day lives. They have ongoing supervision, support and access to multiple adults, including those with whom they have trusting relationships. Schools communicate an ethos of care and support to all students and provide secure structures such as routines, familiar environments and school rules.

Curriculum frameworks provide for skill development and opportunities for all students to speak up and school governance principles encourage student voice. NSW Education provides child protection and respectful relationships education in every stage of learning from Kindergarten to Year 10.

All NSW Education staff are required to inform principals and workplace managers of any concerns about suspected risk of harm, not just ROSH, to children and young people. Child protection training is mandatory so all staff are inducted and updated annually about their child protection responsibilities.

In addition, school staff have detailed guidelines to support them to identify and respond to problematic or harmful sexual behaviour in children and young people, when behaviours are first identified.

The department’s Child Wellbeing Unit (CWU) provides advice to support schools to identify and implement appropriate local responses to support the child, young person and their family where their concerns don’t meet the suspected risk of significant harm threshold.

NSW Education partners with leading mental health organisations including Headspace, Black Dog Institute and NSW Health to support schools in delivering best practice prevention and early intervention in mental health support.  Through these partnerships, NSW Education is delivering evidence-based programs for students as well as building the mental health literacy of teachers, so they can recognise and respond to children and young people with mental health problems.

The Be You Program provides educators with knowledge, resources and strategies for helping children and young people achieve their best possible mental health.

NSW Health Prevention and Early Intervention

NSW Health deliver a broad range of prevention and early intervention services across a range of areas including alcohol and other drugs, violence, abuse and neglect, and maternal child and family health.

NSW maternal child and family health services provide early contact with families and offer essential services to support child health and wellbeing. Services are provided by skilled child and family health nurses and health professionals, and are available to all new parents in NSW.

The NSW Health Domestic Violence Routine Screening Program is an early identification and intervention strategy to promote awareness of the health impact of domestic violence and provide information on relevant health services for victims.

The NSW Health Child Wellbeing Unit (CWU) provides advice to Health professionals on child protection risks, vulnerabilities and responses. In addition to NSW Health staff, access to the Health CWU has been expanded to:

• workers in Affiliated Health Services
• workers in Aboriginal Community Health Services
• all registered medical practitioners, including GPs
• general practice nurses in NSW
• staff of private health facilities who provide services to the public on behalf of a statutory health organisation or the Ministry of Health (public private partnership staff).

Prevention and early intervention for Aboriginal families and communities

The NSW Aboriginal Child, Youth and Family Strategy is a prevention and early intervention strategy funded by DCJ that aims to provide Aboriginal children with the best start in life. This strategy focuses on Aboriginal families expecting a baby or with children aged up to 5 years, and funds Aboriginal supported playgroups, parenting programs, Aboriginal family work and community capacity building.

Aboriginal Child and Family Centres provide a mix of culturally safe services and support for Aboriginal families with children aged 0-8 years, including early childhood education and care, parent and family support, maternal and child health and adult education opportunities.

Aboriginal maternal and infant health services are delivered through a NSW Health based continuity-of-care model, where midwives and Aboriginal Health Workers collaborate to provide a high-quality maternity service that is culturally safe, women-centred, based on primary healthcare principles and provided in partnership with Aboriginal people.

The Building Strong Foundations for Aboriginal Children, Families and Communities service provides free, culturally safe, early childhood health services for Aboriginal families with children from birth through to school age. There are 15 services located across NSW. The service is provided by teams of Aboriginal health workers, child and family health nurses, and in some locations allied health therapists.

Prevention and early intervention for children and family members with disability

A disability is any condition that affects a person's ability to perform daily activities or tasks and participate in the community. Disability is more than just a health issue. A person's experience of disability is a complex interaction between their experience of their mind and body and the society they live in. See Social model of disability and Models of disability

A physical disability is any condition that permanently impairs body movement or control. Physical disabilities may be present at birth or acquired.

People with an intellectual disability may need support in a range of areas including education, social skills, self-care, communication, safety awareness and capacity for self-direction.

Parents with an intellectual disability are over represented in the child protection system and when they are involved with child protection services:

• their cases are likely to remain open longer
• they experience a higher level of intervention
• they are more likely than the general population to have reports of abuse and neglect substantiated
• there is a higher likelihood that their children will be taken into permanent out of home care.

Parents with disability are more likely than the general population to experience a range of barriers. Some of the biggest challenges they face can be overcoming stigma, discrimination, scrutiny and labels about their disability.

Despite their over representation in the child protection system, parents with an intellectual disability can make sustainable change when they receive supports and interventions that are responsive to the family's individual strengths and challenges.

See Australian Network on Disability for further information on disability.

See Healthy Start - Helping professionals support parents with learning difficulties

Re-imagine Australia, formerly known as Early Childhood Intervention Australia, provides support and services for infants and young children with a disability and their families to help their development, wellbeing and participation in family and community life.

The National Disability Insurance Scheme provides support to children and adults as early as possible to reduce the impacts of disability or developmental delay and to build their skills and independence. For children under seven years, the Early Childhood Early Intervention pathway may provide the most appropriate supports for children with disability or developmental delays.

The National Standards for Disability Services are standards that have a greater focus on person-centred approaches and promote choice and control by people with disability. These are considered critical under the National Disability Insurance Scheme.

The Department of Education provides a range of programs for young children who have disability or learning support needs to promote development and meaningful participation in all aspects of life.

Police Citizens and Youth Clubs (PCYC)

PCYCs deliver a broad range of youth and community activities and support empowering young people through personal development programs in partnership with NSW Police Youth and Crime Prevention Command.

Targeted Early Intervention program

The Targeted Early Intervention (TEI) program, funded by DCJ, aims to deliver flexible support to children, young people, families and communities experiencing or at risk of vulnerability. Hundreds of services across NSW deliver TEI activities under two streams:

• Community strengthening - activities that build cohesion, inclusion and wellbeing across all communities, and empower Aboriginal communities
• Wellbeing and safety - activities that support families and individuals, and provide opportunities for personal development such as supported playgroups, counselling, parenting programs and education and skills training.

Key referral points

• Child Wellbeing Units - the Department of Education, NSW Health and NSW Police Force operate Child Wellbeing Units that assist reporters in their agencies to effectively review the level of risk to children and determine whether a report to the Child Protection Helpline is required. They may also be contacted by their staff about referral options and pathways for prevention and early intervention matters.
• NSW Human Services Network (HSNet) is a whole-of-government initiative established to support government and non-government agencies and is a key tool for finding appropriate prevention and early intervention services and programs.
• Family Connect and Support - links vulnerable children, young people and families who are in need of assistance with the most appropriate and available local support services.
• Existing referral networks - your organisation may already be actively involved with the local service network and have effective links with a range of local services.

For more information on the impact of child abuse and neglect, see:

• The Australian Institute of Family Studies fact sheet Effects of child abuse and neglect for adult survivors
• The Education Centre Against Violence fact sheet Health outcomes of and responses to violence and abuse and neglect.

For more on the public health model see:

• the Australian Institute of Family Studies fact sheet Defining public health model for the child welfare services context.

For more on early intervention practice, evidence and service delivery, see:

• Australian Research Alliance for Children & Youth Better systems, better chances: A review of research and practice for prevention and early intervention
• Centers for Disease Control and Prevention (USA) Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence
• The NSW Human Services Outcomes Framework (HSOF), and the application of the HSOF to specific early intervention evidence
• Brighter Beginnings-the first 2000 days of life, a NSW Health strategic policy framework that outlines the importance of the first 2000 days of a child’s life and guides service delivery priorities to ensure that all children have the best possible start in life
• Australian resources on the Adverse Childhood Experiences (ACE) model can be found on the Emerging Minds website.