How accessible are child-abuse prevention services for families?

Child abuse is a serious issue affecting significant numbers of Australian children every year. In 2000-2001, 27,367 cases of child abuse or neglect were substantiated by statutory child-protection authorities nationally. Since the "modern discovery" of child abuse, a range of services has been developed to combat this problem.

For child-abuse prevention services to be effective, it is imperative to discover whether they are proving to be accessible for those families and children most in need of them.

There is currently little documented information available about how families locate, gain access to and use, child-abuse prevention services. In order to start to redress this knowledge gap, the Commonwealth Department of Family and Community Services requested the National Child Protection Clearinghouse at the Australian Institute of Family Studies to undertake a small exploratory research project.

The aim of the research was to investigate issues impacting on accessibility of services designed to prevent maltreatment, and how families with a child at risk of being maltreated avail themselves of such services. For the purposes of this study, those "most in need" are defined as families where the parents have not abused or neglected their children, but are most at risk of doing so.

The accessibility of child-abuse prevention services is determined by various factors, including the availability of child-abuse prevention services, and whether such services were adequately publicised, catered to those most in need of a child abuse prevention service, and were successful in preventing child abuse and neglect.

In order to obtain detailed information about access to child-abuse prevention services, in late 2002 perspectives were obtained from 32 providers currently involved in the operation of either group-based parent education (13) or home-visiting services (19). Most services (20) were being run by non-government agencies, with the remaining 12 services being run by government agencies. Services were located in New South Wales and Victoria (both rural and urban localities). Information about services and accessibility were obtained through a short mailed questionnaire and a 20 minute semi-structured telephone interview.

Need for and availability of services

Child-abuse prevention services in this study were located in areas rated by service providers as having significant levels of child abuse and domestic violence, and characterised by a range of other demographic factors often identified as "risk factors", including single-parent families, high levels of drug abuse (by children and other family members), high levels of criminal activity and antisocial behaviour by children, youth homelessness, unemployment, and a large numbers of families with multiple problems.

While service providers reported that people in the service catchment areas experienced considerable disadvantage, they also reported that there was a low level of welfare services, activities and infrastructure available for children and families in these areas. With regard to child-abuse prevention services specifically, the majority of respondents (88 per cent) stated that there were few services of this type in their areas. Demand on existing services was rated "high" in almost all areas (94 per cent). A further finding was that many areas have a higher level of abuse than available services.

Where services were available, respondents rated the standard in one-third of the areas as "very low" to "low", and another one-third of the areas as "average". Reasons for this were not sought, but may relate to inadequate resourcing since the quality tended to be lower where the demand was higher.

Public awareness of service availability

In order to access a service, those who are most in need of a prevention service need to be aware of its existence. Some providers (six) commented that they did not actively recruit or advertise their service because demand was already very high and they did not wish to be swamped. One respondent stated:

Sporadically we did advertise but we really had more clients than we could deal with and so we only occasionally send fliers to agencies.

However, over half (54 per cent) of the respondents mentioned a lack of community awareness about their program as an issue negatively affecting accessibility. Thus, although demand on services was already high, providers believed that demand could have potentially been higher, as there were still families in the catchment area who were unaware of the existence of the service.

The most common form of advertising was "word of mouth". Many providers commented that if families hear positive reports about the service from other families, then this is a very effective form of engagement.

Provisions to facilitate use

Agencies can encourage the use of services through measures such as limiting costs and providing transport, child care and flexible hours of operation.

In the Accessibility Study, respondents reported that almost all of their services were provided to clients free of charge.

According to respondents, services in 85 per cent (11) of parent-education groups were affected by a general lack of public transport or service-owned transport available to clients. With regard to home visiting, 37 per cent (seven) of the home visiting staff also commented on the matter of transport and the large distances entailed for workers carrying out their visits. They noted that resources were fairly thinly spread across the catchment area and a consequent reduction in the numbers of clients that could be seen.

While service providers were not directly asked about child-care provisions, child care emerged as an important issue. Services that had child-care facilities saw this as a positive factor in increasing accessibility, while services without such facilities saw it as a negative factor. This was especially the case for the group-based parent education services where 54 per cent stated that the presence or absence of child care was a major factor affecting accessibility.

Another factor having a negative impact on accessibility was the operating hours of services. Many services were being offered only during office hours (66 per cent), which was seen by some respondents as useful in that clients could attend while their children were at school. However, narrow hours of operation were seen as a hindrance by other respondents who acknowledged that operating during standard working hours often excluded the participation of fathers. Several providers (six) stated that they were aware that accessibility would be increased by the extension of hours of operation but they were unable to afford to do so.

Servicing those most in need

Are those most in need of a child abuse prevention service able to access and receive the services they need? Service providers were asked whether they believed their service was attracting and assisting those most in need of a child abuse prevention service.

Two-thirds (22) believed that they supported those families most in need. However, when asked to explain, several (five) qualified their answers. For example:

The service does include quite a few families who are in serious need, but we also service some families who don't fit into this category.

In 31 per cent of responses (10), providers stated that they believed they did not assist those most in need of a child abuse prevention service. Typical responses included:

Sometimes those most in need of a child abuse prevention service lack the confidence to attend and often these families are hidden in the community and we don't know they exist.

It is likely that those families and children most at risk are also likely to be the most difficult families to engage. With this in mind, providers were asked about the sorts of initiatives they used to assist potential participants to engage with the service. They mentioned an array of methods for attempting to increase engagement, including encouraging client input into service delivery, verbal encouragement, telephone calls and active outreach, the provision of child care and transport, and arranging social events and activities.

One of the causes of the heavy demand experienced by many services is that they were overwhelmed with tertiary clients (families where children had already been abused), being referred from statutory child protection authorities. Several comments were made by providers about how resources were being absorbed by tertiary clients, leaving little time left to be spent on secondary prevention:

Lack of funding negatively impacts us as we can only afford 30 hours a week of workers and we don't get any time to do prevention. In reality, everyone works extra hours.

Another matter to arise was that the performance of some services is measured by client turnover, so statistically a service looks better if it takes on the easier clients with less complex and time-consuming needs which can be resolved in a limited period of time:

We are finding that it is a number crunching game at present. Outcomes are measured in terms of number of people seen. Therefore we are seeing people who are easier to get and not those most in need of a child-abuse prevention service.

Success in the prevention of child abuse and neglect

It is interesting that, when asked to give the aims of their service, only one provider mentioned the prevention of child abuse and neglect. Further, when asked to outline desired major and minor outcomes of the service, more than half (53 per cent) of providers made no mention of children's welfare; in the majority of cases, service aims revolved around parents or family support and education.

Clearly, many services see the parents as the central clients in their service rather than the children, presuming that providing services to parents would automatically result in the prevention of, or reduction in, maltreatment of children, a view which has traditionally been held by providers in this sector.

The assumed link between parental support and child-abuse prevention is illustrated by responses to the question: "To what degree does your service prevent child abuse and neglect?" Many providers felt that their service was making some contribution towards child abuse prevention. The majority (53 per cent or 17 respondents) believed that they prevented child abuse "completely" or "mostly". Interestingly, 16 per cent (five) of respondents answered that they did not know whether their service was effectively preventing child abuse and neglect.

It is difficult for either observers or service providers themselves to be clear about whether the services are effective in preventing child abuse and neglect. While all agencies but one collected some information about their service operation, information about the impact of services is unavailable because services are seldom formally evaluated. However, there is evidence that service providers are increasingly recognising the importance of gathering information about the effectiveness of their services.

Conclusion

Although the sample was small and not randomly obtained, and therefore the findings not generalisable, some interesting insights were gained.

The study's key findings indicated that there was generally a greater need for child-abuse prevention services than there were services available. The availability of existing services was known in the community but possibly not by those most in need of the service.The most important provisions to facilitate use of the services were seen to be child care, transport, and flexible hours of operation.

With regard to those most in need of a prevention service, concerns were expressed about the fact that these families were not being assisted because services were overwhelmed with tertiary clients requiring intervention. It was difficult to gauge service outcomes as few evaluations were being conducted. However, while the prevention of child abuse was not seen by the majority of services as one of their major aims, providers thought that their services were making some contribution in the child abuse prevention area.

Future studies should increase the sample size so that it can be ascertained whether these findings are generalisable to similar child-abuse prevention services across Australia. It would also be beneficial to include the perspectives of families attending the services, and some independent data about the community characteristics. There is also a critical need for long-term follow-up studies, to assess the impacts of services on the welfare of children over time.