Trauma prevention and early intervention approaches with children and young people

Audion transcript (edited)

DAN MOSS: Hello, everybody. Welcome to this webinar on trauma prevention and early intervention approaches with children. So glad to have you joining us today. My name is Dan Moss, manager here at Emerging Minds, and we are really excited to be able to introduce our facilitators today.

Before we do that, we would like to recognise and pay respects to Aboriginal and Torres Strait Islander people around the country, on the different lands that we work, play and meet on throughout this country. We recognise the contribution that Aboriginal communities and leaders make to the way that we think about approaches to children and the families which underline safety, security.

We acknowledge and respect the traditional connections to land, waters, culture, spirituality, family and communities.

Thank you, everybody, for joining us. Thank you, everybody, for the amazing response to this webinar and to the very insightful questions that we have received. We will try to get through a few of them today.

Before we begin our discussion, I have a little bit of housekeeping. The session is being live captioned. If you require captions, please follow the link in the chat. There is a live Q&A in the end so questions via the questions tab on the control panel. We will aim to get as many of the answers as we can but bear with us because we have had quite a lot of participants in the webinar.

There are some related readings and resources referred to during this webinar that are available in handouts today on the GoToWebinar control panel. For those of you who want to know more about the Australian Child Maltreatment Study and other related resources, you can use that handouts tab. There will be a short feedback survey which we will open at the end of the webinar.

Please feel free to have a read of that.

Importantly and lastly, during this webinar, we will be discussing topics such as child abuse and neglect, maltreatment. Please take care of yourself while you are listening to this. If you think you would benefit from support, there are some resources available in the chat for you, but also take a moment if you need to or speak to a colleague or friend or supervisor.

Also, whenever we are talking about is we want to invite each other to recognise children and young people and adults within families and communities who have many and varied lived experiences of pain, trauma and heartache, including harmful systemic practices. We want to recognise and give compassion to them and also thank them for their contribution to everything that we know about early intervention and prevention strategies for children and young people and adults.

This webinar will hopefully do a lot of things, but really we want to help increase awareness of the findings from the Australian Child Maltreatment Study to support practice skills in making children and young people's safety a fundamental aspect to practices. We want to explore practice skills for supporting children and young people and parents to describe experiences of abuse and neglect, and to be supported to recover early.

Bios for Shankari and Daryl can be found on the handout tabs but it is my privilege to welcome Shankari, Daryl to our webinar today.

Daryl, if I start with you, you are known as one of the chief investigators of the Australian Child Maltreatment Study.

One of the great and significant contributions of that study was to show us the extent of the problem of child abuse and neglect in our society. If we already did not know that problem, it really exemplified some of the issues that we are facing.

Why is it important for us to know just how serious this issue is?

DARYL HIGGINS: Thank you, Dan. It's lovely to be joining you from Wurundjeri Country here in Melbourne today and I acknowledge the lands of the Wurundjeri people and pay respects to Elders, past and present and emerging.

As you say, I think the ACMS has been a really landmark study documenting the extent of abuse and neglect and the reason it was so important was, a number of factors, I suppose. Firstly, when it comes to addressing a problem like child abuse and neglect, unless we know the size of the problem we don't know how much effort is required to be able to deal with it whether we are thinking about prevention or whether we are thinking about healing and recovery and dealing with mental health and health risk behaviours associated with it.

Secondly, we often tend to, up until now, have reverted to our statutory child protection system data to understand the context of how many people have experienced child abuse and neglect. I think the ACMS data when you compare it to the data that is reported each year by the Australian Institute of health and welfare, which is a combination of the state and territory child protection system data, it really lets us know that our statutory systems are only serving the pointy end of a much bigger problem.

Thirdly, from a mental health and well-being perspective, what we realise is that many, many workforces in the health sector, the mental health sector, the drug and alcohol sector are really trauma recovery sectors. Those are the places where the consequences of child abuse and neglect are really seen.

Similarly, we know that many, many professionals who are working and coming into contact with children are prevention potential workforces. And so, for school teachers, early childhood, early childhood is on everyone's mind at the moment. They all need to be able to recognise the very high chance that children in their care, the families they're coming into contact with, either have experienced abuse or are likely to over the rest of the childhood and I think having the prevalence data that the ACMS study has provided really means that we can't turn away from that reality of it being a frequently occurring phenomenon and therefore we actually have to garner together these workforces that are both the trauma prevention and the trauma recovery workforces.

DAN MOSS: Thank you, Daryl. What a wonderful phrase, prevention potential workforces.

DARYL HIGGINS: They may not know it yet. I have faith.

DAN MOSS: Wonderful. Thank you. Shankari, welcome. As a practitioner, can you comment on the importance of early and effective interventions with children and young people?

SHANKARI SUNDARAM: Thank you for having me on this webinar. I am joining from Kaurna country in the Adelaide Plains and I pay my respects to Elders, past, present and emerging.

I just wanted to say as well that we think of trauma as the events that have occurred, but it is not the events, they have the potential to induce and sustain trauma, but it is more than nervous systems' responses to what has occurred that creates the traumatic impact.

And the importance of early and effective interventions is that we know that there is this window of opportunity, right in the aftermath of events occurring, where there is the potential to create those protective factors that can prevent a long-term lingering impact.

Especially with children, we know that developing brains and nervous systems… the impact can be long-term because it can shift how brains develop if abuse occurs.

The same thing is also that window of opportunity because of the developing mind, having the capacity to build resilience. And early interventions are therefore really vital and effective interventions that we are able to tailor what we are doing to the context of the child and not having preconceived ideas about what that should be, being more flexible and tuned into what is happening for the child in that context.

DAN MOSS: Thank you, Shankari. Great insights there.

Daryl, I'm going to ask you now because we have had lots of our participants joining us ask, really, for some background in terms of what is the Australian Child Maltreatment Study. What did it find?

DARYL HIGGINS: Thank you, Dan. It is the first nationally representative study of problems of all five forms of child abuse and neglect, physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence. 

It's a random digit dial so everyone had an equal opportunity to get the phone call from our interviewer team and asked a lot of questions around experiences during childhood. Prior to age 18. Our sample was 8500 Australians aged 16 and over talking retrospectively about the childhood experiences of maltreatment, but equally importantly talking about their current mental health and health-related behaviours, like smoking and drinking and suicidal thoughts or behaviours etc. 

It allowed us to calculate prevalence rates, what proportion of the entire population has experienced each of these five forms of abuse and neglect. As I said before, it's really quite challenging and shocking statistics that we found that 32% of the population have experienced physical abuse, 28.5 percent have experienced sexual abuse, 30.9 percent had experienced emotional abuse, and neglect was reported by 8.9 percent, and finally exposure to domestic violence was the largest group, 39.6 percent, nearly 2 in five Australians.

But also because we measured all five forms at the same time and that allowed us to calculate things like overlap. What we found was that any form of abuse or neglect was experienced by 62% of the population. But of those who did experienced abuse, almost 2/3 experiences not just one type but two or more.

That was a really significant finding, both in terms of understanding of the nature of maltreatment, that multi-type maltreatment is the most common or prevalent presentation, if you like, of those who have experienced maltreatment. Secondly, when we did our analyses of mental health and health risk behaviours, the odds or the likelihood of going onto experience in adulthood a mental health condition or a health risk behaviour was much more substantial if you had experienced multiple types of abuse and neglect compared to those who had just experienced one type and are definitely more than those who had experienced no abuse or neglect.

DAN MOSS: Thank you, Daryl.

Shankari, just thinking about some of that, and the obstacles, I suppose, that children and young people have to describing some of these experiences, what are the strategies that all practitioners can use to help children and young people describe their experiences of abuse?

SHANKARI SUNDARAM: We often find, and we get this feedback because the child sexual abuse counselling service and also the victims of crime service, and we often get this feedback from clients where they say that the existing practitioner that the child was working with was not comfortable with this topic, and therefore they needed a specialised service. I do strongly believe that all practitioners, as you said, developing comfort around creating safety for children, to be able to talk about these experiences is important, not just in a treatment, but also as Daryl said in creating those preventative spaces. If we don't create safe spaces where children are able to talk about these experiences, things go undisclosed. More abuse can occur. All practitioners developing comfort around that is important.

Part of that is to recognise that the primary intervention is the relationship, the relationship that you as a practitioner build with the child. It could be an existing relationship, say, a school counsellor or a teacher.

And offering that sense of space and a safety and attunement, and of course people who work with children use a lot of multimodal ways of expressing, whether it is do drawings, storytelling, metaphors to externalise the problem and it makes it less daunting for a child to talk about problems that are externalised.

And also, allowing expression to go at its own pace and not imposing our need for information on children. And all of these I think create the foundation for children to be able to express it is happening to them. If parents are involved, part of it is also working with the parents to do the same.

One more thing that is just coming to mind is that often when there is a disclosure made for an initial whatever the child is wanting to share, our emotional response can also make it unsafe for the child to share more. Finding ways to ground our own emotions is really important for all practitioners.

DAN MOSS: Thank you, Shankari. Daryl, if we can rejoin with you, much of your work involves advocating for prevention strategies regarding child abuse or neglect. How can practitioners and organisations contribute to these strategies?

DARYL HIGGINS: It's a good question. I just wanted to riff off one of the comments from Shankari and I think it's really important the idea of adults and the self-regulation or how you respond to children was my question.

One of the key pieces of data from Child Maltreatment Study is that 62% of adults have our own childhood abuse or neglect experiences. Often it is the difficulty that we have as adults acknowledging our own experiences that might get in the way of being present and hearing children and young people's experiences. I really resonated, Shankari, with what you were saying, and I think it's really important part.

Dan, yes, you are right. I do have a strong advocacy role in terms of prevention.

How can people contribute to that? A range of ways. Some people are already very directly involved. I would say that there are probably two or three different elements. Some of them are very specific. Child sexual abuse has some of its own kind of prevention strategies that are unique. A lot of people talking about body safety, talking about consent and respect education, talking about what we would call child abuse sexual abuse prevention education whether it is in schools, or working with adults to increase their knowledge and as we have just been saying, their comfort and ability to hear concerns from children and young people, certainly my team at the Institute of Child protection studies has recognised that one of the difficulties is that we often don't want to hear concerns from children. Teachers will often be dismissive when someone raises a concern. That concern might actually be highlighting grooming behaviour. If we listened and paid attention, we might be able to avert that grooming behaviour from turning into an actual instance of child sexual abuse.

In terms of other forms of abuse and neglect, really we know the clean water of child abuse and neglect prevention is parenting, good-quality parenting. And so, the prevention strategy is really delivering evidence-based parenting programs and support. I like to say programs and supports because it is not always a case of funnelling high risk parents into a structured program. That has often been our go-to strategy in Australia, we have a discrete program that often high-risk families typically referred from statutory child protection systems get pushed into those programs.

That is what I would call not even early intervention. That is probably late intervention. Earlier intervention and a genuine prevention, stopping abuse or neglect from occurring in the first place means giving support for all parents, for all families right throughout their lifespan. Starting from pre-birth I would say through those kind of really early years in a maternal and child health sector through the early childhood services, when they may be connecting with a childcare centre or a kindergarten and then through schooling and of course right throughout the continued engagement with health services like GPs, that we need to be able to have appropriate interventions where those who are already coming into contact with a family can be supporting and encouraging around using nonviolent, noncoercive evidence-based approaches to parenting.

In that sense, there is a big range of practitioners who can be involved. But I think some of the traditional child abuse network, they are often not located or basing their services in the places where families already are. Of course, we are seeing signs of change and really good examples of things like community hubs or schools as hubs where those services are actually coming into those places where families already are. And they are operating in ways that are a lot less stigmatising. I don't have to put up my hand and say I have a problem with parenting in order to be able to get the kind of parenting support that I need. It can be at a range of levels of intensity.

We know that school principals and well-being officers, whether it is a regular weekly newsletter or at an assembly where parents are coming in, the promotion of the kind of support that parents might need and normalising having everybody coming along to what we might think of as traditional parenting class. It is not just for the troubled few, but rather recognising that we can all benefit from a level of support.

DAN MOSS: Wonderful. Thank you, Daryl.

Shankari, in terms of overcoming obstacles for children and young people, in terms of talking about some of their experiences of maltreatment or abuse, how do you help them use their own language actually to describe their experiences to you in practice?

SHANKARI SUNDARAM: I find that it is more us not interfering with the process. Adults can sometimes tend to impose their own language on the children's experiences and establishing the foundation of safety, and just not interfering in the process and if children are using symbolic language or they are being vague, and also not being quick to make our own meaning of bed. From a place of curiosity as well, just asking what that means for them. We know that experiences are not just what happens but how we make meaning of what happens. And how children make meaning can be very different to how we make meaning.

Honouring the ownership of the story that children have by honouring the language that they use and mirroring that back to them. If they say that scary thing ought using the same terminology can be helpful rather than using our own.

And also remembering that our role, at least my role, is therapeutic and I am not an investigator. It is not about the facts of what happened, depending on whether any to make a report, I may need information. Even then, not interrogating the child and being child-led and with pace and readiness. And also watching for non-verbal signs.

If disclosures are being made, gently asking, but if there are non-verbal signs of the child feeling unsafe, and also learning how to step back and go back to building safety first and then venturing back to asking about the experience.

DAN MOSS: Thank you, Shankari. Great advice there.

Daryl, why is it important to be helping parents, children and young people to develop common language around consent and respect? Particularly as it relates to child sexual abuse.

DARYL HIGGINS: Thanks, Dan. As I said before, while there are common strategies right across all forms of child abuse and neglect and parenting and parent capabilities are really critical, there are some additional, specific things that are just about child sexual abuse. One important point that I did not say before that we have learned really strongly from the Australian Child Maltreatment Study is the harm of sexual abuse is not coming just from adults, but it's also coming from other children and young people. In fact, that is increasing across time.

Approximately one in two of those 28.5 percent of Australians who have experience of child sexual abuse experienced it from another child or adolescent. The biggest group being those who they knew. Someone else who was a peer, if you like. And also included is those they were in a romantic relationship with at the time.

That is particularly so for our young Australian girls, they had about five times the rate. The idea of addressing not just child sexual abuse but from other children and young people is a really critical part. Therefore, we have to be able to have conversations about addressing the knowledge and the capability of young people to not engage in harmful behaviour towards others.

That is where the respect and consent comes in. Equally, to know that it's not OK to experience this and you can speak up and get help. At the earliest signs, to have the comfort, and both of those things are predicated upon having good knowledge of sex and sexuality and body autonomy and body safety concepts.

And starting right from the early years, we need to build up children's knowledge and their right to bodily integrity and have a child rights focus so that it's not just about adolescence and being worried about having sexual images shared online or difficulties in dating relationships, but right throughout childhood and adolescence, we are preparing young people and giving them the language and the confidence that if there is a concern that they can talk about it, but also ensuring that particularly our young boys are being prepared for and trained to be respectful of boundaries and tonight misuse or abuse their power over other children and young people.

Kind of parents having the same kind of language skills and context as the children and young people that they are wanting to support and care for is really, really important.

DAN MOSS: Thanks, Daryl. Shankari, how can practitioners make decisions about what and when they ask children and young people so that they can be supported to tell their stories, so that they don't find the questions distressing?

SHANKARI SUNDARAM: Again, going back to the previous things that have been said about laying the foundation of relations and safety and grounding first, not being in a hurry, of course. I always find it interesting that it's not the what but more the how that becomes imported as well. The what is the intellectual, the logical. And if we think about the how, and we are tuning into the felt sense of the experience of the child. And the distress that may come from it.

It is the emotional charge that is attached to the memory that you are trying to access. And so, some other things that I often think about is not needing constant eye contact, for example. It seems like a simple thing. When we are engaged in play or something else as we are talking, it does not feel as unsafe as someone staring at you and asking questions.

It's the same for adults but adults have trained themselves to be comfortable with eye contact. At least in the Western cultural context. With children that have experienced abuse, also finding ways to have safety ongoing as we are talking about things that may be distressing.

And of course, grounding our own emotions and being that attuned presents as well. And also, I think we must keep going back to the question, why am I asking this question? Is it for the benefit of the child? Therapeutically or otherwise or for safety or is it to satisfy my own curiosity that I need to know this? Being very intentional in what we are asking. From a therapeutic viewpoint, I like to keep the ideas of dual awareness and bilateral stimulation which is from EMDR in mind. They can be really helpful in grounding while talking about distressing things.

I will explain dual awareness a little bit if that's alright. Dual awareness is the ability to be grounded in the present moment while the mind is being exposed to something distressing. Whether it is talking about an event that is potentially traumatic or any other distressing event that the child or young person is trying to verbalise.

Finding ways to have something that is happening in the present moment whether it is a somatic grounding or a bilateral thing, so it can be, I can be talking to a child while having a ball that the child can toss from one-handed to the other. That is bilateral stimulation while talking about something distressing.

It is the intention of that process which is not just to get information, but it's also to use that as a therapeutic process. Talking about it is experiencing were also establishing safety together, both happening together. That is what is shown to be therapeutic. We can be so creative, it can be relational. If you are playing a game, something back and forth, while we are talking, it can be regulation that we are practising. Any form of bilateral movement, and I have sent through some tools that I often use with children and young people as well as adults. I use alternate breathing from yoga, that is bilateral. We can do that practice to ground and then something wildly talking about distressing things with children. It's quite fascinating how it shifts the comfort levels and how it becomes easier for young people to talk about their experiences.

DAN MOSS: Thank you, Shankari. Wonderful.

Daryl, you talk about developing children and young people this language of respect and consent. Are you seeing changes in the ways that parents have conversations with their children about consent and respect? What more do you think needs to happen?

DARYL HIGGINS: I think changes are occurring. I am often hearing it via professionals that I am talking to, whether it be teachers in schools, whether it be people in health services particularly in the child and family welfare sector. But I am also aware of changes that are happening through the policy shifts and the intervention that governments put in place.

For example, the national child safety has their one talk at a time campaign. It's a very clear and simple campaign of child safe conversations are the responsibility of parents. The parent and carer has to initiate.

It's simply one talk at the time, as the name implies. Every little opportune moment whether you are waiting for a bus or talking over a book, whether you are discussing a film that you have seen, whether you are driving in the car, they are all fantastic opportunities to lean in and be attuned to the emotional needs of your child. But also to introduce these topics that can be a little bit scary and a little bit daunting if we have not done the homework ourselves. If we have not started early on, started with very innocuous conversations around what makes us feel comfortable, what makes us feel uncomfortable.

When we are in a routine space of doing that, every day activities, if something more significant is happening that a child might need to let us as the parent or the adult in the relationship know that they can feel confident that we are going to be listening. We have already given them the language because we have been discussing the topics. If we have seen something in a movie, being able to put language around that to be able to say I am wondering whether they really agreed to that action that that other protagonist was engaging in with them. That is what we call consent. Being able to have those kinds of conversations about stuff that is going on. There are plenty of examples of the popular zeitgeist that we can draw on as parents and carers.

I am also kind of interested in how this relates to another of the areas of concern, which is about online behaviours. Where I am seeing this engagement around changes in parenting is that I don't know we are always calling out how and why it is that parents are rightly concerned about online behaviours. Whether it is about online gaming or sharing sexual images, or whether it is about grooming that might be happening online. We are often not saying why it is that we think this is a space that has a risk. Perhaps because we have not thought it through ourselves. It's a dark and dangerous place that we don't understand, rather than actually understanding the mechanisms by which someone who is wanting to perpetrate, whether that is an adult or another child or young person who may be using an opportunistically they are able to engage in inappropriate behaviour, or the lead up to that, the grooming behaviour.

Being able to be more explicit so that for example if it is gaming, to understand that the person you are engaging with, you have a 13 year old boy, they say they are a 13 year old girl, is it in fact a girl who is 13? What if it was a 54-year-old man who is pretending to be a 13-year-old girl?

Being able to explain that issue of somebody's ability to understand what the nature of the risks are and how opportunities to engage in inappropriate behaviour when there is nobody else observing.

Parents than are not always tuned into, OK, well, there is a lot less risk playing an online game with that 13-year-old girl when I am playing with my 13-year-old son and we are together and playing the game together and we are talking about those interactions and asking questions.

I am perhaps hearing less about that, about how it is that we don't enter into children's world. How we walk alongside them, understand the risks that we might be facing, and talk them through, just in the same way that we do with any other parenting issue. We don't always know exactly where they are and what they are doing.

We can draw on our own personal experiences to the degree that we are able to but we can ask questions, be curious, and have this as a shared journey.

The short answer is I am seeing some changes. But I am seeing some opportunities that we are not yet capitalising on to the degree that I think we need to.

One final comment I would make is that I think there are some really great communication and engagement strategies. People will have perhaps come across the Teeny Tiny Stevies who have a song aimed at quite young children around body safety. It is those things that start off the conversations really early on, and we have to build that momentum from those early childhood years right through so that we don't have this chasm between any parents and adolescent children where you feel like you are on opposite ends of the galaxy.

DAN MOSS: Shankari, thinking about this task that Daryl is describing in terms of supporting parents to support their child or young person, in your work, particularly with non-offending parents, how do you support them recover from the effects specifically of child sexual abuse?

SHANKARI SUNDARAM: It can… it is such a disruptor when something like this happens. We are often the seeing the non-offending parent and the child right in the aftermath, and it could have been a shock or a surprise for the whole family and the family is fractured. Parents are the non-offending parent would be struggling with their own shock and trauma from what has occurred. What I said earlier about the adults finding ways to ground themselves especially when they are trying to help their children, part of our work is helping parents do that and encouraging them to seek their own supports and being able to find ways to contain. Whether it is the language they are using in front of children or young people, pathologizing words they are using to describe what has occurred, and there could be guilt and other things that are coming into play as well for parents. I like to think of events that surround what we identify as the major potentially trauma-inducing event as the trauma points that if we are able to manage those well, we can prevent extra trauma points from occurring. When I work with adult survivors of child sexual abuse, and we talk about trauma memories and if you are working therapeutically through memories, some of them are not directly related to the main event.

It could be the look on my mother's face and the words that she used when she found out, for example.

If we are able to manage our responses in those moments, we can reduce those extra trauma points that we may create, which could be preventable.

In working with parents, I often like to look at that.

Of course, the child will still have emotions and love for the offending parent. It can be really hard for the non-offending parent to manage and create a space for that, the grief and the loss that may occur if the family is suddenly fractured. Of course, every context is different, but I have seen situations where it was tight and living units in the family and then this came out, and the child is really grieving the loss of a parent that was the offender. Helping parents create space for David grief and loss process. Also reminding parents that when we are trying to prevent the impact of trauma, what we're trying to do is we are countering that effect by queueing in safety and attachments. And again, focusing on securing that attachment again as the foundation for trauma prevention.

DAN MOSS: Great, thank you.

We have got some amazing questions coming through from the chat. Thank you for all about from our many participants today. Thank you for bearing with us through the technical issues.

Daryl, quite a few questions about this idea that trends are changing in a child abuse and neglect over the past years. Can you talk a little bit about what you are seeing in relation to these changing trends?

DARYL HIGGINS: The Australian Child Maltreatment Study shows that we do have a few changes. Largely, we still have a very big problem, but one sign of hope that we certainly saw in our data was a reduction across time in the likelihood of experiencing sexual abuse from a parent or caregiver in the home. The rate for that form of child sexual abuse has approximately halved from people in their middle ages and onwards, the rate was around eight or 9%. But for our youth samples, the 3500 young people aged 16 to 24, the rate of child sexual abuse experienced by a parent or caregiver was much lower, around 4%. That is the good news.

Unfortunately, even that good news is offset to a substantial degree by what I was talking about before, that increase in risk of sexual abuse from another child or young person.

That has been growing over time. The 16 to 24-year-olds were much more likely to be reporting sexual abuse either from another child or adolescent who they knew but wasn't in a romantic relationship. Or someone who was. Of course, both of those are very gendered. The trend is towards increased risk for young girls, women during childhood or adolescence, to experience sexual harm from someone in a dating relationship. That is probably one of the biggest trends.

The other one that is slightly outside of this discussion of child abuse and neglect, but we still measured it in the ACMS. That was exposure to corporal punishment. What we saw was a really pleasing decrease in the beliefs around the necessity of using physical punishment by parents. We have got some signs of hope in terms of changing relationship. We know that physical punishment is strongly related to the risk of physical abuse. One of the best ways of avoiding any form of physical abuse is to protect children from every form of violence including physical punishment for the purposes of correction or as a parenting practice. I use parenting in inverted commas because I believe children should be safe and free from violence in every context including within their homes.

We certainly are seeing some signs of hope. The most challenging thing for me was that the proportion of Australians who have experienced multiple forms of abuse and neglect hasn't decreased across time. In fact, there are even trends towards it going up compared to the rest of the sample overall. We have got greater complexity if you like. The risks across the five different types coming together.

DAN MOSS: Thanks, Daryl. Shankari, Daryl is talking there about an increase in young people experiencing harmful sexual behaviour in relationships or through peers. Are you seeing an increase in young people harmful sexual behaviour in your practice?

SHANKARI SUNDARAM: We are. And so, this service has been around for about 3.5 years. We have seen a steady increase. The services for anyone who has experienced child sexual abuse including adults. About 20% of our clients right now would be children. Over the years, there has been a steady increase. I think it is due to greater awareness and more willingness of people to refer children to the service for support. We are seeing an increase in school referrals as well. This includes we are seeing more sibling abuse, peer abuse, more than just apparent. Or other adults.

DAN MOSS: Daryl, some questions about what your research might tell us about the (inaudible) that are needed to help children's mental health after their experiences of maltreatment.

DARYL HIGGINS: Our research in the ACMS was about adults from age 16 onwards. Certainly, what it showed us is that the young adults, the 16 to 24s had really experienced that crystallisation of those child maltreatment impacts very early in life. It's not just in older age that they are apparent. They are apparent early on. The kind of things that we saw that adults have experienced child maltreatment are three times more likely to have a depressive disorder. Three times more likely to have an anxiety disorder. 2.6 times more likely to have a severe alcohol use disorder and 4.6 times more likely to have PTSD.

And similar stories with health risk behaviours like suicide, harm, suicide attempts, dependence on cocaine was a big one. We recognise there is a range of different mental health and health risk factors associated, and we are seeing them early on in life. I think that gives us an clear direction of when a child has experienced maltreatment, what can we do to either prevent these mental health disorders from emerging, or to recognise them early on and to treat them as soon as we can so that they don't become a lifetime disorder. We know that there are great psychological interventions available that can be trauma informed. And that can be delivered for children and adolescents not just waiting until adulthood for the onset of symptoms or diagnoses.

DAN MOSS: From a practice perspective, Shankari, what are you finding the most important in working with children and young people who have experienced abuse or maltreatment, and may be experiencing some of the signs of distress?

SHANKARI SUNDARAM: What Daryl said resonated a lot. What is most important is the prevention of those long-term effects that Daryl spoke about. As in when, whether it is young children, young adults, whenever it is presenting as distress, finding ways to re-establish that sense of safety, and I think the base, whether it is secure attachment or finding ways to guide the nervous system back to safety and practising that, whether it is in our sessions or helping parents practice that with their children, is in a sense, it's trying to counter that potential for long-term impacts.

Somatic practices as well. What I find is that it is harder to help adults shift away from being in their minds back into their bodies. It can be more intuitive, especially for young children, and using that strength that young children have and even young people and young adults may have a little bit more of that than adults who have had a lot of rationalisation around their experiences rather than just the felt experiential sense of what has happened.

Again, using that as an opportunity to go back to regulation.

What Daryl said before about when you have lots of things happen, sorry, I lost my train of thought.

I think re-establishing safety is one of the greatest protective factors. I have lived experience of child sexual abuse, and I find that through my experience as well as speaking to adult survivors, we know that it does not always have to be a certain way. If there are other things that are around the child or young person, it is possible to prevent the long-term impacts of trauma.

DAN MOSS: Thank you for sharing that with us, Shankari. Thank you, everybody, for your time today. And for all of the interest in what is a really crucial research and practice and policy issue for all of us. It affects all of us.

And the research that Daryl has spoken about today goes to the fact that this is such a widespread issue throughout Australia, affecting so many of our children. Thank you to all of you for joining us today.

Thanks again to Shankari and Daryl for your practice and policy research. It has been awesome. Thanks to the audience for hanging in there with some slight technical hiccups at the start. We will have a recording of this webinar later for you, which will have those glitches ironed out. You will be able to see all of those parts of the webinar.

Thanks to the wonderful team at AIFS child and evaluation team, Erin and Kristel for their ongoing support and guidance and patience. Thank you, Erin and Kristel.

And a reminder, make sure that you subscribe to AIFS or Emerging Minds newsletters and you will be notified about this recording and you will also have the opportunity to be seeing so many other webinars that are produced by AIFS and Emerging Minds.

A quick reminder also about our feedback survey. We would really love to hear what you thought about today's webinar and other webinars, actually, and help us to continue to provide the service to you which most fits with your needs.

Next week is Child Protection Week and AIFS is holding a webinar on preventing emotional abuse.

If you are interested in that, please register by the AIFS webinar. Emerging Minds and AIFS will be back with another webinar in October, we will actually be continuing this discussion on child abuse and neglect. We have got some great panellists lined up for that. We hope you can join us in October.

Take care, everyone. Thank you for joining us again. Thank you for your great questions and your interest. And we will see you again soon.

Extended Q&A

DAN MOSS: Hi everybody. I'm Dan Moss again for the Q&A part of Prevention and Early intervention Strategies with children after maltreatment and abuse. Great to have Daryl Higgins and Shankari Sundaram back with me to answer some more of your questions. Just before we begin, we'd just like to recognize that we have had lots of questions from you, which are great questions around working with young children, and infants and toddlers. We might just direct you to how to recognize complex trauma in infants and children and promote well-being. That webinar is available both on the AFS and the Emerging Minds website. So, look forward to continuing the conversation with you around that. But we've had some really fantastic questions from others of you and some, in regard to Daryl, what your research is telling us about suicidal ideation in children and young people after maltreatment?

DARYL HIGGINS: Yeah. Thanks, Dan. So, as I said our study took data from people aged 16 and over. And in that the youth sample, the 16- to 24-year-olds, we actually saw very high levels of suicidal and self-harming behaviour. So in that 16 to 24 year age group, those who had experienced child maltreatment were 3.5 times more likely to self-harm in the prior year, were 4.5 times more likely to have attempted suicide in the past year, and also 6.5 times more likely to be dependent on cannabis, which is often as you know, a coping mechanism for these kinds of, of trauma. And so, you know, right across the youth sample both those with and without child maltreatment we saw self-harm as a as a problem anyway. So almost 3 in 10 Australians aged 16 to 24 had self-harmed at some stage in their life. Of course, much more common for young Australian women compared to young men. But as I said, the much, much, much greater likelihood of those who've experienced maltreatment, you know, 3 or 4 times more likely.

So, it's a really strong, kind of relationship that we see between these experiences of abuse and neglect and the much greater likelihood in those early adult years of experiencing suicidal thoughts or engaging in self-harming behaviour or suicide attempts.

DAN MOSS: Thanks, Daryl. And Shankari are you seeing more of this in your practice? And what strategies do you use to work with young people who are experiencing suicidal ideation?

SHANKARI SUNDARAM: I'm certainly seeing more than the previous years and as Daryl said it's self-harm, self-harming behaviours also in young children and of course, young people. And so part of it, the idea of not wanting to be here anymore. I think I approach with, curiosity again, being grounded and not having an emotional response when disclosures are being made, especially if it is a young teen. They have a lot of fear around lots of, big tools being brought out or big risk assessments being done in, done to the child and young person rather than sitting with the discomfort. So, I do try to reign all those feelings in and still attempt to do risk assessment processes. However, being grounded and calm and being accepting of what's being disclosed in the session, and also being curious again, sitting in that curiosity as to how it's feeling and acknowledging that that is hard, and reaffirming that I'm here. I'm here with you. Let's sit in that discomfort together.

I think that's really important, and that I have seen that having that kind of a response, ensures engagement because the fear also is that the child or young person will refuse to see you if there's a strong response. With self-harm, I also look at self-harm as, the distress needing to be regulated. Somatically. So self-harm is an intentional connection. A quite a strong connection to the body. Again, through pain perhaps, but it is still wanting to reconnect to the body. So, I find practices like, I use the EFT tapping. So Emotional Freedom Technique, it used to be, considered out there or not scientific, but we now know that there are many, many studies that have been done to show the efficacy. There is a leading researcher in Australia, Dr Peter Stapleton from Bond University in Queensland, who is one of the leading researchers in EFT as a technique. So, I have used EFT for self-harm in young people to shift away from. So if you're not familiar, it is tapping, and this is in the list of resources, tapping on different parts of the body which incorporates elements of bilateral stimulation while exposing ourselves to the distressing thoughts and emotions we are having and tuning into the somatic experience of that as well.

So, something like that can be a great tool to use when the urge to self-harm comes up. And I've found that to be quite effective in working with young people.

DAN MOSS: All right. Thanks Shankari. Daryl, lots of questions around what your study covers and about particular cohorts of children and young people and adults, in fact. So, I'm wondering whether you can tell us a little bit about what's next? You know, what more do we know or need to know around children and young people's experiences of child abuse and neglect?

DARYL HIGGINS: Yeah. Well, look, as a team, you know, there were ten of us who were the chief investigators led by Distinguished Professor Ben Mathews from QUT. We're all acutely aware of the limitations of our study. While, of course, we're incredibly proud that we think it's very rigorous. It gives us reliable data on past experiences of abuse and neglect. We know that there are a number of limitations. But thankfully, government has already committed to funding a, a follow up type study. So, a similar methodology with another sample of young people aged 16 to 24 in the future. So, it could be used as a comparison with our study to see are changes occurring, is prevalence reducing on any of our forms of abuse and neglect. We, as the current ACMS team, have also provided some scoping for government around what we think some of the changes and, adjustments that need to be made to that methodology, depending on who it is that conducts such future research. Clearly, one of the things that we recommended was that there needs to be a parallel study that's led by First Nations people.

We had great representation of Aboriginal and Torres Strait Islanders in our study, but for, cultural and ethical reasons, none of the chief investigators were First Nations. And so we have not disaggregated our data and presented, separate prevalence statistics. So any future study like that would need to be led by indigenous researchers and driven by questions from community that can be helpful to, to their healing journey and, and what they need to keep children safe and respond to the problem of, of child abuse and neglect in their communities. But we are also acutely aware that because of the funding and time constraints, that we were not able to ask any questions about protective factors. And we know that that's really important in understanding what the impacts on people across time, but also whether, you know, kind of treatments are effective and whether prevention strategies can be built upon. And so, any future studies need to do that. They also need to have better representation and engagement with questions around things like disability and also culturally and linguistically diverse communities.

So, we know that there's a number of directions that we would like any future ACMS style study to address.

DAN MOSS: Great. Thank you, Daryl. Shankari, some questions here around some of the practice skills and strategies that you described and one in particular. Can you please expand on this idea of making communication intentional with the children you work with?

SHANKARI SUNDARAM: I'd like to use the idea of slowing it down and zooming in. So being fully present as present as we can with what we're doing. And that creates intentionality, which is intuitive. And so, getting rid of the agenda that we may have in our heads about how the session should go, and being fully present. And this reminds me of what Daryl was saying earlier as well, about those incidental interactions that we may have with our children as parents. Right. Like, and we know that teenagers are more likely to talk to us about things that are important to them when we're driving. And so, again, it becomes an incidental, sharing and bonding rather than a planned and agenda-based sharing. And so, intentionality is also not. Having all those rigid intentions. So almost taking the rules away and the connection being the point of it and everything else organically, then flows from that. So that's how I'm looking.

DARYL HIGGINS: At intentional intentionality. Yes.

SHANKARI SUNDARAM: Yes, that's a good phrase. Thanks, Daryl.

DAN MOSS: Professor Daryl Higgins and Shankari Sundaram, thank you for so much for joining me today. Thank you everyone, for joining us. It's been an absolute privilege to bring you this webinar and this Q&A session. Thanks for all the great questions and your interests. And good luck in your future practice with children and young people who have been affected by abuse and neglect. Thank you.