Audio transcript (edited)

RANI KUMAR: Welcome to today's webinar. My name is Rani Kumar and I'm the Deputy CEO of NAPCAN, the National Association for Prevention of Child Abuse and Neglect. Thank you all for joining us and I'm really grateful to AIFS for inviting me to facilitate today. I would like to start by acknowledging and paying my respects to the traditional custodians of the beautiful land that I'm on today. I'm on the lands of the Ngunnawal people here in the capital, in Canberra, land that was never ceded, it always was and always will be Aboriginal land. I'd like to pay my respects to elders past and present and extend that to all the elders from the lands that you're all joining today and to welcome any Aboriginal and Torres Strait Islander colleagues that are logged on today.

Today's topic is about preventing emotional abuse of children - a big topic - and the role of parenting support. Emotional abuse is a form of child maltreatment that is less well known; however, it's prevalence in the community is quite high. Emotional abuse in childhood has immediate and long-term effects on mental health and wellbeing and it can be highly traumatising for those experiencing it. 

The family environment is a key setting for the prevention of emotional abuse of children and this includes parenting support. We know children do better when their parents are supported. Practitioners and services have an important role to play in identifying emotional abuse, assessing its impacts on children, and providing support to parents to prevent emotional abuse. It's high time we started talking about this. 

But we're here today as part of this year's National Child Protection Week. And just to give you some context, National Child Protection Week is about sharing the message that every child in every community needs a fair go. This year, we're also focused on the theme 'where we start matters' and this conversation is a critical part of discussing that start. On Monday, NAPCAN launched Child Protection Week and with that a call for action for the Commonwealth Government to convene a national summit to prevent child maltreatment. 

You can hop onto our website and have a look and find out a bit more about it or contact us directly to discuss this call. We feel that, on the back of the child maltreatment study results, some of which we will discuss today, we can't look away and just hope for things to improve, we need to stop doing the same thing and expecting different results, we need a fresh way of looking at the prevention of harm at a national level now and aligning those plans and systems that are already there, already doing great work, but how do we put prevention at the centre of that. We know where we start matters, but, of course, where we start isn't where we finish, so we invite you to use this theme to explore and talk about the many ways that where we start matters for the children and young people and families that you work with. 

Now, just before we get into our discussion and I introduce our panellists, I have just a little bit of housekeeping. There will be a live question and answer discussion at the end. Questions can be submitted by the question box in the GoTo Webinar dashboard that's on your screen somewhere. And we received a range of really great questions already, so thank you for sending those through when you registered. We'll try to get to as many as we can today. The webinar is recorded. It'll be available in two weeks or so on the AIF's website under the webinar banner and you can subscribe to the AIF news for more information and getting that straightaway. Related readings and resources, anything that we reference, will be available in the handout section of the GoTo Webinar panel and if you have time please do stay on to complete the short survey at the end of the webinar. 

Finally and very importantly, this webinar discusses child maltreatment and emotional abuse, so please take care while you're listening and if you feel uncomfortable or upset, please do step away, take care of yourself, and if you think you'd benefit from some support, please reach out to a service. There's a list of resources in the handout section of the dashboard, right now, of services that you can contact, so don't hesitate to reach out if you need.

And again, thank you for the questions at registration. Big topic. We might not be able to cover everything but we'll try to group things together and get to as much as we can. So, without further ado, I'd like to introduce our presenters, Dr Divna Haslam and Professor Alina Morawska. Dr Divna Haslam is a clinical psychologist and senior research fellow at QUT. She works at the intersection of parenting and child maltreatment. She's been involved in extensive parenting research in Australia and abroad and was recently involved in the Australian Child Maltreatment Study which I'm really keen to unpack here. 

And Associate Professor Alina Morawska is the director of the Parenting & Family Support Centre at University of Queensland. Her research focuses on the central role of parents in influencing all aspects of children's development and the parenting interventions as a way of understanding healthy development and a means for promoting positive family relationships. Critical to what we're talking about today, she's also an author of Triple P program and brings a wealth of knowledge on this topic. Welcome to both of you. 

For today's discussion, we might start with Divna. As I mentioned, Divna was involved in the Australian Child Maltreatment Study. Divna can you tell us a little bit more about the child maltreatment study and its findings, particularly in relation to emotional abuse?

DIVNA HASLAM: Yes, thanks Rani, I can. I've actually got a couple of slides just to show in the beginning to set the scene really about what emotional abuse is and how it fits within other types of child maltreatment and then we can unpack the impact of that and how we can prevent it.

First of all, I think Rani's mentioned the Australian Child Maltreatment Study. It's come up a lot during National Child Protection Week so I just wanted to let you know we do have a website and that it has a whole host of resources that will be available and that anybody can access. In particular, there is a major report that covers everything or a primary content for laypeople and practitioners. There's a special edition in the Medical Journal of Australia which covers the scientific peer-reviewed publications and then we have a range of infographics that can be downloaded and shared on social media or in practice and so forth.

Let me just very briefly give an overview of what the ACMS is. Until recently, we actually had no data on the prevalence of the five types of child maltreatment at a national level. We had good data from child protection units and things like that, so we knew how many kids were in the system but we actually had no idea of how many children are experiencing different types of maltreatment, or by whom, at different stages in childhood, or the impact of that over the course of life.

What we did was a major study. It was funded by the NHMRC with additional top-up funding from the Australian Government and we randomly called eight-and-a-half thousand people across Australia. We called you up and said, 'Would you be in a study?' not particularly people that were experiencing or had experienced maltreatment, just everyday Australians. We included three-and-a-half thousand young people aged 16-24 because we wanted to be able to over-sample them so we could look at change over time. And in fact the Government has announced plans for a wave-two study so we can look at if we're actually progressing and reducing the prevalence of maltreatment, and then 5,000 people from age 25 and up, and I'll talk about the youth people only today because that's most relevant.

What did we assess? We assessed all five types of maltreatment but we also assessed a whole host of other childhood-adversity family risk factors, adverse childhood experiences like parental separation, parental incarceration, neighbourhood violence and things like that, as well as peer bullying and sibling violence. And because we wanted to look at the impact of child maltreatment over the course of life, both in youth but also right across older people, 45-plus, and so forth, we looked at a range of outcomes and in particular we looked at mental health disorders. These are diagnosable psychiatric conditions, not just poor symptomatology but quite serious conditions. We looked at a range of health conditions and also health risk behaviours, so things like suicide and self-harm. 

And what we found, Rani, was really quite devastating news. We found that child maltreatment was incredibly widespread. Until now, we had thought that the number of Australians that were impacted by maltreatment was relatively small, as we see in the child protection data, but our data showed that 32% of young people 16-24 reported experiencing physical abuse before age 18, 28.5 experienced sexual abuse, 30.9 experienced emotional abuse at the hands of parents of primary caregivers, 8.9 experienced neglect, and over 39% experienced exposure to domestic violence, so witnessing parents being physically violent or psychologically violent to one another.

And I'm sure, Rani, you've heard these data a number of times and other people on this call have as well, but these are really confronting numbers. And we're here today to talk about emotional abuse - I'm going to narrow down that - but really I think these numbers highlight the breadth of the problem and the need for us, as a nation, to do something about these numbers, things like the national summit that NAPCAN have suggested.

Let me just quickly talk about what we mean by emotional abuse. And the first thing I want to highlight is that, really when we're talking about emotional abuse, we're actually talking about the impact of parent messaging. And this has actually increased in recent years when we're looking at comparisons between the whole population and young people, so almost 35% of our young people have experienced this form of maltreatment. And what it really is, is it's a negative pattern of interaction between a parent or a parent-caregiver and a child that tells the child or conveys the message to the child that they don't matter, that they're worthless, unloved, unwanted, or actually are only in value in meeting someone else's needs.

These are hard to conceptualise so I've got here the three examples of what we talked about in the study and we assessed three types - verbal hostility. We asked people:

• Did your parents often humiliate you, insult you or call you hurtful names?' and this had to be occurring for at least a period of weeks;
• Did your parent reject you, say that they hated you, didn't love you, wished you were dead or had never been born?'

These are pretty hard things to say yes to and we found that one in 10 - just over 11% - said yes, that their parents had said something like this to them, more than once over a period of weeks. Or:

• Did your parent deny you emotional responsiveness, so did they often ignore you, not show you love and affection, or not show you that you were important in the sense of who you are?'

And these data are really quite confronting when you look at it. When you look at that 34.6, it's easy to say, 'Wow, they're probably very general questions', but when you look at the types of questions we asked, that's really confronting news.

RANI KUMAR: Absolutely, Divna. That is hard to hear and quite disturbing and we should be disturbed by those sorts of numbers. As a sector, for years we've known that the child protection statistics were underreporting the extent of this issue, and emotional abuse, in particular, was always very difficult to capture in the numbers, but did these findings surprise you?

DIVNA HASLAM: Look, to be honest, they did, Rani. We know that emotional harm is commonly represented in child protection data, but the vast extent, when we're looking at just how many children have experienced this type of emotional harm, really did surprise us. And I think we'll unpack a little bit later some of the impact of that. That really surprised us as well because, really, we've spent so much time and attention focusing on reducing sexual abuse and reducing physical abuse, and of course those are important to reduce, but we've spent relatively little attention and effort on reducing emotional abuse and so what we're seeing is that's actually going up, potentially, instead of down and that's really concerning for us.

RANI KUMAR: We know that every parent loses it sometimes with their children, it is just the nature of juggling so many different things. But what we heard there in that definition of emotional abuse was that this is quite a serious type of harm, a serious type of behaviour. Could you tell us a little bit more about that?

DIVNA HASLAM: Yeah. It is, Rani, and I think it's important to reassure parents out there that have ever got frustrated with their children - and I'm a parent and I have got frustrated with my children - Alina's nodding as well - so every parent, I'm sure, listening, will say, 'You know, at times, I've been frustrated. I may have yelled or I might have got angry'. And we're not really talking about those unhelpful patterns of parenting, if we're honest, but we're really talking about an overall pattern of interaction. 

My children know that they are loved. They get plenty of love and attention, they know that they're valued, I ask their opinion. All of those things are important. And when we're talking about emotional abuse, what we're really talking about is a pattern of behaviour that is the primary interaction between parents and children. It's not just the occasional slipup or the occasional frustration, it's really that the child is not confident that their parent loves them or wants them to be there, or that the family is better because they're in the family. It's really much more than unhelpful parenting. 

But what we're seeing from the data is it's still fairly common, so 35% in young people. That's happening a lot. That's happening in households that you know and your friends know and potentially in some of the households that people that are listening and certainly in terms of the clients and practitioners are seeing.

RANI KUMAR: That's quite a significant threshold and the fact that we're seeing that in the numbers is really quite shocking. What about the impacts of experiencing this? What are we seeing about that on children going forward with an experience of emotional abuse as a child?

DIVNA HASLAM: That's a really good question. I think we might just mention one another thing and that is parents might drop in and out of engaging in emotionally abusive behaviour. There might be, for instance, very high-stress times in a parent's life when they're more likely to fall into this adverse negative-interaction pattern. But then, maybe once things stable up, maybe they get out of an unhelpful relationship or financial pressure decreases, they might start to revert to it. 

I think it is important to highlight that, when we're talking about our numbers, it's at any time in childhood. We did have the caveat that it was at least for a period of weeks and actually our data mostly said it was over a period of years, but it doesn't mean that it's every single day in that child's life. But, unfortunately, what we found in terms of the impact was that it has quite a significant impact. 

The first thing to know is that emotional abuse doesn't occur in isolation so we also looked at multitype maltreatment. This is when children are exposed to multiple forms or multiple different types of maltreatment and we know that emotional abuse in particular is very common in different patterns of multitype maltreatment. For example, when we looked at children that only experienced emotional abuse, that was only about 2.6%, so there's a double whammy because kids are experiencing emotional abuse but then they're also experiencing these other child maltreatment, which is independently associated with harm.

When I talk about the impact of emotional abuse, there's two ways to look at it. One way is to look at independent impact, for example taking out any other maltreatment, or we can look at just unadjusted impact. For example, if we just look at the prevalence or the increased odds of a child who's experienced emotional abuse to attempt suicide, they're 6.7 times more likely to attempt suicide in a prior 12 months to when we studied. So, we really see quite highly significant relationships. 

What we did in our study was we adjusted for the experience of any other type of maltreatment and that tells us that this is the unique influence, I suppose, of emotional abuse. And what we found was, even adjusting for all of the other types of maltreatment, even adjusting for experience of sexual abuse or physical abuse, children that experienced or adults that experienced emotional abuse in childhood were twice as likely to experience major psychiatric conditions like major depressive disorder, they were twice as likely to experience PTSD and they were twice as likely to experience generalised anxiety disorder. These are significant debilitating conditions that, without intervention, can persist over the course of life.

RANI KUMAR: What about other areas of life, Divna? Did your study look at how it might impact broadly beyond those very significant mental health disorders that you just mentioned?

DIVNA HASLAM: Yeah, we did, Rani. In terms of other health risk behaviours, we also looked at that. We found that children that experienced emotional abuse, even after accounting for any other experiences of maltreatment, were one-and-a-half times more likely to need psychiatric care, they were twice as likely to need to see a psychologist or to have seen a psychologist in the last 12 months. They were twice as likely to self-harm and they were twice as likely to be dependent on cannabis. Now, in the grand scheme of themes, we have a mental health crisis. The Productivity Commission tells us that it's taken $200 billion a year to deal with mental health and suicide attempts, so we know that child maltreatment and in particular emotional abuse is playing a really significant role. 

I was going to say, in terms of suicide, they're two-and-a-half times more likely to attempt suicide and they're more likely to experience hospitalisations and things like that.  I was going to say one more thing: to put it in context, we've had a lot of attention on sexual harm and sexual abuse and maltreatment, and we should have. And that's because we know that sexual maltreatment is particularly harmful. But our data shows that emotional abuse has very similar levels of harm as sexual abuse and that tells us we need to do something.

RANI KUMAR: Absolutely. And what I was about to say when I interrupted you there, sorry Divna, was just that. You might not be able to answer this, but we've known for years that sexual abuse is so damaging in terms of the impacts, do you have thoughts on why emotional abuse is so damaging?

DIVNA HASLAM: Yeah, I do. We don't know from our ACMS data cells cross-sectional, but what we do know from general theory and from psychology in general is that the interactions between a parent and a caregiver - and Alina will unpack this more - are primary sources of how we interact with others across life. The way that our parents treat us and the way that we interact with our parents helps us to develop our sense of worth, it tells us if we're important, it tells us if we're valued, and all of those things link in or cascade into these negative mental health impacts and coping strategies and things like that, that can be harmful.

If we go back to the prevention of child maltreatment and the prevention of emotional abuse, in particular, if we can change the way that some parents, I should say, are interacting negatively with children in terms of emotional abuse, we can change the way that these children develop themselves and their sense of esteem, which is going to change their trajectory of their life.

RANI KUMAR: Yes. There's a lot to unpack in there and I think it's a great place to bring Alina into the discussion because it really is about that dynamic and that relationship and what the contexts are for these parents who end up in these situations. Alina, I'll just start by asking, when you first heard about these results, Alina Morawska did they surprise you?

ALINA MORAWSKA: Yes. When you look at those results presented as starkly there as Divna had presented them, they're quite shocking across every form of maltreatment and abuse. And I think with emotional abuse, in particular, in many ways it's the hidden abuse. There's really not a lot of research about it on its own up until now, so knowing that it is so common and especially that it seems to be increasingly common, perhaps, in the youngest age groups, is really problematic. And given how common it is in the general population and how harmful the effects are, it suggests that we really need to know a lot more about it and as a society we need to just become much more aware of it and how harmful it is and really start taking it seriously as an issue.

RANI KUMAR: Why do you think, from your expertise and experience, having worked many years in this area, that emotional abuse is so widespread in the community, now that we know that it is?

ALINA MORAWSKA: Yeah and it certainly is widespread given those data. And I think it's important to note that really we don't know a lot about it, so in some ways we're speculating about what some of the connections might be. And it is true that it's probably very, very complex. There's not likely to be any single one reason why any particular parent engages in this sort of behaviour. 

Fundamentally, it's probably associated with stress. When parents are experiencing a lot of stress when they're under stress, their ability to be able to regulate their own emotion and their own behaviour is altered. And when you're feeling really, really stressed - we talked about those things that every parent does - stopping ourselves from saying things that perhaps we shouldn't, we wouldn't want to say to our children is harder. When you're under a chronic stress, that just makes it much more likely that perhaps parents will engage in those sorts of behaviours. 

Clearly, things that make it more difficult for parents, that are stressful for parents include things like financial insecurity, food insecurity, a history of trauma experiences, difficulties with their own mental health or substance abuse disorders. All of those things make it more difficult to manage stress on a day-to-day basis and therefore to be engaging in positive interactions with children. And much of this probably overlaps with every other form of maltreatment as well, so I don't think it's unique to emotional abuse, but you can imagine how saying those sorts of things can be triggered in those situations as stress.

I think it's also possible that as a community we lack awareness of how widespread the emotional abuse is and how harmful it actually is. You know that question that you asked me you know, 'Where do you draw the line between the traps that every parent might fall into versus emotional abuse?' perhaps as a community we're just not aware of what those boundaries are and how harmful those sorts of persistent messages to children really are.

And what this means is that while we clearly need to support children and young people who've experienced emotional abuse, as a community we really need to be focusing our attention on prevention and ensuring that future generations of children are not exposed to emotional abuse. And those approaches really need to focus broadly on supporting children, parents and families. We need to do things like reduce poverty, we need to provide adequate mental health treatment, we need supportive parent leave policies, we need access to affordable childcare, flexible working arrangements, all of those sorts of things which are so obvious in many ways and we already know they work and they're effective but are so important to supporting families. And, of course, we need to make sure that parents have access to evidence-based parenting supports when they're needed.

RANI KUMAR: Absolutely, Alina. All of those things that you're saying are bang-on what we've been saying for a long time as well, collectively, as a sector, isn't it. And having these data really just gives us that extra impetus to be able to push on some of those key actions that need to be taken across the board so that we can reduce that toxic stress on families, take away some of those extra burdens so that parents are able to engage more in the responsive parenting that we all know most parents want to. Nobody wants to harm their child, it's just sometimes there's just so many things going on and we know that the more complex the issues the more difficult it becomes to be a responsive parent. Thanks for your thoughts on that.

On that note, as parents now, there's a lot more information available, there's lots of things online, there's lots of tips on breakfast TV and all of those places, but parents are still really not sure what they should be doing. There's more awareness that physical harm is negative but I don't think we're having that conversation about the words that we use. What are your reflections, Alina, on how does parenting support fit within this? How do we actually help parents with this?

ALINA MORAWSKA: I think the first thing that is really important to emphasise, and you've said it already, that we just need that comprehensive approach. It's not going to be solved simply by providing parents with information. It's a complex issue, it's very, very common. So any kind of parent support really must be embedded within those broader social and policy changes that are designed to support balance. And those include all those things that we've mentioned: reducing financial strain, access to childcare, all that sorts of things. 

But, fundamentally, emotional abuse is about the parent-child interaction and those bonds and relationships between parents and children, so how parents communicate with and to their children, essentially then supporting parents and using positive parenting strategies as an absolutely critical element of any prevention approach.

RANI KUMAR: And what advice would you give to practitioners that are working with parents and families to support them better? Like you said, it's not just one-size-fits-all or one particular approach that's going to work, but what are some of those ideas that might help them have these conversations?

ALINA MORAWSKA: I think most evidence-based parenting interventions incorporate a range of strategies for parents and while we don't have a lot of evidence specifically for emotional abuse, certainly those sorts of strategies are certainly effective in general and they're certainly effective in terms of preventing other forms of maltreatment. They include things like promoting positive parent-child interactions, supporting development of a positive parent-child relationship, so bonding and attachment between the parent, ways to engage with children positively through talking, communication, attention, praise and obviously teaching non-abusive discipline strategies for when the inevitable discipline scenarios come up in any kind of families. 

There's a range of elements that are likely to be important, so strategies to help parents to enhance positive, loving parent-child relationships. Things like sharing affection between parents and children, spending quality time together with children. It's about looking at effective ways of engaging in talking and communicating with children, so listening and using conversations as a way to engage and promote relationships and development. And those avenues to communicate really help to let children know that they're valued and that their opinion matters and that's part of sending that message that 'you're an important person in my life as a parent'. 

It's obviously about things like providing attention for appropriate behaviour, so starting when a child is doing something that you as a parent like and responding to that sensitively. It's using praise and rewards for appropriate behaviour. Again, spotlighting those things that parent likes about their child's behaviour. And of course, very, very critically, having effective, noncoercive, consistent approaches to discipline. That includes things like clear, calm limit setting when a problem arises and having an appropriate set of consequences to back those difficult behaviours up. 

It's also really important probably to address parents' negative attributional patterns. These are the sorts of explanations parents have for their children's behaviour. You can explain a child's behaviour by saying something like, 'Well, it was an accident', and if you say that to yourself chances are you'll just move along with your life and you won't respond negatively to that child. If you say, on the other hand, he did it on purpose, chances are, as a parent, you'll become more angry and more likely to fall into the trap of using those kinds of emotionally abusive messages.

And, fundamentally, we really want to make sure that we're enhancing parents' sense of confidence in their ability to manage the day-to-day challenges of parenting. In terms of how we engage parents to prevent emotional abuse, it really is about focusing on prevention, so ensuring we're getting parents early and that parents are hearing those sorts of messages right from pregnancy throughout their lifespan as a parent, so to speak. It's about thinking how we as practitioners can make parenting interventions accessible and universally available, which helps to reduce the stigma associated with help seeking. And, of course it's, as practitioners, we need to be really thinking about how we communicate that importance of having loving, nurturing environments for children and how we make that message super super clear to everyone in the community.

RANI KUMAR: Absolutely where I was about to go with that was the role of the community in supporting parents because it's a really tou-. No, I should be saying tough job, that's bad framing. It's a really important job that we have as parents but there's a lot going on in everyone's lives and if you've got other issues going on around financial stability, housing stability, mental health concerns, it can become much harder to do a lot of those things of catching yourself and being able to respond. 

But before we get to that community question, I just wanted to ask you, Alina, based on what you were just saying there, are there programs and supports that are available and accessible for parents to get that sort of support and evidence and ideas on what to do in terms of that supportive discipline rather than reacting in the ways that they might have been?

ALINA MORAWSKA: Look, and I think your use of the word 'tough', I think it's a fair comment. Raising children is not an easy job and I think there's often this myth that it comes instinctually, that we just know what to do. But the reality isn't like that and most parents, especially nowadays, come to the job quite unprepared and we often don't know what to do. And that's why having access to evidence-based parenting information is so important, because every parent can benefit from information about how to raise children in a positive way. 

As I mentioned before, there's really limited evidence that's examined the direct impact of programs on child emotional abuse particularly, but there is good data that parenting interventions do impact on other forms of maltreatment. We know that parenting interventions can prevent or reduce maltreatment broadly. As an example, I'll take this from the research that I'm very familiar with - the Triple P Positive Program. There was a system population trial of this program in the US a few years ago now. The program was made available to whole communities and communities were randomly assigned to either receive the Triple P system or not. 

And making Triple P available to all parents in a county - so not just who were at risk or anything like that but everyone in the community - actually led to quite significant reductions in indicators of child maltreatment and in specific child maltreatment. For example, there were fewer hospitalisations for child abuse injuries, about 13% lower. There was about 20% lower out-of-home placements and there was a slow growth of confirmed child abuse cases. This is US data so obviously it's a different context, different systems, but it certainly indicates that when a positive parenting intervention such as Triple P is implemented at a community level, it can really impact on those indicators. 

We have a trial in Australia that has just finished. The data are not quite available but they will be available very very soon. It's called the Every Family trial, not dissimilar in its approach. We provided Triple P to whole communities and compared communities without the availability of the entire Triple P system. And there's some really very promising data coming out of those, but I can't speak to those yet because they're not yet available, but as I said, demonstrating that, at a population level, we can really shift some of these indicators of child maltreatment, although not emotional maltreatment. It was not something that was measured in either of these studies.

Triple P is available to all parents in Australia. Triple P Online is available across the country to all families. In many states, parents can also access face-to-face versions of Triple P, but, of course, there are also other evidence-based parenting interventions in Australia. We are very, very fortunate that we have lots of researchers and lots of practitioners who are trained in other programs, things like Parents under Pressure, the PuP program, or Tuning in to Kids. There's a range of options that are available to parents, which is really great to see.

RANI KUMAR: No, thank you for that and thank you for the teaser. We'll keep an eye out for that data that's going to come soon and hopefully help us make that compelling argument for that community-wide approach, because we know the norms where you live really make a difference and having a lack of stigma, reducing that stigma for accessing parenting support, is really critical because parents often are reluctant to seek help if they think they're going to be judged or shamed for it. 

But also, we know in First Nations communities in particular, or from lots of refugee and asylum seeker communities, there's a fear of losing your kids or the kids being removed when you ask for help. That brings me to a question about intersectionality because really it is important to look at the data and think about what does this mean for families from culturally and linguistically diverse backgrounds, children with a disability who we know are often quite vulnerable to abuse and First Nations children, Aboriginal and Torres Strait Islander children. Divna, did you study look at kids by different cohorts?

DIVNA HASLAM: Yes and no. We did collect data, for example for indigenous Australians. They're a part of our full sample. And at the Australian level, there's about two-and-a-half/2.7% of our nation is indigenous. But we did not look at that separately for a number of reasons, primarily because it was intended as a whole-of-population study. And really we would argue that the work in the assessment of maltreatment in indigenous populations and indeed some of these other culturally and linguistically diverse groups and things like that, really need their own study.

For example, with indigenous kids, we know that they are vastly, vastly overrepresented in the system, but we don't know whether that's just because agencies are more picky and are more likely to provide referrals or notify for those or if it's actually occurring high levels and things like that. I think really what we need to do is we need an indigenous-specific study to assess the prevalence of maltreatment in those communities. 

And similarly for CALD communities. Alina and I both have a student together working in refugees settings with Triple P and the data show that parents really like the program but they are terrified of what's going to happen if they report that they've smacked their children or something like that because there's this inherent fear of 'is my child going to be removed from me?' and in some cases, that's a valid fear. It's really a case of 'how do we conduct sensitive research?'

National Office of Child Safety has announced that they are investigating the possibility of doing some specific studies, for instance with culturally or linguistically diverse families, indigenous families, disability families and things like that. And I think those really need to be codesigned with lived-experience people, people from those communities themselves and I don't know that our team necessarily, in isolation, is the team to do that. But, certainly, we need to support research in this area that's led by, or co-led at the very least, by these communities themselves. So, yes, but not yet, in terms of the data, I think is the answer.

RANI KUMAR: And I think that's a really important point about deeply working together with these communities and understanding the parenting norms and the value of culture in keeping children safe. And I know, coming from a South Asian background, that at times, once I had my children, I'd get lots of conflicting advice from family members and from more Australian/Western parenting experts and my community health nurse, and reconciling some of that can be a challenge.

So, you need that codesign process and then an implementation strategy that really goes to all those frontline workers, particularly frontline health workers, to better understand where some of those concerns might be coming from and how to equip new parents, in particular, but across the board, parents with skills to be able to have those conversations in a way that feels culturally safe and inclusive. It's great to know that there's that consideration of more work being done in that space. 

We are getting great live questions and that question really did link a lot to what people have been asking about. One really important question is, how do we change the rates? What does prevention in this space look like? Obviously, there's the parenting support, but overall we've had a little bit of a teaser to this conversation of we need to bring people along, we need to have a better, bigger conversation about this. I'd like to hear more about what each of you think. Alina, maybe you first, of what will actually change this. Because it's not just doing the work with individual families, is it.

ALINA MORAWSKA: No, absolutely not. Just to build on that point around interventions or strategies for families from indigenous backgrounds or from poor backgrounds, there is good evidence for Triple P, and also for lots of other parenting interventions, that's being done here in Australia and around the world and in other culturally diverse contexts, not just around the world in other English-speaking countries, demonstrating that these kinds of interventions are effective with parents from a variety of different cultural backgrounds. 

And I think that's really important because in many ways we already have the tools, particularly around parenting support. Yes, we need to fine-tune those tools; yes, we need to make sure that they're a really good fit; yes, we need to look at how we engage parents, perhaps more effectively, in some of these interventions, how we facilitate access to parents, but the tools are already there. And I think that speaks to the National Summit idea that you mentioned right at the beginning that we need to bring all of these diverse perspectives. We already have a lot of the strategies. 

When I mentioned before that we need a comprehensive approach to prevention that looks at things like reductions in poverty, it looks at affordable childcare, we already know many of these things. We know they're effective in reducing stress, we know they're effective in supporting parents. We know parenting interventions are effective. It's how do we translate that into a system that effectively supports families at every level and makes children the centrepiece of that and I think the National Summit that you mentioned is a really good step to try to find those solutions and real actions to actually prevent abuse.

RANI KUMAR: That's really powerful because I think what we're hearing there is it's really important to join the dots between all the systems and also really elevate those bits that are working, the things that we have the evidence for. There's programs that are already making that impact. But how do we all raise that awareness across the board so that Health isn't just sitting on the information of things that are working in their space and Education's doing something over here. How do we coordinate that better? How do we then take those stresses off families around cost-of-living pressures and how do we make sure that simple things like transport is available? Because all of these things add to the stress and the pressures on families and then lead to parents having less capacity, at the end of the day, to be able to more of that responsive parenting. 

But we also need to shift, what I'm hearing from both of you, is the social norms. How we actually think about children and how we value children and how we talk to children is such an embodiment of that. It's a really important thing to think about because I think, Alina, it was you who mentioned earlier that it is one of those things where you're not even sure how to disrupt or interrupt someone who might be speaking harshly to a child because the norms aren't shared at the moment. We haven't had a public conversation about this.

We know that if we saw someone slapping someone in the street we'd go 'is everything okay, what's going on?' We would feel more empowered to have some of those conversations. But especially being a parent of children who are at school age, we're always just sharing how difficult things can be, but I think nobody's really feeling empowered to speak up about parenting because we haven't had that universal access to information, and that's really a critical leveller so that there is less stigma and there is this shared understanding of how we might parent better, collectively, for children. 

I'm just reading some of these questions, which are fantastic though, coming through and some of them really are about how to respond to parents and children - well, this goes perfectly to what I was saying - for example in a playground setting or a professional setting and intervene or be able to support having that conversation at that level and what that might look like. Alina, I might go to you again and then, Divna, I'll bring you into the, if you've got any comments about that.

ALINA MORAWSKA: I think part of the issue, as you pointed out, is that we haven't really had a conversation, particularly about emotional abuse, and we have lots of conversations about abuse in general but not about emotional abuse specifically. And I think it was interesting you said that if you saw somebody smacking a kid in the street you might feel a little bit more empowered to do something about it. 

Unfortunately, though, I don't think we necessarily, as a community, feel empowered to do anything about parenting of other people, in many ways, because we still see parenting as very much a private - the way our families are structured or the way our families seem to be structured perhaps, our stereotypical kind of nuclear family, which doesn't really exist but that's the way we view families, the way our communities are organised in households that are disconnected, people are not necessarily sharing the raising of children in a village, so to speak. 

I think, as communities, we don't really have conversations about the shared raising of children, the shared ways that we can contribute to helping parents raise children in the community. And I think that's part of that critical conversation, that we need to engage in that better, we need to raise awareness so people can recognise emotional abuse and respond to it appropriately. And of course, we need to then treat it seriously at every level. Whether it's a parent who sees another parent engaging in it, whether it's a childcare worker or somebody at a playgroup seeing somebody else, we need to treat it seriously and respond to it appropriately in those contexts and not dismiss it and think, 'It doesn't mean anything, it's just words', when really it's not.

RANI KUMAR: Divna, did you want to comment on that?

DIVNA HASLAM: I think really what we need is a public health campaign. We've been very successful in other domains, we're changing the perceptions of the public and the population at large. If you think about drink-driving, we would speak up and say, 'Hey, you can't drive, you've been drinking - <aside discussion> - but we wouldn't do that for emotional abuse. 

But if we're able to change the dynamic in the conversation, like Alina said, at a national level, if we had major campaigns, if we had key leaders in our society backing this up, saying, 'Speak to your friends. If you see your friends acting out, frustrated, have a talk to them. Do they need some support?' we might be more enabled and might feel more empowered to actually speak up the way that we do about 'hey, don't drive, because you've been drinking'. There is success in other fields for these public health campaigns and we really need to bring these to parenting and indeed the prevention of child maltreatment at large.

RANI KUMAR: That is a really important point and I think that would go to the heart of something like the Summit, where you bring together the key thinkers, be able to come up with solutions and then how do we communicate that to the general public so that people do feel empowered? And Alina, to your point, how do we break that thinking around this individual parenting nuclear setup to a collective sense of children are important and it's our social responsibility to ensure that they grow up safe and well and what does that look like? Divna, there was just a few questions about the research and I might just quickly go to some of them that are coming through. One was about the fact that when you said it's a pattern of behaviour, it does mean that if it only happened a couple of times it wouldn't actually be captured, so it really is quite a serious number of occurrences. Could you just comment a little bit on that?

DIVNA HASLAM: Yes. In all research, there are some limitations. Conceptually, the definition of emotional abuse requires it to be a repeated pattern. We assessed days, weeks, months or years and then used a cutoff of at least weeks. That means that we wouldn't capture something that could be potentially very traumatic. If a parent says to a child, 'I wish you'd never been born, you are the bane of my existence', and that was just a single one-off time, that could still lead to ongoing trauma for that child but it wouldn't fit the scientific definition of emotional abuse. Our definitions are about 34.6% are really these patterns of behaviour but it does miss those potentially very traumatic single instances.

RANI KUMAR: And that's critical, the fact that it is showing us such a significant number even though the threshold is so high for that. There's also questions here - and I think this is really important for the audience who are participating today - in terms of emotional abuse being recognised by institutions and those places where you need to be able to have these conversations, with child protection data and being able to talk - you talked a little bit, Divna, about the fact that it's multidimensional, often, like it's co-occurring with other types of abuse. Also, being able to prove it at court or being able to capture that experience for children in Family Court. Just if either of you wanted to comment on the fact that emotional abuse is still not well understood, not just in the general population but also in those institutions that have a lot of impact and power over children's lives.

DIVNA HASLAM: Yeah, I can speak to that, Rani. The diagnosis, if you will - I wouldn't say diagnosis - but of emotional abuse differs a little bit in statutory bodies. In some states in Australia, you do have to report suspected or confirmed emotional abuse if you're a key reporting person, in others, you don't. I think the challenge that we have with the legal system and mandatory reporting in general is that sometimes it hasn't always caught up to what the data says. Because people have thought, 'Words don't matter, really it's the physical abuse or the sexual abuse that's the worst', people have tended to underemphasise the importance of emotional abuse and I think that's what our data will really shine the light on and the need to really prioritise the identification and prevention of emotional abuse moving forward.

RANI KUMAR: Alina, did you want to add anything?

ALINA MORAWSKA: I think it speaks to that broader point that we've alluded to several times now, that it is the hidden abuse in many ways and we really don't have a lot of evidence and research around emotional abuse on its own and what impact it has, where it stems from, what it's related to and all of those other things and we need a lot more data on that to make sure that we really understand it, to be able to prevent it. And I think the data from the SMS study is really powerful in bringing attention to it so that we can actually start having that conversation and do something about it.

RANI KUMAR: Alina, there was a lot of questions also - and this is really important in the context of that parent support and parent education, of being strength based, not deficit-focused, in terms of dealing with parents and this particular practitioner might not be able to do anything about the rent or the longer-term substance abuse issue, but they can, in that moment, equip this parent with some tools and tips and strategies, what does that look like in terms of how you're engaging with the parent? Because there's obviously a need to be child-focused and wanting the best outcome for the child but how do you support the parent in doing that and not ending up in a deficit focus or you're harming the child?

ALINA MORAWSKA: It's always about having the best interests of the child in place. But having the best interests of the child in mind often means that you're thinking about 'well, what can the parent do to engage positively and effectively?' And I think, as you said earlier on, most parents want the best for their child. Most parents do not want to harm their child. 

And when they're presenting in services context, it's usually because they're at wits end and they don't know what else to do and how else to respond to their child, so they're actively seeking support and it's engaging parents around that. What is it that they want for their child? How do they want to do things differently with their child, to have that better relationship, to have that positive, nurturing environment for their child? And there's a whole range of skills built into most of these evidence-based parenting interventions that focus exactly on that as the building block. Because no strategy to just try to remove abuse is going to work without giving parents the skills to actually effectively engage with their children positively to build those relationships. It's a fundamental building block that is necessary in any kind of support for a parent.

RANI KUMAR: And I suppose just in that it is about the adult learning how to regulate themselves and being able to have those skills to then be able to engage with a child, because if the adult's in a really heightened state it's never going to work, even if they know all the things they should do with the child, if they're not doing it for themselves, so that's a really important point. 

There are questions - and I know we're coming towards the end - about the intergenerational impacts because we hear about that a lot. If someone's experienced trauma, they are more likely to go on and have other adverse outcomes in their lives, so these intergenerational effects, are you seeing that in your data, Divna, with any questions around that,or more importantly, can we interrupt these negative paths? What can we do?

DIVNA HASLAM: Yes, it's a really good question. And it's one that concerns a lot of people, I think, when they have experienced maltreatment in childhood, that they're worried or concerned that they might repeat those patterns. First up, it's important to demystify that and that not every child that has experienced maltreatment will go on to perpetrate that in their own family. And in fact, when I was talking about that doubling in terms of mental health disorders, not every child that experiences emotional abuse or other types of maltreatment will go on to develop a mental health disorder either. We know about 50% do, 50% don't. And so there are a whole lot of protective factors that can make a difference and protect those children as they grow up from those adversities and the influence of that adversity. 

In terms of intergenerational data, we didn't assess that particularly in the ACMS - a little bit with corporal punishment but that's really a side issue, but we do know from other data that intergenerational patterns of maltreatment are common. But partly that's because we have intergenerational patterns of poverty and stress and social dysfunction. Really, you can't isolate the impact of maltreatment from the broader context in which the parent lives. 

And really what I would like to highlight is the role of those benevolent childhood experiences or positive childhood experiences that can actually mitigate the impact of early adversity. Things like having a good relationship with parents will actually mitigate to some extent some of the impact of that other types of maltreatment. Things like having a strong culture and all of those things we're talking about, indigenous cultures and CALD communities.

Some of those things can have a really important role to play in protecting the child from the development of some of these adversities and so while the overall picture, I suppose, of emotional abuse and maltreatment is that there are negative effects, that's not always the case. And one of the things that we also need to be doing is how do we enhance these positive childhood experiences and build on the strengths of the individual child and the strength that they have access to within their broader social networks. 

RANI KUMAR: Fantastic. Will we be seeing some of that in the wave-two of the child maltreatment study, looking at those resilience factors, what are those things that helped many of those kids who had experienced childhood trauma not go on to develop those mental health disorders. Is that in scope perhaps?

DIVNA HASLAM: Yes, I hope so. We tried to put it in this study but of course we're limited by time and costs and things like that. But really, what we've established so far is that there's a link between early adversity and adverse outcomes, but now we want to know how can we disrupt that and what can we do to change that trajectory and there's a lot of hope for that moving forward.

RANI KUMAR: Great to see so much good work going on in that space because we really do want to understand that better so we have those good news stories to share and build on the positive things we can do. I know we're very close to close so I'm going to give each of you a chance to give our audience a final comment or takeaway, something you want them to take on in their work, based on this conversation. Alina, I'll go to you first.

ALINA MORAWSKA: Look I think, from me as a researcher primarily in my day-to-day life, I think we really need to make sure we understand more about emotional abuse specifically so that we can be more effective in preventing it and treating it. Having said that, though, I think it's really important that we recognise that, as a society, there are lots of tools that we already have in place and that we as practitioners who have access to training in many of these evidence-based interventions can already support parents in changing their behaviour and their approaches to raising children so that we prevent and decrease the likelihood that children will experience emotional and any other form of maltreatment.

RANI KUMAR: Thank you. It's fantastic that Triple P is free online for all Australian parents. I think that's a really important thing for people to know and be able to share with their networks. Divna, one takeaway?

DIVNA HASLAM: It's hard to distil it into a single thing but I think I have a message of hope. The data is really confronting and staggering but now that we have it we have the opportunity for change and we've seen changes in some areas of maltreatment. In sexual abuse, for example, we see is lowering in younger people and I really think we have the potential to reduce emotional abuse in children if we sufficiently invest. If governments get together and we invest in prevention and we invest in early intervention, we can actually reduce the prevalence of emotional abuse.

RANI KUMAR: That's a great note to end on. Thank you so much, Alina and Divna, for all your wisdom shared with us today. Thank you to the audience for your active participation. Sorry we didn't get to all your questions but there will be some more added to this webinar, if you come back to the recording, which is really important. And a thank you to the AIF’s communications team. You guys set us up really well. Thank you for the opportunity to have this conversation. 

For more information about the ACMS, as Divna mentioned, there is a website with all the details and the data and ways to get involved in promoting more action in this space. Do subscribe to the AIF newsletters and social media to be notified about when the recording's available online. It will include that extended question-and-answer session that I just mentioned. We'll address some of the questions that we didn't quite get to in this live session. 

And there is a feedback survey. Please do send your thoughts through and there are other NAPCAN Child Protection Week webinars still going on. It's not too late to register for them so please do hop onto the NAPCAN website for those ones. And there's an AIF’s webinar on Supporting children bereaved by domestic homicide next week as well, if you want to hear more about that. And also, if this webinar has raised any issues for you, please don't hesitate to reach out for help. Those service numbers are still in the chat. 

Thank you all for joining us today and take care and we'll see you again soon.

DIVNA HASLAM: Thanks, Rani.

ALINA MORAWSKA: Thank you.

RANI KUMAR: Thanks for joining the extended question and answer session. We had a lot of questions in the live webinar and we're going to try to get to a few of them now. I think I might start with you, Divna. Do you have any advice for parents in the context of family violence? A lot of practitioners online today were asking about what we could do to support parents who might be in that situation.

DIVNA HASLAM: It's a tricky one. Our data shows that a lot of young people were growing up in homes where they witnessed, in some capacity, family violence or exposure to domestic violence. I think the really hard thing is that the parent has to try and look after themselves and also try to support the child to the extent that they can. And of course the ACMS wasn't about family violence in particular but there's lots of data that suggests that leaving can be particularly dangerous for some people and the ongoing exposure, of course, to violence can be detrimental for the individual and also for the children. Really, my advice would be to get appropriate support and to be able to navigate it as safely as they can.

RANI KUMAR: There's a related question to this here, in the context of domestic and family violence, which is about coercive control. Do you have any reflections in your study about where coercive control sits within emotional abuse and exposure to domestic violence?

DIVNA HASLAM: I think it's important to be aware of our definitions. In terms of exposure to domestic violence, we're really talking about children witnessing violence between parents and other parental caregivers, so between a mum and her boyfriend or between mum and dad or something like that. And we assess things like seeing physical violence, seeing emotional violence, threats and intimidation and also violence to property and things like that. It's highly likely that our data on exposure to domestic violence covers witnessing that coercive control between parents. That's one part of the answer is that many kids that are exposed to family history and are witnessing that kind of potential coercive control between their parents, may be also more likely to be experiencing emotional abuse. 

In our data, we looked at the overlap between different forms of maltreatment and in the top six most common patterns of multitype maltreatment, exposure to domestic violence featured in all of them and emotional abuse featured in four of them. That tells us that when we're hearing someone's in an environment where they're witnessing domestic or family violence there's a higher likelihood that there may also be emotional abuse going on and it may be from the perpetrator of the violence or it may be in fact the other parent becomes they don't have the capacity to handle all of that. For practitioners, it's really about doing thorough investigations. If you know there's family violence, investigating are there other forms of maltreatment, if so how do you go about treating and preventing those in a trauma-informed approach. 

RANI KUMAR: One more related question is if you looked at mothers and fathers or different caregivers and in terms of perpetration of the views but also if you saw any different impacts depending on who the perpetrator was?

DIVNA HASLAM: Yes, that's a good question. We have two papers coming out looking at the offender types, so who's perpetrating abuse, but they are on physical abuse and sexual abuse. It is possible, based on our data, to look at that for emotional abuse and it would be useful for us to know, for example, is it mostly mothers or mostly fathers or stepparents that are engaging in this kind of emotional abuse and that's something that we will be investigating as time goes on. Similarly, the impact of that. Is it worse if it's a parent? I suspect it probably is but that's something we're still to investigate.

RANI KUMAR: And Alina, I'll go to you with this one because it really does relate to that sense of ongoing impacts in the child's life. The child will eventually be an adult and perhaps become a parent so we do know that Triple P program that we spoke about in this webinar is generally trauma-informed throughout the coursework. But is there any specifically tailored program for parents of children who've experienced severe trauma themselves, such as sexual or emotional abuse, and how to support those adults through dealing with their own trauma while still trying to parent effectively and appropriately? Do you have any comments or ideas on that one?

ALINA MORAWSKA: I think there's probably a few different threads here. One is that there are in fact new interventions that we've developed called Family Lifestyles Triple PPP that is specifically trying to target parents who have, in their own family of origin, experienced trauma. We've done some evaluations of that and we are doing some more tests of that at the moment. 

The other point to make too is that Triple PPP has been used with millions of families around the world now. And while we don't necessarily have specific data for those who might have experienced trauma, given the prevalence rates of trauma, chances are at there are families who have experienced trauma who've gone through the program and we know that it's effective for families in general. 

But the other thing to note, of course, is that if an individual is experiencing the effects of that trauma for themselves, if they are experiencing mental health difficulties, substance abuse disorders or whatever else in their own personal life, that it is really important that they get support for that as well. Parents need to look after themselves in order to be effective and positive and nurturing and looking after their own children.

RANI KUMAR: Absolutely. And that goes back to our conversation earlier about providing those universal supports that are quality and accessible for all. I think we can end on this one, which is an important one overall. We touched on stigma and how hard it can be for parents to seek help. There were questions coming up about how do you recommend a parenting program to someone even if you're in a professional relationship as a practitioner, if you're in a mother's group, a playgroup or a friend at school or a schoolteacher. How generally might you approach this topic with someone if you're feeling that they might benefit from something like this?

ALINA MORAWSKA: I think that's an excellent question and I think even before we get to that point about how do we address - when we see something like this - this is where those public health campaigns are so important. Because if we can create a situation in society where we'd all take responsibility for supporting families and children, where everyone recognises the value of raising children, it becomes so much easier for anyone to step in and say, 'Well, hey look, looks like you need a bit of support. I've been to this great program, I went along to this playgroup', or whatever it might be. I think that's a really really important thing that we can all really barrack for. 

And then in terms of the individual level, it's so important just to normalise, because as we've talked about in the main session, every parent experiences challenges. It doesn't come naturally to parents so every one of us who has ever raised children will have experienced difficulties, stresses. Even those of us who are parenting experts will have experienced these challenges. So, normalising that and acknowledging that it's not an easy role can go a long way to engaging parents effectively in that.

And then, of course, if somebody is in a more professional role, then asking parents about their experiences and really listening to them and what they want for the children, what sorts of things they want for their family, that can be an avenue, too, to having that conversation about 'well, if you want things to be different, if you want your relationship with your child to be better, here are some options for how you might go about improving that relationship'. 

RANI KUMAR: Thank you so much for that. At NAPCAN we've definitely found speaking to practitioners and people running fantastic programs nationally that it is really leading with the benefits and putting the child at the centre that helps bring people along. You might try to have a recommendation and parents are like 'I'm not sure about that' but you say, 'You know, Johnny would benefit or Johnny would probably do this', and they're like, 'Oh, yeah, okay'. It is really opening those doors by really centering the child and the best interests of the child and bringing the parents along but obviously being strengths-based and making them feel definitely valued in that journey. 

Learnt so much from the two of you. Thank you so much for your contributions today. Really enjoyed the discussion and thank you to the AIF’s team once again for helping us and supporting us in setting this up. See you all next time.