IntroductionHuman Computer Interaction
The factors most commonly associated with the occurrence of child abuse and neglect, and identifed
in families involved with child protection services, are domestic violence, parental substance abuse and
parental mental health problems (Cleaver, Nicholson, Tarr, & Cleaver, 2007; Cleaver, Unell, & Aldgate,
1999; Scott, 2009). The signifcance of parental substance misuse, mental health problems and domestic violence is made clear in the National Framework for Protecting Australia’s Children, which states
“A particular focus is sustained on key risk factors of mental health, domestic violence and drug and
alcohol abuse” (Council of Australian Governments, 2009, p. 21). Families in which parents present
with these problems are often situated within a wider context of exclusion and disadvantage (e.g.,
housing instability, poverty, low education, social isolation and neighbourhood disadvantage). Parents
may also be struggling to come to terms with their own experiences of trauma and victimisation. These
types of problems are complex, often inter-related, and chronic in nature and rarely occur in isolation.
Where these problems occur within families, the families are described as “families with multiple and
complex problems”.
no. 33 2010
NCPCissues
N a t I o N a l C h I l d P r o t e C t I o N C l e a r I N g h o u s e
Issues for the safety and wellbeing of
children in families with multiple and
complex problems
The co-occurrence of domestic violence, parental
substance misuse, and mental health problems
Leah Bromfeld, Alister Lamont, Robyn Parker and Briony Horsfall
NCPC
Families with multiple and complex problems are no longer a marginal group in service delivery.
In fact, they have become the primary client group of modern child protection services. the
challenge for child protection services is to respond holistically to address inter-related problems,
in order to better support families to make and sustain changes to better meet the needs of
children.
| 2
NCPC Issues are refereed papers. For a complete list and the full text of the papers in
the NCPC Issues series, visit the National Child Protection Clearinghouse website at
www.aifs.gov.au
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<www.ag.gov.au/cca>.
the australian Institute of Family studies is committed to the creation and dissemination
of research-based information on family functioning and wellbeing. Views expressed in
its publications are those of individual authors and may not reflect those of the australian
Institute of Family studies or the australian government.
australian Institute of Family studies
level 20, 485 la trobe street, Melbourne VIC 3000 australia
Phone: (03) 9214 7888 Fax: (03) 9214 7839
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The National Child Protection Clearinghouse has operated from the
Australian Institute of Family Studies since 1995. The Clearinghouse
is funded by the Australian Government Department of Families,
Housing, Community Services and Indigenous Affairs as part of its
response to child abuse and neglect. The Clearinghouse collects,
produces and distributes information and resources, conducts
research, and offers specialist advice on the latest developments
in child abuse prevention, child protection, out-of-home care and
associated family violence.
The authors
Dr Leah Bromfeld is an associate Professor and deputy director
of the australian Centre for Child Protection at the university of
south australia. Alister Lamont is a research offcer for the
National Child Protection Clearinghouse at the australian Institute
of Family studies. Robyn Parker is a senior research offcer for
the australian Family relationships Clearinghouse at the australian
Institute of Family studies. Briony Horsfall is a research offcer at
the australian Institute of Family studies.
This paper investigates the separate impacts of
parental substance misuse, domestic violence
and parental mental health problems. It presents
evidence regarding the extent to which these
problems co-occur and a discussion of the wider
context of exclusion and disadvantage, its causes and its consequences. Finally, it provides an
overview of research and theory for working with
families with multiple and complex problems.
Families with multiple and complex problems are
families with multiple, chronic and inter-related
problems, the constellation of which can result in
children’s needs being unmet, and children being
at heightened risk of abuse and neglect (Cleaver
et al., 2007; Cleaver et al., 1999).
how do drug and alcohol misuse,
mental health problems and
domestic violence affect parenting?
Substance misuse, mental health problems and
domestic violence are commonly associated with
child protection involvement and are described
as “key risk factors” for child abuse and neglect.
There is substantial research documenting the association between these parental problems and
poor outcomes for children. Children are particularly vulnerable to cumulative harm in families
with multiple and complex problems in which the
unremitting daily impact of multiple adverse circumstance and events has a profound and exponential impact on children, and diminishes their
sense of safety and wellbeing (Bromfeld & Miller,
2007). Despite the strong association between
these parental problems and child protection,
there is limited guidance for practitioners that sets
out exactly how these problems affect parenting.
The focus of this section is to identify the adverse
effects of parental mental health problems, substance misuse and domestic violence on individuals, their parenting behaviours and the consequent
immediate risks to children.
This paper does not investigate the subsequent
long-term effects of abuse and neglect on children.
Contents
How do drug and alcohol misuse, mental health problems
and domestic violence affect parenting? 2
The co-occurrence of parental mental health problems,
substance misuse and domestic violence 11
Social exclusion: The wider context of multiple and
complex problems 13
Trauma histories of parents with multiple and complex
problems 13
Responding to families with multiple and complex problems 13
Practice considerations 14
The structure of the service system: A whole-of-government
approach to service delivery 18
Early intervention and capacity building in an integrated
service system 20
References 21
Acknowledgments 23
NCPC Issues 33 2010 | 3
For more information on the long-term effects of abuse and neglect for adult survivors, see
Lamont (2010).
It is important to note that the severity and longevity of the effects of parental substance misuse, mental health problems and domestic violence on children depend upon the nature, extent and severity of the problem and manner in which it affects the individual. Not all children
whose parents experience mental health problems, substance misuse or domestic violence will
experience poor outcomes. For example, in a meta-analysis of 118 studies, Kitzmann, Gaylord,
Holt, and Kenny (2003) found that 37% of children who had witnessed domestic violence had
comparable or better outcomes than children from otherwise similar backgrounds who had not
witnessed domestic violence. The extent to which parenting capacity is sustained or diminished
and children are at risk of abuse or neglect is also influenced by the presence of protective
factors. Responses within families are diverse; some children are able to experience supportive
and nurturing environments despite the presence of parental problems. This section draws on
research about mental health problems, substance misuse and domestic violence to unpack how
these problems can affect individuals, their capacity to parent and, in turn, their child’s risk of
experiencing abuse or neglect.
despite the strong association between these parental problems and child protection there is limited
guidance for practitioners that sets out exactly how these problems affect parenting.
how can parental substance misuse affect parenting?
Individual impacts
„ there are many different types of licit and illicit substances. the substances most commonly
involved in parenting concerns are alcohol, opiates (heroin, cocaine), amphetamines (ecstasy,
speed), psychoactive drugs (marijuana) and the overuse of prescription drugs.
„ substance use affects the brain, impairing the senses (e.g., blurred vision, impaired hearing),
perception (e.g., reaction time, balance), motor skills (e.g., impaired coordination, shaking),
speech and judgement (e.g., reason, caution, self-restraint, inhibitions). depending upon the
nature of the substance, it may act on the brain as an accelerant (e.g., methamphetamine) or
a depressant (e.g., alcohol). some substances can induce violence (e.g., alcohol) or paranoia
(e.g., “ice”) in some users. substance misuse may result in extreme lethargy, tiredness, lack of
consciousness or “passing out”, coma and death.
„ Withdrawing from addictive drugs can also have severe adverse affects such as increased
anxiety, irritability, sleeplessness, depression, vomiting and paranoia (NsW department of
Community services, 2004).
„ there are serious long-term health effects for chronic substance misuse (e.g., cancer, liver failure, heart disease), which may themselves impair functioning (Commonwealth of australia,
2007; NsW department of Community services, 2004).
„ Maintaining a substance addiction may include involvement in drug dealing (as a buyer or supplier) or criminal behaviour such as shoplifting, burglary or prostitution as individuals attempt
to fnance their drug habit.
4 | australian Institute of Family studies
Impacts on parenting behaviour
„ symptoms of intoxication and withdrawal may mean that parents fnd it diffcult to maintain
household tasks and routines such as preparing meals, ensuring the child’s clothes are clean,
supervising children, maintaining regular routines for school attendance and responding to their
children’s emotional needs (dawe, harnett, & Frye, 2008)
„ Financial diffculties may arise as parents may ignore buying household essentials such as food,
clothes and bills in order to pay for drugs (dawe et al., 2007).
„ substance misuse influences a parent’s mood and can cause inconsistent parenting as a result
of fluctuating mood swings, which may result in parents on some occasions using controlling,
authoritarian and punitive parenting and, at other times, permissive and neglectful parenting
styles (dawe et al., 2007). Parents themselves have reported yelling more often, being inattentive, being more self-focused, using reactive or authoritarian parenting, creating an atmosphere
of secrecy and allowing the child to take on a parenting-type role when affected by substance
misuse (odyssey house Victoria, 2004).
Risks to children
„ there is a high risk of neglect for children whose parents misuse substances. For example, poor
supervision may lead to children’s needs not being met (having regular healthy meals, clothes
being washed, attending school, emotional attention and nurturing) (dawe et al., 2007).
„ Children are at risk of physical and emotional abuse if a parent’s response to intoxication or
withdrawal symptoms is violent, reactive or punitive (dawe et al., 2007). they may also be
at risk of sexual abuse by a parent if the parent has a predisposition to abuse due to loss of
inhibition (dawe et al., 2007). Children are also at risk of sexual abuse from extra-familial perpetrators, especially when the child is at risk of supervisory neglect. exposure to drug use, drug
overdose, drug dealing and other criminal activity is also possible (dawe et al., 2007).
„ Children may develop pervasive fears: of fghts and violence (to parent or themselves); of discovery of family secret and the parent being incarcerated or the child being removed; or for parents’
wellbeing and safety.the added emotional stress can harm the development of children’s brains
and impair cognitive and sensory growth (Perry, 2001). therefore children are at risk of poor developmental outcomes. Fears may trap children into a position where they cannot discuss their
parent’s drug problems or ask for help—from their parents, their peers, other family members,
family support networks or professionals (dawe et al., 2007; odyssey house Victoria, 2004).
„ even before birth, babies in the womb experience the adverse effects of poor diet, drugs and
alcohol use, or violence perpetrated on their mother. Maternal stress experienced during pregnancy can cause physiological stress responses in the foetus, which affect the amount of oxygen and nutrition received by the unborn child (rice, Jones, & thapar, 2007). other peri-natal
complications may include withdrawal symptoms and premature births (Kroll & taylor, 2003;
tunnard, 2002).
NCPC Issues 33 2010 | 5
how can domestic violence affect parenting?
It is vital to consider violence between intimate partners in the context of parenting, as research
shows that violence between intimate partners is more likely to occur between couples with children, often commencing during pregnancy (taft, 2002). Violence between intimate partners is
overwhelmingly a gendered issue with the vast majority of incidents involving a female victim and
male perpetrator (australian Bureau of statistics, 2005). While acknowledging that there are other
patterns of violence (australian Bureau of statistics, 2005), in this paper we address the issues
presented by this dominant pattern of men’s violence towards women.this is evident in the way in
which parenting impacts are delineated below for mothers as victims and fathers as perpetrators
of intimate partner violence.
Individual impacts
„ Physical assaults may result in a range of injuries (e.g., bruising, scratches, cuts, burns, bone
fractures). long-term physical assault may result in reduced mobility, long-term adverse health
effects, disability, miscarriage and sexual and reproductive health problems. a Victorian study
showed that domestic violence is “responsible for more ill-health and premature death in Victorian women under the age of 45 than any other of the well-known risk factors, including high
blood pressure, obesity and smoking” (Vichealth, 2004, p. 8).
„ there is a well-established relationship between the experience of intimate partner violence and
mental health problems (e.g., depression, anxiety, trauma, self-harming and suicide) (Campbell,
2002; golding, 1999; Krug, dahlberg, Mercy, Zwi, & lozano, 2002; Vichealth, 2004). although
not as strong, there is also an association between the experience of domestic violence and substance misuse (golding, 1999; see previous and following sections for discussions of substance
misuse and mental health problems).
„ domestic violence includes sexual assault by an intimate partner (heenan, 2005). In a national
survey of australian women, 12% reported experiencing sexual violence perpetrated by a current or former partner. of women who were sexually assaulted by their partner, 73% were also
physically assaulted (Mouzos & Makkai, 2004).
„ domestic violence is linked with homelessness and housing instability for victims fleeing violent
partners. data from the supported accommodation assistance Program (saaP) for 2007–08
show that the main reason females with children sought support was domestic or family violence (50%) (australian Bureau of statistics, 2006). around 100,000 australians are homeless,
including 7,483 homeless families (10,608 parents and 16,182 children). of this homeless
population, 12% are children under 12 years (most accompanied by a parent) and a further
21% are aged 12–18 years (these children are mainly on their own) (australian Bureau of
statistics, 2006).
„ at its most extreme, domestic violence can result in death. In australia, approximately 20–25%
of all homicides were perpetrated by spouses (Mulroney, 2003).
6 | australian Institute of Family studies
Characteristics of perpetrators
„ Perpetrators of domestic violence have been shown to display the following characteristics
towards their partners:
— control;
— entitlement;
— selfshness and self-centredness;
— superiority;
— possessiveness;
— confusion between love and abuse (e.g., claiming they would not become violent with their
partner if they did not love the partner so much);
— manipulation;
— externalisation of responsibility;
— denial;
— minimisation; and
— victim blaming (Bancroft & silverman, 2002).
„ service providers are cautioned to avoid making assessments about violent men’s propensity
for future violence based on self-reports. Men who are violent towards their partners may make
strong anti-violence statements while continuing their violent behaviour (Bancroft & silverman,
2002). In terms of adverse effects, perpetrators of domestic violence may experience homelessness, housing instability, relationship breakdown, separation from their children, loss of contact
with their children and disintegration of father–child relationships, criminal charges, prosecution, and incarceration as a result of their violent behaviour.
Impacts on parenting behaviour
Mothering
„ Mothers who have experienced domestic violence are frequently held responsible for “failing
to protect” their children (holt, Buckley, & Whelan, 2008) but research shows that the majority
of mothers make considerable efforts to protect their children (Mullender et al., 2002). Women
may actually choose to remain with violent partners as they consider it too dangerous to leave.
With evidence that violence frequently continues and may actually increase after separation
(holt et al., 2008) such fears cannot be discounted. these fndings suggest that a blaming approach with mothers is unlikely to be helpful.
„ effects of violence (e.g., pain, distress, anger, irritability, fear, reduced mobility, hospitalisation)
may affect a mother’s parenting capacity, as may mental illness or substance misuse problems
that emerge as a consequence of domestic violence (see previous and following sections). domestic violence may result in mothers being emotionally distant, unavailable or unable to meet
their children’s needs (holt et al., 2008).
I didn’t have the same patience with the children when he was there, because I think I was
frightened he was going to lose his temper. (Mother in Mullender et al., 2002)
NCPC Issues 33 2010 | 7
„ In their attempts to prevent or manage men’s violence, and as a result of living in fear, mothers
have reported prioritising their partner’s needs over those of their children and denying their
children normal childhood experiences (humphreys, houghton, & ellis, 2008; holt et al., 2008,
p. 801). “I was so hooked into placating him that I emotionally neglected the kids” (mother in
Mullender et al., 2002).
„ evidence suggests that violence can damage the mother–child relationship. Belittling, undermining, insulting and hitting women in front of their children may affect children’s respect for
their mother’s authority (Bancroft & silverman, 2002; humphreys, 2007), and her ability to
exercise authority and control over her children (holt et al., 2008).
„ It is worth noting that some research suggests that the effects of domestic violence on mothering may not be permanent. a study in the united states found that women who had experienced intimate partner violence in the past but were no longer victims had signifcantly
better scores on a self-reported measure of parenting skills than women who were currently
experiencing violence from an intimate partner. there was no signifcant difference between
women who had experienced intimate partner violence in the past and women who had never
experienced intimate partner violence (Casanueva, Martin, runyan, Barth, & Bradley, 2008). on
a similar theme, children who had escaped domestic violence with their mothers predominantly
felt that their fathers were to blame and reported wanting to stay with and support their mums
(Mullender et al., 2002).
Fathering
„ there is limited research regarding the effects of domestic violence on father–child relationships
or on men’s capacity to father. the fathering practices of men who are violent towards their
intimate partners will vary along a continuum of abusive to optimal parenting. It has been argued that men who perpetrate family violence cannot be fully responsible parents, as exposing
children to domestic violence is in itself abusive (Bancroft & silverman, 2002).
„ Based on their clinical experience Bancroft and silverman (2002) identifed common parenting
characteristics of men who were violent towards their spouses. the characteristics, which are
further validated from other empirical evidence, suggest that men who were violent towards
their spouses were more likely to:
— have developmentally inappropriate behavioural expectations of children (Fox & Benson,
2004);
— generally be under-involved with their children and less physically affectionate but, at times
(and unpredictably), to be powerfully present in the child’s life, interacting with energy and
humour, and spending money freely;
— be authoritarian and rigid when involved in the disciplining of children, and self-report being
more likely to use physical punishment and to “smack hard” (Fox & Benson, 2004);
— be self-centred and put their own wants above the needs of their children, or even believe
that children exist to meet their fathers’ needs (Fox & Benson, 2004; Mullender et al., 2002);
— behave in a manner that suggests they are resentful for their children being the centre of
attention (humphreys et al., 2008; radford & hester, 2006);
8 | australian Institute of Family studies
— undermine (in addition to being violent towards her) their children’s mother by overruling
her parenting decisions, ridiculing, belittling and insulting her in children’s presence or to
children, and telling children that their mother is a bad or unsafe parent (humphreys, 2007;
holt et al., 2008; radford & hester, 2006);
— be manipulative with their children: for example, creating confusion about which family
members are responsible for violence and encouraging children to blame themselves or their
mother (radford & hester, 2006); and
— make statements and express emotions regarding their love and pride for their children
and desire to be involved in their children’s life, despite the confusing reality of their underinvolvement (rothman, Mandel, & silverman, 2007).
„ Children’s reports of the damage or disintegration of the father–child relationship as a result
of domestic violence focus on betrayal of trust, loss of respect, seeing their father as a source
of fear and terror, loss of love, and hatred for their father (Mullender et al., 2002). “We do not
see my dad now and don’t want to see him. I am happy about not seeing him” (8-year-old girl
in Mullender et al., 2002).
Risks to children
„ the term “witnessing” domestic violence may imply that children are passive observers who see
or hear the violence between the adults in their home but research shows that children experience domestic violence rather than being passive onlookers.
„ In a us study, mothers reported that:
— 37% of children were accidentally hurt during domestic violence;
— 26% of children were intentionally hurt during domestic violence;
— 49% of mothers were hurt protecting children;
— 47% of perpetrators used the child as pawn to hurt mothers;
— 39% of perpetrators hurt mothers as punishment for children’s acts;
— and 23% of perpetrators blamed mothers for perpetrator’s own excessive punishment of
children (Fox & Benson, 2004).
„ Children are sometimes hurt as a part of the torture and abuse of their mothers. they may be
held hostage or threatened. Children may also be forced to watch or perpetrate the abuse of
their mother, other siblings or pets (humphreys et al., 2008; radford & hester, 2006).
„ the psychological effects of witnessing verbal, physical and sexual assaults perpetrated upon
the mother, combined with the effects of living with a father who is frightening, inconsistent,
intolerant, and unable to put children’s needs frst are abusive.
„ the toxic stress and complex trauma caused by living in a perpetual state of alert can damage
the developing brain and have profound long-term psychological effects (Perry, 2001).
„ Children living with domestic violence display physical, developmental, psychological and behavioural effects, as well as the impact of trauma and developmental regression. Compared to
those who don’t witness abuse, children who do have been shown to have signifcantly poorer
outcomes on 21 childhood psycho-social, developmental and behavioural dimensions. Behav
NCPC Issues 33 2010 | 9
ioural problems include acting out, violence and aggression towards others. outcomes for child
witnesses were similar to those where children were also directly physically abused (Kitzmann
et al., 2003).
„ Family violence has different effects on children at different ages. In utero, the mother’s physical
and emotional distress has a direct impact on the developing foetus (Jordan & sketchley, 2009).
assault of the mother may result in miscarriage, premature birth, physical injury or disability
(Cleaver et al., 1999; Mcgee, 2000). Infants and younger children are at risk of being harmed
while being held in the mother’s arms during an assault; older children may be harmed while
intervening to defend their mother from assault (humphreys et al., 2008).
„ the presence of domestic violence puts children at high risk of experiencing physical abuse with
rates of co-occurrence ranging from 45% to 70% (holt et al., 2008).
„ there is evidence that the presence of domestic violence also increases the risk of child sexual
abuse (holt et al., 2008). If children are sexually abused, they may also be less likely to disclose.
Perpetrator manipulation, threats and intimidation, damage to mother–child relationship and a
belief that their mother cannot protect them may delay or decrease the likelihood of disclosure.
„ the effects of domestic violence on women can result in mothers who are emotionally distant,
unavailable or unable to meet their children’s needs and therefore increase the risk of children
experiencing neglect.
how can parental mental health problems impact parenting?
Individual impacts
„ the term “mental illness” is usually used when referring to a specifc, diagnosable disorder, such
as schizophrenia, while the term “mental health problem” is broader and includes problems
that interfere with a person’s daily functioning but to a lesser extent than a “mental illness”
(huntsman, 2008).
„ the main mental health problems that are likely to affect parenting are depression, bipolar
disorder, schizophrenia, borderline personality disorder, post-traumatic stress disorder, and antisocial personality disorder.
„ depression is a mood disorder. symptoms include: depressed mood (sadness, emptiness); sleep
disturbances (either not being able to sleep well or sleeping too much); loss of interest, motivation and energy; diffculty in concentrating, in holding a conversation, in paying attention or
making decisions that used to be made fairly easily; and suicidal thoughts or intentions (american Psychiatric association, 1994).
„ Bipolar disorder is also a mood disorder, in which the individual experiences episodes of mania
and depression. Mania is an intense high where the person feels euphoric, may have elevated
self-esteem, be talkative, have reduced need for sleep and be easily distracted. the high quickly fades, after which intense depression is often experienced, which can be exacerbated by
rash decisions made while manic (e.g., spending too much money, misuse of drugs or alcohol)
(american Psychiatric association, 1994).
10 | australian Institute of Family studies
„ schizophrenia is a psychotic disorder typically emerging in adolescence or early adulthood that
may be triggered through stress. symptoms include: delusions; hallucinations; disorganised behaviour or speech; flattened or inappropriate emotions; and poor social interaction (american
Psychiatric association, 1994).
„ Borderline personality disorder is most commonly diagnosed in females and often where there is a
childhood history of unstable relationships, sexual abuse, family violence or neglect. Major symptoms are unstable relationships, poor or negative sense of self, inconsistent moods, impulsivity and
an intense fear of abandonment. symptoms are constant, enduring and affect most—if not all—
aspects of life and typically emerge during adolescence (american Psychiatric association, 1994).
„ Post-traumatic stress disorder occurs in response to a traumatic event. symptoms typically
emerge shortly after the event, but may take years to fully manifest. symptoms can be enduring
if untreated and include re-experiencing the trauma through nightmares; obsessive thoughts;
flashbacks; avoidance (of situations, people or objects that are reminders of the traumatic
event); and increased anxiety (american Psychiatric association, 1994).
„ antisocial personality disorder is sometimes referred to as psychopathy or sociopathy and is
characterised by a pervasive disregard for others’ rights. It is preceded by a history of conduct
disorder through childhood and adolescence, marked by violations of norms relating to aggression towards people and animals, destruction of property, deceitfulness or theft, or serious violation of rules. other characteristics that may be associated with this disorder include engagement
in unlawful behaviour; being arrogant, opinionated and superfcially charming; indifference to
others’ wishes, rights or feelings; being deceitful and manipulative; impulsiveness; aggression
and irritability; reckless disregard for their own or others’ safety; being irresponsible with respect
to work and money; and showing little remorse (american Psychiatric association, 1994).
Impacts on parenting behaviour
„ research on the effects of mental health problems and their effects on parenting is limited.
research that has been done has mainly concentrated on depression (huntsman, 2008).
„ the symptoms of a mental health issue can influence a parent’s perception, cognition and communication (hegarty, 2005; NsW department of Community services, 2004). Problems in parenting associated with mental health conditions have included being emotionally unavailable,
withdrawn, unresponsive, overly critical, being disorganised, inconsistent, tense, less happy and
active with children (Mowbray et al., 2000).
„ diffculty controlling emotions can cause parents to become unnecessarily angry with their children.a mental health problem may make it diffcult for parents to get out of bed in the morning
to take their children to school. a loss of motivation can also cause diffculties in performing
basic tasks such as doing housework or the shopping (hegarty, 2005).
„ the characteristics of antisocial personality disorder can lead to a lack of responsible parenting
in the areas of safety; hygiene; nutrition; responsive nurturing of feelings; dealing adequately
with illnesses and physical injuries; and managing money for household goods. some parents
may be fearful of abusing their children and so become withdrawn, or alternatively they may
feel an intense need to protect their children and so appear intrusive and anxious (Newman &
stevenson, 2005).
NCPC Issues 33 2010 | 11
Risks to children
„ Children of parents with an uncontrolled mental illness face a high risk of physical neglect. Basic
needs may not be met, such as having regular healthy meals and clean clothes (Cowling, 2004).
Parents may fail to attend to children’s emotional needs, which can instil a sense of isolation and
possible mistrust in children. there are risks of physical and psychological abuse by parents, if
symptoms of illness contribute to the parent being violent, reactive or punitive (Cowling, 2004).
„ Parental mental health problems can also increase the risk of peri-natal complications due to possible side effects of medications, (e.g., antidepressants) during pregnancy and high stress levels
in mothers (Cowling, 2004; huntsman, 2008). attachment diffculties may arise for babies and
infants of mothers with maternal mental health problems such as depression (Cowling, 2004).
„ Children may become “parentifed” and assume the role of a carer for an ill parent or sibling.
this can cause signifcant emotional stress and disrupt a child’s general development (huntsman, 2008).
„ Children of parents with mental health problems have also been found to be at risk of developing
mental health problems of their own (Cowling, 2004). Problems in a child’s cognitive development
may also arise due to the parent’s inconsistent and neglectful behaviour (Cleaver et al., 1999).
„ the recklessness associated with antisocial personality disorder and the tendency of those suffering from it to minimise the harmful consequences of their actions can put a child at risk of
serious or chronic illness, injury and death. In addition, the promiscuity and poor relationship
choices made by some adults with antisocial personality disorder may put a child at risk of
abuse from others (Newman & stevenson, 2005).
the co-occurrence of parental mental health problems, substance
misuse and domestic violence
The previous section explored how mental health problems, substance misuse and domestic
violence individually affect parenting, the effects of which may diminish parenting capacity. This
in turn can place children at heightened risk of abuse and neglect. Individually, parental mental
health problems, substance misuse and domestic violence represent signifcant risk factors for
child abuse and neglect, but the reality is that parenting problems rarely occur in isolation. Instead, they tend to be part of a complex and inter-related group of problems.
Australian child protection services do not routinely provide data that report the characteristics
of parents involved with child protection. However, where data have been published, the co-occurrence of multiple and complex parenting problems—particularly parental substance misuse,
domestic violence and parental mental health problems—are the norm for Australian child protection clients. For example, data published in the report on the Special Commission of Inquiry
into Child Protection in New South Wales (Wood, 2008) showed that across 302,977 child protection reports in New South Wales during 2007–08, domestic violence (31%), drug and alcohol
problems (20%) and mental health (14%) featured prominently as one of the (up to) three issues
12 | australian Institute of Family studies
prompting the report (Wood, 2008, p. 130). Earlier data from Victoria show that in 2001-–02 the
four most frequent “concerning characteristics” of parents in investigated cases were:
„ domestic violence (40%);
„ substance abuse (25%);
„ alcohol abuse (21%); and
„ psychiatric illness (15%).
Additionally, the 2001–02 data were compared with data from 5-years earlier (1996–97) and it
was found that the number of families presenting to child protection with multiple and complex
problems was increasing over time (Allen Consulting Group, 2003).
Research investigating the parental characteristics of children on care and protection orders or
in out-of-home care in South Australia shows a similar pattern to the New South Wales and Victorian data. In a study on parental substance abuse and children in out of home care, the South
Australian Department for Families and Communities found that of the children entering care
due to a parental substance abuse problem, 69% of parents also experienced domestic violence
and 65% had mental health problems (Jeffreys, Hirte, Rogers, & Wilson, 2009).
One might look at these data and assume that, as they are based on the characteristics of parents referred to child protection services, the statistics represent “the worst of the worst” and
that most parents who experience either mental health problems, substance misuse or domestic
violence will not experience multiple problems. But research into domestic violence, substance
misuse and mental health as problems in their own right and separate from child protection or
parenting issues shows that individuals who experience any one of these problems are likely to
also experience other complex problems. For example, substance abuse has been identifed as
the most common co-morbid condition among people with a severe mental health issue (Hegarty, 2004). Often referred to as “dual diagnosis”, substance abuse and mental health problems
have been linked in large representative samples, particularly in clinical settings (Hegarty, 2004;
Stromwall et al., 2008). Prevalence estimates of substance abuse issues in mental health service
settings consistently report rates of over 25% with estimates of up to 80% (Todd, Sellman, &
Robertson, 2002).
Research also consistently indicates strong associations between domestic violence and substance misuse—particularly alcohol abuse (Chan, 2005; Lipsky & Caetano, 2008; Thompson &
Kingree, 2006). The Australian Bureau of Statistics Survey on Women’s Safety (1996) indicated
that 40% of physical or sexual assaults on women within a 12-month period involved the use
of alcohol. A review by Klostermann and Fals-Stewart (2006) also indicated strong relationships
between alcohol use and domestic violence in primary health care settings, drug and alcohol
treatment programs, family practice clinics and prenatal clinics. It has been argued that drug
use and heavy drinking, especially among men, may increase the risk of violence toward an
intimate partner due to its inhibiting effects on cognition and perceptions (Chan, 2005). Alcohol
and other drugs may also be used by victims of domestic violence to relieve the physical and
emotional pain of abuse (Chan, 2005).
Practitioners need to be aware that parents involved with child protection services are likely to
be experiencing multiple complex problems and that these problems do not just coincidently cooccur—they co-occur because they are inter-related.
NCPC Issues 33 2010 | 13
social exclusion: the wider context of multiple and complex problems
Families referred to child protection services are also commonly living within a broad context of
isolation and disadvantage. Social exclusion manifests through multidimensional and interlinked
problems—primarily poverty, but can also include unemployment, poor housing or homelessness,
crime, substance addiction, teenage pregnancy, victimisation, poor education or job skills, poor
health, lack of social capital and family dysfunction (Social Exclusion Unit, 2001). Bromfeld (2005)
concluded that the characteristics of “the socially excluded” mirrored many of the common risk
factors for child abuse and neglect and that the majority of families involved with child protection services were socially excluded. Furthermore, research has also shown that early childhood
trauma contributes to social disadvantage and exclusion (Frederick & Goddard, 2007). Poverty
and social exclusion are major causes of the problems that child protection services deal with in
practice, yet it is unrealistic to believe that child protection and family services practitioners have
the power to end poverty and social exclusion (Beckett, 2003; Munro, 2005).
Systemic responses to social exclusion require attention to be focused upon the causes of structural, relational and distributional disadvantage that contribute to exclusion (Room, 1995). The
role for practitioners is to focus upon the conditions and characteristics of the excluded, which
require redress through the provision of holistic or “joined up” services (e.g., to tackle homelessness, poverty and isolation). Practitioners need to be supported to think outside their service
silos and work with other services to ensure that the unique needs of families are met.
trauma histories of parents with multiple and complex problems
Frequently, parental substance misuse, domestic violence and mental health problems occur
as a precursor to or consequence of previous experiences of trauma and adversity, such as
physical or sexual assault or childhood experiences of abuse and neglect. For example, based
on data from the Adverse Childhood Experiences Study in the United States researchers found
that adults with four or more adverse experiences in childhood were seven times more likely to
consider themselves an alcoholic compared to other adults and fve times more likely to have
used illicit drugs (Felitti et al., 1998). Based on data from the National Co-Morbidity Survey in the
United States, adults who had experienced child abuse were two and half times more likely to
have major depression compared to adults who had not experienced abuse, and were six times
more likely to have post-traumatic stress disorder (Aff, Boman, Fleisher, & Sareen, 2009). Victims of child abuse or neglect or adult sexual and physical assault may be prone to revictimisation. Widom, Czaja, and Dutton (2008) found that all types of childhood victimisation (physical
abuse, sexual abuse and neglect) were associated with increased risks of lifetime revictimisation.
Other adverse outcomes associated with past histories of child abuse and neglect include homelessness, physical health problems, revictimisation, unemployment and eating disorders (Gilbert
et al., 2009; Johnson, Cohen, Kasen, & Brook, 2002; Kendall-Tackett, 2002).
responding to families with multiple and complex problems
In summary, parental substance misuse, mental health problems and domestic violence affect
parenting and place children at risk of abuse and neglect. Families with multiple and complex
problems are also often situated within a wider context of poverty and exclusion. In reviewing the
literature it is therefore evident that families with multiple and complex problems have emerged as
the primary client group of contemporary child protection services. This has several implications
for practice and for the structure and capacity of the child protection system.
14 | australian Institute of Family studies
Practice considerations
Child protection practitioners working with families with multiple and complex problems need
to recognise the whole experience of parents and children. Practitioners should be supported
and prepared to know how to respond to and work with these families as a matter of routine
practice.
Assessment
When making assessments of families with complex problems, knowing the types of problems
parents are experiencing (e.g., substance addiction and mental health problems) can help to
identify issues that may affect parenting (see the sections on impacts). However, it is not enough
to simply name such problems—assessments need to examine how such problems affect parental capacity and parent–child relationships. The diagnosis of a mental health or substance
abuse problem alone is not suffcient to determine risk (Benjet, Azar, & Kuersten-Hogan, 2003).
It does not really matter whether a family is experiencing one or six problems: what matters is
how such problems affect parenting and place children at risk of abuse and neglect. An assessment of parenting capacity therefore requires the identifcation of how the unique constellation
of problems and strengths in the family results in children’s parenting and safety needs being
met or not being met (NSW Department of Community Services, 2005). Assessing parent–child
interactions, the quality of the home environment, the parent’s perception of child behaviour,
the parent’s social support networks and his or her ability to solve problems is more important
for determining whether a child is at risk of abuse and neglect than simply identifying or diagnosing parental problems such as substance abuse (Mildon, Matthews, & Gavidia-Payne, 2003).
Box 1: What is trauma?
trauma theory provides a useful frame for understanding some of the adverse outcomes experienced by
adults with past histories of violence, abuse and neglect. trauma is the overwhelming and uncontrollable
feeling of intense fear, helplessness and loss of control in response to terrifying life events (herman, 1997).
trauma may be experienced as a single traumatic life event such as rape, a near-death experience or witnessing the torture or abuse of another person.trauma—particularly that which occurs within a domestic context
such as domestic violence or child abuse—can also be prolonged and repeated. herman (1997) equated the
experience of prolonged and repeated domestic violence and child abuse with being held hostage. In this
situation, herman argued, victims can become stuck in a present where their initiative is confned to thinking
not how they will escape but how they will survive.this narrowing of initiative becomes habitual and must be
unlearned to enable the survivor to participate in planning for the future.
traumatic events induce a wide range of debilitating symptoms that affect all aspects of life for survivors,
which can in itself constitute multiple and complex problems. acknowledging the diffculties that parents
may have coming to terms with their own experiences of trauma and victimisation and empathising with
their situation does not mean ignoring or excusing abusive or neglectful behaviour directed towards their
children. however, understanding parents’ past histories may better enable practitioners to determine the
underlying causes of parental problems, therefore helping them to engage parents and to assist them to
make positive change.
NCPC Issues 33 2010 | 15
Observing these aspects of a parent–child relationship can enable assessment results to have a
direct relationship with intervention planning.
Children’s knowledge and awareness of parent problems
Completing a functional assessment of the impact of parental problems on parenting behaviours
is important for identifying the risks for children. Practitioners will also fnd it worth exploring,
as part of the assessment, the extent to which children are aware of these problems. This will
inform the assessment, and may also be a powerful motivator for parents to change.
Parents may minimise or underestimate the impact of their problems on their children due to
their assumption that children have only a limited awareness of the problem, however, research
with children has shown that they know earlier and in greater detail about their parents’ problems than their parents believed (Dawe et al., 2007; Gorin, 2004; Humphreys et al., 2008; Mullender et al., 2002). Based on a review of the research, Gorin (2004) suggested that the average
age children became aware of their parents’ problems was between 4 and 5 years. Interviews
with children have shown that children were able to put the pieces together to form an accurate picture of what was happening in the household, despite parents’ attempts to shield them
(Dawe et al., 2007; Gorin, 2004; Mullender et al., 2002).
I don’t know really—it just kind of crept up on me. All I know is, one day I did know,
so it probably happened bit by bit from me not knowing to me knowing. Then I could
remember back when things happened when I was younger, but I didn’t think anything
of it—like when my mum had bandages and she said she banged herself. But now I
realize my dad must have done it, but they hid it from me and I just accepted that at the
time. We even made jokes about it—like how clumsy she had been to bash herself …
Mum and Dad, me, we all made those jokes. (15-year-old girl in Mullender et al., 2002)
Parents also reported that, while they tried to conceal their problems from their children, as the
problems escalated they became less able to put in place the necessary planning and controls
to prevent their child from fnding out (Dawe et al., 2007; Mullender et al., 2002). Sadly, there
was also evidence that parents’ attempts to control the situation to prevent their children’s discovery of the problem caused their children’s needs to be neglected in other ways (e.g., children
feeling rejected and unwanted as parents excluded them while trying to shield them from their
substance misuse. Children may be forced to constrain their natural desire for play and exuberance as it was a trigger for violence) (Dawe et al., 2007; Gorin, 2004; Mullender et al., 2002).
In the absence of communication between parents and children about parents’ problems, research
has shown that children frequently misattribute the cause of family or parental problems to
themselves (dawe et al., 2007; Mullender et al., 2002).
Planning an intervention strategy
When working with a parent who is dealing with multiple and complex problems, practitioners
are likely to have to try to support them on different fronts. Referring the family to a different
service or professional for each problem or trying to tackle all problems simultaneously will be
overwhelming for the family. An effective intervention is planned and purposeful, based on a
comprehensive assessment and staged to meet the family’s needs and capacities over time.
16 | australian Institute of Family studies
“Maslow’s Hierarchy of Needs” is a theory that can assist in the planning and prioritising of an
intervention in practice. Maslow suggested that humans have a natural drive to fulfl their potential but this cannot be achieved unless other, more basic needs are frst fulflled. According to
Maslow’s theory, individuals are unlikely to be able to focus on their intimate relationships and
connections if their survival and safety needs are not attended to frst (McAdams, 2006). Figure 1
is an adaption of Maslow’s hierarchy to indicate how these needs may be met in service provision.
Families with multiple and complex problems are often situated within a broader context of poverty and disadvantage. Therefore, parents may derive little beneft from or struggle to beneft from
counselling or parenting programs if they are unable to provide their children with appropriate
clothing, fx the car, or replace a broken window. Similarly, they may struggle to provide “good
enough” parenting if other, more pressing problems such as obtaining food and paying heating
bills have not been dealt with.
If families are overwhelmed with multiple and complex problems, a referral to another service that
provides material aid may not be optional but a necessary priority. Practitioners may need to then
follow through and assist a parent to navigate access to other services. It is only when parents are
able to meet the survival and safety and security needs of their family (see Figure 1) that they will
be ready to attend any form of parenting intervention.
Self-actualisation
reaching broader goals
Self-esteem
further education, job seeking
Belonging
parenting programs, social connections
Safety and security needs
e.g., safety from domestic violence, harm minimisation
Survival needs
e.g., emergency food vouchers, emergency housing
Figure 1. Maslow’s Hierarchy of Needs (McAdams, 2006)
NCPC Issues 33 2010 | 17
Effective parenting interventions
Once basic needs are met, interventions that deal with relational or self-esteem needs, such as
good parenting skills, can begin. Parenting is not necessarily something that one knows how to
do intuitively; it is learned (Waylen & Stewart-Brown, 2008). The degree to which each of the
tasks of parenting can be achieved is influenced by a range of factors, including:
„ the amount and type of material resources available to parents;
„ individual characteristics of the parents, including heredity;
„ parents’ own experiences of being parented and observing the parenting of others, their psychological make-up, relationships; and
„ parents’ broader circumstances (e.g., employment, health) (Quinton, 2004).
In a meta-analytical review of components associated with parenting intervention effectiveness,
Wyatt Kaminski, Valle, Filene and Boyle (2008) found that program components associated with
the greatest changes included increasing positive parent–child interactions, encouraging parents to
practise new skills, teaching parents to use “time out” and the importance of parenting consistency.
Further research suggests that effective parenting interventions include components that:
„ encourage one-on-one learning;
„ focus on strengths rather than defcits;
„ offer a shared empowerment to families;
„ build strong client–practitioner relationships that are predictable and reliable;
„ develop positive expectations for change and heightened self-effcacy;
„ enhance problem-solving capacity;
„ provide information that is clear and concise (not lengthy and complicated); and
„ praise parents wherever possible (Berry, 2010; Scott & Dadds, 2009; Wyatt Kaminski et al., 2008).
At times, the effects of parents’ other problems may influence their ability to take in and apply
knowledge and information, and to read, solve problems or follow complex instructions. It is
therefore vital that the factors that may diminish a parent’s capacity to learn new skills are attended to so that parents have the best possible chance of developing good parenting skills.
(See Box 2 on page 18 for strategies for assisting parents to learn new parenting skills).
Assisting to heal the parent–child relationship
Witnessing or experiencing abuse and neglect in the family not only carries with it direct and
indirect injuries to parents and children, but also undermines the parent–child relationships.
Redressing this damage takes time and requires that parents have reached a point at which they
can acknowledge that their parenting or the home environment has had a negative impact on
their child. Parents and children may beneft from specifc interventions designed to heal the
parent–child relationship (Humphreys, 2007). However, deciding to create the space to support parents and children to talk about their experiences of violence, abuse and neglect may
be painful and distressing for parents and children. Practitioners need to carefully prepare and
adequately support parents and children to be ready for interventions of this nature to avoid
causing further harm (Humphreys & Thiara, 2010).
18 | australian Institute of Family studies
Responding to adult trauma
Practitioners making assessments should include a thorough family history to identify whether
current problems, such as domestic violence, mental health problems and substance misuses,
are symptomatic of past traumatic events. Parents may need therapeutic intervention to assist
them to process the trauma they have experienced and to explore and develop more adaptive
coping strategies that will not impede their parenting capacity.
Box 3 identifes fve core empirically derived strategies that have been shown to help adults
recover from experiences of trauma.
the structure of the service system: a whole-of-government approach
to service delivery
Child protection service systems across Australia are struggling to meet the needs of families
with multiple and complex problems (Wood, 2008). This is not only because of a lack of
Box 2: Strategies to assist parents to learn parenting skills
For practitioners working with parents with learning diffculties, the healthy start website provides a range
of resources and tips. Many of these can also apply to work with parents experiencing other diffculties
such as mental health concerns and substance abuse.
„ take an empowering and proactive approach (e.g., structure tasks in ways that success is optimised:
i.e., in small, easily achievable steps).
„ use different methods to teach skills (modelling, video demonstration, realistic pictures, etc).
„ try to teach skills in context (i.e., where they will need to be applied—usually the home but perhaps at
the supermarket or on a train).
„ Play activities can be opportunities for modelling parenting skills, language and safety.
„ Be aware that the parents’ own negative experiences at school may still affect their attitudes towards
learning.
„ Materials may need to be adapted to suit the particular family: for example, helping them adapt skills
and knowledge to suit the age of their child.
„ Provide information in small chunks—avoid long explanations.
„ offer simple explanations (e.g., it is preferable to say: “doing things over and over helps kids learn”,
instead of saying: “repeating particular play activities fosters and reinforces the development of neural
pathways and builds their cognitive abilities and psychomotor skills”).
„ Make room for repetition, reinforcement and practice in different places or with different materials—
this helps parents to feel confdent in their ability to perform each step.
„ ensure activities ft the space available (i.e., play activities should be appropriate to the type of accommodation).
Source: Healthy Start (n.d.). Retrieved from www.healthystart.net.au/developing.php?p=practitioner_resources&r=practice_points.
NCPC Issues 33 2010 | 19
services for children and families but because the service system is designed as completely
separate organisations and agencies or, in effect, “silos” (Bromfeld & Holzer, 2008). Services
for children and families come from a variety of sources (and not just child protection departments) including other government departments (e.g., health, education, juvenile justice) and
the non-government sector, yet most services tend be focused on one problem. For example, a
parent with a dual diagnosis maybe referred from child protection to a rehabilitation service for
a substance abuse problem, but then referred on to a mental health service without either service providing background information on the family, or either service knowing that their client
is a parent. Worse still, a parent may be refused mental health services because of a substance
abuse problem. A further example of the diffculties with a “siloed” system is that families may
be unable to claim social welfare benefts due to homelessness or housing instability. Services
may be available (albeit often with a substantial waiting list) but families who need them these
services the most may not know how to access them. In many instances, a siloed service system
further compounds disadvantage and exclusion.
Box 3: Effective strategies for responding to trauma in adults
research on supporting an individual’s recovery from traumatic events has identifed fve core, empirically
derived strategies that have been shown to help:
Build problem-solving skills
structured problem solving may help when problems appear overwhelming. Working with adults and children in problem solving involves a 6-step process of: defning the problem; identifying possible solutions
together; evaluating these solutions; choosing a solution; planning a solution; and reviewing the plan.
Plan and do positive activities
encouraging adults and children to engage in positive activities may help them to feel more normal. Positive activities may include doing fun things with the kids, continuing family routines, having hope and
optimism, helping others, and spending time with friends.
Develop skills for managing distressing reactions
learning new strategies that may help to manage distressing reactions—for example, calming skills such
as controlled breathing.
Develop helpful thinking
helpful thinking is not the same as positive thinking. Focusing less on unhelpful thoughts and more on
helpful ones can help adults and children to move forward. For example, turning a thought such as “absolutely nothing is going well”, into “this is a tough time, but I am doing some things well” may help to
re-energise parents.
Develop supportive social connections
Working with adults and children to connect/reconnect with family, friends and others can assist in recovery.
Source: included with the consent of the Parenting Research Centre, which developed this content in association with the Australian Centre for
Post-traumatic Mental Health.
20 | australian Institute of Family studies
Bromfeld and Holzer (2008) concluded that, to respond more effectively to families with multiple and complex problems, a whole-of-government approach is needed that facilitates integrated working relationships between child protection and different government agencies
and the non-government sector (e.g., adult services, family support services and child care). A
systematic, multi-agency approach promotes multilateral departmental initiatives to protecting
children, whereby service provision is jointly funded between departments such as health, education, the police and child protection/communities in collaboration with the non-government
sector. A holistic approach promotes greater service collaboration and information sharing so
that families are provided with the most appropriate support (Wood, 2008). Services that have
frst contact with a family play a more active referral and linking role. Joining up services may
help to reduce situations where families with multiple and complex problems are referred from
one service to another where little or no history of the family is known before their frst visit.
An example of a whole-of-government cross-departmental approach to protecting children is
the Think Family program in the United Kingdom. The aim of the approach, developed in 2008,
is to make sure that the support provided by child, adult and family services is coordinated and
takes account of how problems affect the whole family. The initiative was designed to build on
the capacity of all services to reduce the negative impact on children of parents with multiple
and complex problems. The core principles of the initiative have been that:
„ there is no wrong door—contact with any service offers an open door to joined-up support;
„ services look at the whole family—they take into account family circumstances, and adult
services consider clients as parents;
„ services build on family strengths—relationship and strength-based engagement; and
„ services provide support tailored to need—rather than a “one size fts all” approach (Scott,
2009).
early intervention and capacity building in an integrated service system
Even with a whole-of-government approach, a key challenge will be to establish a service
system that leads to early identifcation of children and families who may have multiple and
complex problems before problems escalate. All services have a role to play in preventing children in such families from being abused or neglected and ultimately referred to tertiary child
protection services. Tertiary child protection services are designed to respond to abuse and
neglect situations where children have been harmed or are in immediate danger; they have a
limited capacity to prevent abuse and neglect. Unfortunately for many families, child protection
services are the frst point of contact for intervention (Higgins & Katz, 2008). The greatest challenge therefore is to suffciently resource flexible prevention and early intervention services to
help reduce the number of children requiring state intervention (Wood, 2008). In an integrated
service system, child protection services are a last-resort response and just one part of the child
and family welfare service system where universal services form the foundation.
In order for early intervention in an integrated service system to work, universal and secondary
services need to be available to all families (Higgins & Katz, 2008). Secondary services need to
be appropriately resourced with a highly skilled workforce to have the capacity to meet demand
(Wood, 2008). Building the capacity of adult-focused services (e.g., drug and alcohol services or
domestic violence programs) to be child-sensitive, and child-focused services to be more parent-sensitive are also important for developing better responses for families with multiple and
NCPC Issues 33 2010 | 21
complex problems (Scott, 2009). Ultimately, in an integrated system, adult services would be
able to determine frst if their clients were parents and then be able to refer the family to further
services that meet their needs. An integrated service system, prioritising early intervention and
prevention, can ease demand on tertiary child protection services and lead to better outcomes
for disadvantaged children and families.
Families characterised as having multiple and complex problems are likely to have experienced
either substance misuse problems, mental health problems or domestic violence or a combination of the three. Such families are also likely to be living within a context of isolation and disadvantage, putting children at even greater risk of abuse and neglect. It is therefore no surprise
that families with multiple and complex problems are the primary client group in child protection services. To improve service provision for such families, establishing an integrated service
system may strengthen the capacity of early intervention and prevention services, which may in
turn may ease demand on statutory child protection services.
references
Aff, T., Boman, J., Fleisher, W., & Sareen, J. (2009). The relationship between child abuse, parental divorce, and lifetime mental
disorders and suicidality in a nationally representative adult sample. Child Abuse and Neglect, 33, 139–147.
Allen Consulting Group. (2003). Protecting children: The Child Protection Outcomes Project. Melbourne: Victorian Department of
Human Services. Retrieved from <http://www.cyf.vic.gov.au/__data/assets/pdf_fle/0006/15828/ccd_protecting_children.pdf>.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: APA.
Australian Bureau of Statistics (1996). Women’s safety Australia (Cat. No. 4128.0). Canberra: ABS. Retrieved from <www.abs.gov.
au/ausstats/[email protected]/lookupMF/B62DEB3AC52A2574CA2568A900139340>.
Australian Bureau of Statistics (2005). 4906.0 Personal safety, Australia 2005 (reissue) Retrieved from <www.abs.gov.au/AUSSTATS/
[email protected]/productsbyCatalogue/0556FBD355B2719BCA2571C50074ABF2?OpenDocument>.
Australian Bureau of Statistics (2006). Australian Census analytic program counting the homeless 2006, (Cat. No. 2050.0). Retrieved
from <www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/57393A13387C425DCA2574B900162DF0/$File/20500-2008Reissue.
pdf>.
Bancroft, J., & Silverman, J. (2002). The batterer as parent: Addressing the impact of domestic violence on family dynamics. Thousand
Oaks, California: Sage Publications.
Beckett, C. (2003). Child protection: An introduction. London: SAGE Publications.
Benjet, C., Azar, S., & Kuersten-Hogan (2003). Evaluating the parental ftness of psychiatrically diagnosed individuals: Advocating
a functional-contextual analysis of parenting. Journal of Family Psychology, 17(2), 238–251.
Berry, M. (2010, September). Current trends in child abuse and neglect in the United States: What might Australians learn and
disregard from the evidence base? Paper presented at the Australian Institute of Family Studies Seminar Series, Melbourne.
Bromfeld, L. M. (2005). Chronic child maltreatment in an Australian statutory child protection sample. Unpublished PhD thesis,
Deakin University, Geelong.
Bromfeld, L. M., & Holzer, P. (2008). A national approach for child protection: Project report. Melbourne: Australian Institute of
Family Studies. Retrieved from <www.aifs.gov.au/nch/pubs/reports/cdsmac/cdsmac.pdf>.
Bromfeld, L. M., & Miller, R. (2007). Specialist practice guide: Cumulative harm. Retrieved from <www.dhs.vic.gov.au/offce-forchildren/cpmanual/Output%20fles/Practice%20research/Output%20fles/Execute/cumulative_harm_spg.pdf>.
Campbell, J. C. (2002). Health consequences of intimate partner violence. Lancet, 359(9314), 331–336.
Casanueva, C., Martin, S., Runyan, D., Barth, R., & Bradley, R. (2008). Quality of maternal parenting among intimate-partner
violence victims with the child welfare system. Journal of Family Violence, 23, 413–427.
Chan, C. (2005). Alcohol issues in domestic violence. Australian Domestic and Family Violence Clearinghouse Topic Paper 17.
Retrieved from <www.austdvclearinghouse.unsw.edu.au/PDF%20fles/Alcohol_Issues.pdf>.
Cleaver, H., Nicholson, D., Tarr, S., & Cleaver, D. (2007). Child protection, domestic violence and parental substance misuse: Family
experiences and effective practice. London: Jessica Kingsley Publishers.
Cleaver, H., Unell, I., & Aldgate, J. (1999). Children’s needs—parenting capacity: The impact of parental mental illness, problem
alcohol and drug use and domestic violence on children’s development. London: Department of Health, Stationaey Offce.
Commonwealth of Australia (2007). The winnable war on drugs. Canberra: CanPrint Communications Pty Ltd.
Council of Australian Governments (2009). Protecting children is everyone’s business: National framework for protecting Australia’s
children 2009–2020. Retrieved from <www.coag.gov.au/coag_meeting_outcomes/2009-04-30/docs/child_protection_
framework.pdf>.
Cowling, V. (2004). Children of parents with mental illness: Personal and clinical perspectives. Melbourne, ACER Press.
Dawe, S., Frye, S., Best, D., Lynch, M., Atkinson, J., Evans, C., et al. (2007). Drug use in the family: Impacts and implications for
children: Australian National Council on Drugs. Retrieved from http://www.ancd.org.au/images/PDF/Researchpapers/rp13_
drug_use_in_family.pdf
22 | australian Institute of Family studies
Dawe, S., Harnett, P., & Frye, S. (2008). Improving outcomes for children living in families with parental substance misuse: What
do we know and what should we do. Child Abuse Prevention Issues, 29. Retrieved from <www.aifs.gov.au/nch/pubs/issues/
issues29/issues29.html>.
Felitti, V., Anda, R., Nordenberg, D., Williamson, F., Spitz, A., Edwards, V., et al. (1998). Relationship of childhood abuse and household
dysfunction in many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245-258.
Fox, G., & Benson, M. (2004). Violent men, bad dads? Fathering profles of men involved in intimate partner violence. In R. Day
& M. Lamb (Eds.), Conceptualizing and measuring father involvement. Mahwah, New Jersey: Lawrence Erlbaum Associates
Publishers.
Frederick, J., & Goddard, C. (2007). Exploring the relationship between poverty, childhood adversity and child abuse from the
perspective of adulthood. Child Abuse Review, 16(5), 323-341.
Gilbert, R., Spatz Widom, C., Browne, K., Fergusson, D., Webb, E., & Janson, J. (2009). Burden and consequences of child
maltreatment in high-income countries. Lancet, 373 (9657), 68–81.
Golding, J. M. (1999). Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence,
14(2), 99–132.
Gorin, S. (2004). Understanding what children say: Children’s experiences of domestic violence, parental substance misuse and
parental health problems. London: National Children’s Bureau.
Heenan, M. (2005, April). International Violence Against Women Survey: Findings from the Australian component. In Aware:
Australian Centre for the Study of Sexual Assault Newsletter (6), 2-4.
Hegarty, M. (2004). Mind the gap. The National Illicit Drug Strategy (NIDS) project to improve support for children from families
where there are mental illness and substance abuse issues. Literature Review. Sydney: Mental Health Co-ordinating Council and
NSW Department of Community Services.
Hegarty, M. (2005). Supporting children affected by parental dual diagnosis—Mental illness and substance use—a collaborative
mental health promotion, prevention and early intervention initiative. Ausienetter, 25(3).
Herman, J. (1997). Trauma and recovery: From domestic abuse to political terror. London: Pandora.
Higgins, D. J., & Katz, I. (2008). Enhancing service systems for protecting children. Family Matters, 80, 43–50.
Holt, S., Buckley, H., & Whelan, S. (2008). The impact of exposure to domestic violence on children and young people: A review
of the literature. Child Abuse and Neglect, 32, 797–810.
Humphreys, C. (2007). Talking to my mum: Strengthening relationships between mothers and children in the aftermath of family
violence. Developing Practice, 19, 12–15.
Humphreys, C., Houghton, C., & Ellis, J. (2008). Literature review: Better outcomes for children and young people experiencing
domestic abuse—directions for good practice. Retrieved from <www.scotland.gov.uk/Publications/2008/08/04112614/0>.
Humphreys, C., & Thiara, R. (2010). Readiness to change: mother–child relationship and domestic violence intervention. British
Journal of Social Work, 40(3).
Huntsman, L. (2008). Parents with mental health issues: Consequences for children and effectiveness of interventions designed to
assist children and their families. Literature review. Sydney: NSW Department of Community Services. Retrieved from <www.
community.nsw.gov.au/docswr/_assets/main/documents/research_parentalmentalhealth.pdf>.
Jeffreys, H., Hirte, C., Rogers, N., & Wilson, N. (2009). Parental substance misuse and children’s entry into alternative care in South
Australia. Adelaide: South Australian Department of Families and Communities.
Johnson, J., Cohen, P., Kasen, S., & Brook, J. (2002). Childhood adversities associated with risk for eating disorders or weight
problems during adolescence or early adulthood. American Journal of Psychiatry, 159(3), 394–400.
Jordan, B., & Sketchley, R. (2009). A stitch in time saves nine. Preventing and responding to the abuse and neglect of infants. Child
Abuse Prevention Issues, 30. Retrieved from <www.aifs.gov.au/nch/pubs/issues/issues.html>.
Kendall-Tackett, K. (2002). The health effects of childhood abuse: Four pathways by which abuse can influence health. Child Abuse
and Neglect, 26(6–7), 715–729.
Kitzmann, K., Gaylord, N., Holt, A., & Kenny, E. (2003). Child witnesses to domestic violence: A meta-analytic review. Journal of
Consulting and Clinical Psychology, 71(2), 339–352.
Klostermann, K., & Fals-Stewart, W. (2006). Intimate partner violence and alcohol use: Exploring the role of drinking in partner
violence and its implications for intervention. Aggression and Violent Behavior, 11, 587–597.
Kroll, B., & Taylor, A. (2003). Parental substance misuse and child welfare. London: Jessica Kingsley Publishers.
Krug, E. G., Dahlberg, L. L., Mercy, J. A., Zwi, A. B., & Lozano, R. (Eds.) (2002). World report on violence and health. Geneva:
World Health Organization.
Lamont, A. (2010). Effects of child abuse and neglect for adult survivors (NCPC Resource Sheet). Melbourne: National Child Protection
Clearinghouse, Australian Insitute of Family Studies. Retrieved from: <http://www.aifs.gov.au/nch/pubs/sheets/rs20/rs20.html>
Lipsky, S., & Caetano, R. (2008). Is intimate partner violence associated with the use of alcohol treatment services? Results from the
National Survey on Drug Use and Health. Journal of Studies on Alcohol and Drugs, (January), 30–38.
McAdams, D. (2006). The person. A new introduction to personality psychology (4th ed.). Hoboken, New Jersey: John Wiley &
Sons, Inc.
McGee, C. (2000). Childhood experiences of domestic violence. London: Jessica Kingsley Publishers.
Mildon, R., Matthews, J., & Gavidia-Payne, S. (2003). Understanding and supporting parents with learning diffculties. Melbourne:
Parenting Research Centre. Retrieved from <www.parentingrc.org.au/staging/fles/11082004120824VP029.Best%20Practice.pdf>.
Mouzos, J., & Makkai, T. (2004). Women’s experiences of male violence, Findings from the Australian component of the International
Violence Against Women Survey (IVAWS). Canberra: Australian Institute of Criminology. Retrieved from <www.aic.gov.au/
documents/5/8/D/{58D8592E-CEF7-4005-AB11-B7A8B4842399}RPP56.pdf>.
Mowbray, C., Schwartz, S., Bybee, D., Spang, J., Rueda-Riedle, A., & Oyserman, D. (2000). Mothers with a mental illness: Stressors
and resources for parenting and living. Families in Society, 81(2), 118–129.
NCPC Issues 33 2010 | 23
Muir, K., Katz, I., Purcal, C., Patulny, R., Flaxman, S., Abello, D., et al. (2009). National evaluation (2004–2008) of the Stronger
Families and Communities Strategy. Canberra: Department of Families, Housing, Community Services, and Indigenous Affairs.
Retrieved from <www.facs.gov.au/about/publicationsarticles/research/occasional/Documents/op24/op24.pdf>.
Mullender, A., Hague, G., Imam, U., Kelly, L., Malos, E., & Regan, L. (2002). Children’s perspectives on domestic violence. London:
Sage Publications.
Mulroney, J. (2003). Australian statistics on domestic violence. Australian Domestic and Family Violence Clearinghouse Topic Paper
No. 3 Retrieved from <www.austdvclearinghouse.unsw.edu.au/PDF%20fles/Statistics_fnal.pdf>.
Munro, E. (2005). Improving practice: Child protection as a systems problem. Children & Youth Services Review, 27, 375-391.
Newman, L., & Stevenson, C. (2005). Parenting and borderline personality disorder. Ghosts in the nursery. Clinical Child Psychology
and Psychiatry, 10(3), 385–394.
NSW Department of Community Services (2004). Dual diagnosis support kit: Working with families affected by both mental illness
and substance misuse. Sydney: NSW Department of Community Services.
NSW Department of Community Services (2005). Assessment of parenting capacity: Literature review. Sydney: Centre for Parenting
and Research. Retrieved from <www.community.nsw.gov.au/research_centre/child_protection_research.html>.
Odyssey House Victoria (2004). The Nobody’s Clients Project. Identifying and addressing the needs of children with substance
dependent parents. Melbourne: Odyssey Institute of Studies, Odyssey House Victoria.
Perry, B. (2001). Violence and childhood: How persisting fear can alter the developing child’s brain. In D. Schetky & E. Benedek
(Eds.), Textbook of child and adolescent forensic psychiatry (pp. 221–238). Washington, DC: American Psychiatric Press Inc.
Quinton, D. (2004). Supporting parents. Messages from research. London: Jessica Kingsley Publishers.
Radford, L., & Hester, M. (2006). Mothering through domestic violence. London: Jessica Kingsley Publishers.
Rice, F., Jones, I., & Thapar, A. (2007). The impact of gestational stress and prenatal growth on emotional problems in offspring: a
review. Acta Psychiatrica Scandinavica, 115(3), 171-183.
Room, G. (Ed.). (1995). Beyond the threshold: The measurement and analysis of social exclusion. Bristol, UK: Policy Press.
Rothman, E., Mandel, D., & Silverman, J. (2007). Abusers’ perceptions of effect of their intimate partner violence on children.
Violence Against Women, 13(11), 1179–1191.
Scott, D. (2009). Think child, think family: How adult specialist services can support children at-risk of abuse and neglect. Family
Matters, 81, 37–42.
Scott, S., & Dadds, M. (2009). Practitioner review: When parent training doesn’t work: theory driven clinical strategies. Journal of
Child Psychology and Psychiatry, 50(12), 1441–1450.
Social Exclusion Unit (2001). Preventing social exclusion. London: Cabinet Offce. Retrieved http://www.cabinetoffce.gov.uk/
media/cabinetoffce/social_exclusion_task_force/assets/publications_1997_to_2006/preventing.pdf
Stromwall, L., Larson, N., Nieri, T., Holley, L., Topping, D., Castillo, J., et al. (2008). Parents with co-occurring mental health and
substance abuse conditions involved in child protection services: Clinical profle and treatment needs. Child Welfare, 87(3),
95–113.
Taft, A. (2002). Violence against women in pregnancy and after childbirth. Australian Domestic and Family Violence Clearinghouse
Issues Paper 6. Retrieved from <www.adfvc.unsw.edu.au/documents/Issuespaper6.pdf>.
Thompson, M., & Kingree, J. (2006). The roles of victim and perpetrator alcohol use in intimate partner violence outcomes. Journal
of Interpersonal Violence, 21, 163–177.
Todd, F., Sellman, D., & Robertson, P. (2002). Barriers to optimal care for patients with coexisting substance use and mental health
disorders. Australian and New Zealand Journal of Psychiatry, 36, 792–799.
Tunnard, J. (2002). Parental drug misuse—a review of impact and intervention studies. Research in Practice. Retrieved from http://
www.iswa.ltd.uk/downloads/Parental_drug_misuse%20Tunnard%20RiP_2002.pdf
VicHealth (2004). The health costs of violence: Measuring the burden of disease caused by intimate partner violence. A summary
of fndings. Retrieved from http://www.vichealth.vic.gov.au/~/media/ResourceCentre/PublicationsandResources/Mental%20
health/IPV%20BOD%20web%20version.ashx
Waylen, A., & Stewart-Brown, S. (2008). Parenting in ordinary families: Diversity, complexity and change. York: Joseph Rowntree
Foundation.
Widom, C., Czaja, S., & Dutton, M. (2008). Childhood victimization and lifetime revictimization. Child Abuse & Neglect, 32, 785–796.
Wood, J. (2008). Report of the Special Commission of Inquiry into Child Protection Services in New South Wales: Volumes 1–3. Sydney:
State of NSW through the Special Commission of Inquiry into Child Protection Services in NSW. Retrieved from http://www.dpc.
nsw.gov.au/publications/news/stories/special_commission_of_inquiry_into_child_protection_services_in_new_south_wales
Wyatt Kaminski, J., Valle, L., Filene, J., & Boyle, C. (2008). A meta-analytic review of components associated with parent training
program effectiveness. Journal of Abnormal Child Psychology, 36, 567–589.
acknowledgments
The authors gratefully acknowledge the feedback and advice provided by Dr Robyn Mildon,
Robyn Miller, Elly Robinson and Daryl Higgins who reviewed this paper. The authors also acknowledge the Parenting Research Centre who gave the authors permission to include their
“Effective strategies for responding to trauma in adults” developed by the Parenting Research
Centre in association with the Australian Centre for Post-traumatic Mental Health.
NCPC
National Child Protection Clearinghouse
Australian Institute of Family Studies
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