Glass globe and stethascope

Systems approach to reduce the impact of adversity

With increasing evidence that adversity in childhood, especially related to the family environment, is linked with poor mental and physical health and negative social and economic outcomes, this research program is designed to address this pathway into disadvantage. Consequences extend across the life course and also intergenerationally. The core research tasks are then to i) better understand the relationship between childhood adversity and trauma and the poor outcomes, in terms of underlying mechanisms and the empirical evidence; ii) explore the options for intervening to disrupt these pathways, with a focus on child and adolescent mental health, family support and the current impact of the service system; and iii) develop policy and practice translation elements that can achieve change on the ground that will help vulnerable children and families and reduce societal costs.

Current research projects

Health and social consequences of child abuse and neglect: an analysis using South Australian linked data

(PI: Professor Leonie Segal)

Children subject to abuse and neglect are highly vulnerable, with impacts on mental and physical health, as well as poor social and economic outcomes. But the size of these impacts, especially early in life, and risk profiling is poorly understood. Most research on the consequences of child maltreatment is based on surveys that necessarily exclude those who suffer the worst outcomes in their youth - homelessness, incarceration, low literacy, intellectual disability, major mental illness or death.

Administrative data can provide valuable insights about vulnerable populations that surveys do not reach. In this project we are examining for the first time in an Australian setting, a population cohort of South Australians, born since 1986, using linked administrative records across child protection, health, education, youth justice and registries of births and deaths. Mortality and morbidity (to age 28) and core social outcomes will be examined for populations defined by their pattern of involvement with the child protection (CP) system and compared with those with no such involvement.

Budget impacts will be estimated by combining findings across health and social domains with published unit costs of service provision and modelling long-term economic outcomes from early mortality and education attainment. Stratification and multivariate modelling will be used to explore the interaction of child protection history with socioeconomic risk factors. This project is the largest and most comprehensive of its kind worldwide, with approx. 650,000 children/young adults, of whom around 190,000 will have had some contact with the CP system. This project will improve our understanding of the more severe early mortality, morbidity, social and economic consequences of child maltreatment. It will help identify the most vulnerable populations, their support needs and how child protection system involvement affects outcomes. The aim with this knowledge is to determine more effective strategies to address child maltreatment and associated harms.

Preventing mental illness: Closing the evidence-practice gap through workforce and services planning and development of demonstration projects

(PI: Professor Leonie Segal)

Mental illness is prevalent across the globe and affects multiple aspects of life. Despite advances in treatment, there is little evidence that prevalence rates of mental illness are falling. While the prevention of cardiovascular disease and cancers are common in the policy dialogue and in service delivery, the prevention of mental illness remains a neglected area. There is accumulating evidence that mental illness is, at least partially, preventable, with increasing recognition that its antecedents are often found in infancy, childhood, adolescence and youth, creating multiple opportunities over the lifespan for prevention. Developing valid and reproducible methods for translating the evidence base in mental illness prevention into actionable policy recommendations is a crucial step in preventing mental illness.

In this project we are developing and applying a needs-based workforce and service planning framework to determine the optimal workforce mix and service structures required to deliver best practice preventive care in mental illness. Specifically, the primary goal of this project is to estimate the workforce and service structures required for a given regional population (Australia) to effectively address core risk factors implicated in the development of mental illness in adults (>25 years of age) and thus reduce the incidence and prevalence of adult mental illness. These estimates are then converted into specific policy recommendations for local and national governments. A new mental health service delivery model is being defined – highlighting the value of an outreach-based inter-disciplinary approach that is responsive to client needs.  The requirement for upskilling of the human services workforce is also being explored. This study is a combination of desktop research, multiple conversations with key stakeholders, including service providers and young people with lived experience and the development of demonstration projects.

The return on investment from allocating extra resources to infant, child, adolescent mental health under a new service model will be estimated.

Outcomes for children of prisoners

(PI: Professor Leonie Segal)

This study seeks to describe and determine early life impacts for children of mothers with an incarceration history, during their childhood.  The study is using linked WA administrative data, covering Corrections, Hospital, Community health, Child protection, Perinatal statistics collection and Births and Death’s Registy. The study will in addition explore the effect of incarceration in a more family-friendly therapeutic prison environment, in which infants and young children are welcome in a supportive environment. A full cost-benefit analysis is planned.