[This section is currently being revised]

iCAN Project overview: November 2020

iCAN = Impacts of Child Abuse & Neglect. With evidence we can change Life Trajectories 

Aim: Describe and measure the consequences of child abuse and neglect and the factors that might disrupt or exacerbate child maltreatment perpetuation (including intergenerational transmission).

Lead investigator: Professor Leonie Segal, E: Leonie.Segal@unisa.edu.au T: +61 8 830 22473

Research team:  Dr Jason Armfield, Dr Ha Nguyen, Dr Emmanuel Gnanamanickam

Study design: Longitudinal whole of population cohort study – drawing on linked administrative data.

Theoretical underpinning:  A deep understanding of the causes and consequences of child maltreatment guides the research questions and analysis plans. The theory draws on neurobiology, attachment theory, trauma theory and ethology, that highlights the impacts of relational trauma and toxic childhood environments of child abuse and neglect on the developing brain and thus thinking, emotions, behaviours and relational patterning. See, for example, work of child psychiatrist Dr Bruce Perry, Paediatrician Dr Jack Shonkoff, child and adolescent psychiatrist Dr Jackie Amos. (See Table 1)

Study Population: All person born in SA between 1986 and 31 December 2017 = 6xx,000 persons, and including 40,000 mother-child pairs (where the mothers were cohort members).

Linked data sets:

Child Protection:

• Notifications, Investigations, Substantiations, Out-of-home care, Court orders, Harms grounds, etc.

Education and child development

• Schools census – enrolment year, absenteeism, problem behaviours, disability, basic parental information, etc.
• NAPLAN (numeracy and literacy test grades 5, 7, 9)
• AEDC (Australian early development census) - child emotional, behavioural, interpersonal and physical development at school commencement.  

Health/health services

• Hospital in-patient, Emergency Department
• Deaths - SA Death Registry, National Coronial Information System
• Midwives Perinatal data set

Under request

• Centrelink income support data
• National Death Index

Funding: Funding history – NHMR Project Grant, Channel 7 Children’s Research Foundation (2 grants), University of South Australia internal grant.

Additional funding will be required to support an on-going research program.

Collaborators: Prof David Preen, University of Western Australia; Prof Derek Brown, Washington University in St Louis; Dr James Doidge, Intensive Care National Audit & Research Centre, London; Dr Lan Gao, Deakin University; Prof. David Johnston, Monash University; Prof. Daryl Higgins, Australian Catholic University; Dr Jackie Amos, Centacare SA; Dr Lesley-Anne Ey, University of South Australia; Professor Stuart Kinner? .

Collaborative opportunities: The iCAN data set has taken some 10 years to create. It is now a world class linked-data set able to leverage research on a wide range of high-profile public health and social policy questions. In particular questions related to family violence against children, the role of other child, family and community factors and how the child protection and wider service system might ameliorate or exacerbate harms. Opportunities for collaboration are extensive. Please contact Leonie Segal.

Project Steering group?

xxx

Broad findings

The work is producing world first population-based estimates of the impact of child maltreatment – across many birth cohorts and with contemporaneous assessment of likely child maltreatment exposure and potential confounders, made possible by the use of linked administrative data on a large birth cohort, born from 1986 to end 2017, of 6xx,000 persons. As compared with survey-based studies, it means this work will better represent those most damaged by child abuse and neglect, often missing from surveys; such as those who die young or suffer serious injury or major mental health problems. Interestingly the relative risks identified by the iCAN study suggest even greater damage from child abuse and neglect than generally reported.

• Every outcome explored to date, without exception across health (including premature death), health service use, educational and developmental, child maltreatment exposure as indicated by child protection system involvement increases the risk of poor outcomes – across the life course from infancy through adulthood (to 30+ year-olds). 
• Differential risk is large – typically 2+ times risk of poor outcome with persons exposed to child maltreatment relative to those with no such exposure; after adjusting for potential child, parental and socioeconomic confounders.
• Risk of a poor outcome typically escalates with categories of child protection system contact indicative of more serious / higher certainty of child maltreatment exposure.
• In terms of intergenerational transmission. The likelihood that a mother with child maltreatment  exposure will have a child with child protection system contact, the risk ratios are even higher and especially for the more serious child maltreatment concerns.
• The impact of child protection system contact on on-going child maltreatment exposure and consequences across the life course is as yet poorly understood and requires additional research. Preliminary evidence suggests early removal (even temporarily) before age 3 may be protective, but further