Good morning, everyone.I would like to begin by acknowledging the traditional custodians of the various lands that we are joining from today.I'm joining from beautiful Dharawal Country this morning.I'd also like to acknowledge the Traditional Custodians on the various lands on which you are all coming from today and the Aboriginal and Torres Strait Islander people participating in this community of practice.
I pay my respects to Elders past and present and celebrate the diversity of Aboriginal and Torres Strait Islander peoples and their ongoing connection to their land, country and waters.I'd also like to acknowledge and thank my Aboriginal and Torres Strait Islander colleagues for their invaluable contributions and the insights that they bring to our work every day.My name is Natasa Mitic, I'm the Executive Director of Quality, Participation and Connection at the NSW Department of Education and I welcome you this morning to our community of practise.
Now, we know that the time from pregnancy to when a child starts school is critical to predicting their life trajectory in terms of their health, development and wellbeing.
And we know that there's shared ambition across both the government and non-government sectors to lift early childhood development outcomes.
We also know that there is more work that we have to do and more that we have to do together to improve the health and development outcomes for all children during the first five years of life.
The problems faced by many children and their families are complex and can often have a compounding impact.And as we strive to improve universal supports for children and families across NSW, we also know how crucial it is that we maintain a particular focus on providing targeted supports for children and families experiencing vulnerability.We also know that those children and families have better outcomes when agencies and organisations work together and this is really where this community of practice comes in.This event has been organised by the Brighter Beginnings team here at the NSW Government, across government collaboration really focused on lifting child health and development outcomes in line with the guiding principles of Brighter Beginnings.
The aim of this compact is for us as NSW Government to create a space for organisations to come together and to share information and to share learnings.We know that everyone dialling in today is committed and passionate about improving early childhood health and development and has so much knowledge to share.
We hope that this community of practice really becomes a space that continues to evolve and where we can collectively tackle more cross cutting issues that impact early childhood health and development.And I want to emphasise that everyone in your professional roles and no matter your sector, we all have a role to play in early childhood health and development.
And lastly, I really want to take this opportunity to thank you for your time to be here and to be part of this session today.
And I really look forward to seeing this community of practice take shape and the great work unfold.
So a little bit about today's agenda now.
The recent results of the Australian Early Development Census revealed that in NSW we had a decrease in the number of children developmentally on track in key developmental domains compared to previous years.
This decline again highlights that no single agency or organisation can address the issue of lifting child health development alone, and collaborative efforts like Brighter Beginnings need to consider the range of factors influencing children's development.
As we really unpack this data and look to take action, today's Comprac is on the topic of trauma informed practises.We're hoping that through today's discussion we can further explore how trauma can impact a child's health and development and what responses we can implement as practitioners and at a policy and program level from government agency perspective.
Now we have a fantastic number of speakers lined up today from a variety of disciplines and backgrounds who will provide us with a well-rounded sense of this issue.
We'll be starting with today's session with an overview of the Australian Child Maltreatment Study and its relevance for early childhood health and development provided by its lead investigator, Professor Ben Mathews.Following this, Professor Mathews will be joined by our panel discussion on the application of trauma informed care.The panel will be led by my colleague Nicola Lewis, the Director of the Child and Family Unit Health and Social Policy Branch at the Ministry of Health.
Nicola will also be joined by Sarah Marsh and Julia Shadid, members of the Child and Family Health team at the NSW Refugee Health Service.Melanie Manns from the First People's Disability Network is also joining us this morning and we have an apology from Leona McGrath from the Aboriginal Health Services Manager at Mount Druitt Hospital, who unfortunately wasn't able to make this morning.Finally, we've allowed minutes to enable engagement and actually have conversations.So if you have questions, please feel free to pop these in the Q&A and we will try and work through as many as we can with our wonderful panel.Importantly, we also have a short feedback survey at the end.So if you could please let us know your thoughts on today's event and the kind of topics that you'd like to see on future compact events, that would be wonderful.Now, due to the nature and the sensitive nature of today's topic, we are making use of a moderated Q&A function rather than an open chat for this webinar, and we will make sure that as many of your questions go to the panel as possible.However, if your question is not answered, we encourage you to send it to the Early Childhood Development inbox and we'll we'll share the details with you and this address will be posted in the Q&A feature.Now finally, I'm sure that many of you are aware that there are several serious issues concerning early childhood education and care that you've no doubt heard about being discussed in the media.
I want to emphasise today the importance of maintaining a respectful dialogue and keeping today's discussion focused on the topic of trauma informed care.I ask that our audience consider this please when you're submitting questions for the panel.
And if there's anything else that you'd like to raise, please contact the department.
And again, we'll pop those details in the chat.
And so without further ado, we'll now move to our first item, which will be presented by Professor Ben Mathews.Professor Mathews is a research professor at the School of Law at Queensland University of Technology and the lead investigator of the Australian Child Maltreatment Study, which he's going to speak to us about today.
Welcome Professor Mathews.
Thank you very much Natasa.
And it's a real pleasure to be involved in this really important session today with this early childhood health and development community of practice.
It's a real pleasure to to maintain the connection that the ACMS team has had already with the NSW Department of Education.I've been really privileged to engage with them already on a number of occasions and really impressed with their commitment to engaging in a continuous process of improvement and, and learning in how best to respond to some of the really difficult issues that arise in early childhood and indeed through middle childhood and, and adolescence as well.I'll thank Melanie as well for for advancing my slides today.
And Melanie, perhaps if you can and go to the next slide.
Thank you.
So I'd like to acknowledge the traditional owners.
I'm coming to you from the lands of the Turbul and younger peoples, and I'd like to pay respects to their elders, laws, customs and creation spirits and acknowledge the traditional owners of the lands from which everyone is coming today.Thanks, Melanie.Just a quick acknowledgement to the funding agencies.
So the ACMS, the Australian Child Maltreatment Study was funded by the National Health and Medical Research Council as well as the Australian Government.Thanks, Melanie.
So folks, today just to give you an outline of what I'll be talking about, and obviously it's a very, very large topic, but I've tried to make it as relevant for us today as possible.I'll give just a little bit of background about the whole study, just to put you in the frame.I'll talk about how we measured child maltreatment, and I'll talk particularly there about emotional abuse.
And the reason I'll focus on emotional abuse is because the cluster of findings from this study about emotional abuse are incredibly significant, but also because given we're talking about early childhood in the early years, emotional abuse is particularly important for children in this age and developmental stage, as opposed for example, to sexual abuse, which at least at the population level, is less common amongst kids in these early years.I'll give you some key headline findings about the prevalence and characteristics of child maltreatment in Australia.Again, I will spend particular attention on emotional abuse.I'll then talk a little bit about the mental health outcomes and risk behaviours that we know now are associated with maltreatment, including specific types.I'll then spend a few more minutes on emotional abuse and then I'll draw out some implications for the early childhood health and development context, and that will hopefully be a nice segue in into what happens after this deep dive.Thanks, Melanie.Just to let you know, I'm very happy to share all these slides.
I'll be referring to some of these key articles from our study and I'll share those DOI's in the chat as well.Thank you, Melanie.And with that, just to thank you and just to let you know, everything that I mentioned here today is available to the public at large for free on our dedicated ACMS website.
Thanks, Melanie.
So just a little bit of background about why we did this study.Well, in a nutshell, before our project, Australia as a country, we did not have reliable evidence at the population level about really important phenomena.So we didn't know what was the prevalence of each type of child maltreatment at the national level.
So, for example, what percentage of children experience physical abuse or sexual abuse or emotional abuse?We also didn't know the characteristics of those experiences.So for example, how old are children typically when these types of child maltreatment begin and when they end?We also didn't know who inflicts these different types of maltreatment and when they happen, how chronic are they?That is, do they tend to be a one off or do they happen, you know, multiple times or over a period of years?
And we also didn't know what are the associated mental health disorders and, and health risk behaviours and other health conditions that are and and may not be associated with these different experiences.So in a nutshell, we were really lacking basically all the foundational evidence that we need as a nation and at the state level as well to inform policy and practice about how best to respond to these different phenomena, but also how to prevent them and and which things we should most profitably and, and just from a social justice perspective, most be paying attention to.Thanks, Mel.So what we tried to do in this study and I'm pleased to say we have managed to do is to fill those evidence gaps.And without going into the somewhat dry details of the methodology, I just want to assure you that we left no stone unturned in this study.
We spent a couple of years even before the study began setting it up and then the first couple of years of the five year project making sure that all of our approach was actually international best practise.
What essentially this means is that stakeholders, including yourselves, can trust and rely on our results.Thanks Mel.In a nutshell, how did we do this project?Well, we surveyed and a half thousand Australians aged and over.
This was a random sample of the population.
It was also a nationally representative sample of the population.
That means the results aren't biassed by population level factors.It also means you can extrapolate our findings from this study to the national population as a whole, beyond just the participants who took place in our study.
Within our sample of eight and a half thousand people, we had three and a half thousand people who were aged to at the time they participated in the survey.
Now that group I will call just for convenience at the youth sample, and they're particularly important because they give us an understanding of what the contemporary situation is in Australia and I'll refer to the findings from them quite a lot today.We also had people aged and over right up to age plus.
And they were important because they enabled us to understand what are the health outcomes right through life, but also what are trends in child maltreatment over time in Australian society.
But I'll look at mostly at the youth sample today.Thanks, Mel.So on to the next topic, how did we measure child maltreatment?Thank you.
So just to give you an example of how we measured emotional abuse and we undertook this process with each of the five types of maltreatment, physical, emotional and sexual abuse, neglect and exposure to domestic violence.
And the first thing we did was we identified the most robust, accurate conceptual models of these types of maltreatment from the international literature.It's actually a really complex question about how we understand and define these types of experience.
But obviously, if you're measuring prevalence and outcomes of them, you need to start from a solid foundation so that you're not distorting results, you're not over counting or under counting things.So basically we identified the most robust conceptual model of emotional abuse and it is this.
Emotional abuse is parental behaviour repeated over time that conveys to the child they are worthless, unloved, unwanted, or only of value in meeting another person's needs.
So that's the concept and that concept is now well established in the international field.What's important then is that we took that concept and we developed three survey questions.And these questions we can think of as operational examples in lived experience of emotional abuse.
And these three questions respectively were about verbal hostility.
So we asked, did your parent ever insult you, humiliate you, or call you hurtful names?We also asked about rejection.
So we asked, did your parent ever tell you they hated you, didn't love you, wished you were dead or had never been born?And we also asked about the denial of emotional responsiveness.
So we asked, did your parent ever consistently ignore you or not show you any love or affection?So as you can see just from those questions and they still everyone, they still give me a chill to read those questions out.
And I've given so many presentations about this study.
But you can see that we're talking about experiences.I think you can instinctively see these are experiences that are not trivial.These are experiences that aren't always going to be harmful, but you can see the potential for their harm and how they can really stick to a kid now.Just sorry, just just back to the previous slide, just for a moment.Thanks, Melanie.Just one important thing folks, when someone said yes, this had happened to them, we asked a number of follow up questions to understand the characteristics of that experience.Now one thing we asked was how old were you the first time this happened?And so I'll come back to that shortly, but it'll become clear that a vast majority of these experiences are commencing in the early childhood years.But also we asked people, over what period of time did this happen?Was it days, weeks, months or years?
Now, if something only happened over a period of days, we actually did not count that as a case of emotional abuse because we deemed that not to comply with our conceptual model of being sufficiently repeated over time.
And we also acknowledged that, you know, every so often, even, you know, the most model parent might lose their patience and, and lose their temper, perhaps for a reasonable reason and, and, and say something hurtful, for example.But that's not characteristic of their interaction with the child.
But just so you know, in over % of the cases, people said it happened to them over a period of years.
So knowing that, knowing that duration gives us a really good understanding of why emotional abuse, including of kids when it starts in early childhood can be so damaging.
Thanks, Melanie.
OK, just to let you know, we measured mental health outcomes.So we measured depression, anxiety, PTSD and alcohol use disorder.
Just to let you know, obviously in early childhood formal clinical diagnosis are, not undertaken, but the, the distress, the subclinical distress and the subclinical symptoms are, are very likely to transpire even in in early childhood and through middle childhood as well.
Thanks Melanie.
And we also measured health risk behaviours and obviously many of these if not all are not necessarily going to be happening in in early or even middle childhood.But as we will see, these do transpire.
In the teenage years.
Thank you.
So then on to some of the headline findings on the national prevalence.Thanks Melanie.
So what we found across Australia, this is all people aged or more, we found that unfortunately child maltreatment is quite widespread.
So % of the national population aged and over have experienced physical abuse, .% have experienced sexual abuse, .% have experienced emotional abuse by a parent, .% have experienced neglect, and .% have experienced exposure to domestic violence.
I'll just point out here folks, just generally just for your interest and there's a lot more information about this, But for sexual abuse that can be inflicted by any person, whether familial or not and whether an adult or not.
So that's a bit different that one.
All the others are inflicted by parents with the exception of physical abuse, which we understood as also being able to be inflicted by an institutional adult, someone like a teacher.
Thanks, Melanie.
Now the previous slide was giving the prevalence at the national population level for everyone aged and over.
This slide is showing the prevalence just in that youth sample I mentioned earlier.
So this is just the kind of contemporary setting those age to .
And what I'll just draw your attention to here is that generally these rates of maltreatment are similar.
There has been a slight decline in physical abuse, slight decline in sexual abuse.
Emotional abuse is actually a little bit higher.
So what we have now is we have about one in three kids who are experiencing emotional abuse and over in five are experiencing exposure to domestic violence, About one in four experiencing physical and sexual abuse.
Thanks, Melanie.
I'll just draw your attention to this chart as well, folks.
This is showing that not only is child maltreatment, including emotional abuse, a problem in Australia, but it's also a gendered phenomenon.
And what we found actually is that girls experience more of every type of maltreatment.
So purely gender is a key risk factor here that we need to be mindful of.
So % of females aged to have experienced emotional abuse versus % of males.
This is not to discount the experience of boys by the way at all.
But the fact is we have / times as many girls experiencing emotional abuse as boys.
That is a significant difference.
Thanks, Melanie.
I'll just draw your attention in these next two slides to what we understood in in the ACMS as multi type maltreatment.
So while I'm focusing a lot on emotional abuse today, this experience of multi type maltreatment is very important, especially in the early years, I think.
And multi type maltreatment is basically the experience of more than one of the five types of maltreatment.
And what's actually very common is for kids to experience more than one type of maltreatment rather than just one in isolation.
What we also found is that there's some areas of very, very high risk.
So if we're, if we're thinking of which kids are likely to need the most help, including in early and middle childhood, we might consider have they experienced all five types of maltreatment or even of the five types.
And we found that .% of our youth sample had experienced all five types of child maltreatment.
That's about one in .
Now if you picture, say a typical classroom of roughly kids, that equates to about one child in every full classroom in Australia having experienced all five types of maltreatment.
So that starts to give you an idea of the scale of this issue.
.% have experienced four types of maltreatment.
So combined we had .% who experienced four or five types of maltreatment.
That's about one in eight kids.
Now many, many of these kids are not coming to the attention of child protection agencies or or health services, for example.
So there's a large, very significant level of unmet clinical need here.
So this is being alert to the multi type maltreatment phenomenon is a significant part of this context.
Thanks.
What we found also just as a key point here alongside these raw prevalence data is that certain types of family adversity increase that risk of multi type maltreatment.
So things like parental separation or divorce, living with someone with a mental illness or living with someone with a problem with alcohol or drugs and family economic hardships, a financial strain, these types of family risk factors elevate that risk of maltreatment.
And this is important when considering trauma informed responses as well.
Thanks, Mel.
So just looking at some of the headline findings about the health outcomes of these types of maltreatment.
Thank you, Melanie.
And and here I'm bearing in mind also that, you know, we're dealing today in particular with kids in the early childhood years.
So I'll qualify some of my comments here, but in general we can proceed on the basis that many kids, not all, but many kids who are having these experiences will be exhibiting subclinical symptoms, distress and various other trauma-based responses.
One of the key findings that we can begin from is that mental disorders are much more common in those who experience any type of maltreatment.
So we found that about half of all people who experience child maltreatment met the criteria for one or more of the four mental disorders we measured.
About half.
Now, I'll just pause here to note that about half did not.
And so it is important to note that not everyone who has these experiences of maltreatment have the same outcomes.
And the reason for that can be related to the nature and duration and severity of the maltreatment they experience.
But it can also be related to a number of protective or buffering factors that help to produce resilience to outcomes that might otherwise crystallise.
Nevertheless, about half who experienced maltreatment did have a mental disorder compared to only one in five people who did not experience maltreatment having a disorder.
So a big difference there close to three times once we took into account other confounding factors.
Thanks, Mel.
Now what we find here in this graph, sorry, it's a bit busy, but there's a there's a key take home finding here.
And this is data from just the to year olds.
And basically what this is showing is that mental disorders in young people had already crystallised.
So these mental disorders as a result of maltreatment, they don't just remain latent or dormant and crystallise in much later life.
They happen early.
So they are normal responses to trauma, things like depression and anxiety, then normal responses to trauma and much more likely to be present amongst those who've experienced maltreatment than in those who have not.
Thanks Mel.
Now, the previous couple of slides have been talking about the association between any child maltreatment and any different types of mental disorders.
We dug a bit deeper and we asked which types of maltreatment are most strongly associated with those outcomes.
And what we found here was that two of the five types of maltreatment are particularly damaging, and one is sexual abuse and the other is emotional abuse.
Now, these findings about sexual abuse are consistent with much of the knowledge that's been generated from overseas, but the findings about emotional abuse have helped to really strengthen and advance our understanding of its harmful nature.
And these are some of the most important findings from our study.
So for example, the circles here on this slide are showing the odds ratios for these different conditions, even taking into account other types of child maltreatment that people may have experienced.
And we can see that emotional abuse was even worse for some of these outcomes than sexual abuse.
So anxiety and depression, emotional abuse was even more strongly predictive.
So this is very, very important for targeting areas where we really need to pay more attention in prevention and response for certain types of childhood experience.
And emotional abuse is is one of the keys here.
Thank you, Melanie.
Similarly here we found again, this is the youth sample, we found that the health risk behaviours associated with maltreatment again, they don't just crystallise much later in life, they happen in say mid childhood and later childhood.
But for our purposes here today, folks, the distress and the trauma responses from certain types of maltreatment are going to begin even in the early childhood years, even if they're not, you know, obviously at that point crystallising into some of these really severe health risk behaviours.
And we can see there that some of those outcomes, just for interest, they are virtually absent amongst those with no child maltreatment.
So the, the bluey green bars here are representing those with no maltreatment.
The red bars are those with maltreatment.
And we can see that some of these health risk behaviour outcomes are minimal if not absent amongst those with no maltreatment, whereas they're much higher in those with maltreatment in the red.
These are these types of behaviours.
They're mechanisms to cope with trauma.
So they're entirely understandable responses.
Thanks, Melanie.
And again, with these risk behaviours, emotional abuse was a very, very significant, potent predictor along with sexual abuse.
And again, that's why I'm really focusing here on emotional abuse today.
Thank you.
So my next three slides are going a little bit deeper into emotional abuse and then that'll bring me to the end of my presentation, folks, and it'll hopefully lead nicely into what happens next.
Thanks, Melanie.
So let me go even a little bit deeper into emotional abuse and what we found and I'll just refer again to the types of things that constitute emotional abuse.
We measured three of those six that I've detailed their hostility and we found that this type of verbal abuse, Did your parent ever insult you, humiliate you or call you hurtful names?
The prevalence of that at the population level was .%, again over a period of at least weeks.
And in % of the case, % of the time that's happening over a period of years.
Rejection The prevalence of rejection by a parent being the parent telling the child I hated them or didn't love them all, they'd never been born.
.% nearly one in .
And then the denial of emotional responsiveness, a parent frequently ignoring the child or not showing them any love or affection.
Prevalence .% These types of parental behaviours can be very, very damaging and you'll see in a slide in a couple of minutes there are things we can do that can help parents avoid those types of behaviours and understand how damaging they can be and instead help them understand the types of responses that are much, much better for a child and how to perhaps overcome frustration in certain types of settings.
In terms of onset and duration, we found that these experience typically commencing early childhood.
So those top three at the main age of onset was was about years.
Now that means a lot.
In a lot of these cases, it's starting much, much earlier than .
And we found in terms of duration, they typically last for years.
So of all who experience hostility, those almost a quarter of our sample, % of them said it lasted for years, % of those who experienced rejection said it happened over the course of years and % who experienced unavailability, emotional responsiveness, they said that happened over years.
So these are experiences that are happening as characteristic of the child's experience with their parent, so that not only the nature of the experience, but its duration, its persistence, helps to explain those really severe outcomes that happen.
We'd found that that emotional abuse is strongly associated with those outcomes.
But from the other literature, we also know it's associated with educational attainment, as you can imagine, and even with things like intergenerational transmission.
So how does it have these effects?
Thanks, Melanie.
There's a lot of a growing body of literature about the pathways through which emotional abuse contributes to these adverse outcomes.
There's a biological pathway, but I think the most profound pathway is the developmental pathway.
And here we're talking about the impact of emotional abuse on compromised attachment.
So just a few principles just to highlight here, which which might connect with some of the subsequent discussions today.
So basically, we we know from decades of work now that secure attachment to parental caregivers is essential for children's healthy development.
We know that emotional abuse compromises that secure attachment to either or both parental caregivers who you know, the people who would otherwise be a source of safety and security.
We know also that insecure attachment can manifest as anxiety.
So that's those typical responses of lacking self-worth and fearing abandonment.
And we can also know that it manifests as avoidance.
So viewing other people as untrustworthy and shunning or discounting the importance of relationships.
In a nutshell, insecure attachment impairs the child's self-worth.
It corrodes their feelings of security and safety in the world, and it can also damage the capacity to regulate emotion.
And as well, obviously if the child is being told these things so often or if they're experiencing that emotional unavailability, they can internalise that.
They can take that on and believe that and and have that form part of their own psychological meaning structure and some emotional abuse really can strike to the core of the child's self-image and construct, to the core of their trust in parents and construct to the core of their view of the world.
That insecure attachment and internalisation can then lead to mood disorders and harmful coping mechanisms and distress and other responses that are are more characteristic in the early years.
Now I do want to note here again, these outcomes are not the same for all kids.
Much depends on protective or buffering factors that are present in the child that might be present in the parents.
So for example, other displays of love and parental warmth and other protective factors as well, such as at the school level.
So the outcomes are not this equivalent for all, but certainly emotional abuse can be and we know is damaging for many kids who experience it.
Thank you, Melanie.
So last, my last slide then is just a few implications I've noted for early childhood health and development and implications for these spaces.
Thanks, Melanie.
So there's others on today's session who will know much, much more about this than me, but certainly I I thought these were points worth noting.
So I think some of the findings about the prevalence and duration and frequent outcomes of emotional abuse do have implications for the early childhood health and development context in terms of four domains, and the first one is about primary prevention.
I think one thing that Australia can do generally is to emphasise the necessity and benefits of positive parent child interactions, including in the very, very early years.
And equally of emphasising the harmfulness of negative interactions and just increasing knowledge amongst parents and amongst others who care for kids about the nature and potential consequences of different kinds of interactions with kids.
That development of knowledge can go hand in hand with the development of pro social attitudes towards certain types of interactions with kids and we can help build skills in dealing with kids even under situations of stress or strain.
And these types of primary prevention efforts can can be done both in prenatal and post Natal periods.
Second, in terms of secondary prevention, here we're typically talk talking about what we might do, especially in high-risk context.
So some.
Parents and families will have certain contextual characteristics which might add to the risk of emotional abuse, for example.
So things like financial strain or housing strain and housing risk, for example, unemployment, mental health problems, alcohol and drug problems, these create extra risk factors and where those stack up, you're going to have multiple or potentially amplified risk factors there.
There may also be other risk factors involved, some of which might be related to the child.
So some kids with particular health or behavioural needs may present additional risks or challenges in dealing with behaviour, for example.
And there can be other social determinants that add to parental strain, which can further require or call for additional efforts at different levels of society for secondary prevention.
There's also implications for trauma informed work with parents who are dealing with their own risk factors and the impact of those risk factors on their interactions with their kids.
And then there's implications for work with the abused children themselves and for identifying and determining their needs for support.
And for example, with those buffering or protective factors that I was mentioning before, which can help build the child's and foster the child's resilience to the outcomes of the maltreatment that they may have already experienced.
Melanie, I think that has taken me to the end of the slide deck that I had.
But thank you very much for that.
I hope that helps to set up the panel discussion.
And I hope that that was of interest to everyone.
Thank you very much.
Thank you Professor Mathews for your insights on this most important topic.
As you indicated, we're now going to bring in our other panellists for a discussion on how when working in early childhood spaces, practitioners can implement trauma informed care.
And to facilitate this discussion, I will introduce Nicola Lewis from the Ministry of Health.
Good morning.
Thank you, Natasa, and thank you, Professor Mathews for that presentation on the Australian Child Maltreatment study.
Let's all take a deep breath.
I found that quite challenging to listen to and I'm sure maybe others did as well.
So a deep breath, maybe a look outside at the sky, the birds, if you can.
And, and just to pause before we go on to the next session as it was challenging, particularly for anybody.
I know that the team's going to share some information about some supports, but I just thought it might be a nice moment to take a breath.
OK, so we're now going to move into the panel discussion.
But before I do, I'd like to acknowledge that I'm joining from the lands of the Dharug and Gundungurra people in the beautiful Blue Mountains today.
I'd like to pay my respects to elders past and present, as Natasa says.
I'm Nicola Lewis, the Director of Child and Family Health at the Health and Social Policy Branch in the Ministry of Health.
I'll be facilitating our panel discussion and I'll also facilitate the discussion with yourselves as the audience afterwards.
And we'll get through as many questions as we possibly can.
So please feel free to pop them in at any time into the Q&A section and we'll be able to pull a selection out of those to be able to respond to.
But now let's welcome our panel.
So we're welcoming again Professor Ben Mathews, Lead Investigator of the Australian Child Maltreatment Study.
We're also joined by Sarah Marsh.
Welcome.
And Julia Shadid from the Child and Family Health team at the NSW Refugee Health Service.
Nice to have you with us.
And Melanie Marnes from the First People's Disability Network.
Welcome, Melanie.
OK, thank you all for joining us today to share your expertise and insights and help us better understand trauma informed practise.
Be great to start the session off by getting a bit of an idea about how this range of organisations represent on the panel operate, a bit more about how you work and where and where you work.
So Sarah and Julia, can you introduce yourself and let us know a little bit about your organisational work?
Sarah, did you want to go first?
Yeah.
Hi, everyone.
Actually, Julia's going to introduce us.
Oh, I apologise, Julia.
That's yours.
Thank you.
Thank you, Julia.
Thank you, Nicola and Sarah.
And I also want to acknowledge the Daruk and the Darug people today.
And thank you, Professor Mathews Ben for your presentation.
So we work in NSW Refugee Health Service, which is a statewide specialist medical service providing healthcare to people from a refugee background and people seeking asylum in Australia.
We have clinical programs over Greater Sydney and provide support to other refugee health services across the state.
Beyond the clinical work that we do, our service provides input on policy, state and national refugee strategy and a large component of our work is around advocacy for this priority population.
Sarah and I are clinical nurse specialist child and family health nurses for refugee health.
We provide services for women and children to years of age.
We are a unique service in that we are the only Child family health refugee nurses in Australia with a dedicated program for newly arrived refugee children and families seeking asylum in Australia.
We provide consultancy and clinical support to other child and family health mainstream services that are seeing clients from refugee like backgrounds.
Thank you.
Thank you, Julia, that was very interesting.
I had no idea about the range of services you've provided.
And welcome to Child and Family Health Service nurses.
Always close to my heart, Sarah.
Well, my name is Sarah Marsh.
I'm a Child and Family Health Nurse at NSW Refugee Health, as Julia said, and we're both clinical nurse specialists and there's only . of us.
So we have, you know, lots of work to do and I think Julia's done a great job introducing us.
Terrific.
Thank you, Sarah, and welcome.
Thank you, Melanie, Pleasure to have you with us today.
Can you please tell us a little bit about yourself and your work at the First People's Disability Network?
Firstly, I'd like to acknowledge that the land I'm standing on today is the Darug people in Western Sydney and at First People's Disability Network.
We are, we are a peak organisation that supports and advocates for First Nations people with disability.
We run an individual advocacy program.
We also do systemic and policy to government for First Nations people with disabilities.
So we are a unique organisation as we are governed by a board of Aboriginal people with disability which is unlike any other.
We have been around for a very long time.
We used to be state based which we used to be Aboriginal Disability Network which was a pilot of program from PWD at the time.
So we branched out from ADN and moved on to st went national with First People's Disability Network to support and to elevate voices of Aboriginal people with disability across the board.
Fantastic.
Thank you, Melanie, and welcome to your little ones too.
Their always welcome at our sessions and terrific to hear about your work.
And it sounds, it does sound very unique, and I'm looking forward to hearing more from you as we go ahead with the panel questions.
So thank you, everyone, for your introductions.
We're so fortunate to have such a diverse perspectives and a range of people to speak with us today.
My first question for the group.
The results of the ADC National report show that across all developmental domains, more children were developmentally at risk than in , with particularly noteworthy increases in the developmental vulnerabilities in social competency and emotional maturity.
How can experiences of trauma influence child development in these domains and more generally?
I might throw to you Sarah.
Sure, thank you.
So as nurses, we work on the ground with newly arrived refugee families and families seeking asylum.
We see and hear first-hand impacts of war related trauma on parental mental health and we assess their children who have also experienced some really horrific traumatic events.
These children are confronted with their own trauma experience coupled with the ongoing secondary traumatisation from their caregivers.
So it could be their parents.
Some of them don't come with parents.
These parents or caregivers may have extreme or often have extreme PTSD symptoms that are debilitating and can really overwhelm their capacity to function emotionally and physically.
Therefore, Julia and I routinely see parents who really struggle to respond to their own emotional needs, resulting in varied attachment styles with their children, ranging from some secure to anxious avoidance.
And we get some really disorganised attachment styles.
But I'd just like to introduce you to a family to demonstrate how experiences of trauma influence child development.
So we had a newly arrived family that consisted of the mother, the parental grandmother, and they had five children.
And two of these children were under five years.
So basically they're ours.
The mother had a history of depression and anxiety and chronic suicidal ideation and she experienced PTSD symptoms daily, including fainting, crying and really long dissociation of episodes very often.
I mean, so the parental grandmother also had that history of complex PTSD as three of his sons had been murdered.
And she was often like she was known to show the children quite graphic photos of the family and, you know, things that really traumatised the kids.
And then they had a year old who was parenting the the children.
So the history was, as I said, direct traumatic war experience.
Their father had died and they had witnessed that and they had really witnessed some and experienced some horrific war crimes, as I said before.
And they were displaced in a refugee camp for three years, which was really dangerous environment for them.
And sadly they have like experienced loss of home and loss of their family members and loss of their cultural structures.
So that's something that we see very often, just different families.
Some people come through here.
They they are just quite well, well, you know, while as we know, but then they can go on to school and because we have a team in the schools, our HMP team.
So then they'll often see a lot of preference events talking about.
Yeah.
Thank you, Sarah.
Thank you for giving that example so that we can really understand what it's like for these families.
That's traumatic to hear, but helpful to understand.
Thank you.
I might just ask about some of the trauma informed practises you use when working with families or young children and, and maybe I'll throw over to maybe Melanie and then Julie.
Thanks Melanie, could you repeat that again for me please?
Yeah, no problem.
What are some of the trauma informed practises you use when working with families and young children?
So it's very, very hard in our in, in when we're working with Aboriginal people, if especially when they actually come to us as that is, they've already been three services that weren't culturally aligned or culturally governed in the right way, especially to address our people know people with disability are the most vulnerable people in Australia being being Aboriginal in Australia at the present time is having a disability and with post traumatic distress disorder due to histories of things that that have happened in Australia towards Aboriginal people, it finds it's very, very hard.
But what I've seen from onwards is that the impact of COVID is isolating families, whereas Aboriginal people live in a kinship extended kinship groups of big extended families.
So in that time it has somewhat elevated the lack of children developing in the right way, emotional due to not having that same.
And it's not just Aboriginal people, it is all people.
And the cohort of children that's coming out in the last four years are coming out with development delays because of the changes in society, social emotional action that they would have with normal families, interactions, being able to go out to the shops or have two children that's under five years old and both have disabilities.
They, they were born into this world.
They weren't born into the right settings.
They go to an early childhood centre.
But they do find these challenges of being a part of, of joining in.
Sorry, no, you're right.
There's a lot of bugs around.
So I do find that a lot of Aboriginal children that are born, they born since and onwards are finding it very, very hard to.
And that would be all children.
Yes.
Yeah.
I was just going to.
Oh, sorry, no, the understanding.
So I understand.
And thank you again, Ben, for your, for your presentation because that really, really kind of opened my eyes up a little bit more to what I've been working, working on.
But we're finding that with kids development, it'll be a while before the world is back into track as what it was or it might not never be.
So these new calm water children that are coming through now are going to have this development of delay and they're going to have emotional because it's just a total different generation of kids that are coming through, especially in the early childhood.
So when you just mentioned sexual abuse, it's really hard.
And I understand that the stats were done on and over, but there is really nothing from to .
And if we are looking for something, there should be evidence, you know, or data collected on this cohort of children because by the time it's , it is rather too late.
Professor Mathews, do you have any response to that?
Is there anything that's happening in terms of data collection for that younger age group?
Yeah.
Thanks, Melanie, and thanks Nicola.
I mean, the first thing just to reassure you about when, when we surveyed people, so our, all the people who participated in our survey were aged or more and we were asking them about their experiences in their childhood from birth up to age .
So a lot of the evidence they gave us was about maltreatment that they'd experienced say from age to or that started age to .
So we do have some of that.
Obviously a lot of the maltreatment they experienced happened age etc.
So we, we do have data at those different age ranges and we're actually, Melanie, this might be of interest to you, but given your question, we are in the process of publishing an article about the age of onset of child sexual abuse, which we're just showing some really interesting things.
However, broadly, we know that there's a certain proportion even of sexual abuse, which typically starts later, let's say median age of onset about .
But there's a there's an unfortunate number of kids who are experiencing sexual abuse at really early ages.
And, and that is just, you know, that's just appalling And, and these kids need a particular amount of help.
I could not agree with you more.
I think what you've really alerted us to so well is and, and certainly what I feel is that as a nation we do not give anywhere near enough support to parents pre birth and in the post natal period.
And we don't give anywhere near enough support to kids in in the early childhood years.
There is an enormous amount of extraordinary work done by everyone on this call today and the organisations they belong to.
But what I've been doing over the last couple of years is urging the Australian Government to invest more and to support individuals such as yourselves and agencies such as yourselves so that we can do more to support parents and kids.
Because it's came up here as a question in our community, especially in early childhood centres, that.
We understand sexual health education starts at kindergarten, but why isn't it given to from the to or in the early from the to years in the early space, which I which can be a bit confronting, a bit triggering, but I I do understand some points of why they would would like to implement this.
But, you know, conversation.
Yeah, thank.
Oh, sorry Melanie, so, so sorry.
It's always a bit hard for the leg.
I thought you'd finished apologise.
I was just going to say, actually that sounds like a really important conversation to have with the Department of Education actually around the, you know, the services they deliver in the early childhood sector.
So I'm wondering whether maybe we could set you up to have a conversation with and Natasa after this about it because I think it's actually really important conversation and important issue that you've raised.
And I think it deserves a bit more time and attention.
So if you're OK with that, Natasa, I can see her nodding ahead.
Great making connection to have a chat about that.
And thank you for your openness, Melanie, and talking about some challenging things.
It's important that we have those conversations.
I might just jump to Julia now and just ask you about any of the trauma informed practises that you apply when you're working with your particular cohort of families and young children.
Thanks Nicola.
I also, you know, the points that I'll mention, will they reiterate what Melanie has mentioned about some of their trauma informed practise, but in particular to refugee health.
We have developed a high level of understanding of the ways trauma impacts children's development and behaviour and apply this to our practice.
We focus on creating safe environments.
We've got longer appointments, giving people time to attend and have the assessments and discussion afterwards.
We respond to the child's needs during the appointment.
We actively listen and involve the child using assessments that incorporate play.
We used face to face professional interpreters most of the time, females whenever possible and we've got bilingual nurses as well.
And the core philosophy of child and family health nursing is working in partnership, which means we remove the power of dynamics, the power dynamics from therapeutic relationship.
And this allows us to identify their many strengths.
Despite their adversities, these people are resilient.
They have survived war and they are here.
We provide practical and realistic strategies, understanding the concept of cultural humility and respectful curiosity.
And we ensure it's always about the family and their goals and needs.
We empower the family and discuss the concept and importance of confidentiality.
We are transparent within our practise and we use open communication and collaboration.
We have learned to build networks with stakeholders to ensure easy access for our families and we practice the concept of open door policy, allowing our families flexible flexibility around when they are ready to engage with our service.
So if the mum wasn't ready to engage with us when we call her and make an appointment, it's OK, she can come back to us later and we'll, we'll happily, you know, make an appointment to see her and discuss and and do the assessments etcetera.
We've got a mixture of options to see clients including clinics, home visits and wherever it is safe we will visit.
We're very clear about our role and what we do as refugee child and family health nurses.
Thank you, Julia.
That sounds like a whole range of approaches, which sounds probably helpful.
Thank you.
Thanks.
Sounds like you are.
Yes, I just, we've got minutes now where we're really keen to hear any questions from any of the attendees as well.
So I, I notice there's nothing in the Q&A yet.
So I just encourage anybody who's online who's attending this and would like to ask some questions, pop them into the Q&A and we'll keep an eye on that.
And very happy to to ask any of the panel members to answer your questions.
While we're waiting for those, I've got a few more up my sleeve.
There's always so many questions, so I might just go to the to another question I've got there.
So this one is about collaboration between staff and clients and among staff.
It's a key principle of implementing trauma reform practise.
What are the most successful strategies you've used to create a collaborative approach to healing in your work organisation?
Melanie, I wonder if you you might like to kick off with that question.
You don't have to, just wondered if you might like to speak to that one, right.
With clients and that we use a story based approach that we do not ask some intrusive questions.
Yeah, basically especially the Aboriginal people.
We use a story based approaches as who are you, where are you from?
What is your identity?
And usually most of our workers are very sound in knowledge of the state and and we're different tribal grounds sit as well.
So we idea that, OK, you're in that area and they identify as a Wiradjuri person or whatever tribe that they would like.
So it kind of gives us a broad outlook and an insight into them without asking them intrusive questions.
So we use story based approached.
So there is and that FPDN is come as you are.
So we do not turn, there's no wrong door.
We don't turn anyone or anyone away.
So it is a being inclusive.
So we're also having under our advocacy banner that we've been funded for disability sector strengthening program, which yeah, which is funded by Closing the Gap is around inclusion for people, for Aboriginal people with disability across the board.
So it's all the PRs.
So, we're running that over communities across the state.
But we're finding, and we're finding this a lot is that a lot of the MM regions, MM , they're not, they're not actually being have an accessibility because they are in there so remote areas.
But what we try to do is that we highlight and flag those areas as a high risk area to actually go out and do that face to face on the on the ground community engagement is bringing people in and usually going through the elders in the community, having a community led, community run.
Yeah, yeah.
Oh, thank you so much, Melanie.
And that sort of approach we can see so often, like through the AM S and through other Aboriginal organisations, which I think is something that we saw during COVID and we're really respectful of the ways of working that seem to just make an incredible difference for community.
So, yeah, thank you so much for sharing that.
I've gotten a question in here now from one of the attendees, and it's for you, Professor Mathews.
So are there any studies that identify the impacts of parental trauma and the impacts this has on their parenting style, capacity, skills and style?
Oh, that's a very good question.
Look, not to my knowledge that that doesn't necessarily mean there aren't.
Yeah.
Look, I, I'm afraid I, I can't give you a, a solid answer to that.
There's certainly some work on intergenerational patterns of transmission more broadly.
One of the challenges in this whole field is that studies use different approaches to, you know, what types of interactions they measure, how they define different things.
So you know, it, it's a, it's quite a variable field, but I'm afraid I can't give you a nice, neat answer to that.
And, and again, so much is contingent on individual circumstances, both in relation to the parent, their relationship with their partner, biological or otherwise, their relationship with their family, other children that might be in the household as well, as well as community networks, including say schools, early childhood education and care settings and familial and, and peer networks as well.
So there's a lot that goes into the mix here.
And it's, it's a, as you can see, it's a, a very, very complex scenario.
But I think what we can say is that where parents have themselves experienced various types of trauma, they will benefit from support that is targeted to their needs.
Not not necessarily just a cookie cutter approach.
The types of things that that Julia and Sarah and Melanie were talking about before, people will have different needs.
But certainly if if they can be supported in having their needs met, they're much more likely to be able to provide warm, loving support to their kids.
Even if, you know, certain other aspects of their interactions with their kids might might still sometimes be, you know, for want of mid term less than ideal.
It's about boosting those protective factors.
Yeah, yes.
Thank you so much.
Looks like we've got another question in there, which is great.
Thank you, everyone.
Please pop your questions and while you've got the chance for this amazing panel to answer them.
So this one is a more general question.
So how do you support children who have experienced trauma and also display traits of ADHD, which then actually might be PTSD?
So I'll open that up to whichever panel member would like to take a go at answering that question.
Anyone willing to put their hand up?
I think I think so I'll just make a comment because I think for us, ours are to the children that we take care of.
And as we've said, we get a lot of children with those PTSD type, you know, because we can't diagnose them or anything.
So when we do our, our assessments, we use the ASQ, the ASQSC.
So what we do is we assess them and pick up, you know, what the results are.
And we do get a lot of kids that are, that may appear to have, you know, some ASD traits and stuff like that.
But when we So what, Julia, what refugee health routinely does is we refer them to STARTTS and STARTTS to do some amazing, amazing work with these children, as in counselling, you know, then the parent will also have theirs.
And then we see, we can see changes in their development because there's lots of reasons, you know, when it comes to trauma, why they don't develop along as they should be.
Or you know what, what's classified in Australia as normal.
Yeah.
So I think from our perspective, it's more it's more about trying to link them in with that therapy that that they, you know, may be able to help them with their development.
Thank you, Sarah.
And we're also referred the mums as well to the council, you know, to have counselling, which, you know, will help in the parenting, that will help the parents, you know, with their parenting as well, especially when they've got that trauma background and, you know, specifically work on that as well.
Like, for example, STARTTS counselling or, you know, social workers can address some specific, you know, counselling needs, but it's mainly the starts counselling work on that.
Thank you, Sarah.
Sound like an amazing service.
I've heard about them over time and they sound like they're doing some quite incredible work.
So thank you for mentioning the STARTTS service.
Yeah, that they're in southwest Sydney, but I think they they work more broadly than that.
Is that right, Sarah?
I know that they're in Sydney.
I think probably more so with this settlement.
So yeah, that's out South, Southwest and Western Sydney and the Blue Mountains are like sort of out this way.
Yeah.
I don't know if, I can't say if they're in the city or anywhere around there.
I don't know.
OK.
Thanks, Sarah.
Professor Mathews, did you have any thoughts on that at all in terms of, I guess the traits or definitions of ADHD versus PTSD and the identification of that, which I think is, is where this question might be coming from.
I will definitely defer to Sarah, Julia and Melanie on that for sure.
They have much more expertise on that than me.
OK, thank you.
Melanie, did you want to add anything in response to that question?
Yes, So we're down our Aboriginal families.
We referred them on to local ACCOS, trusted early childhood partners within the community that have shown that they are culturally aligned and culturally governed.
We do not, we do not refer on to a lot of the DCJ or FACS because of fear of government agency.
So that that's PTSD which actually goes around all our Aboriginal communities across the nation is that we do not refer on to government agencies for fear of children being taken.
So it is a very touchy subject.
So mostly we do refer on to Aboriginal, a trusted Aboriginal ACCOS within the communities.
Yeah.
Thanks Melanie.
Yeah, Audit hand in hand with whatever support that is, supported organisation that is available by the community in that ACCO
Yeah, fantastic.
Thank you.
I've had a little bit of engagement with AMS' and I just think that that holistic approach is quite incredible and unique.
And yeah, I can understand why you'd be wanting to refer to those services that are led, run, supported by Aboriginal communities after our history of stolen generations in Australia.
Makes a lot of sense.
Thank you, Melanie.
Any other questions from anybody?
I'm just having a quick rummage through to see if there's any other questions coming through now.
But please feel free to pop anything in while you've got the chance.
And we've got just a few minutes left.
So while we're waiting to see if there are any other questions, I've still got more questions.
This one, Melanie, I wonder if you might be interested in this one.
It's about how can policy makers assist in turning the principles of trauma and forward practice into guidance and how to implement these practises in specific settings.
So what can policy makers do?
Well, I see that a lot of policies are getting drawn up without having that right data that is actually coming from the ground.
I think all our writing policies on stats that are also on the Internet, they're going to ABS.
And what we're doing now in our communities is that we're promoting IDS, you know, mess around yourself, data sovereignty, in charge of your data, your sovereignty, and you have the rights to that.
And I think that especially in our Aboriginal communities and being an Aboriginal person with disability, it finds it hard and makes you a bit more vulnerable on to voice your problems.
So new policy, I honestly think that it should be done on the ground and not through surveys that takes away that face to face.
And especially when you work with Aboriginal people, a lot of our numeracy and literacy skills are very, very low.
That's hard and and probably for, you know, the cohort that used work with Julia and Sarah as well is that their literacy and numeracy is very, very low.
And a lot of the things that are coming out now, they're all in surveys.
How many gone to places?
And it's always done online or in like in a survey mode, which actually takes away all empathy around the people's situation.
Yeah, yeah.
And you're right, Melanie, it needs done from a grassroots level, from the bottom up.
And can it can I, I mean, I think that's a really important bit of feedback, Melanie.
And what would be the right way to do that?
You know, if people were wanting to change their approach, engaging directly, how would they do that?
Well, boy, So what we're actually doing in Aboriginal communities, so we have remote communities that don't do not are unable to speak on their on their own.
So they have other communities speaking on behalf of them, is that we're actually drafting them some cultural engagement principles so that when people actually all government agencies actually go into their community.
Yeah.
They engagement principles that they have to avoid, abide by is respect, caring, sharing, caring and respect, which is the three things when you go into a community, those are the three main principles that you should be going in there on, Yeah.
And sitting down.
And it's also being respective as contacting Aboriginal elders first.
Yeah, yeah.
Asking if you can come into community.
Working out when is the best time to come into community.
Also sitting down and understanding that a lot of people in these communities are angry.
It's about sitting down, engaging and and just really being really straight out.
They like to be straight out.
They don't like to be beat around the Bush.
What are you is actually here for, you know, and and asking them what do they want?
What is their barriers?
What is stopping you from doing this?
And it's around if you find out what the barriers are, then you can always look into what solutions along the line down the track.
So we find remote communities when I go into a community, especially with high disabilities.
So we have a problem with Aboriginal people defining health and disability and separating the two, right.
Yes yeah.
With NDIS being in a separate stream.
Yeah, yeah, yeah.
Outing and I actually in the workshops with the NDIS across the state to break it down and I was always and I'm still explaining to this day what is a health problem and what is a disability problem.
They mix, they intertwine the two and then I, Oh no, we would not be eligible.
If you, if you're a diabetic now you're not eligible.
But if you have a limb taken, yes.
Comes a disability, and I'm all explaining this.
And then you, you go into communities and you ask them how many people here have disability.
They say, well, nobody.
And then you start the conversation is that do you know any children that should be walking at this age, but at a certain age that isn't walking?
Oh yes, and that's the conversation.
And then I said, Oh yes, we think there's something wrong with that little one's ears over there know.
Exactly.
And it's about starting these conversation, then helping them and prompting them on what disability looks like.
Because we don't have a word and not in any dialect.
And there's over Aboriginal different dialects across Australia that we do not have a word for disability.
That's amazing that, and that makes sense about actually sitting and having a conversation right then, because on a survey you'll see a word, it doesn't mean anything, right?
And so of course those results are going to come out with a gap.
But if you sit and have the conversation like you've described, it makes a lot more sense.
And thank you for the advice about how to do that, you know, appropriately for elders and the for the community.
I think that's really important.
So there.
Thanks Melanie and and Julia, I think you will also just raising something about how how to do it in a in a respectful, caring and appropriate way with their community engaging directly.
I'd love to hear from you about that too, if you can, or Sarah one or other or both of you.
So Nicola, how do we engage with the community?
Was that your question?
That's right.
What what are your approaches if you're gonna move from survey based approach to actually engaging with the community?
Yeah, I mean, definitely look, as child and family health nurses, we're on the ground, we're clinical, we do the practical stuff.
So I guess you know, if they're, if you're looking at creating policies or program, speak to us because we've seen that we know how to, you know, advocate for our clients very much what Melanie said.
We see a large cohort actually from a refugee, from our refugee and asylum seeking background that haven't learned how to read and write.
And that's sometimes one parent, sometimes both parents and that, you know, that interferes with, you know, how the child will be learning to do things as well and how they, how the parent understands how to do things with their child.
So I think in that, you know, in that sense, yeah, just understanding the community more, who you're working with and always having the interpreters because sometimes you might think, yes, they do understand or, you know, they're nodding their head, but in many times they don't actually.
Yes, yeah, yeah.
Thanks, Julia.
So engaging with the right people.
And I think both of you have described that, bringing the right people with you, engaging with the right people about what's appropriate and when to engage with the community.
Yes.
Sarah, you were going to add something.
I was just going to say and guess what?
There's no way to refer anyone.
So we can talk all day long, you know, but there's just nowhere to refer people.
These kids, especially these really highly traumatised children, regardless of if they're refugees or, you know, First Nations or wherever, there is nowhere to refer anyone.
The resources, the government would rather throw it at mental, adult, mental health.
It's just crazy.
Early intervention and drug and alcohol and, you know, wait for adults and let's pay nurses billions of dollars in overtime.
What about down here?
You know, let's go back to the start.
It's just, it's right.
Craziness.
Yeah.
And sometimes the hurdles that we see.
OK, you want to refer a child, but they're not.
They're zero to five.
But, you know, they can't see them because, you know, sometimes accessibility, sometimes it's not referred.
Yeah.
It is just, you know, a lot of hurdles that should not be there.
Yeah, no, it is very frustrating.
And we're trying to do something about that, I think in health and Department of Education with, you know, delivering some of these programs
But we also hear the fact that there's still so many kids that are falling through the gaps.
So the more we know about those children and can advocate for them, the better they'll be.
Absolutely.
All right, well, I think we've look.
Thank you so much for your insight, for your openness, for your honesty.
Really appreciate, you know, this panel.
I found it absolutely fascinating and I've learned a lot talking with you all and I hope everyone else has too.
I'll throw back to Natasa, but just before I do, I just wanted to mention on the, if you could have a look in the Q&A, there's the link to the ACMS website.
So if you want to know any more about the Australian Child Maltreatment study, you can jump on there and find out more.
And I'm sure if you've got any questions, you can also share them through the organisers of this group.
And pleasure to meet you, Julia, Melanie, Sarah and Professor Mathews.
Thank you.
I'll hand back to Melanie.
Sorry, Natasa.
You're welcome.
Thanks Nicola.
I would like to thank all of you so much for your engagement in today's Community of Practice.
We've had such interesting insights and such wonderful and informative conversations.
Trauma informed practises are a really significant contributor to supporting Children's Health and development and it's been such a great opportunity for us to get deeper insights into this topic.
So I would really like to also thank all of our wonderful presenters today, Professor Ben Mathews, Sarah Marsh, Julia Shadid and Melanie Marne.
And I would also like to thank Nicola Lewis for stepping in and leading our panel discussion today.
We acknowledge that these community of practice engagements, for them to really be effective, they really need to be shaped by all members.
And so we'd really welcome the opportunity to jointly facilitate and organise these forums with our partners.
And lastly, I'd really like to take this opportunity again, just to thank you for your time and commitment to be part of this community of practice.
And also a huge thank you to the Brighter Beginnings team and all of those who were involved in organising today's forum.
And before you go, we have a really short feedback survey that's available for you to let you know.
Let us know your thoughts on today's event and the kinds of topics that you might like to see brought to a future ComPrac event.
So please take a moment just to snap the QR code and provide us with some feedback.
It is available on the screen.
I hope you all have a lovely rest of your day.
Thank you again for joining us, and we'll see you all at our next event.
Thank you, thank you, thank you.
