Research engagement and impact: The Australian Child Maltreatment Study and pathways to evidence-based policy and practice

On 3 April 2023, the team of chief investigators behind the first national prevalence study of all forms of child abuse and neglect – the Australian Child Maltreatment Study (ACMS) – published our key findings. It was released as a special supplementary issue in the Medical Journal of Australia (MJA; Mathews, 2023a). It included an introductory editorial (Scott & Mathews, 2023), an article on the methods (Haslam et al., 2023a), five articles describing key findings (overall prevalence (Mathews et al., 2023a), multi-type maltreatment (Higgins et al., 2023b), associated mental health conditions (Scott et al., 2023), health-risk behaviours (Lawrence et al., 2023) and service utilisation (Pacella et al., 2023)), and a ‘perspectives’ article summarising key implications and calling for specific evidence-based actions to prevent child maltreatment (Mathews et al., 2023c). Prior to this special edition of the MJA, the team published a range of foundational methodology related papers focused on various dimensions of the ACMS: a systematic review and critical appraisal of surveys of maltreatment (Mathews et al., 2020); the optimal definition of child sexual abuse (Mathews & Collin-Vezina, 2019); a formal study protocol (Mathews et al., 2021); ethical duties to research participants (Mathews et al., 2022); legal duties to research participants (Mathews, 2022); and adolescent capacity to consent in research (Mathews, 2023b).

But what was the real need for the ACMS? And how are the findings being used? In this article, we describe not only the range of ways that our data are being shared and drawn on by governments and service providers – but the opportunities we are using to forge the path for research impact as the ACMS transforms the social policy landscape in Australia and beyond.

In the original funding proposal to the National Health and Medical Research Council (NHMRC), the research team noted, as part of its rationale the recommendation by the Royal Commission into Institutional Responses to Child Sexual Abuse, the need for comprehensive data to understand the national prevalence and associated impacts of all forms of child abuse and neglect. Until now, Australian research has largely been limited to non-representative, small-scale studies, or research that has focused on only a single type or limited number of different types of child maltreatment. National data published annually by the Australian Institute of Health and Welfare (AIHW) describes statutory child protection department service activity, which is limited to cases notified to and substantiated by the various state and territory child protection agencies.

Nations around the world urgently require robust national population data on the prevalence of all five forms of child maltreatment (physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence; Mathews et al., 2020). To generate this evidence for the first time in Australia, and to understand the overlap between maltreatment types and associated health outcomes of maltreatment, the Australian Child Maltreatment Study commenced in 2019, with funding from the NHMRC and supplementary funding from the Australian Government, the Australian Institute of Criminology and Queensland University of Technology (QUT).

From the outset, the ACMS team had two aims: to conduct rigorous research to generate an evidence base on which government and other stakeholders could rely; and to communicate the findings in diverse ways to these diverse stakeholders. The team understood that conducting the research and publishing traditional scientific research outputs would not alone create impact or influence action to prevent, and alleviate the harms that flow from, child maltreatment.

We drew on theoretical foundations to treat child maltreatment as a public health issue, which requires the involvement of diverse government, non-government, service provision and public communities to create co-ownership of the problem and develop and implement solutions (e.g. Hammond et al., 2006; McMahon & Puett, 1999). While involving diverse communities, a public health approach is centred on the actions that governments and societal actors are responsible to take (Krieger & Birn, 1998), and this also informed our approach. General principles of public health as applied to child maltreatment (both generally, and in relation to the individual types of physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence), promote primary, secondary, tertiary and quaternary prevention, with primary prevention as a special priority. We understood a public health approach in its broadest sense as being concerned with what society does to create the conditions in which people can be healthy, with dual core goals of primary prevention and of social justice in promoting the safety and rights of the most vulnerable. A fundamental requirement of a public health approach is to first identify the specific risks to health and wellbeing and then to develop evidence-based responses to prevent and reduce harms associated with those risks. Within this endeavour, the essential foundation was understanding differential levels of risk – for example, through the generation of reliable data on the different prevalence of specific types of maltreatment – and of the different nature and magnitude of risk associated with these different experiences. In this sense, the ACMS addressed two of the four dimensions of a public health response to child maltreatment, namely: defining and measuring the problem; and identifying risk factors (Hammond et al., 2006). This body of evidence then lays the foundation for the other two dimensions: developing and testing interventions; and implementing interventions (Hammond et al., 2006).

We also drew on the theory of diffusion of innovation (Bowen & Zwi, 2005) in order to forge an engagement pathway to enable the research to influence policy and practice reform. Research engagement for impact is not a simple linear or cyclical endeavour (Gentry et al., 2020; Ogilvie et al., 2009), but instead requires a strategic approach involving targeted and iterative sensitisation, awareness-raising, intersectoral collaboration and dialogue. In short, strategic diffusion of evidence to policymakers must ensure that the key stakeholders understand the evidence and are able and willing to adopt the evidence, so that they may then adapt it to meet the needs of their policy area and use it in that setting (Bowen & Zwi, 2005). Engagement must also grapple with the diverse barriers to evidence-based policy reform that exist at individual, organisational and systemic levels (Bowen & Zwi, 2005).

The Australian socio-political context presents additional challenges for research engagement and impact, given we are a federated nation in which eight different states and territories each have legislative responsibility for domains intersecting with child maltreatment, including health, child protection, families and communities, education and justice. Accordingly, multiple different policymakers across jurisdictions, even in the same portfolio, will have different interests and priorities, as well as different individual, organisational and systemic characteristics. Fragmentation of policy and practice in public health settings adds to the challenge of both knowledge translation and sound policy reform and implementation (Mathews, 2017).

This context required our engagement approach to involve strategic selection of fora for communication, triaging of stakeholder engagement and repeated engagement with key policy leaders. Importantly, a good deal of this activity was supported by sponsors and champions of the ACMS in high-level policy and sectoral positions, with whom we were fortunate to foster strong relationships, exemplifying the genuine collaboration and authentic commitment required to advance a public health approach to child maltreatment (Hammond et al., 2006).

Five steps for forging the pathway to impact …

What did the ACMS team do?

1. Prepare for action

There was a systematic, ongoing series of engagement activities, preparatory meetings and presentations to build awareness of the study, prepare governments and key service providers for the release of the data and create awareness within the policy landscape of what the ACMS would generate.

• 2019: a major launch of the study, sponsored by Victoria’s Department for Health and Human Services and Victoria’s peak sector body (Centre for Excellence in Child and Family Welfare), with connected national media coverage.
• 2019: a dedicated ACMS website containing all information required to understand the nature of the study and access all key outcomes, with special sections for survey participants, researchers and policymakers.
• 2020–2022: regular in-person briefings and updates to key government agencies and stakeholders in multiple states, especially in departments of child protection and families and communities.
• 2022: major awareness-raising public presentations, including Tri-Peaks webinars, and for the National Coalition on Child Safety and Wellbeing.
• 2022 and early 2023: 30 confidential briefings in the several months leading up to the April 2023 release, sharing results in advance with diverse Australian Government departments and policy leaders, state and territory government departments and other major policy leaders and stakeholders including the National Office for Child Safety, the National Children’s Commissioner and all state and territory children’s commissioners.

2. Publish widely in different journals

The ACMS team has focused on sharing our results through a wide range of outlets and mechanisms.

• In addition to the seven key articles released in the MJA in April 2023, further peer-reviewed journal articles have been published, providing more in-depth analysis on specific topics. These include analyses of: child maltreatment and criminal justice system involvement (Mathews et al., 2023b); child maltreatment and diverse genders and sexualities (Higgins et al., 2024b); prevalence of child sexual abuse by eight different classes of perpetrators (Mathews et al., 2024); prevalence of child sexual abuse by leaders and other adults in religious organisations (Hunt et al., 2024b); prevalence of corporal punishment (Haslam et al., 2024; Havighurst et al., 2023); sexual harassment by peers (Hunt et al., 2024a); and the maltreatment, childhood adversity and mental health disorders of those who have experienced out-of-home care (Harris et al., 2024).
• As far as possible, all journal articles are published ‘open access’ so that they are free to access, read and share, even for people not affiliated with a university or institute with library subscriptions to otherwise expensive journals. These can all be accessed via a study-specific website, where links to all the publications are housed (https://www.acms.au).
• Additional analyses are underway, with manuscripts in preparation or under review, again with journals targeted as open access.

3. Present, present, present

Since the release of the key findings, the team has delivered a wide range of presentations to diverse audiences of governments, policy leaders, sector stakeholders and the public.

• Key launch event at QUT (in Brisbane).
• Follow-up major launch events by university partners with their key government and non-government organisation (NGO) stakeholders coordinated by Australian Catholic University (in Melbourne), Curtin (in Perth), QUT (in Sydney) and QUT (in Adelaide).
• Briefings to a variety of government portfolios (national and state/territories departments and agencies).
• Separate briefings for a range of key bodies in the child and family welfare sector who can utilise the findings in their work:
  • Multi-sector response hosted by the Centre for Excellence in Child and Family Welfare, in a function room overlooking the hallowed grounds of the Melbourne Cricket Ground;
  • The child and family welfare peak body in NSW: the Association of Children’s Welfare Agencies (ACWA);
  • The peak body in South Australia: Child and Family Focus SA; and
  • The National peak body, Families Australia, which hosted an online national briefing as part of the National Coalition on Child Safety and Wellbeing 2023 Annual Meeting.
• The Governor-General launched the National Association for the Prevention of Child Abuse and Neglect (NAPCAN) signature National Child Protection Week 2023 events with a keynote address given by the ACMS lead investigator Ben Mathews at Admiralty House.
• Throughout the rest of 2023 and into 2024, the ACMS team gave presentations at conferences, seminars and major professional development events both in Australia and overseas.

In total, the ACMS team gave 17 in-confidence presentations in 2022, over 90 public presentations in 2023 and there are more continuing in 2024. These presentations have been to a wide variety of sectors, including: education (independent schools and Catholic schools); child and family welfare services and peak bodies; practitioners and policy leaders from legal and justice systems; family relationship service providers; child protection departments; health departments and services; mental health agencies; sports agencies; psychiatry; domestic violence services; and conferences attended by researchers, policymakers and practitioners focused on parenting, family law, family wellbeing and social policy.

4. Translate into the ‘language’ formats of a wide audience

As well as traditional research ‘outputs’, the team has developed several ‘knowledge translation’ products.

• A Brief Report published online and in hard copy that provides a short, easy-to-read summary of key results (Haslam et al., 2023b).
• A series of 10 downloadable and printable ‘Infographics’ that visually summarise key points from each major topic area on a page.
• Collaborative knowledge translation with state government agencies to translate key findings for policy and practitioner audiences (e.g. Anderson & Jakob, 2024a).
• Blog-style opinion pieces and commentaries emphasising the key messages and implications for taking action to prevent and respond to child maltreatment and its associated health and mental health outcomes – such as:
  • Two complementary articles in MJA Insight:
    • Australian Child Maltreatment Study – the shocking findings (Higgins & Mathews, 2023); and
    • Preventing child maltreatment: everyone's responsibility (Thomas et al., 2023).
  • Two articles in The Conversation:
    • New research shows some gains but fresh difficulties in combating child sexual abuse (Mathews & Contos, 2024); and
    • Major study reveals two-thirds of people who suffer childhood maltreatment suffer more than one kind (Higgins, 2023)
• Podcasts in which the ACMS researchers described different aspects of the study findings and its implications:
  • Australian Child Maltreatment Study, with Prof. David Lawrence and A/Prof. Holly Erskine. Sam Hunt, MJA Podcasts 2023 (https://www.mja.com.au/podcast/218/6/mja-podcasts-2023-episode-1-australian-child-maltreatment-study-prof-david-Lawrence);
  • Uncovering a cycle of child abuse in Australia, with Sharon Bessell and Arnagretta Hunter, Policy Forum Pod (https://open.spotify.com/episode/6ADQ8DWIAYWrA5yfaxuA7i?si=9a93147d44bf4c23&nd=1); and
  • Childhood domestic violence exposure is 'pivotal': An interview with Professor Higgins, an Australian Childhood Maltreatment Study (ACMS) chief investigator. Partnered with a Survivor Safe & Together Institute podcast, Season 5 Episode 7 (https://safeandtogetherinstitute.com/season-5-episode-7-childhood-domestic-violence-exposure/)

5. Media publicity to raise community awareness

The ACMS team has actively engaged with traditional and new media. Public engagement is an important element of a public health approach and knowledge diffusion. In addition, political action is often stimulated by community views and wishes. Accordingly, the ACMS team has leveraged numerous opportunities to discuss key ACMS findings in diverse media outlets – e.g. ABC online, print mastheads and radio – with considerable coverage and reach for the key findings and subsequent papers.

To support wider awareness of the study and its findings, and to promote access to the open-access publications themselves, the supporting visual summaries (infographics) and brief report of the study’s methods and key findings, the team actively engaged on social media. To build awareness and anticipation, we started 3 months ahead of the launch with a post on X (Twitter) hinting at some of the key findings – attracting nearly 10,000 views.

On the day of the launch, the ABC published an online news article (Timms, 2023) about the ACMS and ABC Radio National featured results on AM (the ABC’s morning current affairs program). A piece in The Conversation (Higgins, 2023) published on the same day as the launch has itself been viewed over 11,400 times and republished on a variety of platforms. Then, during the launch week (3–7 April 2023), influential identities and organisations working in child welfare posted or shared the findings on X. As well as posts by the ACMS team, the MJA, The Conversation and the ACMS team’s respective institutions, findings and commentary about the data were shared and reshared by the national children’s commissioner, state/territory children’s commissioners/guardians, peak bodies, child advocacy groups, child abuse prevention agencies, NGOs, children’s charities and government agencies; each post had more than 1000 views. In total, just these highly viewed posts reached more than 62,400 people. Many more posts with smaller numbers of views would put the total reach of the ACMS substantially higher than that.

In the months after the launch, as subsequent papers were published, the number of views of posts on X continued in the same vein; for example, a post by @ABCNews attracted over 10,800 views and another post about a radio interview with ABC Radio National’s Patricia Karvelas on the paper looking at the greater risk of child maltreatment reported by gender and/or sexuality diverse Australians attracted more than 6600 views. Similarly, on LinkedIn, there have been hundreds of posts by different ACMS team members and their respective institutions – and many more comments, re-shares and independent posts by others.

A search on traditional media coverage and social media promotion relating to ACMS for the period of 1 April 2023 to 31 May 2024 revealed that there were 2740 media mentions internationally – which, in terms of potential audience reach, is calculated to be more than 1.2 billion readers, viewers or listeners.

How the data are being used by others

While many of these strategies and outputs have been led by members of the ACMS team, it is even more pleasing to see how external groups are citing and drawing on the ACMS work. The Australian Government publicly declared that 'we will use this data to inform better, more targeted, policies' (Australian Government, 2023). In addition, strong uptake of the findings has been reported to us by government partners in multiple portfolios, including many in Queensland, New South Wales, South Australia and Victoria. Adoption, adaptation and implementation of the findings has occurred through diverse mechanisms, especially in relation to some of the most important findings of the ACMS. These include, for example, findings in relation to: the prevalence, nature and associated outcomes of child sexual abuse; the prevalence, nature and associated outcomes of child emotional abuse; the nature and prevalence of multi-type maltreatment; and differential higher and lower risk posed by selected types of maltreatment. Across a range of portfolios including child protection, families and communities, health and education, these mechanisms of adoption, adaptation and implementation include:

• Revised frameworks for data architecture and systems;
• Revised systems for intake of referrals and triaging;
• Revised policies and procedures; and
• Revised practitioner training.

The ACMS team have also been alerted to examples of take-up of the findings by government and non-government agencies in a range of ways:

• In the Northern Territory, there is an alliance focused on prevention, auspiced by NAPCAN, where the ACMS results have been showcased: https://www.napcan.org.au/about-us/northern-territory-prevention-alliance;
• The evidence summary in relation to child maltreatment published by Respect Victoria draws on the ACMS data (Higgins et al., 2023a);
• The AIHW launched a new data hub at the end of 2023 that features ACMS results as part of the context setting for understanding the extent of child maltreatment and to situate what their other data sources (the Personal Safety Survey, and the statutory child protection service activity data) also show: https://www.aihw.gov.au/family-domestic-and-sexual-violence;
• Organisations have included references to ACMS findings in strategic plans, as a rationale for delivery of programs and services to prevent child maltreatment, and to respond to its consequences (e.g. Cocks et al., 2024);
• The ACMS team was awarded the 2024 Queensland Child Protection Week Award in the professional (non-government) category for 'Outstanding contribution to promoting child protection issues';
• Based on the ACMS study, the Chief Practitioner of the Queensland Department of Child Safety, Seniors and Disability Services has advised that in late 2024, they will introduce 'Exposure to domestic and family violence' as an abuse type (M. Crawford, 30 August 2024, pers. comm.); and
• The justification for amendments to the Australian Capital Territory's child protection legislation in 2024 to expand harm types to include exposure to family violence is because of new evidence of the prevalence of multi-type maltreatment.

It is often difficult to document the impact of specific research findings such as the ACMS on government policy and investment, or how it’s shaping service delivery responses on the ground. However, the team is aware that our findings are being referenced in the strategic plans for multiple organisations. Government departments – including finance/treasury departments responsible for strategic investments – have been in contact with the team to understand how cross-portfolio investments can be used to align with strategies to address the major implications; for example, Anderson and Jakob (2024b):

The ACMS provides reliable and valid data about the extent and nature of child abuse and neglect in Australia. While this summary is only able to provide a high level snapshot, the study publications give a detailed context about maltreatment experiences, including which children are most at risk of which types of abuse and neglect. They also identify the social determinants of abuse and neglect. The ACMS provides comprehensive new evidence, which can inform policy and practice to help prevent and reduce child maltreatment in Australia. It identifies the associated mental health disorders and health risk behaviours to indicate where supports are most needed.

Finally, and most significantly, the Australian Government has recognised the need for further research to chart trends in child maltreatment. This commitment was first made in 2020 by the Coalition Government and was reaffirmed in 2021 by the Albanese Labor Government, demonstrating bipartisan support. The 2021 Labor Government’s National Strategy to Prevent and Respond to Child Sexual Abuse commits to a 'Wave 2' of the ACMS so that we can assess whether prevalence rates change in the future in response to current and future policy directions (National Office for Child Safety, 2021). This commitment was further confirmed by the Australian Government’s joint media release by the Minister for Social Services and the Attorney-General on the day the ACMS findings were publicly released (Australian Government, 2023).

Citations of ACMS data in the first 12 months (noting the considerable time delay between publication submissions and their acceptance/release online) already are showing early signs of considerable uptake within the research community. Scopus – a comprehensive multidisciplinary database of abstracts and citations – revealed that already 138 other published articles have cited ACMS publications (as at 31 May 2024).

Next steps

The ACMS identified a high prevalence of physical abuse, sexual abuse, emotional abuse and exposure to domestic violence, and a high prevalence of multi-type maltreatment. The ACMS also found strong associations between several types of child maltreatment and mental disorders and health risk behaviours and conditions.

To date, national strategies to address mental health, and the risk of suicide and self-harm, or support children in the early years have not specified comprehensive, evidence-based actions that are collectively directed towards primary prevention of child maltreatment. Australia has made commitments under the UN Convention on the Rights of the Child and the 2030 Agenda for Sustainable Development to end all forms of violence against children. However, the ACMS data show that what we have been doing up to now hasn’t yet worked – or isn’t enough. Although there are promising signs of reform, there remains a need for a national, consistent, whole-of-nation integrated approach to prevention, as highlighted by NAPCAN, who have drawn on the ACMS results in their call for a National Summit to Prevent Child Maltreatment.

Although Australia has a range of national policy responses to address the care needs of children once they have been abused or are at significant risk of harm, there is a need for greater focus on preventing maltreatment occurring in the first place. Child protection services are essential parts of this system but do not have, and never have had, the function of primary prevention. All sectors must work together to identify how they can support parents and children. Australia needs a national child maltreatment prevention strategy that integrates responses and substantially improves parenting skills to help families thrive. Initial engagement needs to be amplified into a cross-portfolio, whole-of-government commitment to a new prevention agenda that draws on the best international evidence of what works to prevent each specific type of child maltreatment, at societal, community and individual levels (Mathews et al., 2023c).

To take the ACMS findings forward, we need a new prevention-oriented movement in Australia (Mathews et al., 2023c), further supported by NAPCAN. This should not just be the responsibility of state/territory statutory child protection departments and their ministers. Statutory child protection departments already have considerable work ahead in managing and improving our systems of detecting and responding once maltreatment has occurred and children are unable to remain safely at home. Instead, the prevention-oriented movement must be led by those sectors who already see most families – health, education and early childhood (Herrenkohl et al., 2020; Higgins et al., 2024a). It also needs to coordinate with sectors helping parents with mental health, housing and employment challenges to foster the use of effective, positive, non-violent parenting strategies. It needs to coordinate with other sectors and strategies where there can be mutual benefit and coordinated strategies across the population to change attitudes and behaviours – such as prevention of adult sexual violence, prevention of domestic and family violence, suicide prevention, drug and alcohol and mental health. COVID-19 raised concerns about Australia’s readiness to combat pandemics, so the Australian Government is establishing an Australian Centre for Disease Control. We now have a unique opportunity in Australia for this new entity to prioritise some of its funding and resources to prevent the child maltreatment epidemic. The goal of such a government authority must be to ensure that as many children as possible grow up loved and safe in their families and that parents are given access to evidence-based parenting supports.

Now is the time to plant the seeds of a new collective action on prevention that goes across sector silos, across strategies. Policies are needed to prioritise prevention now. Only then can children really get the opportunity to be their best.

Acknowledgements

Thanks to Emilie Ng, Mary Papadakis and Maria Battaglia at Australian Catholic University for their assistance with traditional and social media reach and impact measures, including the search of information provided by Meltwater, an online media monitoring company.