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Disability and child sexual abuse in institutional contexts, Royal Commission into Institutional Responses to Child Sexual Abuse

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The Royal Commission into Institutional Responses to Child Sexual Abuse recognised early on the likely particular vulnerabilities of children with disability and the institutional contexts which they encounter. This commissioned discussion paper provides a reasoned analysis of the historical, social and policy context surrounding children with disability and examines the evidence about prevalence and prevention of sexual abuse of children with disability in institutional contexts.
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Disability and child sexual abuse in
institutional contexts
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Disability and child sexual abuse in
institutional contexts
Project team
The Royal Commission into Institutional Responses to Child Sexual Abuse
commissioned and funded this research project. It was carried out by the following
researchers:
Professor Gwynnyth Llewellyn, Professor of Family and Disability Studies
Centre for Disability Research and Policy, University of Sydney
Dr Sarah Wayland, Post-doctoral Research Associate
Centre for Disability Research and Policy, University of Sydney
Ms Gabrielle Hindmarsh, Senior Project Officer
Centre for Disability Research and Policy, University of Sydney
Disclaimer
The views and findings expressed in this report are those of the authors and do not
necessarily reflect those of the Royal Commission.
Copyright information
Llewellyn, G, Wayland, S, Hindmarsh, G (2016) Disability and child sexual abuse in
institutional contests, Royal Commission into Institutional Responses to Child Sexual
Abuse, Sydney.
ISBN 978-1-925289-87-9
© Commonwealth of Australia 2016
All material in this report is provided under a Creative Commons Attribution 4.0
Australia licence.
Please see www.creativecommons.org/licenses for conditions and the full legal code
relating to this licence.
Published date
November 2016
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Preface
On Friday 11 January 2013, the Governor-General appointed a six-member Royal
Commission to inquire into how institutions with a responsibility for children have
managed and responded to allegations and instances of child sexual abuse.
The Royal Commission is tasked with investigating where systems have failed to
protect children, and making recommendations on how to improve laws, policies and
practices to prevent and better respond to child sexual abuse in institutions.
The Royal Commission has developed a comprehensive research program to
support its work and to inform its findings and recommendations. The program
focuses on eight themes:
1. Why does child sexual abuse occur in institutions?
2. How can child sexual abuse in institutions be prevented?
3. How can child sexual abuse be better identified?
4. How should institutions respond where child sexual abuse has occurred?
5. How should government and statutory authorities respond?
6. What are the treatment and support needs of victims/survivors and their
families?
7. What is the history of particular institutions of interest?
How do we ensure the Royal Commission has a positive impact?
This research report falls within theme 1.
The research program means the Royal Commission can:
obtain relevant background information
fill key evidence gaps
explore what is known and what works
develop recommendations that are informed by evidence, can be
implemented and respond to contemporary issues.
For more on this program, please visit
www.childabuseroyalcommission.gov.au/research
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Contents
Executive summary ................................................................................................... 1
SECTION 1 Scope of the discussion paper .......................................................... 3
1.1 Research questions ................................................................................... 3
1.2 Overall approach ........................................................................................ 3
1.2.1 Child-centred framework ...................................................................... 5
1.3 Defining disability ....................................................................................... 5
1.4 Children with disability, sexual abuse and institutional responses ............... 6
SECTION 2 Understandings of disability in Australia ........................................... 8
2.1 Population of children with disability ............................................................ 9
2.2 Overview of current understandings of disability........................................ 10
2.2.1 Official understanding of disability ..................................................... 10
2.2.2 Disability as (negative) difference ...................................................... 11
2.3 Previous understandings of disability ........................................................ 12
2.3.1 Pre-1950s internationally ................................................................... 12
2.3.2 Pre-1950s in Australia ....................................................................... 14
2.3.3 1960s and 1970s............................................................................... 16
2.3.4 1980s and 1990s............................................................................... 17
2.4 2000s onwards ......................................................................................... 24
2.4.1 The national disability reform agenda ................................................ 24
2.4.2 Exclusion of children with disability ................................................... 25
2.4.3 Disability as a risk factor in care and protection frameworks .............. 26
2.5 Shape of the current disability service system and policies and practices . 27
2.5.1 Quality and safeguards ..................................................................... 28
2.5.2 Assumptions which underpin responses to sexual abuse of children
with disability .................................................................................................... 31
SECTION 3 Interations that influence the risk of sexual abuse of children with
disability in institutional contexts .............................................................................. 33
3.1 Overview .................................................................................................. 33
3.1.1 Multiple, interacting factors ................................................................ 34
3.1.2 Overlooked factors ............................................................................ 35
3.2 Conceptual framework ............................................................................. 35
3.2.1 Difficulties in relying on international data ......................................... 36
3.3 Search methods ....................................................................................... 37
3.3.1 Scientific literature ............................................................................. 37
3.3.2 Grey literature ................................................................................... 38
3.4 Description of literature ............................................................................ 38
3.5 Findings ................................................................................................... 42
3.5.1 Prevalence ........................................................................................ 42
3.5.2 Risk ................................................................................................... 44
3.5.3 Heterogeneity .................................................................................... 45
3.5.4 Child characteristics .......................................................................... 46
3.5.5 Family factors .................................................................................... 48
3.5.6 Environmental context ....................................................................... 48
3.6 How risk is understood in the grey literature .............................................. 49
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SECTION 4 Key factors in the prevention of sexual abuse of children with
disability in institutional contexts in the future .......................................................... 52
4.1 Overview .................................................................................................. 52
4.2 Conceptual framework ............................................................................. 52
4.3 Search methods ....................................................................................... 53
4.3.1 Scientific literature ............................................................................. 53
4.3.2 Grey literature ................................................................................... 54
4.4 Understanding prevention strategies and evaluation ................................. 54
4.4.1 Evaluation studies ............................................................................. 54
4.5 Prevention of sexual abuse of children with disability ................................ 56
4.5.1 Prevention strategies/interventions focused on the child .................... 57
4.5.2 Family prevention strategies ............................................................. 59
4.5.3 Prevention strategies for staff/managers of organisations .................. 60
4.5.4 Prevention strategies with an organisation / community focus ............ 62
4.6 Two contributions from the international grey literature ............................. 63
SECTION 5 Synopsis and key messages .......................................................... 65
5.1 Disability reform in Australia ..................................................................... 65
5.1.1 Exclusion and mental treatment ........................................................ 65
5.1.2 First wave of reform recognising the rights of people with disability 65
5.1.3 Second wave of reform towards realising the rights of people with
disability ........................................................................................................... 66
5.2 Children with disability and their vulnerability to harm ............................... 67
5.2.1 Prevalence and risk of sexual abuse for children with disability .......... 67
5.2.2 Prevention approaches ..................................................................... 68
5.3 New directions for children with disability .................................................. 70
Appendix ................................................................................................................. 72
References .............................................................................................................. 79
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List of abbreviations
ABS Australian Bureau of Statistics
ADD Attention deficit disorder
ADHD Attention deficit hyperactivity disorder
AIHW Australian Institute of Health and Welfare
ALRC Australian Law Reform Council
CI Confidence interval
COAG Council of Australian Governments
CROC UN Convention on the Rights of the Child
CRPD UN Convention on the Rights of Persons with Disability
CRS Commonwealth Rehabilitation Service
CSC Community Services Commission
CSDAs Commonwealth-State Disability Agreements
CYDA Children and Young People with Disability Australia
DDA Disability Discrimination Act
DPO Disabled People’s Organisations
ICF International Classification of Functioning, Disability and Health
IYDP International Year of Disabled Persons
NDIS National Disability Insurance Scheme
NDRDA National Disability Research and Development Agenda
NDS National Disability Strategy 20102020
PWDA People with Disability Australia
RQ Research question
SDAC Survey of Disability, Ageing and Carers
UN United Nations
UNICEF United Nations Children’s Fund
WHO World Health Organisation
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Executive summary
Children and young people with disability are often absent in discussions about child
sexual abuse as people with disability are left out of discussions about violence,
abuse and neglect. This is due in part to individuals with disability being excluded
from society, hidden away in institutions or in family homes. Community attitudes
contribute to and are informed by the fact that people with disability, including
children, are often seen in segregated, special and demeaning settings. This
situation is changing slowly. People with disability are taking their rightful place as
citizens actively contributing to and increasingly benefiting from all that our society
has to offer.
Segregation and exclusion in closed institutional contexts away from public scrutiny
leaves children (and adults) with disability at heightened risk of violence and harm
including sexual abuse. Further, when children with disability are stereotyped as
dependent and passive and unable to ‘speak up’, they are at heightened vulnerability
to being segregated, abused, overlooked and not heard. The Royal Commission into
Institutional Responses to Child Sexual Abuse recognised early on the likely
particular vulnerabilities of children with disability and the institutional contexts which
they encounter. This commissioned discussion paper set out to provide a reasoned
analysis of the historical, social and policy context surrounding children with disability
and to examine the evidence about prevalence and prevention of sexual abuse of
children with disability in institutional contexts.
To achieve this aim we proceeded iteratively and conceptually, drawing on our
expertise and cumulative experience of over 60 years in disability, child and family
studies, and care and protection. We used reports, submissions, position papers and
scientific literature in Australia to analyse past approaches to children with disability
and the present context of the changing nature of disability services in Australia.
While the paper draws from materials that are relevant to Australia as a whole, some
documents from New South Wales are used to illustrate specific points. Just as
children and young people with disability are rarely present in discussions about
sexual abuse, they are also remarkably absent from Australian literature on this
subject. This is a major failing: we do not know the extent of sexual abuse of
Australian children with disability.
We therefore turned to international literature to identify prevalence figures and to
examine the interactions between impairment and environment and their potential
influence on the risk of sexual abuse. We found that internationally there is no clearly
developed evidence base for the prevalence and risk of sexual abuse of children with
disability. We provide an analysis and critique of international prevalence and risk
figures and the application of these in the Australian context.
Quality of care and safeguarding processes form the basis of the disability reform
agenda in Australia and also of the incoming market approach to specialist support
and service delivery, which relies on mainstreaming, and building inclusive and
accessible communities. This has led to debate on possible fail-safe governance
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mechanisms and prevention strategies, although with remarkably less focus on
children and young people with disability.
There is an absence of empirical data in Australia on strategies to prevent sexual
abuse of children with disability in institutional contexts. Again, we turned to the
international literature to source information on relevant key factors. We approached
this from a public health perspective that recognises the need to implement both
population-based and targeted interventions.
In this discussion paper we argue the need to put aside the community perception
that disability is embedded within the child. This is not the official understanding of
disability in Australia. Instead, disability is understood as arising from interactions
between individuals with impairment and the various barriers that may hinder (their)
full and effective participation in society on an equal basis with others. This
understanding comes from the International Classification of Functioning, Disability
and Health (ICF). We adhere to the key frameworks of the United Nations (UN)
Convention on the Rights of the Child (CROC) and the UN Convention on the Rights
of Persons with Disabilities (CRPD). These international covenants require that
children with disability are considered as children first, with disability considered as
only one feature and not the defining feature of their everyday lives.
We also present an analysis and critique of the available literature on prevention of
sexual abuse, noting the pitfalls in assuming a ‘special group’ approach to children
with disability or a broad-brush approach to diversity. The human rights perspective
is embedded within Australian legislation and policy directives in disability. It provides
an excellent foundation to ensure that children with disability and their rights are
more visible and to give them the same priority as other children. This is essential to
ensure children with disability are safe in institutional contexts in the future.
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SECTION 1 Scope of the
discussion paper
In February 2016, the Royal Commission commissioned a succinct discussion paper
on disability and child sexual abuse in institutional contexts. The discussion paper
aimed to explore (i) the relationship between understandings of disability and the
disability service system in Australia over time and currently, (ii) the interaction
between characteristics of a child’s impairment and the environment which may lead
to the sexual abuse of children with disability in institutional contexts, and (iii)
evidence-based prevention approaches to sexual abuse of children with disability
with a particular focus on children with disability in institutional contexts in the future.
1.1 Research questions
1. How have understandings of disability in Australia changed over time and
how has this influenced the shape of the current Australian disability service system
(for example, structure, models of service delivery and practices/behaviours)?
2. How do characteristics of a child’s impairment and their environment interact
in ways that influence the risk of child sexual abuse in institutions?
3. What does the evidence point to as the key factors in the prevention of the
sexual abuse of children with a disability in institutional contexts in the future?
1.2 Overall approach
In response to research question 1 the discussion paper describes and critically
analyses the legislative, policy and governance frameworks in relation to children
with disability in institutional contexts in Australia briefly with regard to prior to the
1950s and with more detail over the subsequent decades. Section 2 discusses key
historical events that have shaped and continue to shape the understanding of
disability in Australia. The emphasis in our analysis and discussion is purposely given
to two institutional contexts: where children with disability live and the education of
children with disability.
To provide a nationwide perspective, the primary focus is on historical developments
across Australia. To illustrate particular points, we draw primarily on working papers,
submissions and reports from New South Wales due to the ease of accessing them
in the time available to complete this discussion paper. In our view, similar analysis
should be undertaken for each state and territory. This task was beyond the remit of
this discussion paper.
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In section 2, we also present the way in which people’s understanding of disability
influences legislation and policy development as well as service system responses,
models of service delivery, and practices and behaviours. Understandings about
disability at this level are not necessarily the same as popular understandings of
disability. The paper presents two concurrent and competing understandings about
disability in Australia. The ‘official’ perspective understands individuals with disability
as rights-bearers for whom government bears the responsibility to remove barriers to
their full participation in society. The competing understanding locates disability as
(negative) difference requiring specialist solutions from the medical/ health sector.
In response to Research Question 2, section 3 of the discussion paper critically
analyses the evidence on the prevalence of sexual abuse of children with disability
and the concept of risk, drawing on empirical research and grey literature where
appropriate. The scope of this discussion paper did not allow for a comprehensive
international search of individual studies. Accordingly, we used the most recent meta-
analysis published in the Lancet in 2012 as the reference document and updated this
meta-analysis with more recent empirical studies.
Research question 3 is addressed in section 4. This section critically analyses the
evidence in relation to prevention of sexual abuse of children with disability by
seeking evidence-informed and evidence generating approaches. There is a dearth
of Australian (and international) evaluations of prevention strategies in relation to
sexual abuse of children with disability. A comprehensive international search of
individual studies was not feasible within the scope of the discussion paper.
Accordingly we turned to the most recent systematic review on violence against
people with disabilities published in 2014 and conducted Web of Science and Scopus
citation reports for this study to identify more recently published empirical studies.
The Australian grey literature has significantly expanded with the presence of the
Royal Commission and national and state-based commissions and committees of
inquiry into violence and/or abuse and neglect of people with disability over the past
five or so years. This is a welcome development. The major quantum comprises
submissions to and reports from these inquiries, as well as commissioned papers
and position statements from the disability sector. There are several limitations to this
grey literature. This literature primarily cites selected international studies on
prevalence and risk. There is little attention to evidence-based prevention. Most of
the materials focus on adults with disability, with far less attention to children with
disability. There is limited attention to the heavy presence of institutional contexts in
the daily lives of children with disability.
In the absence of an evidence base in Australia, the discussion paper turns to
international evidence on sexual abuse and children with disability and to the
literature on sexual abuse for children more generally where necessary. This is partly
pragmatic given this much larger literature (Kaufman & Erooga, 2016). It is also
because we take a child-centred approach: children with disability are considered as
children first. Disability is only one part of their lives; it is not necessarily the defining
part.
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1.2.1 Child-centred framework
There is potentially much to learn from using a child-centred framework to
understand sexual abuse of children with disability. A child-centred framework means
that children with disability are regarded as active agents in their own lives. This does
not mean that any particularities of disability are ignored or neglected. Rather, as
Power, Lord and DeFranco (2013) noted the question becomes how the state might
reform its approach from their paramount focus on disability which led in the past
(and continues to do so) to excluding people with disability from society and
paternalistic approaches to their ‘care’ and support.
Creating safe environments is critical for children with disability. Population
approaches to prevention are important to ensure safe institutional contexts for all
children (Commonwealth of Australia 2009a; UNICEF GPCW, 2015). The strength of
a population approach resides in providing evidence-based prevention ‘interventions’
to the whole population. For example, seat belts and road safety, or, as in the current
case, creating safe institutional contexts.
The downside of a population approach is effectively addressing outliers. That is,
reducing the risk for those individuals who are more likely to be significantly exposed
to unsafe institutional contexts. These individuals and their institutional contexts
require targeted interventions (Ballard & Syme, 2016; Krahn & Campbell, 2011). This
is not the case currently for children with disability in Australia.
The Australian national framework for protecting children takes a population
approach. Disability is mentioned only briefly in relation to parental risk factors under
Supporting Outcome 3 ‘childhood disability, mental health and/or behavioural
problems’ (Commonwealth of Australia, 2009a, p 21). Risk is located in the child.
This leads to actions to support families rather than children. Only one of the five
actions (the last dot point on p 22) mentions safeguards for children.
When risk is assumed to be the child’s problem, we are of the view that the place of
institutional contexts in child sexual abuse is downplayed or ignored. Locating risk in
disability per se provides little guidance on targeted interventions to ensure all
children with disability are safe in the range of institutional contexts to which they are
exposed.
This discussion paper aims to explore the question of which children with disability
are at risk of sexual abuse, under what circumstances, and to what extent. Answers
to this question will assist in developing effective population approaches and targeted
interventions to prevent the sexual abuse of Australian children with disability.
1.3 Defining disability
Critical to a reading of this discussion paper is how disability is defined in Australia.
We use the definition of disability in Australian statistical collections and recent
legislation. This definition comes from the International classification of functioning,
disability and health (ICF) (WHO, 2002). The ICF definition informed the description
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of disability in the UN convention on the rights of persons with disabilities (CRPD)
(UN, 2006).
The Australian Bureau of Statistics (ABS) is responsible for the definition of disability
in Australia. The baseline survey is the Survey of disability, ageing and carers
(SDAC) carried out approximately every three to five years since 1988. Individuals
with disability are defined as: any person with a limitation, restriction or impairment
which has lasted or is likely to last, for at least six months and restricts everyday
activities. Self-care, mobility and communication are defined as core activities. Core
activity restriction can be mild, moderate, severe or profound.
In common parlance disability is generally thought to ‘belong to’ an individual as an
inherent characteristic of that person. The CRPD is at pains to point out that this is
not the case. Rather disability is described as: ‘Persons with disabilities include those
who have long-term physical, mental, intellectual or sensory impairments which in
interaction with various barriers may hinder their full and effective participation in
society on an equal basis with others’ (Article 1). This description is drawn from the
bio-psycho-social model of disability, which also informs the ICF. The bio-psycho-
social model explains that human functioning is the outcome of interactions between
the biological and the psycho-social components of life. Ipso facto, when difficulties in
human functioning occur these result from bio-psycho-social interactions. When
these difficulties are long term (typically operationalised as six months or more), this
is disability. Disability, however, is not an inevitable outcome of functioning
difficulties. Disability results from difficulties in functioning in interaction with
environmental and personal factors. It is quite possible to have an impairment, health
condition or chronic illness and not to be disabled depending on personal and
environmental factors.
1.4 Children with disability, sexual abuse
and institutional responses
The focus of this discussion paper aligns directly with the Royal Commission’s
definitions of child sexual abuse and institutional contexts.
Does the Royal Commission’s definition of sexual abuse apply to children with
disability in ways that may be different from non-disabled children? Children with
impairments, health conditions and chronic illnesses are ‘handled’ more often and by
a greater range of adults than their non-disabled peers. Although this is not
essentially problematic, there is evidence to suggest that children with disability
whose bodies are frequently touched by non-family carers may find it more difficult to
differentiate, or object to, the invasion of private parts of their bodies (Robinson,
2012). Children with high physical support needs (those unable to care for their daily
personal hygiene and bodily functions) will have adults carrying out these daily tasks.
This creates the potential for abuse under the guise of assistance for physical
support needs.
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With regard to the Royal Commission’s definition of institution, children with disability
spend a great deal of time in a range of institutional contexts. Some of these settings
are the same as those for their non-disabled peers; for example, regular classes in
school. Some however are quite different; such as, special units or special schools.
There are also service settings which are disability specific and not available to
children without disability. Respite care (disability) is one such service setting.
Children with disability may also spend longer time periods in institutional contexts
than their non-disabled peers. For children with disability with a health condition or
chronic illness there is often extended contact with the health sector in hospital
and/or with one or more health service providers. The school leaving age for young
people with disability may be extend several years older than their non-disabled
peers. This is to give young people with intellectual or multiple impairments extended
opportunities to learn.
Policy settings designed to relieve the caring responsibilities of parents and families
actively encourage children with disability to spend more time in institutional contexts.
Respite care is one example. A range of models of relief extend the likelihood that
more families of children with disability will take advantage of this relief. In New South
Wales for example, the Respite care guidelines (disability) (FACS/ADHC April, 2010
Revised January, 2011) lists nine types of respite care: own home, family, peer
support, flexible, teen time, afterschool and vacation support, respite camps, family
solutions program, and centre-based (p i). Another example comes from the
incentive for pre-schools to enrol children with disability and for longer hours of
attendance. This policy mechanism is predicated on giving children with disability or
developmental delay more intensive programming and opportunities for socialisation
than are normally available in the family home. School transport for children with
disability is another policy mechanism which places children with disability in contexts
where they are alone with one unknown adult at an age younger than most other
children.
In summary, it is the authors’ view that a child-centred framework is needed to
understand children with disability as children first living everyday lives as children in
our society. Their everyday lives however may differ substantially from their non-
disabled peers with regard to the institutional activities and contexts in which they
spend extended time periods. Exclusionary practices based on stereotyping children
with disability as less capable, more dependent and less sexual than their peers may
also lead to ‘over protection’ and greater vulnerability.
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SECTION 2 Understandings of
disability in Australia
Australia collects data on disability in the Survey of Disability, Ageing and
Carers (SDAC) conducted approximately every five years. Latest data on the
proportion of children with disability (0-14 years) in the general population is
6.1 per cent (ABS 2012).
In Australia, residential institutional care for people with disability over the
nineteenth and twentieth century followed similar patterns to those in the
United Kingdom, Europe and North America. People with disability were seen
through a medical lens and children and adults, particularly those with cognitive
disability, were ‘put away’ in government and privately owned institutions.
During the 1960s and 1970s, the state became increasingly co-involved with
families in providing care for children with disability. A significant milestone was
the introduction of the Handicapped Child's Allowance in 1974 to assist families
to care for their children at home.
From the 1970s the principle of normalisation began to influence thinking in
Australia. A series of reports identified significant shortcomings in disability
programs and profound detrimental effects for people with disability segregated
from the wider community.
Changes in Australian Government thinking about disability were also driven by
the International Year of Disabled Persons (IYDP) in 1981. The New directions
report (1983) for the first time identified people with disability as people first,
disabled second, a watershed in Australian Government thinking about
disability. The Disability Services Act 1986 (Commonwealth of Australia),
based in a human rights framework, recognised that people with disability have
the same rights as do other members of society.
By the early 2000s, the Australian Government looked to the National People
with Disability and Carers Council to provide expert advice and information on
the development and implementation of a national disability strategy.
The National Disability Strategy 20102020 (2011) brought to the fore the
human rights of people with disability and specifically promoted their social and
economic participation in Australian society.
Disability as a risk factor in maltreatment and abuse was helpful in the past in
drawing welcome attention to maltreatment of children with disability in
institutional contexts. The downside is that disability as risk approach is not in
line with Australia’s international obligations or national legislation to consider
children with disability as children first, disabled second. It also hinders much
needed robust data collection and empirical evidence to understand which
children with disability are more likely to be at heightened risk of sexual abuse
and in what contexts.
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2.1 Population of children with disability
Since 1988, Australian data on children with disability has been available from the
SDAC. This national survey on people with disability is useful to understand within
group characteristics of people with disability in Australia. It is not designed to
address differences between people with disabilities and their non-disabled peers.
The data on Australian children with disability is reported in occasional bulletins from
the Australian Bureau of Statistics (ABS), and annually by the Australian Institute of
Health and Welfare (AIHW) in Australia’s welfare publications (available at
http://www.aihw.gov.au/australias-welfare-publications/). The data from SDAC covers
children aged 0-14 years. Features of SDAC have changed over time; the relevant
data for our current purpose comes from 2003, 2009, 2012 and 2015. However, the
2015 SDAC data on children with disability is yet to be released.
Drawing on 2003 SDAC, the AIHW (2006) reported 8.3 per cent (1 in 12) of
Australians with disability were children (317,000). About half of these children
165,300 had a severe or profound disability. Of all children with disability, those
with autism and intellectual impairment were more likely to have a severe or profound
activity limitation. Boys were more likely than girls to have a disability (10 per cent
compared to 6.5 per cent); almost all children (97 per cent) aged 5-14 years with a
disability were attending school; 89 per cent in mainstream schools and 9 per cent in
special schools. Disability prevalence rates were higher in the 5-14 year age range,
particularly for intellectual/learning disability. This is explained by a child’s
intellectual/learning disability being identified at school, where this impairment
becomes most obvious, or disabling (Emerson & Grover, 2012).
In June 2012, the ABS produced Australian Social Trends June 2012: Children with a
disability based on data from the ABS in the 2003 and 2009 SDAC. For the first time,
the ABS reported the proportion of children with disability (0-14 years) in the general
population averaging at 6.1 per cent (3.4 per cent in 0-4 age range and 8.8 per cent
in 5-14 age range, ABS, 2012). Of the four million Australians in 2009 who had a
disability, 290,000 (7.2 per cent) were children aged 0-14 years. Again, boys aged 0-
14 years were more likely to have a disability (8.8 per cent) than girls (5.0 per cent).
Disability rates increased with age from 3.4 per cent of children aged 0-4 years to 8.8
per cent of children aged 5-14 years. In the 5-14 year age range, boys were nearly
twice as likely (11.4 per cent) to have a disability than girls (6.1 per cent). The
differences in intellectual disability in the school years are clearly seen in the 2009
data. Almost two thirds (61 per cent) of children with a disability aged 5-14 years had
intellectual disability, more than twice the proportion of children aged 0-4 years with
an intellectual disability (29 per cent). Nearly all (98 per cent) school-aged children
(5-14 years) with a disability attended school.
Relevant findings from the 2012 SDAC reported in Australia’s Welfare 2015 (AIHW
2015) demonstrate that more boys than girls in the age group 5 to 14 years continue
to have a disability (11.2 per cent compared with 6.2 per cent); and, that the
prevalence of severe and profound disability continues to be much higher among
boys aged 5-14 years compared with girls of the same age (6.3 per cent and 3.2 per
cent respectively).
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The key points are that more boys than girls have a disability, the proportion of
children with intellectual disability typically doubles at school age, almost all
Australian children with a disability aged five to fourteen attend school, and children
with disability comprise on average around 6 per cent of the total Australian
population.
2.2 Overview of current understandings of
disability
2.2.1 Official understanding of disability
The UN Convention on the Rights of Persons with Disabilities (CRPD) was adopted
on 13 December 2006 at the 68th session of the United Nations General Assembly
and opened for signature with the Optional Protocol on 20 March 2007. (Australia
signed the CRPD on 17 July 2007 and ratified the convention and the optional
protocol on 21 August 2008). The purpose of CRPD is: ‘to promote, protect and
ensure the full and equal enjoyment of all human rights and fundamental freedoms
by all persons with disabilities, and to promote respect for their inherent dignity’
(Article 1). CRPD draws its definition of disability from the International Classification
of Functioning, Disability and Health (ICF) adopted by the World Health Assembly in
May 2001.
In the international standard language of the ICF, functioning and disability are
understood as umbrella terms denoting the positive and negative aspects of
functioning from a biological, individual and societal perspective. Thus, the ICF
brought together the two major models of disability at this time the medical and the
social as a bio-psycho-social synthesis. This bio-psycho-social model of disability
recognises the role of environmental factors in the creation of disability in interaction
with impairment, long-term illness or a chronic health condition.
Australia was an early adopter of the international standard classification of disability.
The first international classification, ICF, was published in 1980 by the World Health
Organisation(WHO). (This was progressively revised to become the ICF released in
2002). The first survey of disability in Australia was conducted by the ABS during the
IYDP, 1981, based on the earlier classification.
For the last 10 to 15 years in Australia, the official perspective on disability found in
legislation, government policy and planning frameworks, and population statistics
comes from the concepts of person-environment interaction (from the ICF),
functioning and disability (from the ICF) and human rights (from the CRPD). The
official understanding of disability in Australia also borrows from the social model of
disability. In the more extreme forms, disability is thought to be entirely caused by
society. This means that society disables individuals by negative attitudes and stigma
which in turn create barriers to, and exclusion of, people with disabilities from social
and economic participation. There is no single social model. Social model theorists
11
place differing emphasis on the extent to which societal barriers cause disability
(Shakespeare, 2014). Critically important to all versions of the social model however
is the understanding that disability is not an inherent characteristic of a person;
rather, disability is the result of barriers and facilitators in the social-cultural
environment.
The rights/social responsibility framework underpins, for example, the National
Disability Strategy, 20142020 (Commonwealth of Australia, 2011a) which also
contains another concept the economic imperative ‘to encourage workforce
participation and build human capital’ (page 19). The National Disability Strategy
20102020 informs the National Disability Reform Agenda along with the National
Disability Agreement (COAG 2009), the National Carer Strategy (Commonwealth of
Australia, 2011c), National Disability Research and Development Agenda
(Department of Social Services, 2011), the Productivity Commission Inquiry into
National Disability Long-term Care and Support Scheme (Commonwealth of Australia
2011b) and, subsequently, the National Disability Insurance Scheme
(Commonwealth of Australia, 2013). Full implementation of the national disability
reform agenda would result in individuals with disability being considered first as
equal citizens, with their ‘disability’ being considered second. Some progress has
been made towards realising this person-centred, active citizenship approach.
2.2.2 Disability as (negative) difference
The competing, longer term understanding is one that locates disability within the
individual as an inherent characteristic of their being. This understanding aligns
with the public/private divide in which families are thought to be responsible for what
happens ‘inside’ the family (the private arena) and the state is responsible for that
which is ‘outside’ the family (Fraser, 1998; Young, 1998). The impact of this
understanding is seen across the globe where people with disability rely primarily on
family or charity. When impairments in childhood are understood as medical
conditions for example, cerebral palsy, epilepsy, Fragile X, Down syndrome
medical solutions are sought. When the impairment, health condition or chronic
illness is prioritised over the everyday life of the person, the disability is treated as a
technical problem with responsibility for persons with disability then being given to
those with technical expertise. This is the medical model of disability (WHO, 2011).
In our view this medical understanding continues to permeate professional,
community and popular (media) understandings of disability. Prior to the last decade,
this was also how disability was defined in legislation and policy frameworks. Note,
for example, the definition of disability in the Disability Discrimination Act 1992
(Commonwealth of Australia) by 10 separate points on loss, disorder and
malfunction, the last stating that ‘disability is imputed to a person’. Scholars argue
that disabled individuals, because their impairment is regarded as loss, are
considered ‘less than’ others, lacking capacity and therefore needing (charitable)
support (for example, Fraser & Llewellyn, 2015; Meekosha, 2006). This
understanding can also encompass people with disability as heroes overcoming their
afflictions and the tragedies of their lives (for example, Wedgwood, 2014).
12
To understand why two quite different understandings of disability coexist in
Australia, we turn now to previous understandings of disability internationally and in
Australia. This is presented chronologically from pre-1950s and over the decades of
the 1960s to 1970s, 1970s to 1980s, 1980s to 1990s and post 2000. In each decade,
drivers of change and their impact are discussed followed by consideration of
changes for children with disability in living arrangements and education.
2.3 Previous understandings of disability
2.3.1 Pre-1950s internationally
Disability (more accurately, impairment) has rarely been accepted as a natural
human phenomenon. Rather people with disability, throughout the ages and across
countries and cultures have been discarded, disrespected and treated as outcasts.
What informs this apparently universal negative disposition towards people with
disability? In many cultures, disability may be seen as retribution for past sins or
those of one’s ancestors, a sign of witchcraft or evil spirits, or a bad omen
(Bickenbach 2009; Ingstad & Whyte 1995; Lewis-Gargett et al., 2015). Theorists
such as Campbell (2009) proposed the concept of ableism to explain the universal
negative disposition towards disability. Ableism comes from the able-bodied
attracting positive value. In contrast, the disable-bodied attract negative value and
become regarded as inferior and are treated accordingly.
Although people with disability have been located at the margins of society, texts of
the world religions frequently offer contradictory messages about disability,
suggesting charitable responses on the one hand and disability ‘meted out as
punishment by God’ on the other (Braddock & Parish 2001, p 14). Past
understandings of disability also vary dependent on onset of disability, historical and
societal timing and social class and can be contradictory. So, for example, while
infanticide was not unusual when impairment was easily recognisable at birth, adult
males disabled as a consequence of war are usually lauded as heroes. There are
echoes of this currently in the notable absence of congratulations at the birth of a
child with impairment in contrast to the attention paid to paralympics sporting figures
(Goggin & Newell 2000).
‘Disfigurement’ has also been accepted in those of royal or high social status. While
present understandings of confining people with disability to institutions are invariably
negative, the historical record suggests otherwise. As Braddock and Parish (2001)
note there is evidence that during the middle ages institutional care was by and large
benevolent when, for example, mental disability was thought to be divinely inspired
rather than of ‘demonic’ origin.
With the rise of the scientific method and the beginnings of modern medicine, new
understandings of disability came about. These offered the possibility of cure for at
least some human ailments. In this curative period, efforts were directed to
minimising the impact of being blind, deaf or being ‘lame’. With the Age of
13
Enlightenment came the possibility of new psychological and educational
interventions particularly for mental illness and intellectual disability. At the same
time, societal initiatives and ‘moral treatment’ were introduced to overcome the
vicissitudes of poverty and inability to work associated with disability. (Inability to
work remains a major determinant in Australian and international social policy
responses to disability.)
The change from institutions being places of treatment to places of removal from
society’s gaze came around the turn of the 20th century. This change was in
response to fewer ‘curative’ successes than anticipated. This resulted in public
apathy, the decline of moral treatment, and overcrowding in institutions. Eugenic
ideas spread at this time to change thinking and the appropriate treatment of
‘deviance’, particularly intellectual disability and mental illness.
The eugenics movement led to the involuntary sterilisation of many women (and
some men) with intellectual disability to protect society against what were considered
the ravages of moral degeneration and unacceptable social costs of procreation. In
that time of belief in the inheritability of intellectual (in)capacity, it is not so surprising
to encounter the now famous words of Justice Wendell Holmes of the Supreme Court
of the United States writing in relation to the sterilisation of a woman with intellectual
disability that ‘three generations of imbeciles is enough’ (Supreme Court of the
United States, 1927, Buck v. Bell).
Understandings of impairments such as blindness and deafness developed along
different pathways. Access to schooling illustrates the (generally) charitable
approaches to those who could not hear or see. Residential schools were
established in the early nineteenth century in the United States, for example, for
children who were deaf and for those who were blind as part of the charitable
movement of care and education for less fortunate children (Braddock & Parish
2001). These residential schools remain in many parts of the world today, including
Australia and its neighbouring countries in the Pacific and South-East Asia. In
contrast, children with intellectual disability and those with more severe and profound
disability were denied access to education, and continued to live at home, or when
families were no longer able to provide care, were placed in ‘mental’ institutions.
This situation did not change substantially until around the mid-twentieth century. For
example, by the 1970s a new era had commenced in the United States (Braddock &
Parish, 2001). Public schools as a child-serving agency were increasingly requested
to provide services for ‘severely handicapped’ children. Ongoing efforts by parents,
who recognised the inhumanity of warehousing children, even when their disability
were severe and profound, resulted in legal action and states assuming responsibility
for educating children with disability. As Schipper, Wilson and Wolf (1997) noted it
was no longer seen as appropriate for society to deny education to those children
who were most in need of opportunities for learning. We turn now to Australia in the
pre-1950s.
14
2.3.2 Pre-1950s in Australia
As noted by Mary Lindsay in her Background paper 2: Commonwealth disability
policy 19831995 (Lindsay, n.d.) at the turn of the twentieth century, apart from those
committed to ‘mental’ institutions, people with disability in Australia – children and
adults relied on their families for sustenance and care. ‘Mental’ institutions were
considered health facilities and therefore funded by state departments of health. This
remained the case after federation. Charitable relief, with some support from state
governments was provided for those who were destitute or unemployed. Following
the formation of the Commonwealth in 1901, the first national ‘flat-rate’ means-tested
invalid pension was introduced in 1908 for those unable to work, and is considered to
be the first direct involvement of the Australian Government with people with
disability.
Lindsay (n.d.) notes that the impact of deaths and injury from two world wars on
women and children and the return of injured, sick and ‘permanently disabled’
soldiers led to an expansion in benefits. The Vocational Training Scheme for Invalid
Pensioners was introduced in 1941 becoming by 1948, the Commonwealth
Rehabilitation Service, changing to CRS Australia in 1998 and remaining so today.
The primary function of the CRS Australia is to provide vocational rehabilitation and
employmentrelated services to the Australian Government and now also to the
private sector. A focus on employment has remained central to Australian
Government social policy on disability, including, for example, the introduction of the
sheltered employment allowance in 1967. Other employment associated benefits
were introduced later, such as the mobility allowance to facilitate entry to, or
remaining in, the workforce.
2.3.2.1 Institutional care or family care
In Australia, residential institutional care for people with disability over the nineteenth
and twentieth century followed similar patterns to those in the United Kingdom,
Europe and North America (Lindsay, n.d.). By and large, residential care was for
children and adults with intellectual disability and adults with mental illness all of
whom lived on the same grounds, although in different wards. In Australia, prior to
the 1950s, parents of children with disability (except for polio, tuberculosis, and
children who were deaf or blind) had the choice of caring for them at home or
committing them to a state mental hospital. For example, in 1867 the Children’s
Cottages at Kew, Victoria (part of Kew Asylum) opened to provide living
accommodation and education for ‘mentally retarded’ children.
Government departments of health operated public institutions across the country: in
New South Wales institutions such as Marsden Hospital Parramatta and Watt
Street Hospital in Newcastle regularly received younger and older children
throughout the 1950s and into the next several decades. Grosvenor Hospital at
Summer Hill was a psychiatric facility and disability institution established by the New
South Wales Government in 1965. It was operated by the Health Department and
occupied the buildings that had been the Benevolent Society's Renwick Home for
Infants. It provided care for children with disability until the 1980s. In 1985, it stopped
15
being listed as a hospital for the developmentally disabled and became known as the
Grosvenor Centre.
There were also charitable and privately owned institutions for children with disability.
The Lorna Hodgkinson Sunshine Home at Gore Hill was founded in 1924 to educate
people with intellectual disability. ‘Sunshine’ continued as a residential facility taking
in young children, adolescents and adults with intellectual disability (many with
accompanying physical and/or sensory impairments) up to the early 1990s. Allowah
Babies Hospital which was established in 1954 initially took in severely handicapped
children under two years of age. Later, expanding on its Dundas site, where it
continues today, as the Allowah Presbyterian Children’s Hospital, to provide care for
children and young people with disability up to 18 years.
Many of the government and non-government institutions housing children with
disability have been investigated (or named) in inquiries since the early nineteenth
century to the present. This is well documented in Swain’s (2014) report to the Royal
Commission titled History of Australian inquiries reviewing institutions providing care
for children.
As well as the disability specific institutions, residential settings for children also
included children with disability. Concern about institutional care of children in
Australia came to a head in 2003 when the Australian Senate referred an inquiry to
the Senate Community Affairs References Committee to inquire into institutional
care. There is frequent mention of disability in both reports of this Senate inquiry. The
second report, Protecting vulnerable children (Commonwealth of Australia, 2005),
points out that large-scale, institutional accommodation of children with disabilities
continued well into the 1980s and early 1990s, lagging behind the phasing out of
orphanages and children’s homes. The first report, Forgotten Australians
(Commonwealth of Australia, 2004), drew attention to children with disability in care
and protection facilities, most frequently ‘uncontrollable’ girls and boys with
intellectual disability in their adolescent years. Disability is also mentioned as a
consequence of harsh treatment over time with disability in later life by wards of the
state leaving ‘care’.
2.3.2.2 Education for children with disability
In contrast, and as early as the 1860s there had been schools for children who were
deaf and blind, although these schools rarely accommodated children with
intellectual disability or multiple disabilities. In 1929, the New South Wales Society for
Crippled Children, founded by Rotary, opened its doors to care for children with polio
or tuberculosis. Children lived in residential settings with school facilities, the most
well-known being the Margaret Reid Home at St Ives and the Beverly Park Estate.
Other children attended day only special schools.
By the late 1940s, parents of children with intellectual and multiple disabilities had
come together to set up their own schools in the face of government resistance to
their demands for education for their children. Taking New South Wales as an
example, in 1946, a group of parents established the Subnormal Children’s Welfare
Association with the intention of sponsoring voluntary association schools. The
16
success of this initiative was such that by 1974, there were some 85 schools in New
South Wales. Similar developments occurred across other Australian jurisdictions.
Schools for children with intellectual disability and multiple disabilities were more
likely to be parent-led and funded voluntary association schools. Schools for children
with physical and sensory disability were more likely to be supported by public
funding across all states and territories until the 1970s.
2.3.3 1960s and 1970s
Through the 1960s and 1970s the Australian Government increased funding to
charitable organisations for accommodation, employment (sheltered workshops) and
other support services. A significant milestone in relation to families of children with
disability was the introduction of the Handicapped Child's Allowance in 1974. This
major policy mechanism was the first benefit paid to parents of a child with disability
to encourage the care of children at home rather than in institutions. It followed the
introduction, in 1968, of a benefit for handicapped children living in homes run by
charitable organisations. This was known as the Handicapped Children's Benefit and
was significant because it marked the entry of the Australian Government into the
area of institutional care of children, previously a state responsibility (Lindsay, n.d.).
2.3.3.1 Institutional care or family care
During the 1960s and 1970s, the state became increasingly co-involved with families
in providing care for family members with disability. There was a heavy policy
emphasis in all jurisdictions on families caring for their children at home as a cost
imperative: it was generally believed to be cheaper to support families to do the
caring for those who would otherwise require expensive residential services
(Llewellyn, Dunn & Fante, 1996). Notably, there was much less state concern at this
time about children with disability already living in residential services as the forces
driving de-institutionalisation had not yet taken hold.
Drivers in the international arena began to change perspectives on children with
disability in Australia in the late 1970s. This first became apparent in relation to
education for children with disability living at home, or attending charitable or
privately owned schools, or in smaller health and disability institutions. The changes
came later for children residing in the larger government health and disability
institutions in which inmates who entered as children remained there as adults,
joining others who had been placed there in late adolescence or early adulthood
(NSW Department of Health 1983). The community was unaware that children ‘put
away’ in large scale mental institutions had basic care only and little schooling or day
activities.
2.3.3.2 Education for children with disability
Jurisdictions incorporated education for children with disability (later called children
with special needs in the educational context) into government responsibilities on
varying timelines across the country. The Australian Government’s Karmel Report of
17
1973 recommended seven programs to remedy deficiencies in the Australian
education system, one of which was to focus on special education. In 1974, as a
result of the Karmel Report and with Schools Commission funding, the NSW
Department of Education commenced a program of assuming responsibility for the
operation of voluntary association schools. By 1982, 32 schools had been transferred
with negotiations continuing for a further number (NSW Department of Education,
1982). Similar developments occurred in other Australian states and territories.
Seminal legislation enacted in the United States in 1975 (Education for All
Handicapped Children Act 1975, PL 94-142) sparked intense discussion and debate
in Australia. The legislation required all public schools accepting federal funds to
provide equal access to education and one free meal a day for children with physical
and mental disability. Public schools were required to evaluate handicapped children
and create an educational plan with parental input that would emulate as closely as
possible the educational experience of non-disabled students.
State government reports followed. For example, in May 1982 in New South Wales, a
report on the deliberations of the Working Party on a plan for special education in
New South Wales (NSW Department of Education 1982) was released, forging new
directions in educating children with disability. Essentially, this plan gave children
with disability, including those with profound and multiple disabilities, a place in the
state-government education system. This more inclusive approach to educating
children with disability took place as thinking about disability changed in Australia.
The next twenty years were to see some ‘new directions’ come to fruition.
2.3.4 1980s and 1990s
Significant changes took place in the Australian Government’s thinking about people
with disability in this period. These changes played out rather differently for children
than for adults with disability. By the early 1980s, state and territory governments
were the major players in disability services encompassing education, health, family
welfare, housing and transport. Non-government organisations delivered a wide
range of services subsidised by Australian, state and territory governments (Lindsay
n.d.).
From the late 1970s, the principle of normalisation began to influence thinking in
Australia. This principle, initially articulated by Bengt Nirje from Sweden, states that
people with disability should be assisted to establish patterns of life that are as close
to or the same as those of society more generally. The normalisation principle as
articulated by Wolf Wolfensburger (1972) was heavily promoted in Australia; later
Wolfensburger added the term social role valorisation to recognise the ‘deep
wounds’ done to people with disability through institutionalisation.
The ideas of normalisation and social role valorisation found fertile ground in
Australia. A series of reports in the late 1970s such as that from the Royal
Commission into Human Relationships (Australian Government Publishing Service,
1977) reported significant shortcomings in disability programs and profound
detrimental effects in segregating people with disability from the wider community.
That said, there was little impact of these ideas initially for children with disability,
18
with the focus being on adults with disability in institutional care (NSW Department of
Health, 1983). This occurred despite the number of inquiries into institutional care of
children during these decades and the regular naming of hospitals/homes for children
with disability in these inquiries (Swain, 2014).
Changes in Australian thinking about disability were also driven by the IYDP in 1981,
complemented in the same year by national information on disability becoming
available for the first time. This survey, Handicapped Persons Australia 1981,
identified the number of people with disability, the nature of their disability, the
services they needed and the extent to which these needs were being met. Of those
determined to be severely handicapped, which was more than half a million persons
(514,000) aged 5 years and over, more than one quarter of a million (271,000) were
aged between 5 and 64 years of age. Of these 271,000, the vast majority 244,000
(90 per cent) lived in households with only 27,000 (10 per cent) living in institutions
(Australian Government Publishing Service, 1985).
Wen and Madden (1998) analysed this data from 1981 and following 10 years to
investigate trends in community living over this time. They showed that by 1993 the
majority (87 per cent) of people with severe handicaps under 65 years were living
with relatives. Without underplaying the critical importance of the later de-
institutionalisation period, these findings from the early 1980s through to the mid-
1990s provide a timely reminder that the majority of individuals with disability as
children and as adults lived at this time in the family home. This was despite their
parents being advised if the child’s impairment was evident at birth - to put their
disabled child away, forget about them and have another baby (Llewellyn et al.
1996). Archival research is needed to substantiate anecdotal evidence about the
most likely age (if not at birth) that children with disability were placed in institutions in
the mid-twentieth century. It appears likely there were two peak times; when younger
siblings were born or when the child with a disability reached puberty and could not
be managed in the family home (Llewellyn et al., 1996).
However, for those living in institutional care the so-called mental institutions the
situation was dire. In New South Wales, this led to the Inquiry into health services for
the psychiatrically ill and developmentally disabled in 1982, the report of which
became known as the Richmond Report named after the Inquiry Chairman, David
Richmond. This report recommended that institutions be closed progressively and
that ‘services be delivered primarily on a system of integrated community-based
networks, backed up by specialist hospital or other services as required’ (NSW
Department of Health, 1983, p 10). This process is ongoing in New South Wales.
2.3.4.1 New thinking New directions
In the international arena at this time (early 1980s) people with disability were
organising themselves into self-help groups such as Disabled Peoples’ International
and similar groups in Australia followed suit. These self-help groups primarily
involved people with physical disability or sensory disability, however in Victoria, a
self-advocacy group for people with intellectual disability called REINFORCE began
in 1982 and this organisation continues today (see http://reinforce.org.au/).
19
In 1983, the Australian Government established the Disability Advisory Council of
Australia to provide direct advice about disability, and in 1985, the Office of Disability.
Concerns about the situation of people with disability followed on from the IYDP,
1981, and led to a review of the Handicapped Persons Program. Writing in the
foreword of the 1985 report New Directions: The report of the handicapped programs
review (Australian Government Publishing Service, 1985), Senator Don Grimes
noted that:
People with disability…have made it clear that they want to be treated as
people first people whose abilities matter more than their disability. They do
not want to be seen as sick or different and they do not want all decisions to
be made for them by other people. When given the opportunity, most people
with disability respond positively to making major life decisions for
themselves, assessing the risks involved and being prepared to make
mistakes and learn from them. Increasingly, people with disability want a say,
both in the development of programs designed to meet their needs and in the
management of resulting services… (p iii).
This understanding of people with disability as people first, disabled second,
represented a watershed in Australian Government thinking about disability (at least
in relation to adults). This perspective of people with disability as ‘responsible
citizens’ was in marked contrast to previous ‘top-down’ approaches based on medical
understandings of disability. The intent now at Australian Government level was to
move the policy focus from services and service providers to individual consumers
(Lindsay, n.d.).
The introduction of the Disability Services Act (Cth) in 1986 was a direct response to
the New directions report of 1983. The Act was accompanied by a statement of
principles and objectives. The Act, based in a human rights framework, also
recognised that people with disability have the same rights as do other members of
society. This marked a significant turn in the official understanding of disability in
Australia. The Act advocated, for the first time in Australia, for the ‘least restrictive
alternative’ principle to assist people with disability to realise their individual potential.
Disability services were to be integrated with mainstream services where at all
possible complemented by a community focus for specialist services where these
were considered necessary.
Pursuant to the Disability Services Act 1986 (Cth), state and territory governments
were required to introduce or modify their legislation to conform to the Act’s principles
and objectives. At the same time, due to the lack of clarity about federal, state and
territory government responsibility for disability services, the first Commonwealth-
State Disability Agreement came into force in 1991. This five-year agreement
attempted to rationalise government roles and responsibilities for the funding and
operation of disability services and to develop a national, integrated disability
services system.
While Australian Government developments during the 1980s primarily focused on
disability services, the UN Declaration on the Rights of Disabled Persons in 1975 and
the Royal Commission into Human Relationships in 1977 galvanised governments to
action to secure basic human rights for people with disability in Australia. This led to
20
the Disability Discrimination Act 1992 (Cth) which provided protection against
discrimination based on disability. It also aimed to promote equal opportunity and
access for people with disability. This Act represented one more step in the lengthy
process during which understandings of disability in Australia changed from disability
as a health and charity issue (and later a welfare issue) to disability as a civil rights
concern and shared community responsibility.
In the next section we discuss how and when this change in thinking came to include
children with disability.
2.3.4.2 UN Convention on the rights of the child
The UN Convention on the Rights of the Child (CROC) entered into force on 2
September 1990, and was ratified by Australia on 17 September 1991. As noted
specifically in Article 1 (point 1), children with disability were to take their place with
all other children:
Parties shall respect and ensure the rights set forth in the present Convention
to each child within their jurisdiction without discrimination of any kind,
irrespective of the child's or his or her parent's or legal guardian's race,
colour, sex, language, religion, political or other opinion, national, ethnic or
social origin, property, disability, birth or other status.
The potential impact of this could have been far-reaching. Article 23 specifically
addresses children with disability. Point 1 of this Article decrees that in ratifying this
convention:
Parties recognize that a mentally or physically disabled child should enjoy a
full and decent life, in conditions which ensure dignity, promote self-reliance
and facilitate the child's active participation in the community (Article 23, point
1).
However, our view is that there was little immediate impact for children with disability
in Australia from the CROC. We suggest several reasons for this. There was an
almost exclusive focus on adults with disability in legislative and policy frameworks;
advocacy groups of people with disability were (almost by definition) comprised of
adults with disability with many ‘battles to fight’; parents of children with disability
were primarily focused on getting better education and services, particularly early
intervention, for their children; the current peak bodies advocating for children with
disability such as Family Advocacy in New South Wales and Children and Young
People with Disability Australia (CYDA) were in their infancy; and, young people with
disability in institutional care had no voice in contrast to the developing voice of
young people leaving care through the CREATE Foundation, founded in 1993.
The Australian Government missed deadlines, or there were significant delays, in
reporting on CROC. As noted in the Consultation paper. Australia's performance on
children's rights (Llewellyn, personal papers, 2002) prepared by the National
Children’s and Youth Law Centre:
Australia's first report was due on 16 January 1993 but was not filed until
December 1995 almost three years late. Its second report due in January
21
1998 has never been completed or filed. Its third report was due in January
2003 (to be completed). It is unlikely that Australia’s third report will be
considered by the United Nations Committee before late 2004. The consistent
failure to meet reporting deadlines will mean that Australia will have avoided
any scrutiny of its performance under CROC for nine years (p 2).
The Shadow report Part VI: Basic Health and Welfare, disability and the rights of the
child in Australia (National Children’s and Youth Law Centre and Defence of Children
International, 2005) documented the significant gap between the claims of the
government and the experiences of children with disability and their families. A useful
analysis of Australian legislation relevant to CROC conducted by Clayton Utz
Australia is available on the Australian Child Rights Taskforce website. The analysis
with regard to Article 23 on children with disability can be found at
http://www.childrights.org.au/wp-content/uploads/2014/06/Article-231.pdf
2.3.4.3 Changing perspectives on living arrangements of
children with disability
Planning for de-institutionalisation in Australia began in the 1960s and 1970s,
however implementation did not occur seriously in the disability field until the mid to
late 1980s and into the early 1990s, depending on the jurisdiction. Reform in child
protection services had begun decades earlier as noted in a dedicated chapter on
this topic in Australia’s Welfare 2001 (AIHW, 2001). Two systems had developed in
Australia for children who could not live at home with their birth families. One was the
health and (disability) system comprised of mental institutions and not-for-profit
charitable homes as discussed previously. The other was the child protection system
for those children at risk of or subject to child maltreatment.
Institutional care of children with disability frequently evokes a picture of confinement
within secure boundaries and high walls: of children in bare and grim ward like
hospital-type buildings under the watchful eye of ever-changing staff, often, but not
always, separated from adults with intellectual disability or mental illness on the same
institutional grounds. There is no doubt that this was the case in many institutions
which housed children with disability in Australia and elsewhere. But not all
institutional care for children with disability was in large ‘mental’ institutions. There
were also smaller publically funded health facilities and charitable and privately
owned facilities which attracted state, and depending on their regulatory status,
Australian Government subsidies.
By the 1990s, residential environments for all children had expanded, many of which
raised cause for concern. In jurisdictions around Australia there were many inquiries
into residential care for children (Swain, 2014). In New South Wales for example, and
under the Community Services Act 1994, the then Community Services Commission
was responsible for reviewing the circumstances of children in care in New South
Wales. During the 1990s the Community Services Commission conducted inquiries
into residential and foster care, respite care, and juvenile justice among others.
These inquiries led to the disclosure of unacceptable physical, social and emotional
environments for children and specifically for children with disability in disability
22
specific and other children’s facilities. For example, evidence of physical abuse
including sexual abuse was clearly identified in two reports Suffer the children: The
hall for children report (Community Services Commission, 1997) which resulted in
this institution being forcibly closed and the Inquiry into care and treatment of
residents of Cram House A service for the Illawarra Society of Crippled Children
(Community Services Commission, 1998).
Many of these inquiries drew attention to the presence of children with disability in
facilities in sectors other than health, disability or care and protection. However, hard
evidence was hard to come by. Recommendations such as the following from the
Just solutions Wards and Juvenile Justice report (NSW Community Services
Commission, 1999) were common - ‘To collect detailed and consistent data on the
health and disability status of wards and other children and young people on entry
into care and at regular intervals while in care’ (p 31).
There was also growing recognition that children and young people with disability
were among those who were homeless. Price-Kelly and Hill (1995), for example,
noted the increase in young people with intellectual disability seeking assistance from
agencies working with people who were homeless in inner city Sydney. In the
National Evaluation of the Supported Accommodation Assistance Program in 1993,
11 per cent of the people using these services were those with a physical or
intellectual disability.
In the 1990s state and territory government policies focused increasingly on
community care. Community care policies were predicated on providing support to
families with children with disability to continue caring for their children at home. This
involved providing supports in the family home, as well as increased availability of
respite, and incentives for mainstream services for children to include children with
disability and appropriately meet their support needs. Institutional care was actively
discouraged. By the mid-1990s however, concerns were being expressed in all
Australian jurisdictions that parents were still seeking institutional care for their
children. This was in complete contradiction of government policy which, in theory,
had removed the option for families to seek residential care for children younger than
18 years of age.
Llewellyn and colleagues (1996) were commissioned by the then Commonwealth
Department of Human Services to identify the reasons why families were seeking
out-of-home care despite the growth in services and support to care for their children
at home. Llewellyn et al. (1999) reported that of the 125 families who took part in this
commissioned study, 75 per cent definitely did not want to place their child out of
home, a further 19 per cent were undecided and 6 per cent were actively seeking or
had already sought placement. Families actively wanted help to keep their children at
home, however, in the absence of assured help departmental waiting lists for
residential care became the ‘norm’. Families were frequently being advised to put
their child’s name down on ‘the list’ from an early age to ensure they secured a place
at a later time.
23
2.3.4.4 Changing perspectives on education of children with
disability
In the early 1980s, the federal Schools Commission funded initiatives to support
children with severe and profound disability, many of whom remained in institutional
care. One of these was an Australia wide investigation to find children with disability
not in school. Another was the setting up of a multi-disciplinary education and
therapy team known as the Resource Support Unit in 1981 as part of the Severely
Handicapped Children’s Program, Division of Guidance and Special Education, NSW
Department of Education. This team of six experienced educators and therapists
which included Llewellyn (198283) developed resources, delivered training and
supported teachers around the state so that children with severe disability could
benefit from being in school. A third was the design, build and distribution of an
innovative posture chair to enable children with severe disability to participate in
classroom activities. Initiatives such as these held promise that children with disability
would be welcomed and appropriately supported in educational settings.
In the late 1980s and early 1990s educational opportunities for children with disability
expanded across Australia. The new opportunities included placement in mainstream
classes with a modified curriculum or additional teaching support, small support
classes in mainstream schools, and special schools for children who required more
intensive support. The primary driver for government departments of education to
include children with disability and offer a range of placements came from the
Salamanca statement and framework for action on special needs education adopted
by the World Congress on Special Education: Access and Quality in September,
1994 (UNESCO, 1994).
This groundbreaking document provided a major stimulus for change and the
foundation for the inclusive education movement seen worldwide today. The guiding
principle that informs this framework is that:
schools should accommodate all children [emphasis in original] regardless of
their physical intellectual, social, emotional, linguistic or other conditions. This
should include disabled and gifted children, street and working children,
children from remote or nomadic populations, children from linguistic, ethnic
or cultural minorities and children from other disadvantaged or marginalised
areas or groups (p 6).
Noteworthy here is that children with disability are considered to be part of all
children as per the CROC.
The Salamanca Statement and Framework for Action is considered seminal for its
offerings of over 80 detailed points of action for principles, policy, and practice in
special needs education. It came less than one year after the UN Standard Rules for
the Equalization of Opportunities for Persons with Disability (UN, 1993) adopted by
the General Assembly at its 48th session on 20 December 1993. These 22 rules
summarised the key messages that had developed through the decade of the World
Programme of Action, during which the human rights perspective in relation to people
with disability had begun to crystallise. The Standard Rules represented a strong
moral and political commitment of governments to take action to attain equalisation of
24
opportunities for persons with disability. However, this was not a legally binding
instrument, serving primarily as an instrument policy-making and as a basis for
technical and economic cooperation. (It was to be more than a decade later before
the UN General Assembly adopted the CRPD on 13 December 2006.)
2.4 2000s onwards
On 13 December 2006 at the United Nations Headquarters in New York the
Convention on the Rights of Persons with Disability (CRPD) and its Optional Protocol
were adopted and subsequently opened for signature on 30 March 2007. There were
82 signatories to the Convention on that day, including Australia. Australia ratified the
Convention and its Optional Protocol on 17 July 2008. The Australian Government
and Disabled People’s Organisations (DPOs) in Australia played a key role in the
negotiations and framing of the CRPD, which in turn, gained wider community
awareness of the shortcomings in Australian legislation, policy and practices affecting
the everyday lives of people with disability and their families and carers.
The Australian Government then looked to the National People with Disability and
Carers Council to provide expert advice and information on the development and
implementation of a national disability strategy. The main thrust of their endeavours
was to hold conversations and consultations around Australia with people with
disability and their families. The resulting report, Shut out: The experience of people
with disability and their families in Australia (Commonwealth of Australia, 2009b),
recorded for the first time in one place and under the auspices of the Australian
Government’s advisory body the serious shortcomings in Australia with regard to the
disadvantage and inequities facing people with disability in all areas of life: in health,
education, social life and being part of the community. Thus began the era of the
national disability reform agenda.
2.4.1 The national disability reform agenda
The first component of the national disability reform agenda was the National
Disability Agreement introduced by the Council of Australian Governments (COAG)
in 2009. This agreement proclaimed nationally agreed objectives and outcomes for
people with disability, their families and carers and set out the roles and
responsibilities for national and state and territory governments for the provision of
disability services for people with disability. This replaced the previous
Commonwealth-State Disability Agreements (CSDAs).
The public centrepiece of the national disability reform agenda was the National
Disability Strategy 20102020 (NDS) (Commonwealth of Australia 2011a). This was
developed under the auspices of COAG to take Australia forward to achieve full
inclusion of people with disability in everyday Australian life (p 13). The strategy was
based on three fundamental understandings of disability which clearly expressed, for
the first time, a coherent and inclusive approach toward disability in Australia.
25
The first of the three imperatives the human rights imperative is drawn from the
understanding that people with disability are citizens, not objects of charity
(Commonwealth of Australia 2011a, p 16). The second of the three is the social
imperative. This is drawn from the findings of the Shut Out report documenting the
widespread rejection and exclusion of people with disability in mainstream Australian
society. The final, economic imperative is drawn from the recognition of the benefits
to society of encouraging workforce participation and building human capital
(Commonwealth of Australia, 2011a, p 19).
A further focus was the development of an evidence base to support the national
disability reform agenda. The National Disability Research and Development Agenda
(NDRDA) (Department of Social Services, 2011) was released in November 2011.
The broad aims of the National Disability Research and Development Agenda were
to:
facilitate the creation of a comprehensive evidence base and the foundations
of robust research that will inform policies and practices of the disability
sector, governments and the mainstream community. (NDRDA, 2011, p 4)
Attached to this agenda was a funding commitment made specifically to support the
delivery of the objectives and reform priorities of the National Disability Strategy and
the National Disability Agreement. The Audit of Disability Research in Australia
(Centre for Disability Research and Policy, 2014) found that the evidence base on
disability in Australia was not fit for purpose in relation to the national disability reform
agenda and the research that existed was difficult to find.
In 2011, the Productivity Commission recommended the setting up of a national
insurance disability scheme and a national injury insurance scheme. The former
attracted bipartisan support at the federal level. The stage was then set for corralling
state and territory support for a national disability insurance scheme and introducing
the necessary legislative changes at federal and state and territory level. The
National Disability Insurance Scheme Act 2013 (as amended) came into force on 1
July 2014. This occurred almost 30 years after similar legislative changes at the state
and territory levels were driven by the introduction of the national Disability Services
Act in 1986.
2.4.2 Exclusion of children with disability
Australian disability legislation, policy and strategy frameworks and implementation
plans are now aligned with international best practice in rights, active citizenship and
social responsibility. However in our view these remain focused on adult persons with
disability, as was the case nearly 30 years ago with the state and territory legislation
that followed the Disability Services Act 1986. One example comes from the NSW
Law Reform Commission (1999), which opined that the New South Wales Disability
Services Act 1993 required amendments to adequately apply to the needs of children
and young people.
More recently, New South Wales introduced the Disability Inclusion Act on 4
December 2014 to replace the earlier Disability Services Act 1993. In this legislation,
26
children with disability receive two mentions. The first mention is point 12 of section
4, General Principle, which states: ‘(12) The needs of children with disability as they
mature, and their rights as equal members of the community, are to be respected’.
The second mention is in section 5, Principles Recognising the Needs of Particular
Groups. Point 5 of this Act is inserted here in full:
(5) Supports and services provided to children with disability are to be
provided in a way that:
a) recognises that a child with disability has the right to a full life in
conditions that ensure the child's dignity, promote self-reliance and
facilitate the child's active and full participation in family, cultural and
social life, and
b) recognises that children are more vulnerable to risk of abuse or
exploitation, and
c) addresses that right and risk, and ensures the best interests of the
child is the primary concern in making decisions affecting the child
while also respecting the responsibilities, rights and duties of a parent
or other person legally responsible for the child in relation to giving
appropriate direction and guidance for the child's welfare, and
d) respects the views of the child with disability (having regard to the
child's age and maturity).
2.4.3 Disability as a risk factor in care and protection
frameworks
Disability in care and protection frameworks in Australia is presented as a risk factor.
This is clearly seen in Protecting Children is Everyone’s Business National
Framework for Protecting Australia’s Children 2009–2020 in which one of the known
risk factors for abuse and neglect is childhood disability, mental health/behavioural
problems (Commonwealth of Australia, 2009a, p 21).
In New South Wales, the Department of Family and Community Services (FACS)
makes publicly available a large number of documents in relation to child protection.
So for example there is the FACS/Community Services (n.d.) Care and protection
practice framework and the FACS/Community Services (2006). Child wellbeing and
child protection NSW Interagency Guidelines and the FACS/Community services
(n.d.) and Joint Investigation Response Teams (n.d.). Similar documents are
available for child protection policies and guidance in the care and protection sector
and for service personnel in the disability sector, for example, Child protection
guidelines: What ADHC staff need to know about child protection (FACS/ADHC
2014). In some states and territories there are also informative publications for
parents of children with disability in relation to protecting children and young people
with disability (for example, Government of South Australia, 2013). Overall these
documents, in our view, continue the ‘tradition’ of regarding disability primarily as a
risk factor.
27
The disability as a risk factor approach was helpful in the past in drawing welcome
attention to maltreatment of children with disability in institutional contexts. The
downside is that this disability as risk approach is not in line with Australia’s
international obligations or national legislation. It also hinders robust data collection
and the empirical evidence needed to understand which children with disability, in
what contexts, under what circumstances and to what extent are most likely to be at
risk of sexual abuse. Fundamental to developing this understanding is regarding
disability as only one component in children’s lives.
2.5 Shape of the current disability service
system and policies and practices
A challenge in answering Research Question 1 on understandings of disability in
Australia and how these have changed over time is to what extent these
understandings represent the everyday circumstances of Australian children with
disability. As we have shown, the focus in Australian legislation and policy is on
persons with disability as adults. This has important ramifications for how children
with disability are regarded in service system policies and practices. Internationally,
authors have also drawn attention to how disability legislation is framed in relation to
assuming persons with disability are adults (Sabatello, 2013). This creates several
difficulties.
The first is that although children with disability may receive separate mention this is
most frequently in relation to family and support of their families. We suggest there
are three presumptions present in this approach: the first is children with disability are
‘special’ and the disabled dependants of families and carers; the second that families
will act in their children’s best interests; and the third is that the family is the
fundamental unit to be supported. These presumptions are clearly seen in two
relevant UN Conventions. The Preamble to the Convention on the Rights of the Child
1993 states that the family, as the fundamental group of society and the natural
environment for the growth and well-being of all its members and particularly
children, should be afforded the necessary protection and assistance so that it can
fully assume its responsibilities within the community (p 1). In CRPD just over a
decade later (2006): the family is the fundamental group unit of society and as such
is entitled to protection by society and the State (CRPD, Preamble, para. X). Both
conventions also take a ‘special’ approach to children with disability: Article 23 of
CROC primarily takes a ‘special needs and circumstances’ approach to the rights of
children with disability; in CRPD, one article Article 7 is devoted to children with
disability.
However commendable the intention, there is some Australian evidence that families
do not always act or are not always able to act in the best interests of their children.
Children with disability are proportionally over-represented in care and protection
proceedings and matters of reportable conduct. In the late 1990s research in New
South Wales demonstrated that children with disability were over-represented in care
and protection caseloads and care matters. The study examined over 407 care
28
matters finalised in two New South Wales Children’s Courts over a nine-month period
from May 1998 to February 1999 and reported that 24 per cent of all children had an
identified disability or medical condition (McConnell, Llewellyn & Ferronato, 2000).
Recently the NSW Ombudsman (2016) noted that over one-quarter 29 per cent
(588) of notifications of reportable conduct (time period 1 July 2013 to 30 June
2015) were children with disability or additional support needs. Further it was noted
that FACS reports that 12 per cent of children in out-of-home care have a disability
however 36 per cent of all closed notifications of reportable conduct matters from this
sector involve a child with a disability. The NSW Ombudsman noted similar over-
representation (although not quite so high) in the reportable conduct matters from the
school sector. The New South Wales government school sector reports 12 per cent
of children in schools have a disability. However, 21 per cent of the notifications from
this sector involve children with a disability. Reports of over-representation of children
and young people with disability in the out-of-home care sector come from other
jurisdictions in Australia (CREATE, 2012). In our view, up to date national studies are
certainly warranted on the prevalence of children with disability in care and reportable
conduct matters.
To be clear these figures do not equate with prevalence or relative risk of child
maltreatment for children with disability. Rather what the data illustrate is that, as a
group, children with disability appear at a higher rate in the out-of-home care sector
than expected according to their presence in the population. The proportion of
children with disability (0-14 years) in the general population is on average 6.1 per
cent (3.4 per cent in 0-4 age range and 8.8 per cent in 5-14 age range, ABS, 2012).
As noted by the NSW Ombudsman (2016) children with disability are in the range of
21-29 per cent in reportable matters, and 24 per cent in finalised care matters.
Overall these New South Wales figures are just over four times higher than the
presence of children with disability at 6.1 per cent in the total child population.
2.5.1 Quality and safeguards
Relevant to this discussion paper and the changing shape of disability support and
services is an outstanding and ongoing concern about ensuring adequate quality and
safeguards for people with disability. There are two aspects of concern to policy
makers, advocacy groups, researchers and people with disability and their families
and carers. The first is to ensure adequate quality and safeguards for individuals with
disability who are eligible for the National Disability Insurance Scheme (NDIS)
(Robinson 2014). The second is to ensure adequate quality and safeguards in the
changing balance of responsibilities from the specialist disability sector to
mainstream services. The responsibilities of each with regard to the NDIS and state
and territory government responsibilities are set out in the COAG Principles to
Determine the Responsibilities of the NDIS and Other Service Systems, 27
November 2015 (available at https://www.coag.gov.au/sites/default/files/Schedule_I-
Principles_determine_responsibilities_NDIS_other_service_systems.PDF).
Four points are critical here in our view. The first is that currently state and territory
governments have responsibility for specialist disability services, some of which are
29
contracted out to the non-government sector. Those remaining are directly funded by
and under the control of the relevant state/territory government. With full NDIS roll-
out occurring from July 2016, state and territory governments will no longer hold
responsibility for specialist disability services. (The timing of this varies somewhat
across the country depending on the Heads of Agreement between the
Commonwealth and State/Territory government).
In New South Wales for example, the Department of Family and Community
Services, Ageing, Disability and Home Care recently announced (5 May 2016) the
process to tender out its disability services to the non-government sector. This is
described thus: From July 2018, the NSW Government will no longer provide
specialist disability supports or basic community services. Services currently
provided directly by the NSW Government will be transferred to the non-government
sector. This means that after July 2018 there will be no disability services provided by
the NSW Government. This raises concerns for peak advocacy groups about
safeguards for people with complex needs including independent advocacy/decision
support, monitoring by the Ombudsman, and establishing ‘provider of last resort’
arrangements.
The second point is that there are many people with disability in the community who
do not currently access specialist disability services. There are many possible
reasons for this including services not being accessible where they live; long waiting
lists particularly for early intervention services in heavy demand urban population
areas; services restricted to people with certain types of impairment and /or level of
severity; unwillingness to disclose their disabling condition; and fear or dislike of
service interventions in their lives.
Approximately 460,000 of the nearly 4 million persons with disability in Australia will
be eligible as participants in the NDIS and within this number a proportion will be
eligible for a funded support package. The choice and control principle underpinning
the NDIS means that eligible participants will be able to source their supports as they
wish. This raises concerns about adequate safeguarding in this so-called ‘market
economy’ for services and supports.
However the NDIS is not only about eligibility for a support plan and, for some
participants, a funded support package. It is also predicated on Australian society
changing to become inclusive and welcoming of people with disability in all aspects
of community life. The third point therefore in the disability reform agenda is the
requirement for all mainstream services education, criminal justice, health,
transport, housing and so on to be inclusive, welcoming, appropriate and safe for
people with disability. This raises the question of safeguarding and accessible and
appropriate complaints mechanisms for people with disability in these mainstream
sectors.
The fourth point is the exponential increase in workforce required to accommodate
the increase in people with disability being served by the NDIS when fully
implemented. In February 2016, the Queensland Office of Public Advocate released
a report titled Upholding the right to life and health: A review of the deaths in care of
people with disability in Queensland (2016). This report states that in Queensland
alone the number of people with disability served under the NDIS will more than
30
double from 45,000 to 97,000, requiring an additional workforce of 13,000 people.
The difficulty in recruitment and retention of a quality workforce in the disability sector
is well documented in Australia (for example, see work by the Community Services
and Health Industry Skills Council available at:
http://www.cshisc.com.au/develop/quality-case-studies/industry-spotlight-
case-studies/recruitment-and-retention/ ).
Specific issues frequently mentioned include a lack of quality induction, and ongoing
training requirements and opportunities to undertake professional development.
Overall the national disability reform agenda constitutes large scale social reform. It
is about reform of disability services. More than that, the major part of the reform
agenda is to change community attitudes about people with disability in Australia so
that all Australians are treated as equal and contributing citizens.
The focus of this reform agenda is not new however. Just on 30 years ago the
Disability Services Act 1986 was introduced, based on a vision of an inclusive and
respectful Australia. Five years ago the National Disability Strategy 20102020 set
out a vision to achieve an inclusive Australian society that enables people with
disability to fulfill their potential as equal citizens (2011, p 22), noting in particular the
need for an improved mainstream response. There is much current activity focused
on how to maintain quality and ensure safeguards for people with disability in this
changing and desired landscape of Australian society. This comes from the National
Disability Insurance Agency (NDIA) in consultation papers, public forums and
consultations reports; from federal and state statutory agencies responsible for
safeguarding the rights of individuals with disability, for example the Commonwealth
Ombudsman, the NSW Ombudsman, the Victorian Disability Discrimination
Commissioner and the Royal Commission into Institutional Responses to Child
Sexual Abuse; from peak advocacy bodies such as Children and Young People with
Disability Australia, People with Disability Australia, Women with Disability Australia
and the NSW Council for Intellectual Disability among others.
Particular projects have also been instigated for example by National Disability
Services (NDS) in the roll-out of its national program Zero Tolerance: A Framework
to prevent and improve sector responses to abuse, neglect and violence experienced
by people with disability. This program aims to provide evidence-based resources to
safeguard the rights of people with disability. There is particular concern about
whether the current regulatory frameworks and oversight bodies in states and
territories in relation to people with disability will continue to function alongside any
future Commonwealth oversight body or mechanisms.
As well as concerns, opportunities have come to light with the roll-out of the NDIS.
These have provided cause for reflection in some quarters on Australia’s obligations
under the CRPD. As the report of the Australian Law Reform Commission into
Equity, Capacity and Disability in Commonwealth Laws (2014) points out at 10.75:
As a national quality and safeguards system for the NDIS is being developed
by COAG, the ALRC considers it desirable for state and territory governments
to review their disability services legislation, with a view to reform that is
consistent with the National Decision-Making Principles and the
31
Commonwealth decision-making model. This might involve, for example,
moving towards compliance with the CRPD, as well as preparing for the
implementation of the NDIS. (ALRC 2014, p 288)
To date to the best of our knowledge there has not been similar reflection on
Australia’s obligations to children with disability under the CROC.
2.5.2 Assumptions which underpin responses to sexual
abuse of children with disability
Earlier in this discussion paper, two competing understandings on disability were
presented. The first is the rights and social responsibility understanding which
underpins the national disability reform agenda. The competing understanding
frames disability as deviance from the norm, as negative difference whereby
individuals with disability are ‘othered’ in many ways, one of which is being thought to
require technical, medical health responses which are outside the responsibility of
society more generally. Stigma, discrimination and social isolation also contribute to
othering children with disability. This process of othering as argued by Robinson
(2012) leads to children with disability being on the one hand more vulnerable to
maltreatment including sexual abuse and on the other hand to disinterest in abuse of
children with disability and less being done to prevent abuse occurring or responding
appropriately after the event. A similar argument has been made by Frohmader,
Dowse and Didi (2015) for Women with Disabilities Australia (WWDA) and others
internationally with regards to women with disability (WHO, 2014).
In our view, if children with disability were regarded as children first, with disability
regarded as only one aspect of their lives, they would have a strong presence in
policy frameworks designed to keep all Australian children safe. One would expect to
see explicit detailing of the ways in which societal attitudes play out in the institutional
contexts frequented by children with disability and the ways in which these children
may be at potential risk of maltreatment including sexual abuse. This is not the case.
2.5.2.1 Non-normalised institutional contexts for children with
disability
As noted in Section 1, children with disability spend a great deal of time in a range of
institutional contexts. Some of these institutional environments are not ‘normalised’.
This means that the only children present will be those with disability, for example in
situations such as respite care, Special Olympics, classes for children with disability,
and school transport. In many contexts, there may be one adult or very few adults
unrelated or not known to the child. This creates an environment in which there is
little oversight of adult or older peer behaviour. There is concern that this situation
where adults are unknown to children and to each other will increase with the
expanding and increasingly casualised workforce in the disability sector with the
NDIS market reforms.
32
The second instance of non-normalised environments is where adult assistance is
required with daily intimate care for children with disability. In this situation the child’s
body is regularly handled by non-familial adults. Often there is only one adult present,
who may be of different gender to the child. Two potential outcomes may arise. The
first is that children with disability in this situation have less opportunity to develop a
sense of their bodily integrity and what constitutes acceptable touch. At the same
time, their vulnerability to sexual abuse is increased when the attending adults
believe that children with disability would not know what was right or wrong and in
addition would be unlikely or unable to report any wrongdoing (Martinello, 2014;
Stalker & McArthur, 2012). As suggested in the literature on sexual abuse of adults
with disability, these circumstances can lead to a reframing and renaming of what
would be called sexual abuse in relation to children without disability as acceptable
behaviour in the minds of both perpetrators and others present (Frohmader, Dowse &
Didi, 2015).
Recognising the particular everyday circumstances of children with disability would
also mean taking into account what is known about the likely behaviours of children
with disability under duress and particularly those with communication difficulties.
There is for example a well-developed evidence base on the so-called ‘challenging’
behaviours of individuals with disability. These behaviours are now understood to be
primarily driven by physical, health, emotional and sensory stressors and need to be
treated accordingly (Emerson & Einfeld, 2011).
33
SECTION 3 Interations that
influence the risk of
sexual abuse of
children with disability
in institutional contexts
3.1 Overview
There is no empirical Australian data available to answer Research Question 2 on
how characteristics of a child’s impairment and their environment interact in ways
that influence the risk of sexual abuse of children with disability in institutional
contexts.
This is a critical question to answer specifically in relation to children with disability for
three reasons. First, children with disability differ from their non-disabled peers
because they spend time in disability-specific institutional contexts such as respite
care, school transport, Special Olympics or school classes for children with disability.
34
In these contexts there may only be one or very few adults present; it is unlikely that
any non-disabled children are present.
Second, children with disability may be thought of as ‘other’, and particularly so in
disability-specific settings. Practices and behaviours that are neglectful or abusive
may be reframed in these contexts as ‘acceptable’. Although this ‘othering’ of people
with disability may be thought to belong to an earlier era, there is good evidence in
Australia that this continues today. This is clearly demonstrated in the reports of the
Senate Inquiry into Involuntary or Coerced Sterilisation of People with Disability in
Australia (Commonwealth of Australia, 2013) and the Senate Inquiry into Violence,
Abuse and Neglect Against People with Disability in Institutional and Residential
Settings, including the gender and age related dimensions, and the particular
situation of Aboriginal and Torres Strait Islander people with disability, and culturally
and linguistically diverse people with disability (Commonwea of Australia, 2015).
Third and highly relevant to this section is that children with disability are children first
and foremost with disability being only one, although an important component of their
lives. As with all children, we need to consider various child-related characteristics
such as age, gender, family and socio-economic circumstances and their family and
community environments and the interaction of these components to understand the
risk of sexual abuse.
3.1.1 Multiple, interacting factors
It is highly unlikely that one single factor is responsible for increased risk of sexual
abuse of children with disability. It is more likely there are multiple interacting factors.
The presence of multiple interacting factors in risk of maltreatment for children is a
live topic in the broader child maltreatment literature. An Australian example speaks
to the dangers of presuming there is one particular risk factor. This comes from
Hunter and Price-Robertson’s (2012) paper on Family structure and child
maltreatment. Do some family types place children at greater risk? The authors point
out that it is often believed that the sole parent family structure is a risk factor for child
maltreatment. Even if there was evidence of association between sole parent families
and maltreatment, association does not mean causation. Furthermore, association
may be mediated by other factors. In other words, just because sole parent families
appear more frequently in care and protection proceedings this does not mean that
this family structure causes child maltreatment. There is a dangerous leap or
slippery slope between observing frequency and then believing that frequency
equals cause. The authors summarise thus:
much of the perceived relationship between family structure and child
maltreatment can be explained by factors such as poverty, substance misuse
and domestic violence…maltreatment reflects the effects of multiple,
dynamic, interrelated and, often, cumulative risk factors. (p 1)
Regrettably a more nuanced understanding of the risk of sexual abuse of children
with disability is not yet available. The overall perception is that it is disability per se
which causes maltreatment. This perception is driven by misinterpretation of
prevalence and risk figures which suggest a higher likelihood (frequency) of sexual
35
abuse for children with disability. This comes from falling into the trap of thinking
association means causation; overlooking potential mediating factors; and ignoring
the multiple, dynamic, interrelated and often cumulative risk factors that may be
present.
3.1.2 Overlooked factors
One factor ‘conveniently’ ignored is to differentiate disability that predates sexual
abuse from disability caused by sexual abuse. As demonstrated in the Forgotten
Australians report (Commonwealth of Australia, 2004) disability is one consequence
of child maltreatment over an extended period of time. There is very little discussion
of this in the scientific and Australian grey literature on children with disability and
child maltreatment.
Another overlooked factor is the setting in which the sexual abuse took place. Thus,
even though there are studies of sexual abuse of children with disability in school or
in hospitals for example, these studies are not about abuse which occurs in those
settings. The institutional contexts of hospital or school have been convenient
settings for sourcing samples of children to study prevalence and/or risk. Further
difficulties with the evidence on sexual abuse of children with disability are explained
after the findings section.
A further difficulty is the limited resources directed to research in this field resulting in
a poor evidence base and a small body of researchers focusing on the topic. This
can be seen particularly in the lack of research which connects abuse of children with
disability with broader child abuse research (Robinson, personal communication, July
2016).
3.2 Conceptual framework
The conceptual framework for this section comes from the Australian standard
definition of disability. To recap, disability results from the interactions between
individuals, their impairment and societal barriers. Ideally, the scientific literature
would provide answers to questions about characteristics and person-environment
interactions in relation to sexual abuse. That is not the case yet even about violence
and adults with disability as noted by Hughes et al. (2012) in their systematic review
of this topic for the World Health Organisation (WHO) reported in the Lancet.
With an increasing number of population surveys and administrative data sets which
include people with disability, there are now more opportunities to examine
characteristics, interactive effects and comparative differences for people with
disability and their non-disabled peers. An Australian example comes from Krnjacki
et al. (2015a), which analysed secondary data from the Personal Safety Survey
(ABS, 2012) of more than 17,000 adults to estimate the population-weighted
prevalence of violence (physical, sexual, and intimate partner violence and
stalking/harassment) in the previous 12 months and since the age of 15. The survey
36
data allowed for investigation of many (although not all) critical components: age,
gender, type of violence, comparison with non-disabled peers, and longevity of
exposure. Using a cross-sectional design for a similar purpose, Emerson et al.
(2015b) analysed secondary data from Wave 3 of the UK Understanding Society
survey. There were additional advantages in this data set including individuals’
perceptions of safety and their socio-economic circumstances. These types of
population data sets and research designs are needed in Australia to investigate the
prevalence and risk of sexual abuse for children with disability and to examine the
personenvironment interactions which exacerbate or diminish this risk.
The implementation of the Child Protection National Minimum Data Set (AIHW, 2014)
is a welcome beginning. Unit record data reliably recorded in each jurisdiction is
needed however to ensure a useful, robust and reliable data set. The in-principle
agreement for jurisdictions to include the disability identifier must be implemented as
soon as possible. Otherwise Australia will have to continue to rely on international
evidence. This is a second best approach, especially when we understand that
settings can be very different in the countries that produce the research data. In our
view, it is critically important that Australia has its own data from which we can derive
evidence-informed approaches to preventing sexual abuse of children with disability.
3.2.1 Difficulties in relying on international data
Having Australia’s own data is even more important when we realise that it may take
some time before the international literature incorporates the individual
characteristics and personenvironment interaction perspective. There are several
reasons for this. The first is because the predominant view of disability per se as the
risk factor for child sexual abuse means that researchers have tended not to ‘look
any further’. A second reason is that in the past less attention has been given to
population surveys and administrative databases for children. Australia now has
national frameworks in disability and in child protection that require this to change
(Commonwealth of Australia 2011a, 2009a).
A third is the ethical and other challenges in child self-report in surveys/administrative
databases which have been overcome in other countries for example the National
Longitudinal Survey of Children and Youth in Canada
(http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=4450). A
fourth reason is that children with disability are frequently excluded from population
and/or administrative data collections because they are considered unreliable or
inaccurate respondents. This is no longer acceptable because of Australia’s
international obligations under CRC and CRPD. International initiatives such as
UNICEF’s Global Partnership on Children with Disability (http://www.gpcwd.org/) and
UNICEF Multiple Indicator Cluster Surveys (http://mics.unicef.org/) provide direction
to ensure detailed and robust data collection of matters pertinent to children happens
worldwide.
We now turn to reporting on prevalence and risk estimates and then analyse the
relatively limited evidence on characteristics and their interaction effects. To align
with other materials from the Royal Commission into Institutional Responses to Child
37
Sexual Abuse, this section uses a format similar to that in Kaufman and Erooga’s
report on Risk Profiles for Institutional Child Sexual Abuse: A literature review (2016).
This section sets out to answer the question: What are the risk and protective factors
for children who are at increased vulnerability to sexual abuse in institutional
contexts? First we report on child factors, followed by a discussion of family factors
and then environmental contextual factors.
3.3 Search methods
This section describes the methods used to examine the scientific and the grey
literature in relation to risk and protective factors for sexual abuse of children with
disability in institutional contexts.
3.3.1 Scientific literature
The search used, as the seminal reference document, the first international
systematic review and meta-analysis of observational studies on violence and
children (aged ≤18 years) with disability by Jones et al. (2012). This research was
commissioned by the WHO and reported in the Lancet. The time period for reports of
studies in Jones et al. (2012) was 1 January 1990 to 17 August 2010. Accordingly,
our search strategy did not return to pre 2010 studies.
The inclusion criteria for the Jones et al. (2012) were: cross-sectional, case control or
cohort design; violence perpetrated against children (≤18 years); specific disability
type, specific disorders, activity limitations or support needs reported; definitions and
methods of measurement for violent outcomes reported; and reported prevalence
rates, odds ratio or raw data to enable calculation of prevalence.
The exclusion criteria were: studies based on selected populations affected by
violence (for example, children with disability referred for problems related to sexual
abuse); focus mainly on adults (>18 years); and response rate <50 per cent or not
reported.
Sixteen of the 17 studies included in Jones et al. (2012) addressed sexual violence
(authors’ term).
To identify studies reported since the August 2010 cut-off date for Jones et al. (2012)
we conducted a Web of Science and Scopus citation report of their study. This
revealed an additional three studies which also met the Jones et al. (2012) inclusion
and exclusion criteria. These were Butler (2013), Devries et al. (2014), and Mueller-
Johnson et al. (2014). Hand searching of the reference list of these three studies
identified one further study by Turner et al. (2011). This resulted in 20 studies to be
analysed: 16 from Jones et al. (2012) and four studies since that time.
38
3.3.2 Grey literature
The grey literature was sourced from four topic areas: child protection; family
violence; disability; and criminal justice. The scope of literature sourced was
intentionally broad given the intersections between these topics and the lack of
material specifically addressing children with disability. We included grey literature
which referred to disability within a broader focus on health in addition to sexual
abuse. Grey literature was sourced online using the cut-off date of 2006 in line with
the introduction of CRPD and relevant Australian inquiries. Reference lists of the grey
literature identified were hand searched.
Searching began online using the four topic areas. This yielded six reports which
addressed maltreatment of children in institutional settings, children with disability in
institutional settings, and papers on the specific needs of people with a disability
including women and children. From these seven papers: Woods (2008), Robinson
(2012, 2016), Bromfield and Holzer (2008) and reports from People with Disability
Australia (PWDA) and Commonwealth of Australia (2009, 2011), a further 13 reports
were identified.
Of the 20 articles analysed for this discussion paper, seven were published or funded
by Commonwealth agencies, seven were funded by state governments, and the
remaining five produced by national peak disability bodies. Fifteen of the 20 were
specific to disability alone.
3.4 Description of literature
Prior to reporting the outcomes of the analysis of the literature, we provide a brief
explanation of the terms ‘prevalence’ and ‘risk’. Prevalence is distinct from incidence.
Prevalence is a measurement of all individuals affected by a condition at a particular
time, whereas incidence is a measurement of the number of new individuals who
develop the condition during a particular period of time. Prevalence can be described
as lifetime prevalence, point prevalence or period prevalence. For example abuse at
the point of time the data was collected would be point prevalence. This is quite
different to abuse over a period of time. In Emerson et al. (2015a) we sourced data
on prevalence at two time periods: over the last 12 months and since 15 years of
age. This is a standard way of investigating whether the abuse is only recent (last 12
months period prevalence) and/or over a much longer period of time. Lifetime
prevalence is self-explanatory how many individuals at any time over whatever is
considered their lifetime. Jones et al. (2012) refer to lifetime prevalence. In their
meta-analysis six studies recorded prevalence as lifetime, one in the past year; in
three studies the time period was not specified (1) or not recorded (2).
Risk is distinct from prevalence. Risk is a measurement of the likelihood at a
population level that a particular condition, in this case sexual abuse, will occur. This
does not mean every person in that population (in this case, children with disability)
will be at the same level of risk. This is because risk is estimated across the entire
population of children with disability and compared to the risk for children without
39
disability (relative risk). As we have noted above, risk is influenced by child
characteristics, impairment, personal factors and environmental factors and the
interactions between these. Future studies which use secondary analysis of
population surveys and administrative data sets will be in a better position to identify
what differences in risk levels exist if any, why and for whom.
The Australian grey literature on sexual abuse of children with disability relies heavily
on citation of selected studies from the international scientific literature. The
authors/studies cited most frequently are Sobsey (1994), Sullivan and Knutson
(1998, 2000), American Academy of Pediatrics (2000) and Jones and colleagues
(2012). When citations are provided there is usually also commentary suggesting that
the findings from other countries would be replicated in the Australian context.
In this section we use the language and terms used in the studies discussed: some
of these are not used in Australia or may be considered unacceptable. The scientific
and grey literature has been combined to provide a presentation of the key issues
that also offers robust insight into the significant complexities of the available
literature. Analysis of the research design, primarily in relation to the scientific
evidence, precedes discussion on what was reported specifically on prevalence and
risk. Study limitations include recruitment or selection of participants (Spencer et al.
2005), disability inclusion by diagnostic type (Turner, 2011) and sample size which is
noted throughout this section.
RESEARCH DESIGN
The studies included in Jones et al. (2012) used a range of research designs. These
include: two cohort studies (Benedict et al., 1990; Spencer et al., 2005); the
remaining were 14 cross-sectional.
The type of research design favours particular findings. The strongest research
design utilises population data from the entire population or a specified sample (for
example, random, representative and stratified). This design also provides the
opportunity to examine between- and within-group differences. That is, if the
population was children and young people, say, between 5 and 18 years, then
children with disability could be compared to their peers without disability (between-
group) and differences among children with disability and among their non-disabled
peers could also be examined (within-group). The differences to be examined are
limited only by items available in the survey. In designs which do not have a
comparison group of children without disability, findings are limited to within-group
data on the children with disability and cannot be generalised beyond that particular
group.
The study by Spencer and colleagues (2005) was the only study included in Jones et
al. (2012) that used a whole population data set. These authors used a UK birth
cohort which was regularly updated throughout childhood and was then linked to a
child protection register. Using a whole population data set eliminates sample
selection bias. The findings of this study showed the association between specific
disabling conditions and child abuse registration. The risk for registration of child
abuse was 7.65 times higher for conduct disorder and 6.38 times higher for
moderate/severe learning difficulties when adjusting for birthweight, gestational age,
40
maternal age and socio-economic status. The risk estimates reported in Jones et al.
(2012) were unadjusted.
Most of the studies in Jones et al. (2012) and the four additional studies used random
or population samples of school students in which disability could be identified
(Alriksson-Schmidt et al. 2010; Blum et al. 2001; Devries et al. 2014; Everett Jones et
al. 2008; Miller 1993; Mueller-Johnson et al. 2014; Sullivan & Knutson 2000; Suris et
al. 1996). Studies which reported findings from random samples of children or
families were Butler (2013), Cuevas et al. (2010), Jemta et al. (2008) and Turner et
al. (2011).
Convenience or specific-setting samples of children with disability were used by
Ammerman et al. (1994), Mandell et al. (2005), Sullivan et al. (2000) and Reiter et al.
(2007). For example, the Ammerman et al. (1994) study sample were children
admitted to a psychiatric hospital providing a service for children with developmental
disabilities. While convenience sampling of children attending a particular setting
allows understanding of children in that setting, it militates against comparisons with
children in other settings.
The rigour with which authors describe their study designs also varies. For example
there is no description of how the samples were derived in Ebeling and Nurkkala
(2002), who investigated child psychiatric inpatients and in Verdugo et al. (1995),
who investigated children in institutional care.
SAMPLE SIZE
The sample sizes of children with disability in the 16 studies in Jones et al. (2012)
ranged from 41 (Ebeling & Nurkkala, 2002) to over 5,500 (Blum et al., 2001). This is
a wide range; generally speaking the larger the sample size the more likely the
findings are not by chance alone. Caution needs to be exercised when interpreting
statistical significance with small sample sizes.
RESPONDENTS
Studies vary by respondents who provided the information on disability and sexual
abuse. What counts as disability may vary considerably when disability is observed,
determined by clinical judgment or by standard measures. In reporting extreme
circumstances such as sexual abuse retrospective reports are known to present
some difficulties. Proxy reports, for example by parents, may deliver different results
to reports from the child or young person who has been harmed.
The most frequently occurring respondents across the 20 studies were children
themselves, followed by their caregivers, official records/professional reports, with
reports by professionals being the least frequent.
Ten studies: Self-report by questionnaire or interview (Alriksson-Schmidt et al., 2010;
Blum et al., 2001; Butler 2013; Devries et al., 2014; Everett-Jones & Lollar, 2002;
Jemta et al., 2008; Miller, 1993; Mueller-Johnson et al., 2014; Reiter et al., 2007;
Suris et al., 1996)
41
Five studies: Official records or professional reports (Benedict et al., 1990; Ebeling &
Nurkkala, 2002; Spencer et al., 2005; Sullivan et al., 2000; Sullivan and Knutson,
2000)
Two studies: Interviews with caregivers (Ammerman et al., 1994; Mandell et al.,
2005)
Two studies: Caregiver interviewed if child very young (<10years) and child
interviews if >9 years of age (Cuevas et al., 2010; Turner et al., 2011)
One study: Questionnaire by professionals (Verugo et al., 1995)
COMPARISON GROUP
There was no comparison group in seven studies (Ammerman et al., 1994; Benedict
et al., 1990; Ebeling & Nurkkala, 2002; Jemta et al., 2008; Miller, 1993; Sullivan et
al., 2000; Turner et al., 2011).
In the remaining 13 studies, comparisons between children with and without disability
were reported. Stronger designs utilise a comparison group which is from the same
overall sample. Ten studies used comparison groups from the same data set or
sample. For the other three studies different methods were used: Miller’s (1993)
comparison group was recruited from participating public schools in the district;
Reiter and colleagues (2007) asked children with disability to ‘bring a friend’ for the
comparison group; and although Verugo et al. (1995) stated non-disabled children,
there was no source reported.
CONFOUNDING VARIABLES
Studies need to account for potential confounding variables. Confounding variables
are variables/factors that may influence the relationship between disability and sexual
abuse. Researchers can only control for variables that are in the data set for
example, socio-economic status, neighbourhood and parental mental health. Studies
which controlled for potential confounders were Alriksson-Schmidt et al. (2010),
Benedict et al. (1990), Butler (2013), Cuevas et al. (2010), Devries et al. (2014),
Everett-Jones and Lollar (2008), Spencer et al. (2005), Mandell et al. (2005), Mueller-
Johnson et al. (2014) and Turner et al. (2011).
When studies controlled for socio-demographic and family factors (Turner et al.,
2011; Spencer et al., 2008), the association between violence and disability was
reduced. For example, Turner et al. (2011) examined sexual victimisation among
children with physical disability, internalising psychological disorder, ADD/ADHD
(Attention deficit disorder/Attention deficit hyperactivity disorder) and
developmental/learning disorder. Initial analyses showed that children with any (of
the four) disorders, as well as physical disability and internalising psychological
disorder reported significantly higher rates of sexual victimisation. When factors such
as ethnicity, age, gender, socio-economic status, number of parents in the house and
parental psychological disorder were controlled for in the analyses, only internalising
psychological disorders was shown to be a predictor of sexual victimisation. This is
quite a different finding to that which occurred before controlling for those variables.
42
In other words, only the children with internalising psychological disorder (compared
to children with no disability) had greater odds of experiencing sexual victimisation.
Devries et al. (2014) investigated three child factors: age, working outside the home
and having mental health difficulties. The report identified that these risk factors were
similar for young people with disability as well as their non-disabled peers,
suggesting that there may be a factor or factors common to the risk of violence for all
children over and above the disability variable.
The recent study by Mueller-Johnson and colleagues (2014) used data from a US
national school-based survey (n=6,749) to investigate sexual victimisation among
physically disabled youth and controlled for 17 socio-demographic, lifestyle-related
and family/parenting-related factors. Findings revealed physical disability was a
significant predictor of (contact and non-contact) sexual victimisation for boys and not
for girls.
When population data is available it is possible to account for at least some potential
confounding variables. The current state of evidence suggests that disability may not
be the risk factor per se that it is believed to be. This is a critical finding which needs
to inform population and targeted prevention and intervention approaches. This
finding mirrors those being reported in other disability research using population data
with control of variables such as Emerson et al. (2015a) and Emerson et al. (2015b).
Llewellyn and Hindmarsh (2015) recently reported findings of diminished risk (against
usual expectations) in a review of population based studies on pregnancy and birth
outcomes and child protection for parents with and without intellectual disability.
3.5 Findings
3.5.1 Prevalence
Jones et al. (2012) reported the pooled prevalence rates of sexual violence at 13.7
per cent (range <1.0 per cent 40 per cent) from 15 out of 16 studies addressing
sexual violence in their meta-analysis of 17 studies on violence against children with
disability. The 16th study which addressed sexual abuse Spencer et al. (2005)
did not report prevalence.
Note that the range of these pooled prevalence rates is extreme. The range is from
less than 1 per cent of the population of children with disability to 40 per cent of this
population. The reason for this extreme range is the substantial heterogeneity of
these studies. This means that although all studies met the inclusion criteria for the
meta-analysis, the studies were not alike, thus the pooling of the prevalence rates
brings together rates from studies which were different on several dimensions. Given
the substantial heterogeneity between the estimates in the 15 studies and the
possibility of small sample size study effects, Jones et al. (2012) calculated a fixed-
effect estimate which for sexual violence resulted in a lower pooled prevalence
estimate of 8.9 per cent (95 per cent CI 8.49.3). This rate is likely to be closer to the
‘true’ prevalence estimate.
43
The studies differed with respect to research design including the way participants
were sampled, sample size, the person providing the information or how potential
confounding variables were controlled and whether there was a comparison group.
Definitions of disability and sexual abuse also differed between studies. Each of
these is discussed in detail below.
The additional four studies since Jones et al. (2012) reported prevalence rates within
the range in their meta-analysis. These were: 18.3 per cent in Butler (2013), 7.1 per
cent for boys and 23.6 per cent for girls in Devries et al. (2014), 22.35 per cent in
Mueller-Johnson et al. (2014) and 9.0 per cent in Turner et al. (2011). We were not
able to calculate risk from these studies.
In the absence of Australian empirical evidence on prevalence and risk, the grey
literature also relies on organisational collective knowledge or anecdotal information
collected through membership enquiries. This is not surprising. As noted in
Protecting children is everyone’s business. National Framework for protecting
Australia’s children 2009-2020 (Commonwealth of Australia, 2009) there is no robust
data on child abuse and neglect on incidence/prevalence (p 11). Specifically
speaking about disability, Robinson (2012) noted that it is difficult to discuss the
rates of prevalence of abuse and neglect of children and young people with disability
with any certainty (p 12). Jackson, Waters and Abell (2015) noted There is even
less data available regarding the prevalence of people with intellectual disability who
have experienced trauma (p 56).
Prevalence of maltreatment of children with disability in the Australian grey literature
is most frequently cited as being three times (3.143.4) more likely in comparison to
their non-disabled peers (Robinson, 2012; Children with Disability Australia, 2015;
Australian Cross Disability Alliance, 2015). Robinson (2012) stated a prevalence
figure of around three times higher based on findings from Sullivan and Knutson
(2000). This figure is relative risk not prevalence. As noted in Sullivan and Knutson
(2000) disabled children were 3.4 times more likely to be the victim of some type of
maltreatment than their nondisabled peers, a risk factor coefficient…’ ( p 1268). The
prevalence rate reported by Sullivan and Knutson (2000) is 31 per cent for children
with disability and 3 per cent for their non-disabled peers.
To put this in perspective, Jones et al. (2012) reported pooled prevalence estimates
(from 16 studies) of 13.7 per cent (9.218.9) from a total of 1,455 incidents in 14,675
children. The prevalence range from the 15 studies was from <1 per cent to 40 per
cent. Citing the prevalence rates from individual studies is less helpful than citing
prevalence rates from a meta-analysis, for all the design limitations mentioned
above. This is because in a meta-analysis samples are pooled, allowing for more
powerful statistical techniques to come closer to an estimate of true prevalence. Note
carefully however the detailed discussion in Jones et al. (2012) of the limitations of
the individual studies and therefore of their meta-analysis, which however remains
the most robust available in the scientific literature to date.
The Australian grey literature also refers to factors mentioned in the international
literature that may affect reporting of sexual abuse of children with disability. Three
documents are relevant here. Submissions from National Disability Services (2015),
Robinson et al. (2015) and Robinson (2016) all note that abuse may be under-
44
reported. Reasons given include parents and others not pursuing criminal justice
proceedings; children with disability being regarded as unreliable witnesses; and,
disability services staff at all levels being unaware of or overlooking incidents that
constitute sexual abuse.
3.5.2 Risk
Jones et al. (2012) estimated the risk of sexual violence for children with disability
using 10 out of 16 studies. The relative risk ratio was 2.88. This means that children
with a disability as a group have a 2.88 times higher risk of sexual violence than
children who do not have a disability. Jones et al. (2012) caution against a one size
fits all interpretation of this figure because this is an estimated risk figure derived from
only 10 heterogeneous studies. What this means is that the best risk estimate
available at this time is 2.9 (2.88 rounded) times higher for children with disability
than for non-disabled children.
Jones et al. (2012) were able to calculate risk specifically for one impairment group
only, those with mental/intellectual disability. They calculated this risk as 4.6 times
higher than for children without disability (n=732). It was not possible to estimate risk
from the four additional studies identified for this discussion paper.
There is limited mention of risk characteristics related to children with disability in the
Australian grey literature. Rather ‘disability’ is presented as the stand-alone risk
factor for child maltreatment (Bromfield and Holzer, 2008; COAG, 2009; Senate
Community Affairs Reference Committee, 2015; Wood, 2008). There is however
mention of risk circumstances for example, factors that increase risk (Robinson,
2012, p 7) and drivers for abuse (NDS, 2015), noting that impairment does not of
itself make a child or young person vulnerable (p 3). Robinson (2012) noted that
‘other features in young people’s environments, relationships and the cultures of their
communities may have a greater part to play in how vulnerable (or otherwise)
children with disability are to abuse and neglect than does their impairment (p 12) .
This is welcome and in line with international understandings of disability in ICF
(WHO, 2013) and CRPD (UN, 2006).
Other risk factors in relation to disability and the risk of sexual victimisation were
mentioned in the grey literature:
children with disability who require assistance with intimate care activities
(Commonwealth of Australia, 2011; Robinson, 2015);
children and young people who require behaviour modification or
management (Frohmader and Sands, 2015);
children who live or spend significant time in settings where they are
expected to be always compliant and well behaved (Robinson, 2012, p 12); and
children with communication, speech difficulties or high behavioural support
needs (CYDA Submission, 2015).
45
3.5.3 Heterogeneity
Study heterogeneity is critical to understanding the strength of the prevalence
estimates. Stoltenborgh et al. (2011) is the largest meta-analysis of combined
prevalence figures of childhood sexual abuse to date. These authors included data
from 217 publications (1980-2008) which included 331 independent samples with a
total of 9,911,748 participants. They also reported heterogeneity. Jones et al. (2012)
in similar fashion were at pains to point out the limitations of their meta-analysis.
DISABILITY DEFINITION AND MEASUREMENT
Which disability was investigated and how this was defined and measured varied
across the scientific studies. Most studies examined multiple disabilities (for example,
physical and intellectual and psychological). A few studies examined a single
disability, for example, Ammerman et al. (1994): developmental disability; Mandell et
al. (2005): children with autism; Miller (1993): behavioural disorders; Verdugo et al.
(1995) and Reiter et al. (2007): intellectual disability.
Disability was identified by self/parental-report (for example, Alriksson-Schmidt et al.
2010), standardised measures/instruments (for example, Butler, 2013), and
diagnoses contained in administrative records (for example, Ebeling & Nurkkala,
2002).
SEXUAL ABUSE DEFINITION AND MEASUREMENT
Sexual abuse definitions also varied and in the following ways:
unwanted sexual touch (Cuevas et al., 2010; Reiter et al., 2007; Suris et al.,
1996)
forced involvement in sexual acts (Alriksson-Schmidt et al., 2010; Blum et al.,
2001; Cuevas et al., 2010; Everett-Jones & Lollar, 2008; Jemta et al., 2008;
Suris et al., 1996; )
intercourse before 12 years (Blum et al., 2001)
noncontact (no physical contact with abuser) and contact sexual abuse
(Mueller-Johnson et al., 2014)
Seven studies used items from existing or purposefully developed instruments to
measure sexual abuse. For example, Juvenile Victimisation Questionnaire (Cuevas
et al., 2010; Mueller-Johnson et al., 2014; Turner et al., 2011); International Society
for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool and
selected items from the WHO Multi Country Study on Women’s Health and Domestic
Violence against Women (Devries et al., 2014); Child Abuse and Neglect Interview
Schedule (CANIS) (Ammerman et al., 1994).
Eight studies asked the respondent (child or caregiver) a specific question or
questions about sexual abuse (Alriksson-Schmidt et al., 2010; Blum et al., 2001;
Butler 2013; Everett-Jones et al., 2008; Jemta et al., 2008; Mandell et al., 2005;
Reiter et al., 2007; Suris et al., 1996). Examples include: ‘have you ever been
sexually assaulted or raped?’; ‘intercourse before 12 years of age?’; ‘unwanted
sexual touch, forcing to touch someone sexually?’
46
The remaining five studies obtained the measurement of sexual abuse from existing
records (for example, child protection records) (Benedict et al., 1990; Ebeling &
Nurkkala, 2002; Sullivan et al., 2000; Sullivan & Knutson, 2000; Spencer et al.,
2005).
3.5.4 Child characteristics
DISABILITY TYPE
Jones et al. (2012) reported mental/intellectual disability with a higher risk of sexual
violence (4.62) compared to all other violence/maltreatment (any maltreatment risk,
4.28; physical violence, 3.08; emotional abuse, 4.31). This apparent higher risk may
be partly influenced by the low number of studies on children with physical, sensory
and other impairments, such that pooled data could not be analysed.
Turner et al. (2011) included different forms of disability: physical disability,
internalising psychological disorder, ADD/ADHD and learning/developmental
disorders. Using the National Survey of Children’s Exposure to Violence (USA) and
controlling for socio-economic and parental factors, there was elevated risk of sexual
victimisation only for those with internalising psychological disorders. Sullivan and
Knutson (2000) defined nine disability types: visual impairment, hearing impairment,
speech/language, mental retardation, behaviour disorder, learning disability, health
impairment, autism and physical. When comparing risk of sexual abuse for children
by disability type compared to non-disabled children, there was an increased risk of
3.14. Specifically, for autism, no increased risk; children with visual and hearing
impairment slightly greater risk (both 1.2); learning disability, 1.8; health impairment,
2.0; physical, 2.0; with speech/language difficulties, 2.0; mental retardation, 4.0; and
behaviour disorder, 5.5.
SEVERITY OF DISABILITY
Children with disability are most often treated as a homogenous group in prevalence
and risk studies without level of impairment being recorded. Those with more
severe/profound impairments may have been excluded from the studies. For
example, Mueller-Johnston et al. (2014) in their national school-based survey of
adolescents did not include children who attended special needs schools.
Additionally, any study which relies on self-report and phone interviews (such as
Turner et al., 2011) is most likely to exclude youth with severe developmental
disability. Suris et al. (1996) required 169 questions to be completed in 50 minutes,
thus minimising the opportunity for participation by those with significant intellectual
impairment.
The only study which attempted to understand disability by functional characteristics
comes from Benedict et al. (1990). The authors examined level of functional
characteristics feeding, dressing, and toilet training as delayed vs age appropriate.
Their findings suggest ‘marginally’ functioning children may be at greater risk than
47
the ‘more impaired’ for maltreatment (not specifically sexual abuse), contrary to their
expectations. The study has significant limitations however including small sample
size and specific setting (53 children with disability in a hospital treatment program
cross-matched with a state abuse register). Of these 53 there were sexual abuse
reports for three of the children.
AGE
Jones et al. (2012) reported insufficient data available from the included studies to
calculate an adjusted odds ratio by age. Of the studies that considered age, there is
varied evidence on the influence of this child-related factor. Sullivan and Knutson
(2000) compared age ranges of children with disabilities and reported that preschool
age children with disability experience significantly more sexual abuse than children
with disability in elementary, middle school and high school age groups.
Two studies report conflicting findings, that is, that younger children with disability are
at lower risk of sexual abuse. Alriksson-Schmidt et al. (2010) reported ninth grade
female students with a range of disabilities were at significant lower risk of being
forced to have sexual intercourse than 12th grade students. Similarly, Turner et al.
(2011) reported the odds of sexual victimisation increased with age for children with
physical, internalising psychological disorders, ADD/ADHD or development/learning
disorders.
GENDER
The influence of gender has been examined in two ways: Comparing disabled girls
with non-disabled girls (between group differences); and disabled boys vs disabled
girls (within disability group differences). This leaves out between group comparisons
for non-disabled children by gender with comparisons between disabled children by
gender.
When examining disabled vs non-disabled maltreated children, Devries et al. (2014)
reported that disabled adolescent girls self-reported nearly twice as much sexual
violence as that reported by non-disabled girls (23.6 per cent vs 12.3 per cent). There
were no significant differences in reports of sexual violence between the two groups
of boys. Suris et al. (1996) examined differences in reporting the experience of
sexual abuse by adolescents with visible and non-visible chronic health conditions,
using data from the Minnesota Adolescent Health Survey. Both girls and boys with
non-visible chronic health conditions were significantly higher than controls (non-
disabled girls and boys) in reporting a history of sexual abuse. In contrast, there were
no significant differences for girls as well as boys with visible chronic health
conditions compared to the control groups of girls and boys without chronic health
conditions.
Mueller-Johnson et al. (2014) reported gender results comparing disabled girls with
non-disabled girls. Findings showed boys with physical disability nearly three times
more likely to suffer (lifetime) contact sexual victimisation than able-bodied boys.
Girls with physical disability were 1.4 times more likely to experience lifetime non-
contact sexual victimisation than able-bodied girls, however they were not more likely
48
to experience (lifetime) contact sexual victimisation. The odds ratios for past-year
victimisation were largely similar to lifetime victimisation for both boys and girls.
Two studies compared sexual abuse for disabled girls vs. disabled boys. Sullivan and
Knutson (2000) reported that among maltreated (sexual, physical, sexual/physical,
and emotional) children with disability, significantly more girls than boys were victims
of sexual abuse. Similarly Turner et al. (2011) reported lower odds of sexual
victimisation for males relative to females when controlling for a range of factors
including ethnicity, age, gender, socio-economic status, number of parents in the
house and parental psychological disorder.
3.5.5 Family factors
If family factors are considered in the studies, the factors vary considerably. For
example, number of parents in the household, parenting practices, inter-parental
violence, socio-economic status and parental mental health.
Mueller-Johnson et al. (2014) examined gender differences with regard to family
factors. For example, boys with physical disability were more likely to come from
single parent families, to have fewer friends, be involved in violent behaviour, less
likely to experience warm parenting, more likely to experience harsh parenting and to
be exposed to inter-parental violence. For girls with physical disability there were no
significant differences except higher exposure to harsh parenting. When controlling
for risk factors for the overall sample (girls and boys), gender was a predictor of
sexual victimisation, with girls with physical disability having a higher risk than boys
with physical disability. When analysing boys and girls separately predictors of sexual
violence showed different patterns for boys and girls. For boys physical disability
remained a significant risk factor for both contact and non-contact sexual
victimisation when other risk factors were controlled for. However for girls physical
disability was not a predictor.
One study, Benedict et al. (1990) noted above, reported an association between
maltreatment and children with unmarried parents, parents with fewer years of formal
education and those who lacked stable employment in that these children were more
likely to have substantiated reports. The limitations of these findings come from the
study being small numbers, and about all maltreatment as there only 34 records and
only three children sexually abused. As Hunter and Price-Robertson (2012) noted,
there are significant limitations in using child protection data.
3.5.6 Environmental context
COUNTRY
The evidence base on prevalence and risk of sexual abuse for children with disability
is primarily drawn from studies conducted in high income countries, specifically the
United States and the WHO European region. The exception to this is the study from
Uganda by Devries and colleagues (2013). In this study, secondary data analysis of
49
baseline data from a school-based intervention program revealed the prevalence of
sexual violence of disabled children (aged 11-14) as higher (males 7.1 per cent;
females 23.6 per cent) than for their non-disabled peers (3.8 per cent males; 12.3 per
cent females). These prevalence rates are within the range found in the meta-
analysis by Jones et al. (2012). The lack of evidence from low- and middle-income
countries should be addressed as these countries have been noted to have higher
population rates of disability and higher levels of violence (WHO, 2011). This is
echoed in the UNICEF Global Partnership on Children with Disabilities Child
Protection Task Force Literature Review Paper (2015).
SETTINGS
Regrettably for the purpose of this discussion paper we could not locate empirical
evidence on the impact of settings on the prevalence of sexual abuse for children
with disability. As noted above the primary way in which settings are used in the
scientific literature is as recruitment/sample sources. So, for example Jones et al.
(2012) reported higher estimates of prevalence of all types of maltreatment including
sexual violence in the studies which recruit participants/respondents from hospital
settings. This is not surprising given that hospital settings include children who are
attending in relation to identified clinical concerns. Devries et al. (2014) reported that
the school environment was the main venue at which violence is occurring. However
this related to differentiation between perpetrators of violence. That is, the study used
a sample of young people from a school setting and then categorised and compared
instances of violence from parents, from female peers, male peers, from other.
The grey literature in contrast to the scientific literature does focus attention on
institutional settings. These include out-of-home care (Woods, 2008), educational
settings (Robinson & McArthur, 2014), safe spaces for women and children
(including those with disability) escaping violence (Senate Community Affairs
Reference Committee, 2015), and generalist services available to children and
families where children with disability are present (Commonwealth of Australia,
2009).
For example, the report of the Senate Community Affairs Reference Committee
(2015) noted that submissions to their inquiry
showed that a root cause of violence, abuse and neglect of people with
disability begins with the devaluing of people with disability. This devaluing
permeates the attitudes of individual disability workers, service delivery
organisations and most disturbingly, government systems designed to protect
the rights of individuals. (p xxvi)
3.6 How risk is understood in the grey
literature
The current focus on person-centred care in disability services (ACT NDIS trial 2015)
identifies potential risk circumstances at the individual level as well as addressing
50
quality assurance safeguards with respect to service providers. The National
Disability Services submission (2015) to the Royal Commission into Institutional
Responses to Child Sexual Abuse identified that the NDIS will
see increased delivery of services to people in environments that are hard to
regulate, such as people’s own homes or community settings. Such
environments may offer increased opportunity for abuse and exploitation of
vulnerable individuals and reinforce the need to build safeguards into the
system at all levels to minimise risks. (NDS 2015, p 2)
Segregation of children and young people with disability from mainstream settings is
another recurrent theme in the grey literature. This is particularly so for children with
cognitive disability and for those with communication difficulties. This is mentioned by
3 out of the 20 reports examined for the purposes of the present discussion paper.
For example, Robinson and McArthur (2014) in Safe at school? Exploring safety and
harm of students with cognitive disability in and around school drew attention to the
potentially reduced capacity of children with cognitive disability to share concerns
about abuse and neglect, including sexual abuse, or their fears about speaking up.
These factors may exacerbate the potential for abuse as perpetrators may rely on
children not ‘telling’. In segregated settings where there is little external oversight,
organisational cultures may develop where staff are not encouraged (or are actively
discouraged) from speaking up and children not believed when they do speak up. It
is also important to note that for those students with high support needs whose
voices need to be heard in the research, creative research methods are required to
ensure the potential communication difficulties of the child do not inhibit the sharing
of information about safety and abuse and neglect.
Earlier, French, Dardel and Price-Kelly (2009) reported increased potential for abuse
when adults and children with cognitive impairment shared the same spaces in an
institutional setting. For example, concerns are noted by French et al. (2010), CDA
(2015), Robinson (2012) and Robinson and McGovern (2014) about safe settings in
education including school transport for those children and young people where there
is likely to be only one adult not related or unknown to the child passengers.
Robinson (2015) noted that existing environmental and structural levels within the
community perpetuate the abuse of children with disability. Robinson (2015) went on
to state that circumstances within an organisational context may exacerbate or
perpetuate abuse for children with disability. Kaufman and Erooga (2016) noted that
risk factors for children including those with disability can be defined as ‘setting-
based’, with factors such as physical condition, policies and procedures, training of
staff and organisational culture contributing to prevalence and risk of sexual
victimisation for children with disability.
Robinson’s (2012) review of scientific literature noted the correlation between high-
risk environments where violence and exploitation are common features and a
culture of closed communication that can exacerbate risk. One strategy is to make
available information that sexual abusers may target those with ‘impairment issues’
or ‘those reliant on others for assistance’ (Government of South Australia 2012, p 5).
51
The grey literature draws attention to two concerns about the scientific literature. The
first issue is the lack of inclusion of the voices of children with disability in prevalence
and risk data (Senate Community Affairs Reference Committee 2015; Robinson
2012). This provides an example of how children with disability in contrast to non-
disabled children are not regarded as active agents in their own right. Just as for all
children, giving voice to the lived experience narratives of children and young people
is critical to understandings of risk and also critically to understanding the impact of
harm (Save the Children, Handicap International, 2011).
The second issue is that critical analysis is required about why disability per se
continues to be thought of as the determining factor in the lives of children and young
people in relation to their risk of maltreatment. As authors in the grey literature
comment, this is entirely out of kilter with the official understanding of disability in
Australia and national legislative, governance and policy frameworks addressing the
lives and circumstances of people with disability in Australia. In our view, it is time to
move on from attributing risk for children with disability only to their disability and to
focus attention on institutional settings, the people in those settings, and effective
governance, safeguarding and quality mechanisms.
52
SECTION 4 Key factors in the
prevention of sexual
abuse of children with
disability in
institutional contexts in
the future
There is little scientific evaluation of programs and prevention strategies for
sexual abuse of children with disability.
Robinson (2012) argued for the development of protective frameworks, which
actively and specifically work to prevent harm (p 28).
Prevention strategies identified fall into four categories: strategies for the child,
for the family/carer, for staff/managers and for organisations.
Strategies for children and families promote education relating to safe touching,
protective behaviours and recognition of behaviour that might indicate abuse.
Strategies for staff and organisations focus on policy and procedures: reporting
concerns, training staff, and challenging the culture of silence that historically
has surrounded this issue.
Some international organisations are currently attempting to map international
evaluations of prevention strategies, the results of which could be applied to
the Australian community.
4.1 Overview
Our approach in this section was to identify the most robust evidence available from
the international literature, to identify knowledge gaps and to consider how
international findings may inform prevention approaches in Australia in the future.
This is critical given that we could not identify any Australian effectiveness or
evaluation studies on prevention of sexual abuse for children with disability in
institutional settings.
4.2 Conceptual framework
The conceptual framework employed here takes a situational approach consistent
with best practice in the field of prevention of sexual abuse of children. This
situational prevention framework developed initially by Kaufman (2005) comes from
53
situational crime prevention theory. Kaufman et al. (2012) later aligned this
framework more closely with institutional settings. The relevance here is that over
and above consideration of child, family and community, the framework specifically
incorporates characteristics of the setting. This framework points to five institutional
level components. These are: target locations, physical environment, facilitators,
lifestyle and routine activities, and organisational climate and local community
influences. The framework offers a systematic way to analyse institutional contexts
for all children many of which also include children with disability. It is also useful for
considering disability-specific institutional contexts.
4.3 Search methods
4.3.1 Scientific literature
We were unable to locate a meta-analysis or systematic review of effectiveness of
interventions for sexual abuse of children with disability. We turned to the recent
systematic review by Mikton et al. (2014) on interventions to prevent violence against
persons with disabilities as the reference document for sourcing scientific literature.
The Mikton et al. (2014) review analysed the effectiveness of different types of
interventions. The review period covered January 2000 to August 2011. Inclusion
criteria were: universal, selective or indicated intervention; sexual violence, child
maltreatment, youth violence, intimate partner violence and elder maltreatment;
physical impairments, sensory impairments, mental health conditions or intellectual
impairments; intervention compared with no intervention or service as usual; distal or
proximal outcomes; and, any study design except surveys of participant satisfaction.
The authors conducted searches of electronic databases, hand searches of specific
journals and reference lists of review articles, and communication with experts in the
field. Ten studies were identified.
Of these 10, only one study focused on sexual abuse for children with disabilities
(Bowman et al., 2010). Seven were about adults with disabilities, one on physical
abuse only and one addressed child maltreatment without specifying sexual violence.
To identify additional literature we conducted a Web of Science and Scopus citation
report for Mikton et al. (2014). No additional studies were identified which focused on
sexual abuse and children with disability. Therefore we undertook a search of Web of
Science databases. We used the following search terms: disab*; handicap*;
impairment*; child*; youth; young; young people; young person; adolescen*; sexual
abuse; sexual violence; child maltreatment; sexual assault; youth violence; sexual
victimization; sexual exploitation; intervention; prevention; training; governance;
regulation; legislation; evaluation; program; curriculum; pilot.
We refined the output of this search to ‘review articles’ publications and 2011-2016.
Two were located: McEachern (2012) and Wissink et al. 2015. Hand searches of the
reference lists of these two review papers revealed no additional
intervention/prevention studies since 2011, the latest date included in Mikton et al.
54
(2014). One additional program evaluation by Lee & Tang (1998) was identified in a
recent Cochrane Systematic Review (Walsh et al. 2015) on school-based programs
for the prevention of child sexual assault.
4.3.2 Grey literature
The search strategy began with the key reports of Robinson (2012), COAG (2009),
Kaufman and Erooga (2016) and submissions to the recent Senate inquiry into
Domestic Violence in Australia (Commonwealth of Australia 2015 at
http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Finance_and_P
ublic_Administration/Domestic_Violence/Report). We also conducted a Google
search using the search term ‘evaluation of child sexual abuse prevention programs’.
The output was further refined by ‘disability’ and then by ‘Australia’. Searches of
websites of peak disability advocacy bodies, the peak disability services body
(National Disability Services) and statutory agencies were also undertaken. Hand
searching of reference lists from identified reports was also conducted.
These search strategies for the grey literature yielded 25 documents addressing
prevention strategies for sexual abuse potentially relevant to children with disability.
Text of all documents was searched to identify mention of disability. Two documents
were Australian evaluation outcome reports (UNSW 2010; 2014). Four provided
commentary on factors relevant to evaluation (Commonwealth of Australia 2009;
Robinson 2012; Robinson & McGovern 2014; Commonwealth of Australia 2015). The
remaining 19 documents included program descriptions or practice
recommendations, of which 15 were Australian. The remaining four documents were
sourced from the international grey literature to supplement the small quantum of
Australian materials.
4.4 Understanding prevention strategies
and evaluation
In the first section we report on the small evidence base of evaluation of programs
and prevention strategies from the scientific and grey literature. We supplement this
with analysis of the recommendations suggested in the literature sourced for
Research Question 2 on prevalence and risk of sexual abuse of children with
disability.
4.4.1 Evaluation studies
The two evaluation studies found in the analysis of the available scientific literature
were Bowman et al. (2010) and Lee & Tang (1998). The results of the evaluation of
the intervention programs in these studies are presented in the Appendix Table 1.
The first program targets the individual with disability. Using a randomised control
method, Lee and Tang (1998) evaluated the effectiveness of Wurtele’s (1990)
55
Behavioral Skills Program with a group of Chinese female adolescents (11-17 years)
with mild mental retardation. This program teaches self-protection skills and has
been used successfully with preschool age children from high income countries (for
example, Wurtele 1990). It covers seven safety rules, one personal body safety rule
and four self-protection skills. Safety rules include: we are the boss of our bodies;
location of private parts; when is it acceptable to touch your own private parts; when
is appropriate for doctors/nurses/parents to touch children’s private parts; otherwise it
is wrong to have private parts touched/looked at; it is wrong to be forced to touch
others private parts; inappropriate touching by others is never the child’s fault. The
personal body safety rule was ‘It’s not okay for a bigger person to touch or look at my
private parts (unless they need help as in situations when their private parts get hurt
(Lee & Tang 1998, p 108). The four self-protection skills: verbal response; movement
responses; telling trusted persons; reporting. The program delivered to the control
group covered safety skills unrelated to sexual abuse. Post program delivery the
intervention group showed greater knowledge of sexual abuse and self-protection
skills as well as recognition of appropriate/inappropriate touch requests. Not all
knowledge was maintained at two-month follow up.
The second program (Bowman et al., 2010) targeted developmental disabilities
service providers. The program aimed to evaluate a prevention workshop on service
providers’ knowledge and attitudes concerning sexuality (including sexual abuse) of
persons with developmental disabilities (55 per cent of the individuals served by the
practitioners attending this program were below 18 years). The four hour workshop
covered content such as definitions of sexual abuse, reporting laws, statistics and
patterns of sexual abuse, and risk factors. This was followed by identification and
how to respond to sexual abuse. Finally the workshop covered content such as risk
reduction, changing attitudes and prevention programs/curricula. The pre/post
evaluation of the workshop showed a significant although small increase in
knowledge related to sexual abuse. There was no significant change in the
participants ‘global perception’ or attitudes about people with developmental
disability. The authors recommend introducing more intensive programs with follow-
up.
We were not able to locate in the Australian grey literature any evaluation or
effectiveness/efficiency studies on programs for prevention of sexual abuse of
children with disability in institutional contexts. The National Framework for Protecting
Australia’s Children (COAG, 2009) offers differentiated approaches to address child
maltreatment. This is laudable however differentiated approaches require
effectiveness and cost efficiency studies to determine which are effective for whom,
to what extent and under what conditions. The gap in evaluation studies severely
limits the capacity of the sector to provide evidence-based prevention programs.
Robinson (2012) in a grey literature report discussed this lack of empirical evidence
in the field of child disability and maltreatment including evaluation of prevention and
intervention approaches. She noted that in order to make significant changes in the
lives of children with disability, development of protective frameworks, which actively
and specifically work to prevent harm (p 28) are required. Recently in work exploring
school as an institutional setting, Robinson and McGovern (2014) again noted the
lack of evidence-based materials for children with disability, their families and carers
56
to understand risk including sexual risk and lack of access to evidence-based
prevention approaches. This is a critical gap in knowledge which hinders the
commitment to and development of prevention programs to address the heightened
risk of sexual abuse experienced by children with disability. Due to the lack of
specific materials for children with disability we turn now to evaluation of child
protection frameworks for all children.
Two of the 25 reports located in the Australian grey literature evaluated programs
based in New South Wales. Both evaluations acknowledged vulnerability and risk for
particular groups of children including children with disability. The earliest, an
evaluation of Brighter Futures (Hilferty et al, 2010) used a survey design and a cross-
sectional analysis of at-risk families to investigate the efficacy of the intervention.
This report noted that both parental and child disability present a more complex
picture and require different engagement and response than are typically used with
families with young children. Thus, the authors reported the evaluation findings may
not be ‘relevant to families who have a child with a disability because traditional
parenting programs were inappropriate’ (p 133).
The evaluation of the New South Wales Care and Protection Framework, Keep Them
Safe (UNSW, 2014), used a survey design to seek feedback from service providers
and a cross-sectional analysis of at-risk families. The report noted that only 5 per
cent of respondents were from disability services. This limits the applicability of these
findings to families of children with disability. The absence of evaluation studies of
prevention programs or strategies for sexual abuse of children with disability is a
disturbing knowledge gap. That said, the lack of effectiveness and efficiency studies
overall of child protection prevention and intervention strategies is well documented
and as recently as the 2015 report on Violence, abuse and neglect against people
with disability in institutional and residential settings, including the gender and age
related dimensions, and the particular situation of Aboriginal and Torres Strait
Islander people with disability, and culturally and linguistically diverse people with
disability (Commonwealth of Australia, 2015). This serious knowledge gap about
what works for whom, to what extent and under what circumstances needs to be
urgently addressed.
4.5 Prevention of sexual abuse of children
with disability
In this section we present findings on prevention approaches using the situational
prevention framework of Kaufman et al. (2012) followed by the identification of key
themes relevant to the application of prevention strategies in the disability sector.
Under each framework heading we first report findings from the scientific and grey
literature including that sourced internationally. The findings overall consist of
recommended prevention strategies and suggested program approaches. This is
indicative of a literature in which there is a dearth of evidence on best practice and/or
tried and tested prevention strategies.
57
The findings in this section from the scientific literature come from that examined for
Research Question 2, the Robinson (2012) report, the Cochrane Systematic Review
(Walsh et al., 2015) and the two evaluation studies of Bowman et al. (2010) and Lee
and Tang (1998). The findings from the grey literature in this section come from
recommendations found in reports from inquiries, practice and program approaches
in Australia and three more widely referenced prevention approaches found in the
international literature. For ease of presentation, the findings from the grey literature
are summarised in the Appendix Table 2.
4.5.1 Prevention strategies/interventions focused on the
child
Programs, interventions and educational materials need to be inclusive and tailored
to the specific needs of children with disability. Several authors commented on the
need to modify existing materials depending on the nature of the child’s cognitive,
physical and emotional abilities. The format of prevention materials as well as how
these are delivered need to be accessible, understandable and available in different
formats, for example in braille/large print, using pictures and graphics, and Easy
English as appropriate to the child participant audience (Alriksson-Schmidt et al.,
2010; Devries et al., 2014; Everett-Jones & Lollar, 2008). Ammerman et al. (1994)
suggested that questioning child participants about indicators and instances of sexual
abuse may have value in the detection of abuse. Specific recommendations included
increasing the ability of children with disability to identify, prevent and report sexual
abuse (Lee & Tang, 1998; McEachern, 2012; Reiter et al., 2007).
The grey literature is more extensive on programs and policy directives in relation to
prevention and intervention strategies for sexual abuse of children with disability.
Primarily these adopt ‘the child as empty vessel’ approach rather than viewing the
child as an active agent with the capacity for learning, being aware of the possibility
of sexual abuse, and the ability to change and to make choices. Initiatives and policy
actions that refer specifically to children and young people with disability are scarce.
Robinson (2012) noted a wide range of broad policy and practice initiatives in the
National Framework for Protecting Australia’s Children (COAG, 2009) from which
children and young people with disability may benefit. However generalist population
programs may have limited effectiveness without also targeted interventions relevant
to the particular circumstances and institutional settings of children with disability.
Robinson and McGovern (2014) suggested that gathering perspectives of students
with disability in relation to harm might help reduce and generate effective strategies
to keep children safe. In other areas of disability research it is well accepted that
involving individuals with disability and incorporating their perspectives in program
design lead to greater program engagement and more effective program outcomes.
As Robertson (2012) noted disability-inclusive program development is particularly
critical when normative understandings of children, and of child abuse, exclude
children with disability, or that they include them only partially, in broader initiatives
about preventing abuse of children and responding when it does occur (p 17).
58
In recent years a great deal of work has been conducted on sexuality with individuals
with disabilities, particularly with people with intellectual/developmental disability.
Initially this work derived from a risk paradigm, with programs and interventions
designed to protect/prevent people with intellectual/developmental disability engaging
in sexual or intimate behaviours. The focus is now on assisting people with disability
to become aware of themselves as sexual beings and to experience safe and
fulfilling sexual lives (Jahoda & Powell, 2014; Martinello, 2014). One evidence-
informed Australian program Living safer sexual lives (Johnson et al., 2001) has
been used in many programs for adults with intellectual/development disability
around Australia. As yet it has not been adapted for use with children and
adolescents. Two points are worthy of attention in relation to programs such as this.
As the authors noted, one of the barriers to implementing sexual abuse prevention is
the capacity to secure funding. Another is that those wishing to provide such
programs need to ensure that practitioners are well trained and capable of providing
appropriate support so that people with disability are not made more vulnerable in
reliving the experiences of abuse.
Briggs and Hawkins (2005) in their New Zealand study of 116 students with an
intellectual disability noted that children with learning disabilities may be viewed as
targets because ‘they would be less aware of the difference between right and wrong’
(p 19). As a prevention strategy it was recommended that students be taught
personal safety skills in schools and that police officers and teachers were perceived
as being best suited to do this. It is noted that the results of this study related to
abuse broadly and were not specifically in relation to children with disability, sexual
abuse and institutional settings.
4.5.1.1 Specific programs relevant to children with a disability
Three Australian programs were located which offer the opportunity for safety
conversations and consumer/client training to assist in navigating intimidating or
unhelpful relationships. These training opportunities, targeting children with learning
delays, also focus on the law and sexual victimisation. The first of these is the Family
Planning ACT Schools disability program training package for young people and
adults with intellectual disability. The second is the SoSafe! Tools and training
resource delivered by Sexual Health and Family Planning (ACT), which also
incorporates the use of the ‘touch triangle’ concept in terms of educating children and
young people about safe touching. The last program is the Relationships and private
stuff training workshop conducted by a private practitioner in New South Wales.
These programs assume a certain level of communication and language capacity.
We were unable to locate any programs for children with multiple disabilities or
complex communication difficulties.
Information available from Commonwealth and state governments and statutory
agencies that was located included policy directives, frameworks and guidance for
practitioners. One example is the material available from the Department for
Education and Child Protection South Australia (2012). This material is the most
comprehensive in Australia to present information on regulatory background checks
and guidelines for child-safe organisations as well as a user-friendly parent booklet
59
that includes a practical checklist for parents (Protecting Children and Young People
with Disability. A Booklet for Parents, Department for Education and Child Protection
South Australia, 2013). Materials such as these or in other states such as Western
Australia from the Children and Young People Commissioner (2016) offer a
coordinated approach for children and young people, their family and child safe
organisations (https://www.ccyp.wa.gov.au/our-work/resources/child-safe-
organisations/).
In contrast, specific fact sheets may be based on legislated schemes such as the
NSW Working with Children Check (https://www.kidsguardian.nsw.gov.au/working-
with-children/working-with-children-check) or informed by evidence on the particular
vulnerabilities of specific groups of children. These approaches typically focus on
engaging staff at all levels in provider organisations, with specific responsibilities set
out for personnel at each level in the organisation. There are also instances where
statutory agencies work directly with and respond to people with disability, for
example, the NSW Ombudsman (https://www.ombo.nsw.gov.au/). This office
provides information and workshops directly to people with a disability to ensure
consumers understand their rights and the complaints procedures available to them.
The Office of the Public Advocate Community Visitors Scheme in Victoria offers an
extension of this approach (http://www.publicadvocate.vic.gov.au/our-
services/community-visitors).
The application of these focused initiatives for staff and other organisation personnel,
and coordinated approaches to engage with children, their families and organisations
in both specialist and mainstream settings is yet to happen in Australia. The strategic
implementation of such systematic approaches should be subject to evidence-
informed evaluation to understand their effectiveness and efficiency in preventing
sexual abuse of children with disability.
4.5.2 Family prevention strategies
Mueller-Johnston et al. (2014), McEachern (2012), Miller (1993) Turner et al. (2011)
and Verdugo et al. (1995) discussed the importance of childcaregiver relationships
in ensuring children with disability are aware, safe and able to communicate any
instances of maltreatment. These authors suggested the introduction of programs
that improve childcaregiver communication skills, increase the quality of the child
caregiver bond and build trusting, positive relationships. This could be done by using
strategies to enhance communication between families and children about children’s
rights, procedures for reporting abuse, and how to locate a safe place.
Information in the grey literature for families and carers focuses primarily on the
understanding of risk factors, despite the evidence on risk factors being ambiguous
and of an international nature, as discussed in section 3. Family Planning NSW and
Shine SA (formerly Family Planning South Australia) provide online resources which
use prevention language (see Appendix Table 2).
60
4.5.2.1 Specific programs relevant to carers and family
members
Programs that focus more specifically on providing information to parents of children
with a disability were identified through an analysis of grey literature. An example of
this is the South Australian Protecting children and young people with disability. A
Booklet for parents and carers available at
http://www.macswd.sa.gov.au/files/links/Protecting_children_and_yo.pdf and its
companion document, A guide to protecting children and young people with disability.
For parents and carers available at http://www.secasa.com.au/assets/Documents/a-
guide-to-protecting-children-and-young-people-with-disability-and-preventing-sexual-
abuse.pdf. This type of approach aims to instruct parents how to keep their child safe
by upskilling children about protective behaviours and understanding sexualised
behaviours. This approach also aims to teach parents and caregivers the skills to
identify indicators and signs of sexual abuse.
There is no available evidence on whether this type of ‘awareness-raising’
information is effective. Similarly it is not certain whether government materials which
rely on parents to become acquainted with agency policies and procedures are
effective. This latter approach relies heavily on ‘information savvy’ parents. These
types of materials do not address the needs of parents who may need targeted
interventions as well as population prevention approaches.
4.5.3 Prevention strategies for staff/managers of
organisations
The scientific literature emphasises the importance of a whole of organisation
approach. This means all staff in institutional settings and all workers associated with
the institution. This includes casual staff, outdoor staff and others not directly
responsible for children such as the staff in a school canteen or tuckshop.
Specifically, Bowman et al. (2010), Devries et al. (2014) and Sullivan et al. (2000)
recommended the need for training of staff in institutional settings to recognise signs
of abuse and also to respond to these signs both by reporting appropriately and
putting practices in place to safeguard the child. Alriksson-Schmidt et al. (2010),
Bowman et al. (2010) and Devries et al. (2014) focused attention on the need to
increase staff knowledge and the capacity to respond appropriately. These authors
specifically recommended education programs to cover factors that increase the risk
of abuse occurring and protective factors and strategies to minimise occurrence.
Less emphasis was placed on governance procedures in the scientific literature
although this is a frequent focus in the Australian grey literature. The Australian grey
literature emphasises the importance of prevention strategies targeting staff of
disability-specific organisations. Training and staff screening are frequently
mentioned. Table 2 in the Appendix shows that policy development and program
implementation are current key strategies used to target awareness of staff or
organisational level. Kaufman and Erooga (2016) noted that there has been a call for
prevention planning that is more reflective of offenders’ specific patterns of child
61
sexual abuse perpetration (p 91). These authors went on to state that training
requirements, early detection of staff behaviours of concern, facilitation of staff
reporting other staff, and the need to engage families, carers and other stakeholders
are all part of the prevention ‘solution’. Attention to all these factors is not evident in
the Australian grey literature.
In line with the more recent recognition of whole of organisation approaches to
keeping children safe, a number of Australian agencies have produced guidelines on
child safe organisations. One example is the Victorian Children’s Commission for
Young People Tip sheet: child safe organisations (n.d. available at
http://www.ccyp.vic.gov.au/downloads/tipsheets/tipsheet-safety-children-
disability.pdf). This is based on the understanding that children and young people
due to their developmental age and stage and being in a dependent relationship with
adults have limited capacity to identify and report concerns. This places the
responsibility squarely on the staff and organisation to create a child-safe culture
where children are safe and empowered to speak out and to seek support.
From an organisational culture perspective the grey literature highlights the need to
explore the vulnerability of children as being more than ‘the disability’. This is
encouraging and in line with the change in perspective which regards individuals with
disability as people first, disability second (CRPD and the national disability reform
agenda). The National Disability Strategy (Commonwealth of Australia 2011a) is
clear on this point. Under the second area of policy action Rights protection, justice
and legislation, Policy Direction 4 states that people with disability to be safe from
violence, exploitation and neglect (p 38).
In the grey literature it is anticipated that changes in staff culture and the way in
which supports are provided along with a deeper understanding of the vulnerabilities
of disability may heighten awareness of and response to people with disability, their
supporters, support providers and the broader community in relation to abuse,
neglect and exploitation. There are also concerns noted that over-emphasis on child-
safe organisations may overlook or negate critical awareness and knowledge about
potential or actual perpetrators of child sexual abuse. In other words, that
organisational practices may tend to de-emphasise actions taken by individuals
which harm children, including sexual abuse.
Quadara, Higgins and Siegal (2015), writing about Australian child sexual abuse and
policy and practice challenges more generally, noted that prevention approaches can
only be effective when the higher level policy directives intersect with initiatives
surrounding protecting children from harm. The potential offered by the National
Disability Strategy 20102020 (2011) and National Framework for Protecting
Australia’s Children (COAG 2009) and subsequent implementation plans is yet to be
realised in evidence-informed and evidence-generating prevention approaches in
Australia.
62
4.5.4 Prevention strategies with an organisation / community
focus
The remaining level in the Kaufman et al. (2012) situational prevention framework
speaks to an integrated organisational, agency and community prevention approach.
It is through this lens that the literature on prevention strategies at an organisational
level is explored.
In the scientific literature there is concern for implementation, monitoring and
evaluation frameworks at government level to ensure all institutions comply with
disability legislation. In the US for example, this is the Americans with Disabilities Act,
1990) and the Education for All Handicapped Children Act, 1975). Complying with
legislative and regulatory requirements is critical to ensure safe environments for
children with disability. It is also critical as McEachern (2012) noted to ensure the
relevant agencies such as law enforcement and child protection systematically collect
and report data on sexual assaults and abuse. This is needed to ensure an accurate
account of the frequency and extent of sexual abuse of children with disability, where
this is most likely to occur, and factors which militate against sexual abuse of children
with disability occurring in institutional contexts.
Reiter et al. (2007), Sullivan and Knutson (2000) and Sullivan et al. (2000)
recommended good communication systems between sectors and accurate
recordkeeping with reliable data are critical to understanding the presence and extent
of sexual abuse of children with disability. Further, in our view, when this data can be
linked across sectors and aggregated across institutional settings such as education,
child welfare and law enforcement there is a greater possibility of understanding the
necessary and sufficient elements of child safe institutional settings. For example,
ensuring there are effective referral mechanisms and appropriate counselling
services for all children who are sexually abused, including children with various
disabilities, and in ways which are universally accessible for these children (e.g.
Alriksson-Schmidt et al., 2010).
Skarbek et al. (2009) in a study of sexual abuse prevention for children with disability
explored prevention and intervention programs that rely on Bronfenbrenner’s
ecological model. The authors suggested prevention at three levels primary,
secondary and tertiary. At each level prevention strategies need to be identified
relevant to whether abuse is known to occur or has not yet occurred. For prevention
at the primary level (where abuse has not yet occurred) it is suggested the focus
should be on communication and relationships between the child and carer, staff
recognition of relevant policies and procedures, and organisation understanding
about how to protect children. The secondary and tertiary levels the authors
suggested relate to circumstances where abuse is known to have occurred and relies
on engagement with mandatory reporting guidelines, multidisciplinary support
services enacted to assist the child, and understanding of the impact of abuse on
behaviour.
In addition to the scientific literature, our analysis of grey literature addressed the
strategies that could be used by children and their carers and by staff within
organisations. The literature identifies briefly the role of bystanders in the prevention
63
of sexual abuse for children with disability. Robinson (2014) for example noted that
‘at the community level, engaging bystanders to take action against abuse and
neglect of children and young people with disability is a way to broaden the base of
support in both preventing harm and in ensuring when it happens, it is effectively
responded to’ (p 27). A focus on the role of individuals outside the child, family or
staff member is thought to assist the development of community-based prevention
strategies. Open and transparent information sharing relies on organisations being
committed to and developing an appropriate culture to achieve this or being
mandated to do so by legislation or governance mechanisms. It also relies on
effective internal mechanisms to ensure data is reliably recorded and accessible and
able to be transmitted in a timely, reliable and confidential manner.
4.6 Two contributions from the
international grey literature
Two international reports on effective prevention strategies were analysed to
supplement the scarcity of Australian grey literature. These come from Stop it now!
(US and UK) and the National Society for the Prevention of Cruelty to Children (UK)
which also incorporates mention of the Eradicating child sexual abuse (ESCA)
database from the Lucy Faithfull Foundation (UK).
The first approach, a guide titled Family safety planning for parents of children with
disabilities published by Stop it Now! (US, UK and Ireland based organisation), is
designed for families and carers to enhance opportunities to keep children with
disability ‘safe’ (http://www.stopitnow.org/ohc-content/tip-sheet-family-safety-
planning-for-parents-of-children-with-disabilities). The guide explores issues of both
sexuality and sexual safety by asking families to understand their child’s unique
vulnerabilities rather than relying on the singular concept of ‘disability’ as predictive of
risk. The guide encourages families to establish guidelines for care of their child by
imposing limits, such as the degree of assistance their child requires with personal
care. This guide addresses expectations about sexual vulnerability through the
identification of safe people in the lives of the child and knowledge about local
statutory resources if concerns arise.
The second approach comes from the National Society for the Prevention of Cruelty
to Children (UK). Its most recent publication, Preventing child sexual abuse. Towards
a national strategy for England (Brown & Saied-Tessier 2015), investigated specific
strategies for children with disability to use in preventing abuse. They reported that
although information is available for children about staying safe, this information has
to be made accessible particularly for children with limited communication. This
report also discussed the Eradicating Child Sexual Abuse (ECSA) database. This is
an international repository of prevention approaches currently managed by the Lucy
Faithfull Foundation (UK). This foundation is a registered charity that seeks to assist
in the prevention of sexual offences as well as studies the effects of prevention
strategies. It is currently completing the three-year ECSA project funded by Oak
Foundation Switzerland.
64
The database, currently seeking submissions, cites primary, secondary and tertiary
factors that impact on the number of children at risk, including children with disability,
and the potential for prevention strategies to have a targeted approach. A 2013
review of the ECSA is available at
http://www.lucyfaithfull.org.uk/ecsa_eradicating_child_sexual_abuse.htm. At the time
of this review there were 170 self-report submissions from agencies across the world
on prevention campaigns relating to sexual abuse and children. A preliminary
analysis of the database found that whilst a great deal can be done to prevent the
sexual abuse of children, current approaches are often inadequate in scope, poorly
targeted and lacking evaluation (Lucy Faithfull Foundation, 2013).
The ECSA-Prevention Framework uses a four by three matrix for prevention (see
http://www.lucyfaithfull.org.uk/files/ECSA%20Framework.pdf). The first part of the
matrix utilises a public health model of primary prevention ( preventing child sexual
abuse before it would otherwise occur); secondary prevention (reducing the risk of
child sexual abuse in ‘at risk’ groups ; and tertiary prevention (preventing further child
sexual abuse offences by known child sexual abuse offenders and preventing
revictimisation of known victims). The second part of the matrix identifies four distinct
sets of prevention targets. These are offenders and potential offenders; children and
young people (victims); families and communities; and situations (for example
institutional contexts). The Annual Report of the Lucy Faithfull Foundation identifies
that: The ultimate goal is the provision of a toolkit that will assist a nation, area or
region, anywhere in the world, to develop a considered and credible strategy for the
prevention of child sexual abuse within that nation, area or region (2015, p 23).
The ECSA-Prevention Framework reports that this will occur through the collection of
information from service providers about the prevention programs they facilitate and
data regarding their efficacy. The project is due for completion in 2016, with analysis
of the toolkit to be shared via the International Society for the Prevention of Child
Abuse and Neglect (ISPCAN). Finalisation of this project and sharing of findings will,
we anticipate, offer the evidence-based information that is currently sorely lacking to
inform Australian policy directives on creating child safe organisations and keeping
children with disability safe.
65
SECTION 5 Synopsis and key
messages
In this concluding section we offer a synopsis and key messages derived from the
historical understandings and changes in discourse about disability in Australia over
time and analysis of the international scientific and Australian grey literature on
prevalence and risk of sexual abuse against children with disability. This synopsis is
contextualised by our experience and expertise derived from research, practice,
policy debate and submissions and inquiries over more than four decades in matters
related to families and children with disabilities in the Australian context.
5.1 Disability reform in Australia
5.1.1 Exclusion and mental treatment
Prior to the 1970s and despite the community perception to the contrary, most
children and adults with disability lived at home with their families. In line with
community thinking, families assumed responsibility for their children with disability,
managing as best they could with extended family and charitable support. Their
children were rarely seen in public; in many cases they were kept hidden from
neighbours and the wider community.
When families were unable or unwilling to care for their child with a disability, they
were placed away from public scrutiny in government ‘mental’ institutions or
charitable disability hospitals. This became ‘home’ for the rest of their lives.
Government inquiries over decades (Swain, 2014) record multiple instances of
neglect, with barely adequate basic care and limited day activities, and instances of
physical, emotional and sexual maltreatment often meted out as ‘punishment’ for
‘bad’ behaviour.
5.1.2 First wave of reform recognising the rights of people
with disability
The first wave of reform began in Australia in the late 1970s following international
momentum to secure human rights for all, including people with disability. For those
living in ‘care’ little changed until the 1980s despite the ‘outing’ of abuse and sub-
standard living conditions in institutional contexts by national inquiries. A driver of
change came with the heavy promotion of normalisation in Australia. The
normalisation principle states that people with disability should be assisted to
establish patterns of life as close as possible to those of society more generally. This
was clearly impossible within the closed walls of segregated institutions or children in
family homes kept out of sight of the community’s gaze.
66
Reform began first in the education sector. Commonwealth initiatives, for the first
time, focused on providing funding to educate children with disability including those
with more severe and profound disabilities. International developments in particular
the US 1975 Education for All Handicapped Children Act fuelled optimism and action
across Australia to develop appropriate educational opportunities for children with
disability.
Reform began later, proceeded more slowly, and is still continuing today to move
adults and children with disability out of institutions and into the community. The
deinstitutionalisation movement did not begin to gather momentum in Australia until
the late 1980s. This was despite the landmark New Directions report of 1985 in
which, for the first time in Australia, people with disability were acknowledged as
more than sick and more than dependent. Senator Don Grimes makes this plain -
‘People with disability …… have made it clear that they want to be treated as people
first people whose abilities matter more than their disability (New Directions, 1985
Foreword, p iii).
Legislative reform followed based on human rights and active citizenship principles
for people with disability. Commonwealth then state and territory legislation set the
tone: people with disability were people first and entitled to a respected place in
society, support and services, due process and protection from harm.
5.1.3 Second wave of reform towards realising the rights of
people with disability
Reform faltered in the following decades. International human rights treaties such as
the UN Convention on the Rights of the Child had little impact for children with
disability in Australia. By the 2000s however people with disability and their families
and carers were no longer willing to stay quiet and ‘grateful’. The impetus for the
second wave of reform came from the United Nations Convention of the Rights of
Persons with Disabilities (2006). No longer could governments and to a lesser extent
the public ignore the voices of people with disabilities requesting their rightful place in
society.
So began the first decade 2006-2016 of the national disability reform agenda.
The National Disability Strategy 20102020 came just over 20 years after the
Disability Services Act (C) 1986. The fundamental purpose of the strategy is to
include Australians with disability as full and equal citizens in Australia society. A
national disability research agenda was developed to focus research on the actions
foreshadowed in the disability strategy. The reform agenda dictates that people with
disability participate in the mainstream of society in health, education, transport,
housing and so on and access specialist support and services only when required.
The National Disability Insurance Scheme sets out to bring this to fruition.
To achieve the promise of mainstreaming requires inclusive and accessible
communities. The human rights, social and economic imperatives of the National
Disability Strategy are now well embedded in Australian legislation, governance
mechanisms and policy directives. Nevertheless, to achieve inclusive and accessible
67
communities requires a paradigm shift in community attitudes. Communities and
institutional contexts can only become inclusive and accessible when they too take
on board that people with disability are citizens first and foremost, and entitled to a
respected place in society, due process and protection from harm.
5.2 Children with disability and their
vulnerability to harm
The national disability reform agenda is not enough. As we have demonstrated, this
reform agenda is mostly silent on children with disability. Policy frameworks and
mechanisms focus attention on supporting their families and appropriately so. This
comes at a price however. Children with disability are positioned as dependent,
passive and under the care of their parents. When children with disability are
stereotyped in this way they are at heightened vulnerability to abuse, being
segregated, overlooked and not heard. In our view: as in the past, now in the
present. Australia has a long history of exclusion of children with disability from
society either in institutions or ‘protected’ within the family home. The perspectives of
children with disability their voices are missing from the disability reform agenda.
5.2.1 Prevalence and risk of sexual abuse for children with
disability
There is no Australian data on prevalence and risk of sexual abuse for children with
disability. This is a major failing. In its absence advocates and researchers have
turned to the international literature on children with disability. They have also drawn
conclusions from the more substantive literature on sexual abuse of adults with
disability.
The most reliable prevalence figure comes from an international systematic review
and meta-analysis of violence toward children with disability (Jones et al. 2012). The
authors reported a pooled prevalence figure of 13.7 per cent for sexual abuse based
on 15 studies (none from Australia). Because of the extreme range (1 per cent40
per cent) they also report a fixed-estimate prevalence rate which is lower, at 8.9 per
cent. Together these figures suggest that between 9 and 14 children in every 100
children with disability are likely to experience sexual abuse.
There are obvious drawbacks in rigidly asserting one figure as the ‘true’ prevalence.
Nevertheless, the international figures suggest heightened vulnerability to sexual
abuse and they align with other vulnerabilities that are experienced by children with
disability. These include discrimination, social exclusion, poorer development and
lower wellbeing.
A single prevalence figure however does not shine light on the critical policy and
practice questions of which children are likely to be subject to abuse, to what extent
and under what circumstances. There are pointers that children with intellectual
68
disability and psychological disorders are at greater risk of sexual abuse. The jury is
out on whether gender or age influence risk of sexual abuse. Critically there is no
robust population evidence on the impact of particular institutional contexts on
prevalence and risk of sexual abuse for children with disability. There is some
Australian evidence that children with disability are proportionately over-represented
in reportable incidents of all types emanating from the out-of-home care and
education sectors.
5.2.2 Prevention approaches
One could expect that heightened vulnerability to harm would lead to increased
efforts to develop evidence-informed approaches to prevent sexual abuse. The
opposite is the case. The physical exclusion of children with disability plays out in
their virtual absence from national frameworks and implementation plans to protect
all Australia’s children. As well, and again despite heightened risk, there is no
evidence base in Australia on effective and cost-efficient prevention strategies to
reduce sexual abuse of children with disability. This is another major failing.
In the absence of an evidence base, researchers and advocates have put forward
recommendations for prevention approaches to be trialled and tested.
Recommendations focus on children, families, on organisational mechanisms and
cultures, and the wider community. The primary concern is to include children with
disability in all child-focused prevention approaches, rather than exclude these
children and young people from learning about sexual abuse, when they more than
others are likely to become sexual abuse victims.
The principle of ensuring the voices of children are present in matters affecting their
lives is now well accepted. This principle needs to be extended to children with
disability, and particularly as active participants in developing protective behaviours.
To be effective in meeting the needs of children with disability, adults policy
makers, families, practitioners need to be prepared to see the world through the
eyes of these children and young people. This is critically important given that
exclusionary practices based on stereotyping children with disabilities as less
capable, more dependent and less sexual than their peers lead to ‘over protection’
and greater vulnerability. When relevant knowledge is available and skills taught,
these build capacity, resilience and protective behaviours.
The over-representation of children with disability in reportable conduct matters
implies that attention needs to be focused on ‘closed contexts’ that are high risk
settings. Disability-specific settings such as respite care, school transport and
personal care services feature one-on-one interactions between adults and children.
This is particularly relevant to quality and safeguarding in the changing disability
services context in Australia. The NDIS is predicated on a market expansion of
disability specialist supports and services. This raises questions of provider ‘safety’ at
all levels: organisational, staff and individual providers. Effective governance and
monitoring mechanisms need to ensure best practice, standards compliance and
accessible complaint processes.
69
Working with children checks already exist in Australia; a vulnerable persons’ check
is one possible solution to monitoring all individuals working with persons with
disability including children. National disability service standards have existed in
Australia for some time. However, these standards remain adult focused. They do
not address child safe organisations, support services or independent providers. The
disability standards also focus on disability-specific contexts. Children with disability
no longer find themselves in disability specific contexts only: their everyday lives are
also spent in mainstream settings in education, recreation and health. Mainstream
institutional contexts also need to be safe for children with disability. Inclusive
approaches require a comprehensive national (or nationally consistent) system to
ensure and monitor child safe organisations in specialist and mainstream settings.
National regulation while necessary is unlikely to be sufficient. Building, maintaining
and sustaining child safe organisations is the responsibility of management
accountable to an organisation’s governing body. This requires leadership, policies
and practices, and an organisational culture in which children always come first.
Disability-specific organisations may not be particularly familiar with or have strong
networks within the mainstream child sector and the leadership and practices
required to build, maintain and sustain a child safe organisation.
Specialist disability organisations and their peak bodies could benefit from engaging
in ‘communities of practice’, which are becoming a regular feature across child,
education, health and welfare sectors. Simply put, communities of practice are
groups of people who come together face to face or virtually to share knowledge
and experience to forge better practice in their respective fields of endeavour. How
communities of practice are organised and supported varies widely. That said, these
typically include diverse, open and transparent communication channels to share
professional wisdom, and working to create resources to assist organisations,
families and communities to respond better within their field of endeavour.
Developing a community of practice in Australia relevant to the particular needs and
contexts of children with disability in disability-specific and mainstream service
settings would be a major step forward.
5.2.1.1 Children with disability as a special group
The current approach in Australia tends to focus on children with disability as a
special group. In our view, there are distinct dangers in doing so. The most obvious is
that responsibility for special groups is thought to reside ‘outside’ the mainstream.
The converse is that the mainstream is ‘relieved’ of their responsibilities for children
with disability. This is contrary to Australia’s obligations under CROC and CRPD.
Child safe organisations must be child safe for all children. This means that in child
safe organisations due diligence must be paid to ensuring any particularities relevant
to children with disability are understood and responded to using evidence-informed
strategies, practices and behaviours.
This discussion paper highlights the role of services and various communities in
responding to and supporting children and young people living with a disability. There
is considerable professional expertise in the Australian disability community that has
begun to explore primary prevention strategies. Finding ways to strategically
70
enhance this community of practice by bringing together the resources of service
providers, families, communities and individuals with lived experience may enhance
the development of what a child safe organisation requires for all children, not only
those living with disability.
In our view, it is not enough to include disability only as a cross-cutting theme for
child safe organisations. This is because community attitudes and the ways in which
children with disability have been treated in the past places them at heightened
vulnerability to violence including sexual abuse. Community attitudes play out in
institutional contexts. These attitudes have to be changed. This requires a direct
approach. For an organisation to be safe for children with disability a population-
based approach will not be enough. The past tells us that children with disability
would continue to be ignored. Targeted interventions will also be needed to reduce
the heightened risk of sexual abuse for children with disability. Disability and
mainstream organisations must be child safe for all children and demonstrate their
competence to remain so over time.
5.3 New directions for children with
disability
There is tragic irony in understanding that children with disability are at a heightened
risk of sexual abuse related to child characteristics, settings and organisational
factors, yet national legislation and policy frameworks are virtually silent on this point.
Attitudes toward disability, segregation and institutionalisation, treating children with
disability as a small and special group, or assuming that the community takes care of
its most vulnerable should not continue as excuses for inaction.
This discussion paper points to the exclusion of children with disability in many areas
of life which affect them most deeply, including knowledge about sexual abuse in
institutional contexts. The Audit of Disability Research in Australia (Centre for
Disability Research and Policy 2014) reported that research on inclusion and
participation of children and young people with disability in everyday life was
significantly under-represented in the Australian disability evidence base.
To inform implementation of child safe organisations in Australia researchers need to
address the following question set out at the beginning of this Discussion Paper. That
is, which Australian children with disability are more likely to experience sexual
abuse, to what extent, and under what circumstances. This implies researchers
investing time and research agencies investing funds to: (i) address the particular
circumstances of heightened risk of sexual abuse for children with disability; and (ii)
to address children with disability as an integral part of the reform agenda on bringing
people with disability into everyday institutions in the community.
The Audit recommended expanded research efforts using administrative data sets
such as the National Child Protection Minimum Data Set (AIHW 2014). One way to
do this is to make it easier for disability researchers and policy makers to use
registries and routine surveys and data sets. It is a truism that only that which is
71
measured counts. The over-representation of children with disability in care and
protection proceedings and out-of-home care is on the public record. Routine and
reliable identification of disability in administrative data sets will go a long way toward
better understanding the specificities (as above) of sexual abuse of children with
disability in institutional contexts in Australia. There is in principle agreement to do so
across all jurisdictions but this has not yet been implemented. As the recent World
Health Organisation (2015) publication Toolkit on mapping legal, health and social
services responses to child maltreatment reports Recently, Australia advanced from
provincial data sets on child maltreatment incidence to a national minimum data set
of child protection (2015, p 7). Footnote 10 notes that However, as two of the eight
jurisdictions still chose to report aggregate data due to competing priorities, the
picture is not complete (p 7). This means that the Australian Institute of Health and
Welfare responsible for reporting on the Child Protection National Minimum Data Set
is not yet able to report disability data (AIHW, 2014).
Further, the Audit also commented on the need to expand Australian longitudinal
child cohort studies. This includes over-sampling of children with disability to ensure
adequate sample sizes to understand the potential drivers (social, economic, cultural,
impairment-related) of maltreatment of children with disability. One of the findings of
the Audit in relation to the disability evidence base in Australia is the higher
proportion of study designs which explore or investigate attitudes, knowledge or
perspectives. This means:
These studies essentially describe the ‘problem’. While an important
contribution, descriptive research cannot produce evidence based solutions
(although it may propose solutions to be tested in the future). There was
much less research using study designs which test interventions or solutions
or evaluate policy initiatives. In other words, study designs that allow us to
know what works, and ideally, for whom and under what conditions. Research
that can determine what works and in which settings is urgently needed. For
example, the disability reform agenda aims to ensure people with disability
can access and use mainstream activities and services to participate fully in
all aspects of society. Research on how to achieve accessible and
participatory mainstream services, and at scale and across all sectors is
currently missing from the disability research base in Australia ... It would be
misleading to only focus on the situation of people with disability. Without
comparison within and between groups of people, we cannot know whether
the policy initiatives of the disability reform agenda are working, and in the
desired direction, and for whom. (Centre for Disability Research and Policy,
2014, pp 8-9)
This statement applies equally to children with disability. Ensuring that population
data and administrative data sets include and are relevant to children with disability is
critical to be able to compare their circumstances alongside that of their non-disabled
peers. We repeat: it would be misleading to focus only on the situation of children
with disability. Without comparison within and between groups of children we cannot
know whether the policy initiatives of the reform agendas on disability and on
protecting children are working, and in the desired direction, and for whom.
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Appendix
Table 1 Characteristics of the two interventions on sexual
abuse of children with disabilities
Study
Bowman et al. 2010
Lee & Tang 1998
Country
USA
Hong Kong
Study design
Cohort: pre and post, no
control group
RCT#
Participants
Gender
Age
Intervention Group
Control Group
73.2% female
Mean = 30.1years
124 service providers
NA*
100% female
11-17yrs at special school for
children with mental retardation
38
34
Disability type
Developmental disabilities
Mild mental retardation
Intervention
Training program for service
providers (4hr workshop)
2 x 45mins sessions with
children
Outcome
Measures
Pre and Post:
Sexual Abuse Attitudes &
Knowledge Questionnaire
(SAAKQ)
Global Perceptions Scale
(GPS) assesses general
attitudes about people with
disabilities
Pre, post, 2mth follow-up.
Intervention Group:
‘What If’ Situation Test+
measures ability to differentiate
appropriate from inappropriate
sexual advances and knowledge
about self-protection skills in
response to hypothetical
abusive situations
Personal Safety Questionnaire+
assesses sexual abuse
knowledge
Fear Assessment Scale^
assesses fear of various
objects, people and situations
Control Group:
Attention Control Program$
covers various safety skills
unrelated to sexual abuse (for
73
example, car safety, stranger
safety, playground safety)
Results
57% completed pre- and post-
test:
SAAKQ Knowledge scale
increase 34 to 42.3/70,
p<0.001
SAAKQ Attitude scale increase
3.7 to 3.9, p<0.001
No significant change in GPS
Improvement in knowledge
about sexual abuse and self-
protection and maintained for
2mth
Improved recognition of
appropriate touch requests
dissipated with time
Intervention group showed less
fear after 2mths showing they
became better equipped to
recognise appropriate and
inappropriate touch
Recommendations
More intensive training and
follow up (due to small
changes)
Agencies provide sexual
abuse training to
developmental disability
service provider
Booster sessions and longer
program duration to show better
retention of learned material
Include ratings of parents and
teachers on instruments
Limitations
Participants (primarily young
women) may not be
representative of all service
providers
Low post participation rate
Attitudes and global
perceptions may be difficult to
see change after only 4 hours
Self-report (question whether
the verbal descriptions of skills
can translate into actual
self-protection behaviour in the
natural environment
Findings cannot be generalised
to other disabilities
*NA not applicable; #randomised control trial; +Wurtele, 1990; ^Wurtele & Miller-
Perrin, 1997; $Wurtele et al., 1992
74
Table 2 Prevention programs, policy frameworks and
Australian initiatives targeting prevention of child
sexual abuse in institutional settings including children
and young people with disability
Topic
Author / Program
implementer /
available at
Agency type
Program / Policy
detail
Child Focused
Relationship and
Private Stuff’
Workshops to
support people with
intellectual disability
Private practitioner,
NSW
http://www.relationship
sandprivatestuff.com
Private
enterprise,
disability-
specific
Sexual awareness
and sexual safety for
young people with
disability
Schools disability
program
Sexual Health and
Family Planning ACT
http://www.shfpact.org
.au/community-health-
promotion/schools-
disability-program
State-funded,
Health
Social safety, sexual
and reproductive
health needs
(including the law
regarding harassment
and assault)
Feel Safe CD
(2015)
True relationships and
reproductive health
(Formally Family
Planning Qld)
http://www.true.org.au/
Resources/shop#!/Fee
l-safe-
CD/p/57318487/categ
ory=18053014&forces
croll=true
State-funded,
Health
Self-protection
resource for young
people 12-16 years
with a learning
disability
I have a right to be
safe (2015)
True relationships and
reproductive health
(formerly Family
Planning Qld)
State-funded,
Health
Self-protection skills
resource of flip charts
and brochures for
children 5-10 years
75
http://www.true.org.au/
Resources/shop#!/I-
have-the-right-to-be-
safe-flip-chart-and-
brochures/p/57318730
with limited learning
skills
Reportable incidents
scheme for people
with a disability in
supported
accommodation
(2014)
Ombudsman NSW
https://www.ombo.nsw
.gov.au/what-we-
do/our-
work/community-and-
disability-
services/part-3c-
reportable-incidents
Statutory
agency, NSW
Online and telephone
complaints division
established to
respond to employee-
client and client-client
abuse and
maltreatment
concerns
Family
Parent forum for
parents/carers of
people with
intellectual disability
Family planning NSW
http://www.fpnsw.org.a
u/335019_54.html
State-funded,
Health
Access to resources
and sharing of
information relating to
decision making and
safety in relation to
sexuality
Sexuality and
Disability Links
online resource for
consumers, parents
and carers to
explore resources
freely available in
Australia, UK,
Canada (2015)
Shine SA (previously
Family Planning of
South Australia)
http://www.shinesa.org
.au/media/2015/05/Se
xuality-and-Disability-
Links.pdf
State-funded,
Health
Resource kit for
individuals and carers
(including service
providers) to seek out
resources relating to
sexuality and sexual
safety
Limited resources for
young people with
disability including link
to SoSAFE! training
program
76
Staff
NSW Ombudsman
workshops with
disability staff on
client-safe
environments
Ombudsman NSW
https://www.ombo.nsw
.gov.au/training-
workshops-and-
events/our-
workshops/investigatio
n-training/handling-
serious-incidents-in-
the-disability-sector
Statutory
agency, NSW
Organisation
workshops with focus
on responding to
serious incidents of
abuse and allegations
where there is a
criminal element
Commitment to
inter-jurisdictional
exchange of
information about
people working with
children
Recommendation from
Commonwealth of
Australia (2011)
Commonwealth
directive to
statutory
agencies
Policy initiative to
enable enhanced
sharing of knowledge
Zero Tolerance
Framework
National Disability
Services in
partnership with the
disability sector
https://www.nds.org.a
u/resources/zero-
tolerance
Peak body for
disability
services across
Australia
Framework to assist
disability services to
implement practices
that safeguard the
people they support in
relation to abuse and
exploitation
Enhanced sharing
of information
regarding working
with vulnerable
individuals
NDIA trial roll-out
(ACT)
http://www.ndis.gov.au
/sites/default/files/docu
ments/quality_assuran
ce_safeguards_workin
g_arrangements_austr
alian_capital_territory.
pdf
Statutory
agency,
Commonwealth
To identify patterns of
behaviour that may
not necessarily be
reflected in traditional
police checks
77
Broad application of
duty of care
guidelines in the
issuing of licenses
for provision of
services and in
funding agreements
Commission for
Children and Young
People, Victoria
http://www.ccyp.vic.go
v.au/childsafetycommi
ssioner/downloads/chil
dsafe_sched01.pdf
Statutory
agency, Victoria
Enhanced policy
directive that seeks to
identify and
implement structures
specific to child safe
organisations
Enhanced
recruitment and
selection processes
with explicit
statements of
commitment to child
safety in all
advertising
Commission for
Children and Young
People, Victoria
http://www.ccyp.vic.go
v.au/childsafetycommi
ssioner/downloads/chil
dsafe_sched01.pdf
Statutory
agency, Victoria
Enhanced policy
directive that seeks to
identify and
implement structures
specific to child safe
organisations
Organisation / System
Australian
jurisdictions work
toward developing a
comprehensive
national data
collection framework
by 2022
National plan to
reduce violence
against women and
their children, 2010-
2022, Council of
Australian
Governments (2011)
See also:
http://www.decd.sa.go
v.au/docs/documents/
1/Schdl3GuideInfoShr
gJuris.pdf
Council of
Australian
Governments
Data collection
relating to the
protection of children
including those with
disability
Technology
solutions to
streamline and
simplify notification
process for
complaints relating
to disability services
Ombudsman NSW
https://www.ombo.nsw
.gov.au/__data/assets/
pdf_file/0008/23876/N
SW-Ombudsman-
submission-to-
Federal-Senate-
Statutory
agency, NSW
To assist the
electronic lodgment of
complaints to ensure
that concerns can be
raised quickly and
with a notification trail
78
inquiry-into-abuse-
and-neglect-of-people-
with-disability-April-
2015_web.pdf
Identification of joint
clients between
Community
Services NSW and
Department of
Ageing Disability
and Home Care,
NSW
Family and
Community Services
http://www.community.
nsw.gov.au/__data/as
sets/pdf_file/0004/319
918/joint_practice_gui
delines_cs_adhc.pdf
State
department,
NSW
Streamlining of
information to ensure
children and young
people with disability
and their needs
remain at the forefront
of intervention
Development of a
virtual centre for the
prevention of
violence against
women and children
with disabilities
Stop the violence,
UNSW in consultation
with peak disability
agencies
http://wwda.org.au/wp-
content/uploads/2013/
12/STV_Outcomes_P
aper.pdf
Disability
Services
The Virtual Centre
would foster and
support evidence-
based approaches to
more efficiently and
effectively design,
implement, monitor
and evaluate
initiatives to prevent
and respond to
violence against
women and girls with
disabilities (p 19)
12 standards for a
child-wise
organisation
Child Wise, Victoria
http://www.childwise.o
rg.au/page/37/online-
publications
Not-for-profit
child abuse
prevention
organisation
A risk management
framework aimed at
strengthening agency
child safe standards
through training and
consultancy to
enhance the safety
and protection of
children
79
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