Submission 15 — Australian Research Alliance for Children and Youth — Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability

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ROYAL COMMISSION INTO VIOLENCE,

ABUSE, NEGLECT, AND EXPLOITATION

OF PEOPLE WITH DISABILITY

SUBMISSION BY THE AUSTRALIAN RESEARCH ALLIANCE

FOR CHILDREN AND YOUTH.

MARCH 2020

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CONTENTS

• Who We Are

• Defining Disability

• Terms of Reference

• Disability in the Context of Children and Young People

• Response

• What are the drivers of abuse/neglect/exploitation of children with disability? ………………………

• What are the barriers to reporting, investigating, and responding to maltreatment?

• What actions can be taken to prevent and protect children with disability from abuse/neglect/exploitation?

• What actions can be taken to promote reporting, investigation and response to maltreatment?

• Summary of Key Points & Recommendations …….. ……… ………………………. … …………………….

• References

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WHO WE ARE

The Australian Research Al Iiance for Children and Youth (ARACY) is a nationa Inot-for-profit that exists to improve the wellbeing of all young Australians aged 0-24. Our consultations with over 3000 Australians, including children and young people, have told us what wellbeing means to them: to be loved and safe, have access to material basics, physically and mentally healthy, learning, participating, and have a positive sense of identity and culture. Violence, abuse, neglect, and exploitation of children and young people with disability violates these values. ARACY therefore has a vested interest in representing the interests of children and young people with disability in this Royal Commission.

DEFINING DISABILITY

For the purposes ofthis report, the definition of disability provided by the Royal Commission has been adopted:

“people with disability means people with any kind ofimpairment, whether existing at birth or acquired through illness, accident or the ageing process, including cognitive impairment and physical, sensory, intellectual and psycho-social disability” (Commonwealth of Australia)

In line with the Australian Bureau of Statistics (ABS) ARACY defines children and young people as aged 0-24; the following content will refer to people within this age bracket.

TERMS OF REFERENCE

As per Commonwealth Letters Patent (April 4, 2019):

• What governments, institutions and the community should do to prevent, and better protect, people with disability from experiencing violence, abuse, neglect and exploitation, having regard to the extent of violence, abuse, neglect and exploitation experienced by people with disability in all settings and contexts;

• What governments, institutions and the community should do to achieve best practice to encourage reporting of, and effective investigations of and responses to, violence against, and abuse, neglect and exploitation of, people with disability, including addressing failures in, and impediments to, reporting, investigating and responding to such conduct;

• What should be done to promote a more inclusive society that supports the independence of people with disability and their right to live free from violence, abuse, neglect and exploitation;

• Any matter reasonably incidental to a matter referred to in paragraphs (a) to (c) or that you believe is reasonably relevant to your inquiry.

ARACY submission to the Royal Commission into Violence, Abuse, Neglect, and Exploitation ofPeople with Disability.

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DISABILITY IN THE CONTEXT OF CHILDREN AND YOUNG PEOPLE

Children with disability are overrepresented in mistreatment allegations and substantiations. For example, a recent study conducted in Western Australia showed that while children with disability constitute 10% of the WA population, they account for 25% of maltreatment allegations and 29% of maltreatment substantiations (Maclean, et al., 2017).

The duration and extent of maltreatment is greater for children with disability than children without disability. A Canadian study found that children with developmental delay were “more likely to be reported as having experienced both multiple types and multiple incidents of maltreatment, spanning longer periods oftime and inflicted by multiple perpetrators” (Schormans & Brown, 2002). For example, 52.6% of children with developmental delay were abused for 6 months or longer compared to 40.1% of children without developmental delay (Schormans & Brown, 2002). Research into sexual abuse also indicates that abuse of children with disability can be more severe, with higher rates of penetration involving children with disability compared to children without disability (Breckenridge & Flax, 2016).

International data indicates that maltreatment is by far most likely to be perpetrated by the child’s primary caregiver, most frequently the child’s biological parent.

Although institutional maltreatment has been the focus of recent literature, a Canadian study indicated that the most common alleged perpetrator of the primary maltreatment type was the biological mother in 67% of cases, followed by the child’s biological father in 37% of cases (Schormans & Brown,

2002. 1 . Step-parents, other relatives, and “other” were the next most common, each constituting 4-7% of allegations. Strangers, foster family, and adoptive parents accounted for less than 1% each, and the alleged perpetrator was unknown in 1.1% of cases. This is likely due to the fact that biological carers are most likely to be the primary carer; the same study indicated that over 90% of children with disability have a biological parent as the primary carer. Not only do these families tend to have socioeconomic stressors (such as socioeconomic disadvantage, mental health or substance use disorders - see point below), they are also dealing with the significant challenges associated with being the primary carer of a child with disability. This does not negate the importance of maltreatment which occurs in institutional settings, but helps put into perspective where resourcing for additional supports should be allocated.

Risk factors for child maltreatment tend to co-occur in families with children with disability. At face value, children with disability are twice as likely to have a maltreatment allegation and three times more likely to have a maltreatment substantiation than children without disability (Maclean, et al., 2017). This is partly due to risk factors for maltreatment being clustered in families that have children with disability (Fisher, Hodapp, & Dykens, in Maclean, et al., 2017). Examples of risk factors include young parental age, parental mental health or substance use problems, and socioeconomic disadvantage (O’Donnell, et al, in Maclean, et al, 2017). However, when other risk factors for ma !treatment are adjusted for, children with disa bi Iity remain at higher risk for ma!treatment than children without disability (Maclean, et al., 2017). Disability therefore remains an independent risk

1 Percentages total to more than 100% due to multiple alleged perpetrators.

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factor for child maltreatment, compounded by the social context of the child. What this suggests is that supports for fam iIies with children with disability shou Id be holistic, evidence-based strategies that reduce the risk of ma!treatment, that address both the socioeconomic and other factors that predispose to maltreatment, as well as specific supports related to the child’s abilities.

Children with disability experience similar types of maltreatment to children without disability. The most commonly occurring forms of maltreatment are neglect and physical abuse, constituting 25% and 24% of primary maltreatment allegations respectively (Maclean, et al., 2017). This is followed by sexual abuse (19%) and emotional abuse (3.5%). Children with intellectual disability had a higher proportion of neglect allegations (33% of all allegations), and children with conduct disorder had a higher proportion of physical abuse allegations (31% of all allegations) (Maclean, et al., 2017).

There is variability in maltreatment risk according to the type and severity of disability. Intellectual disability, conduct disorder, and other social/emotional disorders are associated with higher rates of maltreatment reporting (Maclean, et al., 2017). Conversely, autism and congenital malformations/cerebral palsy are less strongly associated with rates of maltreatment reporting, and rates of maltreatment reporting in children with Down syndrome are no higher than children without disability (Maclean, et al., 2017). The severity of intellectual disability has also been shown to be a risk factor, with more severe intellectual disability associated with lower rates of maltreatment allegations and substantiations (Maclean, et al., 2017). It is important to note however that rates of maltreatment allegations and substantiations do not necessarily reflect actual rates of violence, abuse, neglect, or exploitation, given inherent barriers to reporting and underreporting of maltreatment identified in the literature. This will be explored further below.

RESPONSE

WHAT ARE THE DRIVERS OF ABUSE/NEGLECT/EXPLOITATION OF CHILDREN WITH

DISABILITY?

Identifying the drivers of violence, abuse, neglect, and exploitation of children with disability is helpful in directing strategies to mitigate these drivers. Drivers of maltreatment include:

1. Clustering of risk factors for maltreatment. Additional risk factors for maltreatment (such as parental mental health or substance use disorders, poverty, young parents) tend to coexist in families with children with disability (Maclean, et al., 2017). This may be compounded by other factors, including stress associated with providing care, negative feelings about having a child with a disability, and inappropriate behaviour management strategies by caregivers (Frederick, Devaney, & Alisic, 2019).

2. Increased vulnerability to abuse. Factors increasing vulnerability to abuse, identified through literature examining child sexual abuse, could include: cognitive impairment, limiting the child’s ability to recognise abuse and understand their rights, and communications difficulties, limiting the child’s ability to disclose abuse (Breckenridge & Flax, 2016). Other factors may include: limitations with mobility, impairing a child’s ability to avoid a perpetrator, and the perception

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by perpetrators that the child will not recognise inappropriate behaviour (Frederick, Devaney, & Alisic, 2019).

3. Lack of voice for children and young people with disability. This refers to the emphasis on caregiver and parent needs, the underlying presumption that these are the same as the child’s needs, and lack of engagement by professionals with children with disability (Frederick, Devaney, & Alisic, 2019). Anecdotally, people with disability have been perceived as somehow ‘less human’; they are underrepresented in media, and have frequent issues with participation (such as having a say in decision that affect them). Not being represented as a normal part of a diverse society perpetuates violence, abuse, neglect, and exploitation.

4. Increased exposure to settings of abuse. These include: placement in group care settings, contact with a variety of service providers (Breckenridge & Flax, 2016), and the child’s need for personal care (Frederick, Devaney, & Alisic, 2019).

WHAT ARE THE BARRIERS TO REPORTING, INVESTIGATING, AND RESPONDING TO

MALTREATMENT?

Much ofthe evidence around disclosure, reporting, and responses to violence, abuse, neglect, and exploitation of children has come from the Royal Commission into Institutional Responses to Child Sexual Abuse, and thus a lot ofthe evidence is based on sexual abuse specifically. Challenges to reporting and response to abuse arise from many sources, including factors affecting the child, the family, and service factors.

1. Child factors impacting reporting The literature indicates that sexual abuse in children with disability, like children without disability, is underreported (Breckenridge & Flax, 2016). Children with disability are less Ii kely to disclose sexua I abuse, and disclose sexual abuse later compared to children without disability (Breckenridge & Flax, 2016). Children with disability often have additional barriers to reporting, some of which have been identified in the literature. Compiled from Breckenridge & Flax (2016) and Robinson & Graham (2019), these include:

• Communication barriers

• Cognitive barriers: either not understanding that abuse has occurred, or difficulty recognising appropriate from inappropriate touch, especially given personal care needs

• Fear of removal of services

• Expectations of compliance with caregivers

• Reduced opportunity for reporting, given persistent presence of and dependence on caregivers

• Beliefthat reports of maltreatment will be received poorly or not acted upon

• Previous experience of inadequate response when maltreatment had been reported

2. Family factors impacting reporting

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Additional barriers to caregivers reporting abuse cited in the literature include (Breckenridge & Flax, 2016):

• Communication barriers, including not understanding verbal communication, misunderstanding non-verbal cues (such as changes to sleep, appetite, and mood), and misinterpreting behavioural indicators of abuse as features ofthe child’s disability

• Intentional failure to report, which is increased above the general population. This is consistent with data indicating that a child’s biological parent is the most common alleged perpetrator of maltreatment (Schormans & Brown, 2002).

  2 • Misguided beliefs about sexuality and sensitivity to pain of children with disability

3. Challenges of responding to maltreatment Providing suitable therapeutic responses and management of reported abuse can be complex in children with disability, due to the variability in their needs, the limited overlap in expertise of clinicians versus expertise of people working with disability, and the lack of adapted therapies. For example, Breckenridge and Flax (2016) refer to the “siloed service system”, stating that “service providers with a knowledge of disability have little understanding of therapy, and many clinicians who might provide therapeutic treatment have insufficient knowledge ofthe special needs of people with disability”. Other barriers include the unsuitability oftraditional therapies due to lack of adaptation to suit various child needs. For example, insight-orientated mental health therapies (used in the management of past sexual abuse) may be unsuitable for children with cognitive impairment due to limitations in abstract thinking and language skills (Breckenridge & Flax, 2016).

WHAT ACTIONS CAN BE TAKEN TO PREVENT AND PROTECT CHILDREN WITH

DISABILITY FROM ABUSE/NEGLECT/EXPLOITATION?

1. Instigate holistic, evidence-based supports for families which promote secure parent-child attachment.

With the recent Royal Commission into Institutional Responses to Child Sexual Abuse, much ofthe literature is focussed on institutional safety. However, the vast majority of children with disability are cared for by their biological parents, who are by far the most commonly alleged perpetrators of child maltreatment (see Disability in the Context of Children and Young People, above) (Schormans & Brown, 2002). This occurs in the context of families who are significantly more likely to be experiencing stressors such as socioeconomic disadvantage, and mental health and substance use issues (O’Donnell, et al, in Maclean, et al, 2017). This is compounded by the significant challenges involved in caring for a child with disability, and influenced by their own childhood experiences. Parents of children with disability are more likely to show harsh parenting styles (Corr & Santos, 2017), and are more likely to have additional risk factors for child maltreatment (Maclean, et al., 2017). International data indicates that children with disabilities who have experienced abuse are much more likely to come from homes

2 Note that the literature cited around these misguided beliefs was published in 1992 (Mansell, Sobsey & Calder in Breckenridge & Flax, 2016), and may not necessarily be indicative of current caregiver knowledge.

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where violence occurs between caregivers, and mothers experiencing violence are more likely to use harsh parenting styles (Corr & Santos, 2017).

However, fostering parental warmth and responsiveness establishes secure parent-child attachment, which is protective against maltreatment (Fox, et al., 2015). Parental social-emotional factors as well as parental socioeconomic context influence parenting sensitivity and subsequent parent-child attachment (Moul Iin, Waldfogel, & Wash brook, 2018). A positive early caregiving environment has also been shown to have a positive impact on early development (Fox, et al., 2015). Parenting capability is known to be impacted by the parents’ own wellbeing (Fox et al, 2015). Therefore, promoting positive attachment in a holistic manner through evidence-based interventions that foster warm and responsive parenting, by supporting the socioeconomic and social-emotional challenges ofthe parent and family, is a strategy that can be utilised to reduce the risk of maltreatment for children with disability.

2. Give children with disability a voice. Children with disability have views that are separate and unique from their parents and caregivers, and have a right to have these views taken into account. Literature indicates that there is a discrepancy between the views of children with disability and the views oftheir parents on how having a disability affects their lives (Robinson & Graham, 2019). The Convention on the Rights of Persons with Disabilities supports the inclusion ofthese views, stating that “children with disabilities have the right to express their views freely on all matters affecting them, their views being given due weight in accordance with their age and maturity, on an equal basis with other children, and to be provided with disability and age-appropriate assistance to realize that right” (United Nations, 2006). As summed up by Robinson and Graham (2019), “Such findings point clearly to the need for further research that engages directly with children with disability, and for ensuring the views of supporters complement, not substitute, children and young people’s perspectives when developing policy, programs and practice to designed to ensure their safety.”

Giving children a voice can also improve the safety of children with disability. Consulting with children and young people has been argued to improve research and be beneficial to the effectiveness of policies (Moore, Saunders, & McArthur, 2011). This is supported in the literature, where protective factors are centred upon autonomy, respect, and self-efficacy. For example, Robinson and Graham (2019) found the following factors correlated to personal safety and abuse prevention in children with disabilities included:

Quality of life • Self-determination • Sense of personal agency • Being respected • Reciprocity in relationships • Access to responsive adults • Viewed as having capability •

This echoes the findings of Robinson et al (2017), who summarise the means by which children and young people with disability can be supported to promote their personal safety into three key

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strategies: by building strong, foundational relationship with a range of people; by promoting the autonomy of young people to take action, in the context of a responsive and supportive social network; and by building a young person’s capability around personal safety.

These findings are consistent with what young people with disability have to say about improving personal safety. A recent study of young people with disability identified the following strategies that young people themselves can do to feel safer (Robinson et al, 2017)

• Strengthen relationships with people who can support them by providing advice and guidance
• Learn skills in resilience and supporting peers
• Learning who and how to access help
• Learning how to be safe in common situations Children and young people with disability have views that are independent from their parents and caregivers. Not only do they have a human right to express these views, but doing so can be beneficial to their safety. Evidence supports the autonomy and self-efficacy of children and young people with disability as improving safety, especially in conjunction with a broad and supportive social network.

3. Make institutions child-safe. Although evidence suggests that the majority of maltreatment allegations arise in the home setting, preventing institutional maltreatment of children is important given the significant amount of time children with disability spend in these settings (for example, respite care, school support classes). Child­ safe institutions may also provide an avenue for children to report maltreatment that is happening at home.

Although empirical data is lacking, factors suggested to increase vulnerability to maltreatment in institutions include: segregated settings, closed and locked settings, children being alone with an adult, organisational culture supporting closed communication, and poor leadership (Wayland & Hindmarsh, 2017). Strategies that have been suggested to increase the safety of institutions include (Wayland & Hindmarsh, 2017):

• Providing education for children around maltreatment and protective behaviours

• Including children’s voices in the development of child-safe strategies

• Creating a collaborative culture across service providers, by moving away from specialist disability services and towards a community of practice approach

• Addressing change at an institutional level, including leaders who acknowledge and respect the rights of children with disability, involving all staff in the implementation and upkeep of child­ safety strategies, and mechanisms to counter cultures of closed communication around maltreatment reporting.

When children and young people with disability are asked about their views on safety in institutional settings, their emphasis is on relationships: being known and valued by their peers and staff members was the most important theme in relation to personal safety (Robinson et al., 2017). When asked about asked how services can improve safety, they collectively identified the following strategies (Robinson, et al., 2017):

• Increasing the importance of responding to reports of harm within services

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• Improve choice and control over services, especially relevant in rural and remote communities where this may be limited

• Addressing service gaps for specific populations, e.g. having options for same gender or culture of provider

• Providing education for both service providers and young clients on recognising and responding to harm, about relationships, about leadership, and about how to support their peers.

A final consideration is peer to peer abuse, in the form of bullying at schools. Children with disability are significantly more likely to experience bullying. For example, a review of US data indicates that 60% of children with disabilities are harassed regularly compared to 25% of children without disability (PACER’s National Prevention bullying strategy in Hernandez, Brodwin, & Siu, 2017). Bullying could be quite severe, with forms of bullying including physical abuse such as “body-slamming”, scratching and spitting, and verbal and emotional abuse leading to suicide (Hernandez, Brodwin, & Siu, 2017). Children with Asperger’s has particularly high rates of abuse, with 94% experiencing bullying as reported by their mothers (Little in Hernandez, Brodwin & Siu, 2017). Strategies to address bullying of children with special education needs were based on creating an inclusive and tolerant school environment (Swearer, Wang, Maag, Siebecker, & Frerichs, 2012). An Australian study which interviewed children with Autism Spectrum Disorder and their parents found the following recommendations to prevent bullying (Carrington, et al., 2017):

• Improved communication between students, parents, and schools, so that all relevant parties are aware of reports of bullying

• Providing supervised, structured activities at free time (e.g. recess, lunch, before and after school)

• Improve the responsiveness of teachers to reports of bullying, so that the response is proportionate and students feel supported

• Have good systems protocols around bullying, where perpetrators face serious consequences that are clearly communicated (less than half of all Australian students in Years 5-10 were aware their school had a policy around safe and supportive environments, despite this being mandatory for all schools since 2003) (Rigby and Johnson in Carrington, et al. 2017).

• Government legislation around bullying, particularly laws around cyberbullying and specific legal consequences for bullying

• Education and awareness campaign around bullying and the consequences of bullying

• Including parents and families in the management of perpetrators of bullying Improving institutional safety is a broad topic that extends beyond the scope of this report. However, key themes emerging from the literature are: including consideration of peer-to-peer abuse, particularly in the setting of school bullying; improving the culture of safety, especially through open communication within and across services, and with children and young people themselves; educating both service providers and children and young people on how to recognise and respond to maltreatment, for themselves and for peers or clients; fostering a range of supportive and trusted relationships; giving children choice and a voice - on which service providers they engage with and on how those services can improve their child-safety.

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WHAT ACTIONS CAN BE TAKEN TO PROMOTE REPORTING, INVESTIGATION AND

RESPONSE TO MALTREATMENT?

1. Gain a better understanding of unreported violence, abuse, neglect, and exploitation in children with disability.

Rates of maltreatment allegations and substantiations have been used to estimate the prevalence of maltreatment in children with disability. However, there is evidence that significant numbers of child maltreatment go unreported (Breckenridge & Flax, 2016). Furthermore, current literature is conflicting. For example:

• Rates of maltreatment allegations/substantiations suggest that autism has lower rates of child maltreatment than other disabilities, showing even a protective effect of autism on maltreatment allegations once other risk factors for maltreatment were adjusted for (i.e. rates of maltreatment allegations were lower for children with autism than for children without disability) (Maclean, et al., 2017).

• However, this contrasts with other data, which identifies autism as a specific risk factor for child homicide (Frederick, Devaney, & Alisic, 2019). For example, in a US study of 22 case studies of filicide-suicide in children with disability, 12 had been diagnosed with autism spectrum disorder (Coorg & Tournay in Frederick, Devaney, & Alisic, 2019).

Similarly:

• An Australian study showed that rates of maltreatment allegations increased as the severity of intellectual impairment decreases. For example, children with borderline-mild intellectual disability were found to have triple the rate of maltreatment allegations compared to children without disability, children with mild-moderate double the rate, and severe intellectual disability showed no difference compared to children without disability (Maclean, et al., 2017).

• However, Wi Ison et a I (2016) note that “children with intellectual disability and/or complex communication needs are the most marginalised within the disability population. As a result they are the least researched, most vulnerable and excluded”. Anecdotally, this view has been supported by service providers, who indicate that children with severe communication limitations would be extremely vulnerable to abuse. This is also supported by evidence, which indicates that children with severe disability are less likely to disclose sexual abuse than in children without disability, and that children with intellectual disability disclose sexual abuse later than for their non-disables peers (Breckenridge & Flax, 2016). It is therefore possible that maltreatment is less often detected in children with more severe intellectual disability, rather than less often occurring.

These findings suggest that there is a need for a clearer understanding of actual child maltreatment, especially the maltreatment that goes unreported, which is inherently much more likely to occur in those with far greater vulnerability to abuse.

2. Empower professional and non-professional supports to recognise and respond adequately to disclosure of maltreatment.

ARACY submission to the Royal Commission into Violence, Abuse, Neglect, and Exploitation ofPeople with Disability.

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Education and training of both professionals and families has been argued to be an important feature of responding to maltreatment, and access to a responsive adult has been found to correlate with personal safety for children and young people with disability (Robinson & Graham, 2019). Yet research conducted with children and young people with disability shows that their reports to authorities of violence or abuse often go unheeded. This has the result of amplifying their fear of maltreatment, and setting the expectation of little action if further reports were made (Robinson et al, 2017).

There are multiple barriers to engaging with young people about maltreatment. Professionals feel unsupported in developing skills in working with children with disability (Robinson & Graham, 2019). There is also little overlap between service providers skilled in working with children with disability and service provides skilled in therapeutic management (Breckenridge & Flax, 2016). Families also feel tension around discussing sexuality and self-protection with their children, and are unclear about their child’s understanding of safety (Robinson & Graham, 2019). Teaching families and professionals how to engage in discussions or reports of maltreatment and safety is an important step in improving reporting and response. Additionally, where children are unable to report maltreatment themselves, primary caregivers and service providers can be taught how to recognise signs of abuse (such as: extreme fear or behavioural changes when a child is left with particular people, injuries to private parts of their body) (Wayland & Hindmarsh, 2017).

Children and young people with disability have provided suggestions on how professionals and caregivers can help them feel safer. Research from Robinson et al. (2017) based on focus groups, adapted interviews, and surveys of children and young people with disability identified the following strategies that made children and young people feel safe:

• Take action in response to issues, but don’t take over

• Be proactive about harm prevention

• Emphasise high quality relationships so that young people feel comfortable, valuable, and respected

• Consider and respond according to the young person’s specific circumstances, and how safety may differ from person to person according to this

• Emphasise strengths: where a young person’s supports are lacking, build supports in other areas

• Help young people keep themselves safe by understanding their safety strategies and by building on and enhancing these

• Learn not just “train”

• Create an environment where young people feel welcome, included, and less personally responsible for maintaining their own safety

These insights from children and young people provide a starting point from which professionals and caregivers can learn to recognise, engage, and respond effectively to maltreatment.

3. Develop and implement suitable therapies. The development of effective and accessible therapies for children with disability who have been maltreated is essential. Accessibility to services and therapies includes accommodating for the

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cognitive and communication needs of clients (not only physical accessibility), which has been reported to be a barrier to services by people with disability (Breckenridge & Flax, 2016). Some therapeutic approaches have been adapted to increase their suitability and accessibility to children with disability, for example as outlines in Breckenridge and Flax (2006):

• Therapists using sign language to treat to children with hearing impairment who had been sexually abused

• The use of non-verbal therapies, such a play and art-based therapies

• The use of group therapy for children with intellectual disability who had been sexually abused Unfortunately, there is little to no high-quality research demonstrating the effectiveness ofthese adapted therapies. The lack of evidence-based and effective therapies for children with disa bi Iity requires a collaborative approach to their development, which includes the voices of key stakeholders (including a variety of relevant professionals, caregivers, and particularly children with disability who have been affected by maltreatment), and scientific evaluation oftheir effectiveness in relevant populations.

SUMMARY OF KEY POINTS & RECOMMENDATIONS

The above report is by no means an exhaustive account of how violence, abuse, neglect, and exploitation of children and young people with disabilities can be prevented and responded to. It does however provide an overview of some of the key issues and strategies that can be used as a starting point. The key points and recommendations are summarised below.

► Children with disability experience higher rates and greater severity of violence, abuse, neglect, and exploitation. This is true both at home (indicated by maltreatment reports) and in institutional settings (such as bullying at schools).

► Although institutional maltreatment is heavily emphasised in current literature, international data suggests that the biological parents account for the overwhelming majority of maltreatment allegations for children and young people with disability, as they also most often the child’s primary carers.

► Family dynamics and the broader social context of children and young people with disability play a critical role in their risk of violence, abuse, neglect and exploitation. Strategies to reduce violence, abuse, neglect, and exploitation of children and young people with disability must therefore aim to mitigate risk factors for maltreatment, including those specific to the child’s disability as well as those related to the broader social context of the child and family.

►  Given the important role of parents and families,  it is critical that every family gets supported

according to their needs by our community to create a healthier, fairer Australia for all children. A key element of this strategy is fostering secure parent-child attachment.

► Children and young people with disability are more vulnerable to violence, abuse, neglect, and exploitation. This can be inherent in their disability (e.g. due to communication barriers, mobility or cognitive impairment), and is reinforced by increased exposure to settings of abuse, the need for personal care, and- critically-the lack of voice of children and young people with disability.

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► A key strategy for mitigating this vulnerability lies in the empowerment of children and young people with disability to recognise and respond to maltreatment. This includes: fostering a sense of personal agency; equipping children with the skills to be safe, resilient, support their peers, and access help themselves; and- critically - embedding the child in a network of strong, supportive, and responsive relationships.

► Institutional safety also relies heavily on education and empowerment, of both children with disability and professionals. Key strategies which improve the safety of institutions are founded upon: creating a culture of open communication; including the views of children and young people in policies and systems; having responsive staff members skilled in responding to maltreatment disclosure; providing adequate choice and control over services; and ensuring schools have adequate and effective anti-bullying strategies.

► Once violence, abuse, neglect, or exploitation has occurred, the detection and response to maltreatment is vital to reducing the impact on children and young people. There is conflicting data among maltreatment patterns, incidences of maltreatment are underreported, and both families and professionals face challenges in addressing maltreatment in children with disabilities. A more comprehensive understanding of patterns of abuse, particularly unreported abuse, must be coupled with education and skill development in the detection, response, and longer term management of maltreatment for professionals and caregivers.

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Carrington, S., Campbell, M., Saggers, B., Ashburner, J., Vicig, F., Dillon-Wallace, J., & Hwang, Y. S. (2017). Recommendations of school students with autism spectrum disorder and their parents in regard to bullying and cyberbullying prevention and intervention. International Journal of Inclusive Education, 21(10), 1045-1064. Retrieved from https://www.tandfonIine .com/doi/a bs/10. 1080/13603116. 2017 .1331381

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Corr, C., & Santos, R. M. (2017). Abuse and young children with disabilities: A review ofthe literature. Journal ofEarly Intervention, 39(1), 3-17. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/1053815116677823?journalCode=jeib

Fox, S., Southwell, A., Stafford, N., Goodhue, R., Jackson, D., & Smith, C. (2015). Better Systems, Better Chances: A Review ofResearch and Practicefor Prevention and Early Intervention. Canberra: Australian Research Alliance for Children and Youth.

Frederick, J., Devaney, J., & Alisic, E. (2019). Homicides and maltreatment-related deaths of disabled children: A systematic review.. Child Abuse Review.

Hernandez, E. J., Brodwin, M. G., & Siu, F. W. (2017). Bullying, Students with Disabilities, and Recommendations for Prevention of Bullying. The Rehabilitation Professional, 25(1), 51-58. Retrieved from https://disa buse.eu/sites/defau lt/files/2018­ 10/Bu Ilying%20Students%20with%20Disa bi Iities%20and%20Recommendations%20for%20Pr evention%2oof%20Bullying.pdf#page=53

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