Delyse Hutchinson

Background: Despite calls for increased investment in child maltreatment prevention and early family support, governments globally continue to spend funds disproportionately on downstream statutory intervention and out-of-home care (OOHC). The aim of this study was to investigate whether prevention and early family support expenditure patterns were associated with subsequent changes in child protection service outcomes.Methods: Data from all Australian states and territories between 2015–16 to 2024–25 were included. Associations between expenditure and subsequent child protection service outcomes were examined using one-year lagged models. Expenditure on prevention – through family support services (FSS) – and early family support – through intensive family support services (IFSS) – was operationalised as: absolute (total cost per child); proportional (proportion of expenditure allocated to FSS and IFSS relative to total expenditure); demand-adjusted (cost per child subject to a child protection notification); and needs-adjusted (cost per developmentally vulnerable child). Child protection service outcomes included: children and families commencing IFSS; new and repeat child protection clients; new care and protection orders; and entry into OOHC.Findings: Higher expenditure on FSS was consistently associated with lower rates of repeat child protection clients and entries into OOHC, with effects strongest when expenditure was needs-adjusted for population-level developmental vulnerability. Higher expenditure on IFSS was associated with increased rates of children and families commencing these services, and increased rates of new child protection clients.Interpretation: Results show that child protection outcomes are sensitive to investment decisions. Investing in prevention is critical to reducing downstream demand for statutory intervention and OOHC.

Background: Perinatal depression and anxiety are significant public health concerns, affecting up to 1 in 5 women globally, with disproportionate burden carried by women in regional, rural, and remote communities where structural and social inequities amplify vulnerability. Access to perinatal mental health support in these settings is severely constrained by geographical isolation, workforce shortages, financial barriers, and a lack of culturally safe services. Prevention is recognized as critical to reducing this burden, with evidence suggesting that effective preventive approaches can reduce population-level illness by up to 40% and alleviate downstream demand on overstretched services. Digital mental health interventions hold promise for improving access to support, yet few are co-designed with underserved perinatal populations. Objective: This study aimed to identify the mental health needs of perinatal women in regional, rural, and remote communities and to co-design a framework for a preventive social media–based intervention informed by platform-specific affordances and constraints, using Northern Queensland, Australia, as an exemplar. Methods: Using a participatory co-design approach, 26 perinatal women (21 postnatal and 5 antenatal) and 8 mental health care professionals from regional, rural, and remote Northern Queensland participated in focus groups or interviews, supplemented by ongoing consultation with a community advisory group comprising lived experience representatives, clinicians, and local community leaders. Qualitative data were analyzed using reflexive thematic analysis to identify core community mental health needs. Identified needs were then examined through a needs-affordances framework to determine how specific platform features could address, enable, or constrain those needs in the context of a preventive intervention. Results: Five core mental health needs were identified: (1) social connection and support; (2) personalized and respectful health care; (3) information that empowers; (4) place-based and culturally safe support; and (5) accessible, low-burden digital formats. Participants viewed social media as a potentially useful platform for fostering peer connection, normalizing perinatal experiences, and providing timely psychoeducation. However, both mothers and professionals expressed concerns about misinformation, harmful social comparison, and privacy risks that must be proactively addressed in program design. These insights were synthesized into a set of prototype design guidelines specifying recommended content, features, tone, and delivery formats to inform subsequent intervention development. Conclusions: This study provides a place-based, co-designed needs-affordances framework to guide the development of a preventive social media–based intervention for perinatal mental health support in regional, rural, and remote communities. The findings demonstrate that social media is an acceptable and promising platform for preventive perinatal mental health support in these settings, provided that design is driven by community need, platform affordances are systematically analyzed, and known risks are explicitly mitigated. These findings address a significant gap in the literature and offer a replicable methodological approach for co-designing contextually relevant digital mental health interventions with underserved populations.

BackgroundExcessive screen use in childhood is associated with adverse mental health and behavioural outcomes, yet whether early exposure predicts later use patterns is unclear. We examined associations between infant screen exposure and screen use, including social media, at age 8 years.MethodsWe analysed data from a pregnancy cohort in Sydney and Perth, Australia, following dyads (n = 598) from pregnancy to age 8 years. Mothers reported children’s daily screen time at age 1 (television, movies, gaming, internet) and age 8 (television/movies, social media, gaming/internet entertainment, educational content). Infant exposure (total, educational, entertainment) was categorised as none (reference), <1h, 1–<2h, and ≥2h/day. The primary outcome was total screen time at age 8 (<2h [reference], 2–<4h, ≥4h/day). Multinomial logistic regression estimated relative risk ratios (RRRs) with 95% confidence intervals (CIs), adjusting for sociodemographic and perinatal factors.ResultsAt age 1, 81.6% of infants had screen exposure. At age 8, 73.8% exceeded 2h/day and 17.6% used social media. Infant exposure ≥2h/day (vs none) was associated with higher risk of 2–<4h/day (RRR 2.99; 95% CI 1.45–6.17) and ≥4h/day (RRR 5.66; 95% CI 2.44–13.10), with a dose–response pattern. Entertainment exposure at age 1 was associated with social media use at age 8 (RR 1.94; 95% CI 1.15–3.27).ConclusionsScreen exposure in infancy is associated with substantially higher screen use in later childhood, including social media use. Interventions to limit screen exposure in the first year of life may help prevent excessive use and related harms.

Nurturing family environments (NFEs) are theorised to underpin positive development, with most studies investigating NFEs in childhood. Comparatively limited research has explored the role of NFEs during adolescence in promoting positive development during emerging adulthood. We used longitudinal data from The Australian Temperament Project ( n = 1,377) to: (1) identify classes of NFEs at ages 17–18 years; and, (2) examine associations between adolescent NFE classes and positive development across emerging adulthood (19–20, 23–24, and 27–28 years). Four nurturance classes were identified at baseline: high (36.59%), normative (35.97%), low (16.39%), and normative with inter-parental relational problems (11.05%). Adolescents in the high nurturance class had higher positive development in emerging adulthood compared to all other classes, whilst the normative class had higher positive development compared to the low and normative with inter-parental relational problems classes. These findings highlight important prognostic associations between adolescent NFEs and positive development in emerging adulthood, with implications for family-based interventions.

Background: Child protection systems are critical in responding to and resolving child maltreatment concerns. Mapping trends in system activity and expenditure can highlight opportunities to better support vulnerable children and families.Objective: To describe national and state/territory trends in child protection system activity and government expenditure in Australia.Participants and Setting: All children aged <18 years who had contact with Australian state/territory child protection systems between 2014-15 and 2023-24.Methods: We conducted a descriptive analysis of publicly reported population-level data from the Australian Institute of Health and Welfare and the Productivity Commission. Child protection system activity indicators included investigations of alleged maltreatment notifications, substantiated investigations, care and protection orders, and out‑of‑home care (OOHC) placements. Expenditure included the total and per child costs of child protection system activity to the government.Results: National child protection activity remained largely stable from 2014-15 to 2023-24, despite notable variation across states/territories. Over 50% of children with any prior history of investigation for alleged maltreatment were re‑investigated, each year. Substantiated notifications for emotional abuse rose from 43.1% to 57.0% over the period, while government spending on child protection services nearly doubled from AUD 5.4 billion in 2014-15, to AUD 10.2 billion in 2023-24.Conclusions: Despite increased national investment in child protection, overall system activity has remained stable, with notable variation across states/territories. High rates of re‑investigation point to persistent unmet needs among children and families. These results highlight the value of earlier, preventive support to create more sustainable pathways and reduce reliance on mandated statutory responses.

Intergenerational studies suggest that the developmental foundations of children’s early relational health are seeded well before conception. Here, we present studies that report on associations between factors in the parental preconception life course (across childhood, adolescence, and young adulthood), and indicators of the child’s early relational ecology (e.g., infant-to-parent attachment, parent-to-infant bonds). We searched MEDLINE, PsycINFO and Embase databases for peer-reviewed articles, published in English, that reported on prospectively assessed factors at any stage of a parent’s life course prior to conception, and associations with offspring relational health from conception to end of age 3 years. No date restrictions were imposed. A total of 13,594 articles were screened of which 30 met inclusion criteria, reporting data from 17 separate cohorts. Next generation child relational health was assessed using both coded observations and parent reports, with most studies focused on the mother–child relationship (70%). Most preconception predictors were assessed at the individual level (63%) or within the family microsystem (53%) and were measured during adolescence (60%). Few studies assessed other microsystems or broader ecological systems, with no studies investigating workplaces, online interactions, or cultural belief systems as predictors of next generation relational health. We conclude that longitudinal cohorts that track individuals into parenthood can provide critical insights into the preconception origins of early relational health; however, the existing body of prospective studies is heterogeneous and reflects a nascent field of enquiry. We present five recommendations for future investment in public health approaches that promote early relational health.

Background and Aims: There is evidence to suggest that earlier initiation to alcohol increases the rate and severity of alcohol consumption. However, this often overlooks the fact that earlier initiation also means a longer drinking history. This paper estimated differences in patterns of alcohol use and harm across adolescence and early adulthood, allowing for the fact that the patterns over time may differ depending on the age at which initiation occurred. Design: Prospective cohort study. Setting: Australia. Participants: The Australian Parental Supply of Alcohol Longitudinal Study (APSALS), a cohort of n = 1906 adolescents recruited in adolescence (mean age 12.9) from 107 Australian schools and followed up until adulthood (11 annual waves total, 2010–2021). Measurements: We defined age of initiation as the age at which alcohol consumption was first reported in the study. Our outcomes were amount of alcohol consumed, monthly heavy episodic drinking, alcohol‐related harm and self‐reported symptoms of alcohol use disorder in the years following initiation. Findings: Those who initiated at age 12 had a lower risk of consumption [risk ratio (RR) 0.01; 95% confidence interval (CI) = 0.01–0.02] in the year following initiation (age 13), compared with those who initiated at age 18. Similarly, those who initiated at age 15 had a lower risk of alcohol use disorder in the year after initiation (RR 0.66; 95% CI = 0.52–0.83), compared with those who initiated at age 18. However, at age 20, those who initiated at age 12 showed higher consumption (RR 1.57; 95% CI = 1.18–2.09), monthly heavy episodic drinking (RR 1.24; 95% CI = 1.02–1.51) and alcohol‐related harms [incidence‐rate ratio (IRR) 1.73; 95% CI = 1.21–2.46] than those who initiated at age 18. Similar results were seen for symptoms consistent with DSM‐IV alcohol dependence (RR 1.20; 95% CI = 1.05–1.38), DSM‐IV alcohol abuse (RR 1.54; 95% CI = 1.04–2.29) and DSM‐5 alcohol use disorder (RR 1.36; 95% CI = 1.12–1.65). However, there was evidence of ageing out, with risk of heavy episodic drinking and alcohol‐related harm peaking around age 20 and then declining, regardless of when initiation occurred. Conclusions: Later initiation to alcohol appears to be associated with more rapid escalation in drinking and related harm, but lower ‘peak’ harm than earlier initiation. The findings support the current guidelines recommending adolescents avoid alcohol until adulthood, and reinforce the need for public health intervention targeting both children and parents.