First-time Child Protection Contacts from 0 to 15 Years in a Whole-Population Cohort of Australian Aboriginal Children Born 2006-2020: a Data Linkage Study

Background First Nations children are over-represented in child protection systems in Australia and other colonised countries. Here, we apply a prevention and equity lens to the use of child protection data, to inform early opportunities to support Aboriginal children and families at risk of escalating child protection contact, from pregnancy to adolescence. Methods We followed 15 whole-population cohorts (born 2006-2020) of Aboriginal (n=119,716) and non-Aboriginal (n=1,456,698) children in New South Wales (NSW), Australia, to December 2021, using birth and child protection datasets linked for the NSW Child E-Cohort. In each Aboriginal and non-Aboriginal cohort (2006-2020), we calculated the cumulative incidence (risk) of first-time child protection contacts from the prenatal period up to age 15 years: child concern reports, screened in reports, investigations, child protection-defined substantiations, and OOHC placements. Risk differences and relative risks were also calculated. Findings By birth, 10-15% of Aboriginal children born 2006-2020 had a first report to child protection, with 48-54% by age 5y (2006-2016 births), and 74% by age 15y (2006 births), with similar risks of screened-in reports (e.g. 68% by age 15y). The risk of first-time substantiation was 1-5% of Aboriginal children by birth, 17-20% by 5y, and 32% by 15y, with higher risks in more contemporary cohorts. By age 1y, 3-4% of Aboriginal children born 2006-2020 had a first OOHC placement, with 7-9% by 5y, and 14% by 15y. The risk differences between Aboriginal and non-Aboriginal children were 23 and 3 percentage points for reports and OOHC by age 1y (2020 births), respectively, increasing as children age. Interpretation Despite extensive inquiries, calls for prevention and Closing the Gap targets, our study shows the lifetime risk of child protection involvement for Aboriginal families has not improved and inequities persist. These findings support the call for Aboriginal‑led approaches and greater investment in early supports for First Nations children and families. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The NSW Child E-Cohort Project has receiving funding support from a National Health and Medical Research Council (NHMRC) Clinical Trials and Cohort Studies Grant (1187489) and a UNSW Medicine Neuroscience, Mental Health and Addictions Theme and SPHERE Clinical Academic Group seed funding grant. The Bring Them Home, Keep Them Home Project was funded by an ARC Discovery Indigenous grant (194187). This study also received funding through a pilot grant from the Research Excellence in Aboriginal Child and Adolescent Health (REACH) Centre for Research Excellence (1135273). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the NSW Population and Health Services Research Ethics Committee (2020/ETH01265), the University of NSW HREC (2020/ETH01265), and the Aboriginal Health and Medical Research Council (AH&MRC) of NSW Ethics Committee (1688/20) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript and supplemental tables