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

BackgroundFirst 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. MethodsWe 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. FindingsBy 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. InterpretationDespite 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. Research in ContextEvidence before this study We searched PubMed and Medline for studies on the lifetime risk of child protection contacts among First Nations child populations, published January 2005 to May 2025. Thirteen studies reported various child protection contacts, from the perinatal period through childhood, among birth or synthetic cohorts of First Nations children, born between 1990 and 2018, created from population data sources in jurisdictions in Australia (n=5), the United States(US) (n=6), and Aotearoa/New Zealand (NZ) (n=2) (Table E1). O_TBL View this table: org.highwire.dtl.DTLVardef@1a0d510org.highwire.dtl.DTLVardef@4198eorg.highwire.dtl.DTLVardef@129da77org.highwire.dtl.DTLVardef@c5e234org.highwire.dtl.DTLVardef@18600d7_HPS_FORMAT_FIGEXP M_TBL O_FLOATNOTable E1.C_FLOATNO O_TABLECAPTIONSystematic Review Results: Details of 13 studies on the lifetime risk of child protection contacts among First Nations child populations, published January 2005 to May 2025. C_TABLECAPTION C_TBL The most recently published study included First Nations children born 2000 to 2013 in Western Australia, which quantified the risk of reports, investigations, substantiations and removals into OOHC, from age 1 to 16 years. By age 1, 12% were reported and 3% were removed into OOHC. By age 16, 52% were reported, and 14% were removed into OOHC. Prior studies of birth or synthetic cohorts of First Nations children born 1990-2018, in the USA, NZ, and South Australia showed similar results. By age 5 years, 16% to 54% for reports, 20% for investigations, 7% to 11% for substantiations and 8% for removals into OOHC. Among the five studies with cohorts followed to 18 years, 42% were reported, 28% to 50% were investigated, 9% to 27% were substantiated, 7% to 16% were removed into OOHC and 0.8% to 3.8% had termination of parental rights. Added value of this study This is the largest and most contemporary study to quantify the lifetime risk of child protection contact among whole-populations of First Nations children internationally. Among 15 consecutive whole-population cohorts of First Nations children in New South Wales (NSW), Australia, born 2006 to 2020, we reported--for the first time--the full spectrum of child protection contacts, from the prenatal period. By birth, 16% were reported to child protection, 14% were investigated and 5% were substantiated in the most contemporary cohort born 2020. By age 1 year, 2.8% were removed into OOHC. In the oldest cohort born 2006, 74% were reported and 14.4% removed into OOHC by age 15 years. We also reveal the magnitude of the inequity in child protection contacts between First Nations and non-Indigenous children across the lifecourse. For example, among 2006 births, the risk of first-time reports to child protection for Aboriginal and non-Aboriginal children, respectively, was 10.5% versus 1.5% by birth (risk difference (RD), 9 percentage points; risk ratio (RR), 7.0), 53% vs 16% by age five (RD, 38pp; RR, 3.4) and 74% vs 33% by age 15 (RD, 41pp; RR 2.2). Implications of all the available evidence This study unequivocally shows that the lifetime risk of child protection involvement in the lives of First Nations families has not reduced in more contemporary whole-population cohorts and that inequities persist. This is consistent with evidence from prior studies internationally. It is critical that First Nations-led responses and investment in early family supports must be at the centre of system reform to realise the long-called-for shift toward prevention and to re-dress the pervasive inequities experienced by First Nations children and families in colonised countries such as Australia.