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Restoration of Aboriginal children (also called reunification) is an under-researched area despite being the preferred permanency outcome for children. To investigate the rate of restoration for Aboriginal children, the factors that influence restoration, and to explore the experiences of parents whose Aboriginal children have been restored, and their children. Analyses were conducted using data from the NSW Department of Communities and Justice Pathways of Care Longitudinal Study (POCLS). The quantitative sample includes all Aboriginal children in NSW who were on final Children's Court care and protection orders by 30 April 2013. Qualitative data were extracted from the POCLS survey instruments. Of the 1018 Aboriginal children in the study, 15.2% were restored. Around 40 % of children entered care following just one (or no) substantiated Risk of Significant Harm reports. Children entering care under the age of 2 years were the least likely to be restored. Parents expressed dissatisfaction with child protection agencies and family support services both at the time their child was removed and in the restoration period. Parents and children expressed the importance of being supported to maintain family relationships while children are in care. Despite policy priorities to the contrary, few Aboriginal children are considered for restoration. More support is needed for Aboriginal parents interfacing with all stages of the care system and following restoration. Additional research is needed to understand the factors underlying decisions to remove Aboriginal children from their families and whether restoration to their family is considered or achieved. [ABSTRACT FROM AUTHOR]

A systematic literature review was conducted to address the immense national gap in knowledge on child sexual abuse (CSA) and ethnic minority communities in Australia, which necessarily borrowed from overseas. One theme explored within the review was that of prevention, and it was found that school-based programs are the most common type of prevention effort. The literature also calls for ‘culturally tailored’ programs to avoid homogenising victims' needs, however in Western multicultural countries like Australia there is a risk that such school-based programs heighten racism for ethnic minority children. Thus, program elements that are culturally sensitive could be incorporated into universal programs instead. Universal programs are also beneficial because they help reach many children regardless of their cultural background, help send the message that all children are equally valued and protected, help create unity and support among diverse victims, and can be further justified by three relatively stable cross-cultural findings: (i) that the prevalence of CSA is high worldwide, (ii) all children require protection irrespective of gender, and (iii) perpetrators are usually known to the victim. To help mobilise their role, service providers could co-deliver school-based programs especially to address institutional CSA within schools. They could also provide training to other health professionals to improve their identification of CSA and confidence to probe; a form of early intervention and therefore ‘secondary prevention’. Overall, this review argues that the importance of family reputation in collectivist cultures needs to be taken into account when designing and evaluating prevention programs so that delays in disclosure and help-seeking due to cultural pressure are not mistaken as evidence for their ineffectiveness. The findings are significant because they help progress the ‘prevention’ field in Australia where literature is essentially absent, particularly in the school and service system arenas. [ABSTRACT FROM AUTHOR]

Research on child sexual abuse (CSA) among ethnic minority communities in Australia is essentially absent. To begin to address the gap, a systematic literature review was conducted; which necessarily borrowed from overseas to help inform the national context. A wide array of barriers to disclosure were identified, suggesting that this is a fundamental issue for ethnic minorities. The most significant of these barriers appears to be the need to protect family name. This also leads to non-supportive and protective responses from non-offending mothers, however this experience (although more intense) is shared with the Western mainstream. In comparison, fear of stigmatising their whole community is a unique barrier and highlights that racism is a significant and additional burden. The findings suggest that service worker training in Australia is critical for informing professionals of: the importance of family reputation for collectivist groups; the importance of responding supportively and protectively to child victims who have disclosed to them first; the cross-cultural complexities that surround construals of ‘child safety’; educating non-offending mothers about the importance of at least believing their child's disclosure (associated with mediating mental illness among victims, but also culturally appropriate because it acknowledges the protective role of family cohesion in collectivist cultures and the high motivation to avoid social exclusion – the most common reprisal for shaming the family name); exploring acculturation as a possible predictor of disclosure; and the risk of racism being overlooked or minimised. Overall, it is argued that practice informed by a well-developed national research agenda is critical. [ABSTRACT FROM AUTHOR]

A systematic literature review was conducted to help address the gap in national and international knowledge about child sexual abuse (CSA) and ethnic minority communities. This paper reports the findings of that review in relation to the theme of community awareness. The results suggest that awareness of CSA may be low in ethnic minority communities due to misperceptions that it is ‘a Western problem’. This in turn may be associated with norms in the country of origin which are asserted to transfer after migration, such as CSA being seen as a private family matter that does not invite systematic intervention from the state, low media and research attention, widespread acceptance of myths about CSA, and prohibitive norms on discussing matters to do with sex including abuse. Such trends are seen to be the result of, but also then further protect and preserve, collectivist and patriarchal structures. They also make it challenging for raising community awareness. Nevertheless, genuine community engagement through outreach/educational/preventative programs that empower minorities through co-delivery, are high on cultural competency, tailored to specific groups, and use a feminist framework where appropriate, are seen as necessary; they represent investment in minority communities and child safety of children from minority communities. Overall, realistic goals about the effectiveness of outreach educational programs, combined with value for culturally meaningful constructions of child safety, are seen as key toward the success of awareness-raising programs. [ABSTRACT FROM AUTHOR]

One significant finding from an exhaustive literature review on child sexual abuse (CSA) and ethnic minority communities is that victims appear to be at higher risk for suicidality. This may be due to the many barriers to professional help-seeking in this group, most commonly associated with protecting the family's name. This makes their treatment needs particularly critical, after the barriers have finally been crossed. Of all their treatment needs, cultural competency is identified as essential. It asks for non-racist attitudes and practice, self-reflection and awareness, a ‘multicultural framework’ which recognises differences in power between mainstream and minority groups and respects the right to cultural differences, the provision of an interpreter trained in matters to do with sexual assault, choice about having an ethnically matched or non-matched service provider (and thus employment of workers from diverse backgrounds), the routine provision of training in cultural competency by management in service organisations, and mandatory data collection on variables related to ethnicity. A ‘multicultural framework’ is seen to be the most important of these elements, else it could lead to the vilification of collectivist and patriarchal cultures (which ethnic minority communities tend to be), threatening cultural safety. This adds trauma to the victim who has already suffered an abuse of power, and further alienates clients in critical need of clinical intervention. [ABSTRACT FROM AUTHOR]

A year has passed since COVID-19 began disrupting systems. Although children are not considered a risk population for the virus, there is accumulating knowledge regarding children's escalating risk for maltreatment during the pandemic. The current study is part of a larger initiative using an international platform to examine child maltreatment (CM) reports and child protective service (CPS) responses in various countries. The first data collection, which included a comparison between eight countries after the pandemic's first wave (March–June 2020), illustrated a worrisome picture regarding children's wellbeing. The current study presents the second wave of data across 12 regions via population data (Australia [New South Wales], Brazil, United States [California, Pennsylvania], Colombia, England, Germany, Israel, Japan, Canada [Ontario, Quebec], South Africa). Regional information was gathered, including demographics, economic situation, and CPS responses to COVID-19. A descriptive analysis was conducted to provide an overview of the phenomenon. Across all of the countries, COVID-19 had a substantial negative impact on the operation of CPSs and the children and families they serve by disrupting in-person services. One year into the COVID-19 pandemic, new reports of CM varied across the regions. 1 1 The term regions is used rather than countries because in some countries child protection systems are governed by states or provinces rather than at the national level. In some, the impact of COVID-19 on CPS was low to moderate, while in others, more significant changes created multiple challenges for CPS services. COVID-19 created a barrier for CPS to access and protect children. The dramatic variance between the regions demonstrated how social, economic and structural contexts impact both CM reports and CPS responses. [ABSTRACT FROM AUTHOR]

Governments in multiple countries have established redress schemes to acknowledge institutional responsibility for child maltreatment; to provide survivors with access to compensation, counselling and apologies; and to prompt better practice to prevent child maltreatment. Establishing a National Redress Scheme was recommended by Australia's Royal Commission into Institutional Responses to Child Sexual Abuse. The Scheme commenced in 2018 and will run for a decade. This study sought to understand the ways survivors have experienced applying for redress under the National Redress Scheme, and how Scheme processes could be improved for survivors. Participants were 322 survivors of child sexual abuse who had applied for redress or considered doing so during the first two years of the Scheme's operation. Two thirds (68%) were aged 55 or over and over half (55%) were men. To provide feedback about their experiences and perceptions of the National Redress Scheme, participants completed closed and open-ended survey questions. Only a minority rated the Scheme as either good (16%) or very good (11%). Survey comments provide insight into the ways waiting has contributed to survivors' negative experiences of the Scheme. Survivors waited for the Scheme to be established, for institutions to opt-in, for decisions, and for direct personal responses. Waiting compounded uncertainty and was retraumatising for survivors. Some avoided seeking redress due to likely delays and risks of retraumatisation. Australia's National Redress Scheme is an ambivalent policy innovation which can both facilitate support and exacerbate harm. The design of redress schemes should pre-emptively address their potential to generate harm, including by recognising that rapid responses are essential to procedural justice, and particularly important for older survivors of child sexual abuse. [ABSTRACT FROM AUTHOR]

The latest wave of reforms of the child protection system in Australia have been based on attempts to provide support to all families with vulnerable children, rather than increasing surveillance of ‘at risk’ families and forensic responses to incidents of maltreatment. This includes a drive to widen the remit of child protection from the statutory child protection agency and involve other government agencies such as health and education as well as the non-government sector in child protection. This paper reports on the effects of one such reform, the NSW initiative Keep Them Safe. It focuses on the classification of families as needing either early intervention or intensive support, using thematic analysis of qualitative interview data. Method Interviews and focus groups were conducted with practitioners and managers from human service agencies (total n = 115), and discussed their perceptions of the initiative and the changes it had introduced to service delivery. Findings Practitioners discussed family needs in ways which contested the policy meanings of ‘early intervention’: whether families are conceptualised in terms of their needs or risk; whether engagement with services should be voluntary or mandated; and whether the agencies to support them should be the statutory agency or an NGO. The implications for these tensions, in terms of policy and practice, are discussed. [ABSTRACT FROM AUTHOR]

Abstract: The adsorption of dissolved organic matter (DOM) on granular-activated carbon (GAC) as a pretreatment to reverse osmosis (RO) desalination of membrane bioreactor (MBR) effluents was studied in lab- and pilot-scale columns. The pattern and efficiency of DOM adsorption and fate of the hydrophobic (HPO), transphilic (TPI) and hydrophilic (HPI) fractions were characterized, as well as their impact on organic fouling of the RO membranes. Relatively low DOM adsorption capacity and low intensity of adsorption were observed in batch studies. Continuous adsorption experiments performed within a range of hydraulic velocities of 0.9–12m/h depicted permissible values within the mass transfer zone up to 1.6m/h. The breakthrough curves within this range displayed a non-adsorbable fraction of 24±6% and a biodegradable fraction of 49±12%. Interestingly, the adsorbable fraction remained almost constant (∼30%) in the entire hydraulic range studied. Comparative analysis by HPO interaction chromatography showed a steady removal (63–66%) of the HPO fraction. SUVA index and Fourier Transform Infrared (FTIR) spectra indicated that DOM changes during the adsorption phase were mainly due to elution of the more HPI components. GAC pretreatment in pilot-scale columns resulted in 80–90% DOM removal from MBR effluents, which in turn stabilized membrane permeability and increased permeate quality. FTIR analysis indicated that the residual DOM present in the RO permeate, regardless of the pretreatment, was mainly of HPI character (e.g., low-molecular-weight humics linked to polysaccharides and proteins). The DOM removed by GAC pretreatment is composed mainly of HPO and biodegradable components, which constitutes the fraction primarily causing organic fouling. [Copyright &y& Elsevier]

Abstract: The structure and microbial communities of biofilms developing on cross-flow nanofiltration (NF) membranes at different temperatures (20, 25 or 34°C) and operation lengths (8h–24days) were studied. Feedwater comprised tertiary quality wastewater effluent or synthetic media mimicking effluents of intermediate quality. After each run, the membranes were autopsied for bacterial enumeration, bacterial community composition and microscopy visualization (SEM, CLSM and AFM/NSOM). Community composition was analyzed by polymerase chain reaction–denaturing gradient gel electrophoresis (PCR–DGGE) coupled with sequence analysis of 16S rRNA gene fragments from dominant bands. Deposition of polysaccharides and initial bacterial colonization were observed within 8h, whereas developed biofilms markedly affecting membrane permeability were evident from days 2–3 onwards. Regardless of applied conditions, the heterotrophic plate counts in the biofilm were 3–4×106 CFU/cm2 and the thickness of the biofouling layer was 20–30μm. From a total of 22 sequences obtained from 14 independent experiments, most species identified were Gram negative (19 of 22 sequences). Proteobacteria were found to be a prevalent group in all cases (16 of 22 sequences) and among it, the β-subclass was the most predominant (8 sequences), followed by the γ-subclass (5 sequences). Pseudomonas/Burkholderia, Ralstonia, Bacteroidetes and Sphingomonas were the dominant groups found in most cases. Even though the microbial population might be important with respect to biofouling patterns, membrane permeability decline seems to be more substantially influenced by the formation and accumulation of exopolymeric substances (EPS). [Copyright &y& Elsevier]

COVID-19 has become a worldwide pandemic impacting child protection services (CPSs) in many countries. With quarantine and social distancing restrictions, school closures, and recreational venues suspended or providing reduced access, the social safety net for violence prevention has been disrupted significantly. Impacts include the concerns of underreporting and increased risk of child abuse and neglect, as well as challenges in operating CPSs and keeping their workforce safe. The current discussion paper explored the impact of COVID-19 on child maltreatment reports and CPS responses by comparing countries using available population data. Information was gathered from researchers in eight countries, including contextual information about the country's demographics and economic situation, key elements of the CPS, and the CPS response to COVID-19. Where available, information about other factors affecting children was also collected. These data informed a discussion about between-country similarities and differences. COVID-19 had significant impact on the operation of every CPS, whether in high- income or low-income countries. Most systems encountered some degree of service disruption or change. Risk factors for children appeared to increase while there were often substantial deficits in CPS responses, and in most countries there was at a temporary decrease in CM reports despite the increased risks to children. The initial data presented and discussed among the international teams pointed to the way COVID-19 has hampered CPS responses and the protection of children more generally in most jurisdictions, highlighting that children appear to have been at greater risk for maltreatment during COVID-19. [ABSTRACT FROM AUTHOR]

• Six key themes emerged that characterise the trajectories of dual involved children. • A Developmental Cascade Framework highlights high-risk pathways for dual involved. • The relationship between risk factors and offending trajectory is context specific. • DST provides theoretical basis for identifying and diverting dual involved. • Cumulative Risk and ACE scores provide an empirical measure of dual involved pathways. Children who experience dual involvement by child protection and juvenile justice statutory systems have poorer life outcomes attributable to higher levels of disadvantage and more complex needs compared to single system involved children. Literature regarding dual involved children in high income, western, and democratic nations are largely based on US studies. Whilst child protection and juvenile justice systems across the United States, United Kingdom, Canada, New Zealand, and Australia have somewhat similar legislative systems, cohort outcomes and relationships between risk factors and offending trajectories for dual involved children are influenced by differing legislative, geographic, and demographic contexts. Compared to international literature, significant gaps exist regarding the Australian context. Further, within Australia, there are no evaluated specific responses and/or strategies directed towards supporting this highly vulnerable cohort towards increased long-term positive outcomes. This is the first comprehensive review of Australian studies that examines the characteristics of children who have had dual involvement with juvenile justice and child protection agencies within Australia. Using a thematic analysis twenty-five studies with dual involved samples were analysed, examining the individual, familial, environmental, and systemic factors that contribute to the likelihood of children becoming involved in both child protection and juvenile justice systems within Australia. Six thematic factors emerged that characterised the trajectories of dual involved children: cumulative and destabilising adversity; maltreatment timing and type; offending onset and context; educational disadvantage and disengagement; co-occurring challenges; and First Nations overrepresentation. Our findings are applied to Developmental Systems Theory, extending on previous literature to depict an Australian first developmental cascade framework illustrating the context specific pathways of dual involved children and opportunities for intervention in Australia. The discussion highlights and compares differences between Australian and international contexts with the intention of emphasising key areas for future research, and policy and practice reform. This is important because of the nuanced differences between dual involved characteristics across different legislative and geographic contexts, with particular relevance to the experiences of First Nations children and families. Future research, policy and practice would benefit from continued reforms that focus resources on co-ordinated system responses and cohort specific services; namely, culturally appropriate diversion strategies that promote behavioural de-escalation and educational engagement. [ABSTRACT FROM AUTHOR]

There has been a limited understanding of the longitudinal trajectory and determinants of socio-emotional outcomes among children in out-of-home care (OOHC). This study aimed to examine child socio-demographics, pre-care maltreatment, placement, and caregiver factors associated with trajectories of socio-emotional difficulties of children in OOHC. The study sample (n = 345) included data from the Pathways of Care Longitudinal Study (POCLS), a prospective longitudinal cohort of children aged 3–17 years who entered the OOHC system in New South Wales (NSW) Australia, between 2010 and 2011. Group-based trajectory models were used to identify distinct socio-emotional trajectory groups based on the Child Behaviour Check List (CBCL) Total Problem T-scores completed at all four Waves 1–4. Modified Poisson regression analysis was conducted to assess the association (risk ratios) of socio-emotional trajectory group membership with pre-care maltreatment, placement, and caregiver-related factors. Three trajectories of socio-emotional development were identified: 'persistently low difficulties' (average CBCL T-score changed from 40 to 38 over time), normal (average CBCL T-score changed from 52 to 55 over time), and clinical (average CBCL T-score remained at 68 over time) trajectories. Each trajectory presented a stable trend over time. Relative/kinship care, as compared with foster care, was associated with the "persistently low" socio-emotional trajectory. Being male, exposure to ≥8 pre-care substantiated risk of significant harm (ROSH) reports, placement changes, and caregiver's psychological distress (more than two-fold increased risk) were associated with the clinical socio-emotional trajectory. Early intervention to ensure children have a nurturing care environment and psychological support to caregivers are vital for positive socio-emotional development over time among children in long-term OOHC. [ABSTRACT FROM AUTHOR]

Children with disability are over-represented in out-of-home care (OOHC) in Australia and internationally. Yet we know little about their circumstances, placement types, support needs, and the outcomes of their trajectories and wellbeing through care. We examine the wellbeing and outcomes of children with and without disabilities in OOHC. We use panel data from waves 1–4 of the Pathways of Care Longitudinal Study (POCLS) collected between June 2011 and November 2018 by the New South Wales (NSW) Department of Communities and Justice (DCJ), Australia. The POCLS sampling framework covers all children aged 0–17 years who entered OOHC in NSW for the first time between May 2010 and October 2011 (n = 4126). A subset of these children (n = 2828) had final Children's Court orders by 30 April 2013. Among these, caregivers of 1789 children agreed to participate in the interview component of the POCLS. We employ a random effects estimator to analyse the panel data. This is standard practice to exploit a panel database when some of the key explanatory variables are time invariant. Children with disability have poorer wellbeing than children without disability across the three domains of physical health, socio-emotional wellbeing, and cognitive ability. However, children with disability have fewer difficulties at school and better school bonding. The type of placements – namely relative/kinship care, restoration/adoption/guardianship, foster care and residential care – have little or limited association with wellbeing of children with disability. Children with disability tend to have lower levels of wellbeing in OOHC than children without disability, and this is driven mainly by their disability status rather than care factors. [ABSTRACT FROM AUTHOR]

• There are many young people with cognitive impairment in out of home care. • Young people make significant decisions when leaving out of home care. • Young people in out of home care may not have opportunities to develop capacity to make decisions. • We talked to young people with cognitive impairment, their parents, and to other stakeholders about how they supported evolving capacity to make decisions. • The study shows close supports can enable evolving capacity, while broader systems can be barriers to evolving capacity. Young people living in out-of-home care (OOHC) are required to make significant decisions when transitioning from care. Without measures to support participation in the planning process, young people, particularly those with cognitive impairment, are at risk of having decisions made for them 'in their best interests' by others and, without capacity to identify will and preference, are at increased risk of being placed under a guardianship order for decision-making. Little is known about (1) how young people with cognitive impairment are supported to develop autonomy in decision-making over time, and (2) what systems and services support the evolving capacity of young people with cognitive impairment in OOHC to participate in transition planning. We undertook a qualitative study to address this knowledge gap and contribute to practice. We interviewed 17 Young people with cognitive impairment (15–30 years old), 13 parents of young people with cognitive impairment, and 22 other stakeholders supporting young people with cognitive impairment, and analysed results thematically using a human rights framework and Bronfenbrenner's ecological systems theory. We found support for evolving capacity is an active process provided by those close to the young person – family, paid support workers and friends. These supports may not be available to all young people in OOHC. We also found broader systems appear to be barriers to rather than enablers of evolving capacity. This study highlights the opportunity to provide greater support for evolving capacity around young people in OOHC across different systems to support their transition from OOHC and transition to adulthood. [ABSTRACT FROM AUTHOR]

Cross-agency administrative data can improve cost-effective triage systems for child protection and other human service delivery. To determine the minimum set of cross-agency indicators that could accurately classify placement in out-of-home-care (OOHC) before age 13–14 years. Participants were 72,079 Australian children (mean age = 13.16 years; SD = 0.37; 51.4% male) and their parents, for whom linked administrative records spanning the years 1994–2016 were available for analysis within the 'New South Wales Child Development Study'. First, a series of logistic regression analyses were conducted to examine associations between cross-agency (health, justice, education) risk indicators and membership of the sub-cohort of 1239 children who had an OOHC placement prior to age 13–14 years, relative to (1) the sub-cohort of 55,473 children who had no previous contact with child protection services, and (2) the sub-cohort of 15,367 children who had been reported to child protection services but had no record of OOHC placement. We then explored the classification characteristics associated with a smaller combination of risk factors, and the utility of specific familial risk factors, for classifying membership of the OOHC subgroup. A combination of six risk indicators evident before OOHC placement can classify children placed in OOHC with approximately 95% accuracy, and the presence of at least four of these risk indicators provides excellent specificity (99.6%). A combination of risk factors observable in administrative datasets held by multiple government agencies may be used to target support services to prevent entry into OOHC for children from vulnerable families. [ABSTRACT FROM AUTHOR]

Children in out-of-home care (OOHC) are generally at increased risk of health and social adversities compared to their peers. However, the experiences of children in OOHC are not uniform and their associated health and social indices may vary in relation to characteristics of OOHC placements and child protection contact. To examine associations between a range of characteristics of OOHC placements and child protection contact (e.g., number, type, and age of placement) with educational underachievement, mental disorder, and police contact (as a victim, witness, or person of interest) in childhood. Participants were Australian children drawn from the New South Wales Child Development Study cohort who had been placed in OOHC at least once between the ages of 0–13 years (n = 2082). Logistic regression was used to examine prospective associations of OOHC placement and child protection contact characteristics (type of carer, placement instability, duration and frequency of maltreatment, and amount of time in care) with educational underachievement, mental disorder diagnosis and any type of police contact. Placements with foster carers, greater placement instability, longer and more frequent exposure to maltreatment, and longer time spent in care were each associated with greater likelihood of consequences in all domains of functioning. Children with certain placement characteristics are at higher risk of adverse consequences and should be prioritised for support services. The magnitude of relationships was not uniform across different health and social indices, highlighting the need for holistic, multiagency approaches to support children placed in care. [ABSTRACT FROM AUTHOR]

Alongside deficits in children's wellbeing, the COVID-19 pandemic has created an elevated risk for child maltreatment and challenges for child protective services worldwide. Therefore, some children might be doubly marginalized, as prior inequalities become exacerbated and new risk factors arise. To provide initial insight into international researchers' identification of children who might have been overlooked or excluded from services during the pandemic. This study was part of an international collaboration involving researchers from Brazil, Canada, Colombia, Israel, South Africa, Uganda, the UK and the USA. Researchers from each country provided a written narrative in response to the three research questions in focus, which integrated the available data from their countries. Three main questions were explored: 1) Who are the children that were doubly marginalized? 2) What possible mechanisms may be at the root? and 3) In what ways were children doubly marginalized? The international scholars provided information regarding the three questions. A thematic analysis was employed using the intersectional theoretical framework to highlight the impact of children's various identities. The analysis yielded three domains: (1) five categories of doubly marginalized children at increased risk of maltreatment, (2) mechanisms of neglect consisting of unplanned, discriminatory and inadequate actions, and (3) children were doubly marginalized through exclusion in policy and practice and the challenges faced by belonging to vulnerable groups. The COVID-19 pandemic can be used as a case study to illustrate the protection of children from maltreatment during worldwide crises. Findings generated the understanding that child protective systems worldwide must adhere to an intersectionality framework to protect all children and promote quality child protection services. [ABSTRACT FROM AUTHOR]

Longitudinal data on health costs associated with physical and mental conditions are not available for children reported to child protection services. To estimate the costs of hospitalization for physical and mental health conditions by child protection status, including out-of-home-care (OOHC) placement, from birth until 13-years, and to assess the excess costs associated with child protection contact over this period. Australian population cohort of 79,285 children in a multi-agency linkage study. Costs of hospitalization were estimated from birth (if available) using Round 17, National Hospital Cost Data Collection (2012-13; deflated to 2015-16 AUD). Records of the state child protection authority determined contact status. Data were reported separately for children in OOHC. Hospital separations were classified as mental disorder-related if the primary diagnosis was recorded in ICD-10 Chapter V (F00-F99). Hospital separations were more common in children with child protection contact. Physical health care costs per child decreased with age for all children, but were significantly higher for children with contact. Mental health costs per child were always significantly higher for children with contact, with marked increases at 3 ≤ 4 years and 8 ≤ 9 years. Point estimates of annual costs per child were always highest for children with an OOHC placement. The net present value of the excess costs was $3,224 per child until 13- years, discounted at 5 %. Children in contact with child protection services show higher rates and costs for physical and mental health hospitalizations in each of their first 13 years of life. [ABSTRACT FROM AUTHOR]