An evidence-based approach
The Emergency Response should have been formulated on the basis of the best available evidence and supplemented with rigorous prospective evaluation from inception. For some aspects, such as the proposal to institute screening examinations to uncover the sexual abuse of children, the available literature was relatively abundant and unambiguous.
Within days of the announcement of child health checks, Menzies’ prepared a review of the literature for the NT Department of Health and Community Services14. The review concluded that physical examinations were rarely suggestive or conclusive of sexual abuse, even in cases where abuse was highly likely to have occurred. Moreover, studies of low-risk children revealed that normal physical variants can be misinterpreted as evidence of abuse, even by paediatricians. The potential to inflict harm by instituting indiscriminate screening by non-experts was obvious. An evidence-based approach would have rejected screening for abuse from the onset, and therefore avoided much of the apprehension generated by this proposal. For other aspects of the Emergency Response, little quality evidence was available for guidance in the first instance; but this fact only underscores the importance of rigorous prospective evaluation of each intervention.
The lack of data to inform about the impact and effectiveness of the Emergency Response is, in itself, an important issue. Retrospective evaluation of program effectiveness is always limited by lack of suitable data because existing data collections have not been designed specifically for such evaluations and their suitability for specific evaluation questions is usually limited. Prospective design of an evaluation, assessment of the suitability of existing data sources and initiation of new data collection when needed is a far better way to provide relevant evidence, rather than relying on anecdote and opinion.
Evaluation of the Emergency Response should have been initiated at its commencement, and should have been carefully planned and informed by the rigour of high quality research. The Review should ensure, since the Emergency Response is likely to continue in some form for the medium term at least, that an appropriate program design, data collection, monitoring and evaluation mechanism is set up from now on.
Menzies, together with the NT Department of Health and Families, is creating a Child Protection Unit within the organisation. Partly a result of the processes initiated by the NT Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse and the resulting inquiry findings15 and Government response16, the collaboration aims, inter alia, to develop a service-oriented research capacity within Menzies to develop an evidence-base to inform policies, programs and services.
14. Snelling TL, Andrews R, Morris P, Singh G, Chang A, Carapetis JR. The role of medical examinations in the evaluation of children suspected to be victims of sexual abuse: a literature review. Menzies School of Health Research, Darwin. June 2007.
15. Ampe Akelyernemane Meke Mekarle, Little Children are Sacred. Northern Territory Government Report of the Northern Territory Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse. 2007
16. Closing the Gap of Indigenous Disadvantage: A Generational Plan of Action. Northern Territory Government. 2007