Who can protect our children?

4:00AM Sunday Aug 16, 2009
By David Fisher

Our state services fail to protect some of New Zealand’s most severely abused children and allow them to be “revictimised”, according to research published in an international medical journal.

It says the child protection system could be seen as a “poorly controlled experiment” through the inability of government agencies to work together on cases of child abuse.

It follows two cases of alleged child abuse last week in Northland, one of which ended in the death of a 2-year-old. The child in the other case – a 17-month-old – was severely injured.

Social Development Minister Paula Bennett met the families of the two children on Friday. “Protecting our most vulnerable children is of the highest priority to this Government,” she said afterwards.

Bennett will this week announce the reintroduction of the Never Shake A Baby Campaign.

“We are also progressing a plan on how agencies will better work together to ensure an abused child is protected if they have been hospitalised,” she said.

New figures from Starship hospital show the number of children under two with “inflicted traumatic brain injury” has risen sharply over a 20-year study period. They show that in 1988 one child was admitted with an inflicted head injury. Numbers peaked at 13 in 2006 and most recently at 11 children last year.

The report, published in the Child Abuse & Neglect International Journal, was written by two Starship doctors Patrick Kelly and Judith MacCormick, and an Auckland health board social worker Rebecca Strange, who works with child abuse victims.

It studies the fate of 39 children aged under two who were treated at Auckland Hospital for “shaken baby syndrome” during the 1990s. It follows their health and development for up to 17 years.

The “syndrome” has become a term for traumatic brain injury in infants. One of its common causes is hard, physical shaking of the child.

Most of the children are referred to in the report as “survivors” – six died in hospital and two others have died since, one 15-months later after complications from the original head injury. They were also mainly Maori – a staggering 77 per cent of the 39 children admitted to hospital.

By December 2007, the children had grown older – they ranged from nine years to 21 – and concerns about repeat abuse had been raised in 44 per cent of cases. This was a “major concern”, the report said.

It is particularly critical of the former Child Youth and Family service, now part of the Ministry of Social Development. Investigations of “doubtful quality” by CYF meant reports to the agency of fresh abuse against children – even in front of witnesses – would be treated as unproven, when they likely indicated serious risk.

While the report found CYF had records in all cases, it also found two of the child deaths were never referred to police. And it highlighted a death where a CYF worker rejected medical evidence of abuse to accept the caregiver’s explanation that the child had choked on a piece of bread.

None of the surviving children was killed or suffered further brain injury from future abuse, possibly due to involvement by state agencies.

But the authors said the high number who were again seen by agencies was a “major concern” when the object of intervention was not only to prevent death but to keep children safe.

Sometimes the agencies were called in afresh to deal with cases of neglect and failing to meet a child’s needs – the tragic consequence of extended family trying to cope with a child who has suffered brain damage from earlier abuse.

Kelly says New Zealand has seen a steady 20-year climb in the number of children being admitted to hospital with head injuries caused by abuse.

Having two “fatal or near-fatal” admissions in a week was unusual but Starship normally had several children at any time being treated for serious abuse injuries.

“Children die, children suffer serious damage, and sometimes it is the result of a few seconds of uncontrollable rage,” he said.

No one from CYF would be interviewed but in a statement, deputy chief executive Ray Smith said the service had improved.

“Can we do more? Absolutely – and I’m committed to finding new and better ways to keep children and young people safe.”

High hopes for baby scheme
Every new parent in the Auckland area will be spoken to about the dangers of shaking babies in a new government-funded trial.

Dr Patrick Kelly, a paediatrician at Starship children’s hospital, said there were great hopes the programme would save lives. In it parents will be spoken to “in the first few days after [the birth] to talk about the dangers of shaking a baby”.

They would then have to sign a sheet of paper acknowledging the discussion and the ways to avoid abuse.

If successful, the pilot scheme may be rolled out across the country. In the United States it has resulted in a 40 per cent reduction in abuse.

Health professionals at Starship hope to have it running by the end of this year.

The Shaken Baby Prevention Programme is being funded by the Ministry of Social Development, and is based on a programme developed by US professor Mark Dias.

Kelly said the programme was suited to New Zealand’s independent midwife network. The trial was awaiting the appointment of key staff and development of material such as a video.

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