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Heather Roy's Diary

Posted on 08 Jul 2006

I had many responses to last week's Diary discussing the sad fate of the Kahui twins and child abuse in general.  Many comments were informative and some spoke of painful personal memories.  Some people asked what ACT would do about the problem - a fair question and one I intend to address today.  A good place to start is to examine the risk factors for child abuse.
Most of the risks relate to the parents and some to the child.  I emphasise that these factors are just statistical probabilities and being in one category does not, in itself, necessarily mean anything.  It is important to remember that risk is about the increased likelihood of an outcome - not about a direct correlation.  Risk factors give us some clues about who might be affected.
Below are the risk factors in the parents:

  • Teenage parents
  • Alcoholism in a parent
  • Illegal drug use in a parent
  • Social isolation
  • Single parent
  • Parent themselves victims of abuse
  • Children and a parent who are not biological relatives
  • Poverty
  • Depression in a parent

Here are the risks in the child:

  • Handicap
  • Long term illness
  • Male sex

There is an element of controversy about these factors and some are too complicated to be addressed in a list.  One chilling factor is the age of the victims.   The textbook "Practical Paediatrics" comments that the highest death rates are amongst boys from newborns to age 4, followed by girls of the same age.  I once asked a salty old paediatrician I knew why these figures indicated that it was the youngest who were at greatest risk.  He replied that by the age of five most children can run pretty fast.
There are also many social factors to be considered.  When society as a whole is violent some sociologists suggest that domestic violence is increased.
A quick glance at the list of risk factors shows that it is possible to draw widely varying conclusions from them.  Socialist politicians find another reason to tax more and to spend on benefits, so as to combat poverty.   Other politicians point out that the traditional lifestyle where children live with their natural parents with Dad working and Mum staying at home provides the safest environment for children.
Finally there is the controversial question of race.  Again quoting from  "Practical Paediatrics" there is a chapter on the "Maori view of child health and illness" written by Lower Hutt paediatrician Leo Buchanan.  He makes the following observation :

"Compared with non-Maori children, tamariki [Maori children] are four times more likely to be hospitalised for injuries sustained as a result of deliberately inflicted physical injuries. Notifications to the statutory authority for investigating child abuse in New Zealand have likewise been found to be higher for Maori"

Why Maori?  I think it is safe to say that it is nothing genetic because when scanning the list of child homicides since 1990 I was struck by how seldom Pacific Islanders were mentioned.

Amongst the large number of commentaries in the media this week was an informative article in the Sunday Star Times by Michael Laws.  He asked if the Kahui family are symptomatic of an underclass within Maori who are resistant to both mainstream and Maori assistance.

Time for Action
The first thing that needs to change is that people must have realistic expectations.  The thought that Child, Youth and Family Service (CYF) should be responsible for all cases including ones not on its caseload is unreasonable and simply drives good people out of the service.  There must be a differentiation between preventing problems and dealing with problems that have arisen already. A two-pronged approach is needed.  It is not enough just to try and deal with problems as they arise - that is just treating the symptoms of the problem.  If any progress is to be made in preventing further deaths like the Kahui twins the actual causes of the problem must be tackled.  I'm not just talking here about domestic violence, but also the burgeoning problem of welfare dependency.

We have to align CYF powers with its responsibilities and CYF workers need access to better facilities for children requiring placement.   Some type of institutional placement (for want of a better term) is essential for emergency cases.  Safe houses for children are not a long term solution but social workers need to be able to make emergency placements to ensure a safe temporary environment. 
Most importantly, CYF must have the obligation to place children with whanau removed.  Children in danger and at risk must be placed in a safe environment.  Sometimes this will be with family but we have seen too many cases where, because of the law, children have been taken from one unsafe situation and placed in another equally unsafe family situation, leading to tragic results.  This simple change would make a big difference and I am puzzled as to why the current law was introduced in the first place.  As the television advertisements remind us, domestic violence is often an inter-generational phenomenon. 
Finally CYF should be changed into a Child Protection Service with police, social workers and doctors working together on a full time basis.

This model is functioning well at Auckland Hospital.  Because of the passion and drive of a select few a service now operates to serve children with suspected abuse who live in Auckland.  It wasn't easy and it won't surprise many to know that one of the biggest obstacles was a protracted argument about how the participating government departments - health, welfare and police - would divide the costs of floor space!  Unfortunately this model hasn't been replicated elsewhere.  This service would better reflect the needs children and would help overcome the conflict that currently exists between the policing and helping roles of CYF Social Workers.
Prevention, as always, is a much tougher area and one that warrants an article of its own - that's next weeks diary.