Child Abuse in New Zealand - who abuses children and what is being done about it?

1. Child Abuse in New Zealand- who abuses children and what is being done about it? St Aidan’s Winter Lecture Series June 26, 2012 Patrick Kelly

2. Outline • Child abuse in New Zealand • Child protection in New Zealand • Prevention • Child protection in the health system • Personal perspective

3. Who abuses children • Anyone • Risk factors (e.g. “Family Stress Checklist”)1 • Childhood • Substance abuse, mental health, history of arrests • Previous or current child protection involvement • Self-esteem, available support, depression, coping skills • Stressors • Potential for violence • Expectations of baby's behavior • Discipline of children • How do you describe your baby? • Bonding/attachment • Limitations of risk factors 1 Orkow, B. Implementation of a Family Stress Checklist. Child Abuse & Neglect,1985:9:405-410.

4. Physical abuse • Maxwell 1996 (259 children 11 – 13)1 • 10% punched, kicked or beaten by adult in previous year • Youth 2000 and 2007 (9699, 9107 students 13 – 17) 2 • Hit or physically harmed by another in previous year • 45% in 2001, 41% in 2007 • Witnessed adults yelling or swearing at a child • 46% in 2007 • Witnessed adults hitting or physically hurting a child • 17% in 2007 • Physically hurt (kicked, hit or punched) at home • 12% • Witnessed adults hitting other adults • 6% in 2000, 10% in 2007 “Among those who had been hit or physically harmed, approximately one quarter reported the severity of the violence was pretty bad, really bad or terrible”. 1 Maxwell G, Carroll-Lind J. Children's Experiences of Violence. OCC. Wellington, 1996. 2 http://www.youth2000.ac.nz/default.htm

5. Sexual abuse • “One in five female students (20%) and one in twenty male students had experienced one or more episodes of unwanted sexual behaviour from another person. About half of these episodes had occurred in the last 12 months. Among those episodes of sexual abuse occurring in the last 12 months, one-third of the students reported the abuse as severe (pretty bad, really bad or terrible)” • “The majority (60%) of students suffering sexual abuse had not told anyone about it” 9107 young people aged 13 – 17. Available from URL:http://www.youth2000.ac.nz/publications/reports-1142.htm

6. Under 3 years 1 • “Assault on child’s self-esteem” • called child dumb or lazy; said would leave child; swore or cursed at child • Correlated with slapping on face, head, ears • 10% (1 year), 21% (2 years), 26% (3 years) • “Severe physical assault” • burned or scalded on purpose; grabbed around the neck and choked; threw or knocked down the child; and hit child with fist or kicked hard • 1% (1 year), 4% (2 years), 3% (3 years) 1 Windham AM et al. Risk of mother-reported child abuse in the first 3 years of life. Child Abuse Negl. 2004 Jun;28(6):645-67

7. It is mostly infants who die

8. 1961 Crimes Act 1968 Guardianship Act 1972 Dept of Social Welfare 1974 Children and Young Persons Act 1980 Family Court 1986 Puao-Te-Ata-Tu 1986 Children and Young Persons Bill 1989 UNCROC 1989 Children Young Persons and Their Families Act 1989 Commissioner for Children 1992 Mason report 1995 Act amended

9. ** The rate varies by region – from 119/1000 in CMDHB in 2007 , to 46/1000 in ADHB

12. Public outrage Politicians Policy Ministry of Social Development

13. Child Maltreatment Prevention In the absence of hard data… “child abuse prevention programs and other psychosocial initiatives have been based more on advocacy, theory, weaker program evaluation designs, fashion, guesswork and hope” Mark Chaffin. “Is it time to rethink Healthy Start / Healthy Families? Child Abuse & Neglect, 2004;28:589 - 595

15. Repeal of S59 “Every parent of a child and every person in the place of the parent of a child is justified in using force by way of correction towards the child, if the force used is reasonable under the circumstances… The reasonableness of the force used is a question of fact”

21. Child maltreatment prevention • Prevention and social policy • “the primary determinants of disease are mainly economic and social” (Rose) • Poverty, socio-economic deprivation • Prevention and specific interventions • Maternal depression • Partner violence • Substance abuse • Prevention and clinical practice • Those at greatest risk… • … are those to whom it is already happening

22. 11000 1000 Inter-agency collaboration 120,000

24. Inter-Agency Collaboration Demise of the Case Conference 1990 “Breaking the Cycle” 1995 and 1996 Auckland CYF Liaison Social Worker 1998 Puawaitahi (“Multi-Agency Centre”, Auckland) 2002 Children’s Commissioner’s Report on the Safety of Children in Hospital 2006 MOU between CYF, Police and DHB 2006 CYF Liaison Social Workers in every DHB 2010 Child Protection Protocol (CPP) – CYF and Police MOU between CYF, Police and DHB 2011 Kelly and Farrant. Shaken baby syndrome in New Zealand, 2000-2002. J Paediatr Child Health. 2008 Mar;44(3):99-107. Epub 2007 Dec 12.

25. Violence Intervention Programme • Ministry of Health Violence Intervention Guidelines • Violence Intervention Programme • Universal screening of adult women • Training of health professionals • “Systems approach” • Co-ordinator in every District Health Board • DHB reporting requirement • Annual audit by AUT for 5 years • National Co-ordinator • Website • Bi-annual meetings • Annual combined meeting at Paediatric Society ASM → “Managed Clinical Network”

26. National Child Protection Alert System • Origin of Child Protection Alerts • Existing health information • Hawkes Bay and Auckland • Essential criteria • Notification to CYF • Multi-disciplinary team decision • Removal of an Alert • Sharing the information with health providers • National Health Index, National Medical Warning System • Privacy and other risks

27. 300 100 30 100 2000 100 30 400 100 2500 3000 100 30 150 100 200 200 700

28. “For everyone to whom much is given, from him much will be required; and to whom much has been committed, of him they will ask the more.” (Luke 12:48) “for evil men to accomplish their purpose it is only necessary that good men should do nothing”. Rev C Aked, 1916