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Critics warn on pregnant mother alerts re abuse

Whilst the public debate about child abuse in NZ has been somewhat distracted by deaths and horrific injuries to a very small number of children, the overall social vandalism of larger numbers of children is perhaps more disabling, in the territory of emotional neglect. Although emotional neglect leaves no bruises or broken bones and a few days of neglect is readily compensated for, months of neglect of babies leaves long lasting social damage, that so far has been extremely difficult to correct later on. Our prison building programme illustrates a small fraction of the total cost. Suicide gravestones illustrates another face of the cost of emotional neglect.

Men’s advocates have been slow to notice this distraction device. In some cases, the fathers would be equally unsatisfactory parents, as humans tend to assortively-mate. In most cases, the father of the emotionally neglected child can offer safer and more effective parenting, rather than remove the child from the parents completely, with all of the hazards and risks that this entails. The CYFs Act already provides for this, but in practice some social workers and “judges” fail to follow through with those clauses, perhaps due to unresolved problems with their own childhoods? Even more worrying, the manner of intervention by CYFs sometimes disables fathers from being able to care for their children, when they would have been capable if the intervention was appropriately sensitive to the situation. Pure vandalism.

Due to the apparent impossibility to rectify the damage done to babies and young children by sustained emotional neglect, rather draconian looking measures are required – to be sure that all children are being protected from this hazard. (Future research might discover methods of helping to correct for effects of childhood emotional neglect, but thus far this seems to be very elusive, Prevention is presently far more effective than trying to later cure.)

Judy Bailey, for Brainwave Trust, spoke on these issues, at the recent Family First Forum on the Family.

The practical reality is unfortunately tempered by the social damage done by stigmatising parents, through possibly well meaning alerts, placed by professionals in healthcare or social work or psychology, who nonetheless are unable to assess accurately and reliably parenting skills and resources. Thus, in our zeal to protect some children, we may be doing serious harm to a larger group of perhaps lower skilled but quite satisfactory parents.

Calls for Starship child unit inquiry

A good example of such a health professional, well qualified in medicine, but I suspect lacking forensic skills, is Dr. Patrick Kelly, who is under investigation by the Health and Disability Commissioner, for acting unethically, outside of legal authority and outside of his established professional medical competence. This investigation has resulted from complaints laid by aggrieved parents. I expect that there are many further parents, who don’t know enough to formulate their complaints and submit them. I feel very sorry for the children of these parents, whom the parents were unable to protect from the actions and interventions of Dr. Patrick Kelly. In many cases the genie cannot be put back into the bottle, serious and irreversible relationships damage has already been done.

I am not suggesting that forensic medicine is easy. On the contrary, it is less well developed than everyday medicine, as it attempts to deal with relatively rare conditions. Most importantly, we need to separate what we know and what may or may not be a shrewd guess. Also, to separate forensic functions from medical practitioner functions, as the necessary mindset and ethics are so different and one person trying to perform both functions is difficult to probably impossible (as well as being unethical). Professor Goodyear-Smith made these points very well and she has years of relevant experience, from all points of interest. Professor Felicity Goodyear-Smith Inaugural Lecture

Our biggest barrier to improving child protection, is the lack of ability to reliably assess parenting skills and resources and report on this, irrespective of the gender of the parent.

Through the present faltering steps taken by MSD, I expect that we will eventually provide better protection for all of our children. I feel very sorry for the children mangled, while we try erratically to improve. On present indications, there will be a decade of more damage done, until we evaluate present child protection performance rigorously, frequently and competently. Presently, Government interventions are poorly researched, poorly designed and even more poorly evaluated after introduction.

Present gender politics driven design of social programmes, with improvement through occasional royal commissions, is a slow, destructive and dismal approach, compared to good quality evidence based design, evaluation and quality improvement.

Too much damage is being done, while we fail to quickly evaluate our performance.

Critics warn on pregnant mother alerts

TONY WALL – Sunday Star Times
Last updated 05:00 12/12/2010

Alerts are being placed on the health files of pregnant women whose unborn children are deemed at risk of abuse — a move critics say could stigmatise and wrongly label parents.

The Sunday Star-Times has learned that health professionals can now place flags on the national medical warning system for children who have been treated for abuse — but also for pregnant women deemed “vulnerable”.

The system attaches the alert directly to an individual’s health index number, so that if they are assessed at hospitals or medical centres throughout the country, medical staff will know their history. An alert stays in place until a child turns 17, and parents may not always be told about them. Siblings of an abused child can also have alerts placed on their files without a medical assessment.

The system, developed by doctors and supported by the Ministry of Health, is aimed at identifying child abuse early and preventing recurrent abuse.

Former health and disability commissioner Robyn Stent, whose stepdaughter was wrongly suspected of abuse at Starship hospital’s child protection unit, says she does not trust medical professionals to make the right calls around the alerts. In her stepdaughter’s case, a note referring to suspected abuse was never removed from the file.

“These are the people who insist on treating parents as criminal suspects in all cases where abuse is `possible’, and who based their abuse suspicions in our family’s case on a non-existent report,” Stent said.

“We would not trust them with the power to denounce families to the medical world as likely abusers, unless they have evidence which satisfies a court.”

The New Zealand College of Midwives has also expressed concern about the alert system. “The consequences for families and babies are great if the guidelines are inappropriate,” chief executive Karen Guilliland said. “So far, the discussion has been largely hospital-focused with little input from mothers and parents, or midwives.” She said the college found out about the system only last week, and while those behind it seemed to have good intentions, any alert system raised issues of privacy, confidentiality and human rights. A senior Auckland midwife, who asked not to be named, said the system had been developed by child abuse “zealots”.

“There are people who will think it’s a good thing and others who will be horrified. They may have made changes and got on with life, changed partners, and they’ve got this tag. It’s like a tattoo saying `I’m a bad mother’.”
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The national child protection alert system is based on one that has been in place in Hawke’s Bay since 2004, and was developed by paediatrician Russell Wills, of the Hawke’s Bay District Health Board, along with other leading child abuse experts, such as Starship hospital’s Patrick Kelly.

Wills said alerts were placed on the national health index number of children treated for inflicted injuries, so if they “presented” at another hospital, the previous incident would come up. Alerts were put on the system only where a referral had been made to Child, Youth and Family, and where there was considered a likelihood of further abuse. A “multi-disciplinary team” of doctors, nurses and social workers made the decision on whether to lodge an alert.

Wills said medical staff were taught that just because a child protection alert was placed on a file, it did not mean that any new injury was non-accidental. “It just means you have to bear in mind that previous injury when you’re assessing this injury, so there’s no stigmatisation or assumptions. The whole training package in the national rules is designed to avoid stigmatising.”

Meanwhile, the Ministry of Social Development is developing another alert system to notify it when a woman who had abused a child, or had her children taken from her, gave birth again. Social Development Minister Paula Bennett acted after a case last year in which a mother, who allegedly killed her child, had previously had children removed from her care, yet the department did not know about the new child.

tony.wall@star-times.co.nz