Every day in New Zealand babies are born into families where parents are too young, poorly supported or have childhoods themselves that have left them emotionally scarred. These babies do badly.
They get sick. They arrive at school not ready to learn. As they grow up they don't learn and leave school early.
They become the next generation of benefit-dependent, underachieving parents and so the cycle continues.
Teachers, Plunket, Child, Youth and Family, and child health clinicians in our DHBs and primary care often do a great job with such children. But it's not enough.
Something has to change.
A "wicked" problem like this is one that has many causes and all cases are different in ways that matter and affect how you intervene.
The solution requires several things to happen at once, across several different services in a co-ordinated way.
There are many opportunities to get it wrong and high risk of a bad outcome if you do.
The first step in solving a wicked problem is to decide to do so. The government green paper on vulnerable children aims to encourage people and communities to have a say on how New Zealand can better protect abused, neglected and disadvantaged children. My vision for children in New Zealand is simple.
Our children should grow up well loved by parents who are well supported and well prepared for parenthood. Their material needs should be met and their development supported. Preventive care should be delivered to all, on time. This needs surprisingly few changes at remarkably little cost. Here are a few.
First, we need a Children's Act and a Children's Action Plan.
The preamble of the act should state that our children are taonga and our most valuable resource.
Governments and policies come and go, money gets tight, but an act endures - consider the "No Nuclear Ships" legislation. The act would hold chief executives and ministries accountable for measurable targets such as reducing child poverty, child abuse and neglect, and improving educational outcomes.
Goals like these would have cross-ministry strategies both nationally and (most importantly) locally. Relevant legislation and policy should be subject to a child impact statement before it reaches the Cabinet.
There should be an independent national report on the state of the nation's children every year that measures and publicises progress against these goals.
Most of these children are not severely abused, they are neglected. We don't do well with neglect. It's hard to define and there is often no single event to act on.
We need much better training and systems to identify and act on neglect in all professions.
When you look closely at programmes in New Zealand that have been successful at improving outcomes for vulnerable children, they share common features.
Effective services for vulnerable children:
* Share common values (no child left behind, no parent stands alone).
* Have an inter-sector, multi-disciplinary team working with high trust.
* Intervene at the earliest possible point in the life of the problem and in the life of the child.
* Have nationally agreed, evidence-based standards and resources and freedom to implement according to local circumstances, and effective use of IT systems to give regular feedback to guide performance management of providers.
* Have well-trained staff with up-to-date skills, such as recognition and management of child and partner abuse and challenging conversations.
* Give staff time to meet, and use formal mechanisms to address disagreements
* Actively connect people to services, for example text-to-remind, community workers delivering services in schools, on marae and in homes, outreach programmes.
* Evaluate and continually improve the programme.
While there are more examples of this kind of working arrangement, it's not yet routine. I believe it's time that government purchasing and performance monitoring of services for vulnerable families and children demanded this kind of structure.
The green paper also asks about monitoring and information sharing for vulnerable children.
We already monitor children in many ways. The National Immunisation Register, Oral Health Service, Plunket and Before School Check databases ensure children receive these services on time.
But these databases don't talk to each other. If a family moves and tells one service (say their GP), that database can't tell the others and correspondence goes to the old address.
For poor, highly mobile families this means they miss out on services. It should be a priority for the National Health Board to improve connectivity of health databases so the recorded address for children is current.
It's always best practice for people to know if professionals are talking about them. Sometimes, however, particularly in child protection, we need to share information about children without families knowing.
It's not legal for a principal and a paediatrician, or a non-governmental organisation social worker and a GP, to share information about a child without a parent's consent.
Child, Youth and Family and police also can't share information back to other services. In New South Wales, the Wood Royal Inquiry heard several examples of dreadful outcomes because information wasn't shared, so they changed the law to require all these services to share information with each other, if asked.
I think we should do the same in New Zealand.
Submissions on the green paper close on February 28, 2012.
To make a submission go to:
Dr Wills' discussion paper is at www.occ.org.nz