Social Welfare Minister Paula Bennett is at the helm of a mission to lower New Zealand's appalling child abuse statistics. Andrew Laxon reports on the emerging themes from a two-day forum of child abuse experts.
New cases of child abuse are bad enough. What makes Paula Bennett really angry is when little children are beaten again and again, while the state is supposed to be protecting them.
"We know who these babies are, we know what's happened to them and ... (she pauses for effect) Again? Really?"
The Minister of Social Development gives a shrug of pure frustration. "How does that happen?"
Bennett is on a mission to tackle child abuse and she knows she has her work cut out.
An average of eight children are killed each year, and many more end up battered in hospital at the hands of family members.
Children under two are especially vulnerable; each year 59 are admitted to hospitals for what doctors call "non-accidental head injury" (often known as shaken baby syndrome) and more than 2000 confirmed cases of child maltreatment come to the attention of Child Youth and Family.
New Zealand has the fourth-worst child murder rate in the OECD at 0.9 deaths for every 100,000 children.
The whole country knows the horror stories: James Whakaruru, Hinewaoriki "Lillybing" Karaitiana-Matiaha, Coral-Ellen Burrows.
In the last three years public anger has boiled over at the callous murders of three-year-old Nia Glassie - spun in a clothes dryer and hung from a washing line - and of twin babies Chris and Cru Kahui, for which no one has been held accountable.
Yet despite a lot of talk about change, the brutal violence against children continues. In August alone two children were beaten to death and another two critically injured.
As Bennett talks, police have just confirmed they are investigating the alleged murder of 2-year-old Karl Perigo-Check, son of Wanganui gang member Karl Check. "This has been a really bad week," she says.
She is quick to say there have been improvements, but the driving force behind her crusade is a conviction that vulnerable youngsters are still falling between the gaps in state services.
Last year an average of five children a day were re-abused within six months of the first offence coming to light.
She has discussed the problem with Dr Patrick Kelly, the country's leading child abuse specialist at Auckland's Starship Hospital - who has described our child protection system as a "poorly controlled experiment" - and started a far-reaching look at how we organise the services that are meant to protect young children.
Starting measures include a multi-media campaign which urges parents to "never, ever shake a baby", backed up by a Starship trial in which nurses and midwives will talk to new parents about the dangers.
Behind the scenes, doctors, social workers and police will have to draw up safety plans for abused children when they leave hospital and make sure they are carried out. Social workers will be based at key hospitals and government agencies have been told to get more consistent data between them.
This week Bennett held a two-day forum for child abuse experts, including Kelly, health researcher Professor David Fergusson, Children's Commissioner John Angus, Principal Family Court Judge Peter Boshier and Maori child safety advocate Dr Hone Kaa. Their advice remains confidential but some key themes are emerging.
Bring in the experts
Research led by Dr Kelly shows a staggeringly high level of repeat abuse in children under two admitted to Starship Hospital with non-accidental head injuries between 1988 and 1998 - 44 per cent were renotified to Child, Youth and Family and one child was re-abused six times.
The researchers strongly criticised CYF social workers for failing to keep proper records, using informal arrangements which masked poor decision-making and accepting contrived excuses from adult abusers.
"This study found several examples of episodes of abuse witnessed by independent third parties, or instances of serious concern raised by other professionals, which CYF regard as unsubstantiated after investigations of doubtful quality... many 'unsubstantiated' notifications may in fact represent significant risk."
In the decade since that study numbers have more than doubled, from 39 cases to 88 between 1998 and 2008.
So have things got worse? Kelly says some of the teamwork is better.
The inter-agency child abuse centre where he works brings together doctors, nurses, police and social workers at Starship Hospital, forcing professionals to sit down in the same room and examine all the evidence in each case - from family circumstances to X-rays of the injuries.
They then have to agree on a joint course of action. Similar combined efforts on a smaller scale are planned or under way at Middlemore Hospital in South Auckland and in Tauranga, Hawkes Bay and Northland.
But the basic problem remains, Kelly argues, because most social workers -along with most GPs and other health workers - do not have the experience to identify serious child abuse and most hospital specialists are unable or unwilling to help them.
Poor communication doesn't help either. "There's such a culture clash sometimes between health professionals and CYF. It takes a lot of time to make the relationship work."
The stereotypical social worker view is that doctors are "up-themselves arrogant white professionals who don't understand the realities of life in this part of town". Doctors tend to regard social workers as "fluffy" and too willing to side with the family, rather than the child.
Abusive families understand this tension and are experts at playing the two groups off against each other, says Kelly. "You end up with a very dysfunctional way of managing the case... The child would be in hospital and the doctors would be saying one thing and the social workers would be hearing it but not necessarily believing it."
Often social workers would send the child back into a family environment hospital staff regarded as unsuitable and dangerous - and the child would be abused again.
Bennett's announcement of a compulsory safety plan for all abused children leaving hospital is designed to stop this happening. But Kelly wants to go much further, with a law change which would require social workers to involve doctors, police and other professionals in all their child protection decisions, instead of relying on voluntary co-operation.
"Child Youth and Family is theoretically accountable now but... I get involved in many of these cases and often people put the boot into CYF, sometimes justifiably, sometimes I have to say not.
"It's created in CYF, as an organisation, an incredibly defensive mentality, which makes them extremely reluctant to share information, particularly if their practice has been less than ideal."
Equally, says Kelly, blaming social workers for every child abuse disaster lets doctors, nurses and even teachers off the hook.
"It's about thinking; 'I have ownership of this problem and I have a responsibility to keep an eye on this child.' And that's what I think the current system militates against."
Don't wait for a crisis
When former chief social worker Shannon Pakura was asked seven years ago why CYF failed to investigate so many warnings of child abuse, she pointed in frustration to the 29,000 calls it had received about suspected child abuse and neglect that year.
"CYF cannot fight this battle on our own," she told the Herald. "We're barely keeping our nose above water."
Since then the calls - known as notifications - have soared to 110,000 a year, boosted mainly by police referrals from domestic violence call-outs, plus media coverage of prominent cases and the introduction of a national call centre.
Bennett argues that CYF has picked up its act since a series of scathing reviews earlier in the decade. Unallocated cases are at an all-time low (254 at the end of June), the proportion of qualified social workers has risen from 43 per cent in 2002 to 75 per cent today and the "real" abuse rate after CYF investigation is officially static at about 20,000 cases a year.
However, a report in June to the Children's Commissioner on child deaths and serious injuries supports Kelly's claim that the true rate is likely to be much higher.
The authors said it was a major concern that so many children under two were being seen again after "an early, possibly erroneous, decision that the risks did not justify a face-to-face social worker assessment".
Within two years more than 1000 children - 62 per cent of those classed as requiring no further action - had been renotified.
The answer, according to Bennett, is to bring in non-government agencies to tackle these apparently less urgent cases before they escalate into a crisis.
She has started a trial programme in Auckland, using social workers from Shine (formerly Preventing Violence in the Home) to follow up police domestic violence calls which don't normally rate a response from CYF. .
The new approach could also fit with a push by church leaders and the Maori Party for greater delivery of social services by community agencies instead of the state.
However, a report by former Children's Commissioner Cindy Kiro on CYF's involvement in child deaths between 2000 and 2006 warns of the dangers of outsourcing cases to other agencies.
Letters from Dr Kiro to the Ministry of Social Development, obtained under the Official Information Act, strongly criticise Government social workers for handing on supposedly low-level cases, which should have been recognised as higher priority, in two of the deaths.
Keep track of the children
It might sound remarkable, says Bennett, but she had to call a virtual summit meeting with Health Minister Tony Ryall and the heads of both their departments to find out the re-abuse rate for young children in hospitals - and she's still waiting for an answer.
"Can you imagine how frustrating it is for either of us ministers when we sit there and say; 'How many children are hospitalised and then re-abused' and no one can come up with the numbers because they don't collect the data the same? Incredible."
Her concern is based on separate CYF figures on re-abuse which show 1797 children each year are renotified for abuse or neglect within six months - an average of five a day.
Bennett says she has also been frustrated by other information gaps in the system, such as when a mother has a child removed but goes on to have other children without CYF's knowledge.
One possible answer, which child health advocates have promoted for years, is a national database for all children. But Bennett feels a more likely compromise for cost and privacy reasons is a much improved information-sharing system between CYF, police and the health system.
Kelly says doctors often don't know that a child has been abused if a family moves town, because there is no centralised record.
He is working with the Ministry of Health to put child abuse notific-ations on the national medical warning system.
Children's Commissioner John Angus supports more information-sharing but is sceptical about the value of a register. He says social workers who've worked in Britain say the UK version doesn't work particularly effectively, as it's hard to keep up to date and "people think they've solved a child's problems by putting it on the register".
Help parents learn to cope
New parents in Auckland will soon receive a face-to-face talk within days of having their baby on how to look after a crying child and why you should never shake a baby.
Kelly says the advice may sound obvious but US research found the scheme reduced shaken baby syndrome by 40 per cent.
Starship doctors and nurses regard the face-to-face talk as the crucial element of the trial programme, ahead of the short video and pamphlets.
The hard question is deciding who should give the talk - hospital nurses, midwives or Plunket nurses - as many New Zealand babies aren't born in a hospital and many mothers leave within a few hours.
Tackle the wider issues
Angus says that if the Government is serious about reducing child abuse it has to tackle root causes such as violence and drug and alcohol abuse.
"Our rate of child abuse does appear to be high and I think that has got to be related in some way to the general level of violence in NZ society."
Family First spokesman Bob McCoskrie's wishlist includes tougher sentences for abusers and making changes to family structure.
He points to research commissioned by the group which found a child was 50 times more likely to be abused by a mother's live-in boyfriend than by her husband.
Meanwhile police are finding their own way round misuse of the right to silence - most notoriously abused by the Kahui family "tight 12" who closed ranks to shield the killer of the 3-month-old twins.
When detectives faced a similar wall of silence from Azees and Tabbasum Mahomed over the suspicious death of their 11-week-old daughter Tahani, they bugged the family home on the day of her funeral and gained enough evidence for a murder conviction last week against the father, Azees.
Police also face unresolved questions over their handling of child abuse investigations.
The Independent Police Conduct Authority is investigating a backlog of more than 100 child abuse files in Wairarapa.
Investigators are now auditing child abuse files throughout New Zealand to see if other areas have similar problems and a report is expected before the end of the year.