How can the Australian child protection system better help children who experience cumulative harm?

What is cumulative harm?

A child that has experienced ‘cumulative harm’ is one that has been harmed (or is at risk of harm) as the result of:

• an ongoing adverse event or circumstance in their life (e.g. ongoing neglect); and/or
• an accumulation of adverse circumstances (e.g. experiences of neglect, inconsistent and harsh discipline, exposure to physical harm).¹¹

These adverse events/circumstances contribute to chronic maltreatment, which causes the child cumulative harm.  In the context of Australian child protection, “cumulative harm involves a series of events and circumstances which individually may not constitute grounds for child protection intervention but contribute to chronic child maltreatment causing cumulative harm”.¹⁷

The impact of cumulative harm

Cumulative harm can have significant consequences for child wellbeing and development, often into adult life.^{8, 11, 14} Repeated exposure to maltreatment, rather than to an isolated incident, has been found to predict a range of negative outcomes including mental health difficulties.^{8, 14, 15} The impact of such maltreatment may not always be immediately evident, but can become apparent as the child ages.⁹

Despite the significant impact of cumulative harm on children, it is under-acknowledged as a child protection concern, and is poorly integrated by legislation and legal decision-makers.²  The issue of cumulative harm also receives minimal statistical, research or policy attention.¹³ For example, the Australian Institute of Health and Welfare’s (AIHW) statistics on substantiated child protection concerns do not capture the prevalence of cumulative harm.^{1, 16} Instead, they focus on the individual categories of emotional abuse, physical abuse, sexual abuse and neglect, to fit within legal parameters.¹

There are also challenges in responding to cumulative harm at a practice level. Child welfare and legal professionals lack clarity about which responses are effective for children experiencing cumulative harm. In addition, child protection and legal practices are overwhelmingly crisis-driven, focussing on the event that is in front of them. This limits a broader understanding of what a child might be experiencing. It also reduces opportunities for prevention and early intervention solutions, which can reduce the cumulative impact of adverse events/experiences.

The current study

The current study conducted a systematic literature review, examining how cumulative harm is understood and operationalised within current child protection legislation, policy and practice in Australia.⁷ The study explored two main research questions:

• How is cumulative harm to children identified, assessed and incorporated into child protection and legal structures?
• What have been identified as the most effective responses to cumulative harm by child protection and child and family welfare workers?

What did the findings of the current study suggest?

Whilst the idea of cumulative harm is increasingly included in child protection practices and legislation, the study found that chronic child maltreatment attracts little attention. This lack of understanding, paired with current crisis-driven practices, limits the effectiveness of responses by child welfare and legal professionals.

Findings suggest that legal frameworks and judicial officers find it difficult to reduce broad child welfare concerns, such as those typical of cumulative harm, to factors acceptable in court proceedings.⁴ Furthermore, the ‘event’ model of child abuse favoured by Australian legislation imagines child maltreatment as a singular event.¹⁶ As a result, children experiencing chronic maltreatment rarely meet the threshold for statutory and court intervention.³  While some legislation allows for child protection claims based on cumulative harm, and cumulative harm may characterise some child protection concerns, judicial decision-makers still seek concrete evidence of serious neglect or abuse to support a child protection application.¹⁶

A number of Australian child protection statutory authorities have attempted to combat this issue by establishing differential response approaches. These approaches aim to separate concerns about ‘lower-risk’ families who present with child maltreatment and child wellbeing issues from ‘high risk’ cases.⁶ The goal is to divert ‘lower-risk’ families away from the child protection system and into voluntary community-based organisations, which offer early intervention and prevention services.⁶

These approaches were expected to offer a more effective response to child wellbeing, particularly in cases of chronic maltreatment. In reality, the service orientation of child protection, which is child-centred and focuses on child safety and risk of harm, differs from that of family welfare services which adopt a whole of family-centred approach. This focus on family needs and preservation of the family unit can mask child protection concerns, especially the less acute concerns characteristic of cumulative harm.

Recommendations

Despite a welcome increase in policy attention and research into cumulative harm, this literature review suggested it is unclear how various legislative, policy and practice changes impact on child welfare practices and outcomes for children and young people. More attention must be given to the barriers and enablers for the identification, prevention and addressing of cumulative harm within the child protection and family services sectors.

These findings suggest that the needs of children who experience cumulative harm should be considered just as urgent as cases involving safety issues. The cumulative impact of adverse childhood experiences (ACEs) needs to be recognised as representing a significant risk of harm to a child, with the same practices, legal concerns and measures applied.

References

1. Australian Institute of Health and Welfare (2016). Child protection Australia 2015-16, Canberra: AIHW.
2. Bromfield, L. & Miller, R. (2012). Cumulative harm – Best interests case practice model: Specialist practice resource. Melbourne: Victorian Government Department of Human Services.
3. Bryce, I. (2018).  A review of cumulative harm:  A comparison of international child protection practices.  Children Australia, 43 (1), 23-31.
4. Cummins, P., Scott, D. & Scales, D. (2012). Report of the protecting Victoria’s Vulnerable Children Inquiry. Melbourne: Victorian Government Department of Premier and Cabinet.
5. Healy, K., Harrison, G., Venables, J. & Bosly, F. (2014). Collaborating with families in differential responses: Practitioners’ views. Child & Family Social Work, 21(3), 1-11.
6. Healy, Harrison, Venables, & Bosly. (2014). p. 10.
7. Jesson, J., Matheson, L. & Lacey, F. (2012). Doing your literature review: Traditional and systematic techniques. London: SAGE.
8. Jonson-Reid, M., Kohl, P.L. & Drake, B. (2012). Child and adult outcomes of chronic child maltreatment. Paediatrics, 129(5), 839–845.
9. Li, F. & Godinet, M.T. (2014). The impact of repeated maltreatment on behavioural trajectories from early childhood to early adolescence. Children and Youth Services Review, 36, 22–29.
10. McQueen, D., Itzin, C., Kennedy, R., Sinason, V., & Maxted, F. (2009). Psychoanalytic psychotherapy after child abuse. The treatment of adults and children who have experienced sexual abuse, violence, and neglect in childhood. London: Karnac Books Ltd.
11. Miller, R. (2007). Cumulative harm: A conceptual overview. Melbourne: Victorian Government Department of Human Services.
12. Nader, K. (2008). Understanding and assessing trauma in children and adolescents. New York, NY: Routledge.
13. Pecora, P., Sanders, D., Wilson, D., Puckett, A. & Rudland-Perman, K. (2014). Addressing common forms of child maltreatment: Evidence-informed interventions and gaps in current knowledge. Child & Family Social Work, 19, 321–332.
14. Price-Robertson, R., Rush, P., Wall, L. & Higgins, D. (2013). Rarely an isolated incident: Acknowledging the interrelatedness of child maltreatment, victimisation and trauma. Melbourne: AIFS.
15. Radford, L., Corral, S., Bradley, C. & Fisher, H.L. (2013). The prevalence and impact of child maltreatment and other types of victimization in the UK: Findings from a population survey of caregivers, children and young people and young adults. Child Abuse & Neglect, 37 (10), 801–813.
16. Sheehan, R. (2019). Cumulative harm in the child protection system: The Australian Context.  Child and Family Social Work, 1-9.
17. Sheehan, R. (2019). p. 1.
18. Sheehan, R., & Borowski, A. (2013). Australia’s children’s courts today and tomorrow. New York: Springer.