The saddest dilemma

"In a perfect world every child would be seen every time, but you would need an army" ... Minister for Community ...
"In a perfect world every child would be seen every time, but you would need an army" ... Minister for Community Services, Pru Goward. 

Lisa Pryor examines how child protection staff try to meet the overwhelming demand for their help.

Each weekday, Sophia makes her way to an office in the western suburbs.

She works in triage, but isn't a nurse. Sophia is a social worker, employed by the government department charged with protecting children from abuse and neglect. With more desperate kids than workers to care for them, she is forced to decide who gets help and who doesn't.

When the public learns about the death of a vulnerable child, we usually start at the end of the story and work backwards. We discover a child was "known to" community services. Crucial moments are catalogued, times in the child's life when their suffering was obvious, and we wonder how it could have happened.

In August last year it happened again. A toddler died in Wollongong. We'll simply call him Sam. In his two short years, he was reported to community services nine times. Three of these reports came in the last five weeks of his life, after his child carers noticed he'd arrived with bruises on his body, face and legs. On his torso were human bite marks. An older brother had been reported to community services 22 times.

Many children are reported to the authorities; a very small number die. In 2011, there were 228,821 reports about children's welfare, and 99,283 of those were considered to be at risk of significant harm. In the same year there were 110 deaths of children known to community services, most caused by illness and disease.

Sophia does not have the luxury of hindsight when she considers the reports that stream in. None are trivial, as only the most serious reports make it to her desk. She enters in the middle of the story, not at the end.

So imagine what you would do if you were Sophia, facing a typical week in the middle of last year. "We look at all the information we know about this family, we look at all the reports, what services have been engaged, what are the presenting issues, what are the risk factors, what are the strengths," she says.

When it came to picking cases to take to the weekly meeting, where it's decided which children will get a visit from a child protection worker, three cases stood out. And though Sophia's name has been changed, all these cases are real.

The first report came from a hospital. A suicidal woman had arrived in the emergency department after swallowing too many pills. As the doctors worked on her they learned she had a baby at home, less than six months old. Making matters worse, the woman had a history of drug abuse, violence and had recently been in prison for crimes committed while high on ice. 


The second case concerned a young boy with autism, who had vanished along with his mother and a younger sibling. The mother had been living with mental health problems for some time, then recently had to confront a newly diagnosed, life-threatening disease. The mother resolved to take her six-year-old out of school, and said something about moving interstate. But no one knew where they had gone, so the case was reported to community services.

The third case was that of three children who had been living with just their mother until the father of one of the kids decided to move back into the family home. A call came in claiming the man was a registered sex offender. The details were sketchy. Now he was living with three small children.

Would you send someone to check if these children were OK? If you could only pick one, which would it be?

Guidance for workers

When it comes to deciding which child to help first, there are decades of research guiding Sophia. Across the world, child-protection agencies are adopting ways of calculating risk not so different from the way insurance companies calculate the risk of drivers having a car crash. This actuarial approach is known as "structured decision making".

The NSW government's policy and procedures manual for child protection makes for harrowing reading. It offers an insight into the horrors that happen in the lives of children; using this manual, child-protection workers have to answer questions to determine the statistical likelihood that children in a family will be mistreated in the future.

Predictors of future neglect include having four or more children in the household, having a child aged under two or a parent with drug, alcohol or mental health problems, as well as having previous contact with child protection. Children who are sick or slow to develop are also more likely to be neglected.

Predicting mistreatment is possible, predicting death is much harder. International research suggests it may not be possible to accurately predict which children are most likely to die.

But there there are a few things that researchers do know: kids are much more likely to be killed by step-parents than biological parents, especially step-fathers. They are also likely to experience physical violence before the episode that kills them.

In determining which children are helped first, the person conducting triage has to also consider whether it is a type of case that gets priority from community services, such as siblings in a family where a child has previously died, unaccompanied refugee children and international child abduction. Warning bells also sound if it concerns a family who has already had a child taken away. 

Making the decision

The day of the meeting arrives. Sophia sits down with other managers to discuss the cases she's most concerned about - and many others. It becomes clear there's no way all three cases will get a visit. This week there are 40 cases so serious they have made it to this meeting. And with all the workers busy with cases already on the books, only one of these 40 families will get a visit.

So what's the outcome? None of the children Sophia is worried about gets a visit.

No one knocks on the door of the house where the baby was living. No one phones police to see if the stepfather living with three children is a convicted paedophile. The autistic boy with the sick mum might be happily enrolled in a school in another state, or he might not. All three cases are "closed without assessment".

This is because there is an even more worrying case, which another manager has brought to the meeting. It is a report that has come in about a boy, aged six, who has revealed that he has been sexually abused by his father, who has already been charged with sexual abuse of a niece. He gets the visit.

It is a brutal game of numbers. Thousands of reports are made to the helpline. Hundreds are serious enough for triage; 40 are so bad they make it to the weekly meeting. On this week only one is allocated to a case worker. "That week we had a bad week," Sophia says.

The Minister for Community Services, Pru Goward, says that, on its face, it is "not acceptable" that families in these three circumstances would not receive a visit. She also points out that other agencies may have had a responsibility to follow up, and may have done so. "In a perfect world every child would be seen every time, but you would need an army."

Slipping through the system

This is the process that let down Sam. Just like the children Sophia was worried about, his name came up at meetings - again and again. And just like the children Sophia was worried about, he was never seen.

The events leading up to his death are catalogued in documents obtained by The Sun-Herald. The day before Sam died, the local child-protection office held its weekly meeting. His bruises were discussed for the third time in less than two months. His case missed out on being allocated "due to higher priority cases". His case was held over for review the next week.

But for Sam, the next week never came. The day after the meeting, a Friday, a triple-0 call was logged at 3.30pm. Someone had called from Sam's home, saying he was pale and vomiting. An ambulance was dispatched. By the time they arrived he was unconscious. 

He was rushed to hospital where they kept working on him, but just before 6pm the doctors decided to stop.  

Finally, once it was too late, Sam's case got the priority it deserved. Five hours after his death, the incident was reported to the help line and escalated to a manager. Just before midnight, six hours after his death, the crisis response team was activated. Department workers swooped, collecting his sister and a brother from two houses near Wollongong.

After nine years of reports about the family - including about risk of physical harm, inadequate supervision, risk of sexual harm, drug or alcohol abuse by carers, exposure to domestic violence and poor school attendance - the children were finally taken into foster care.

This is how the system works.

This article first appeared in The Sun-Herald