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Saturday, August 3, 2013

Know thy case - History does matter

It was several years ago that I was watching the Canadian Broadcasting Corporation program, The Fifth Estate and its story on the death of Jeffrey Baldwin. I have written in an earlier post the full details of the death, but simply put, as the CBC summed it up, Jeffrey died of starvation at the hands of his grandparents in one of the world's richest cities, while those who could have stopped it did not.

Like all cases where a child dies with child protection involvement, there were many factors at play. One was certainly information that was buried in child protection files about past convictions for child abuse involving both grandparents. In addition, there had been some form of parenting capacity assessment that had apparently concluded that the grandmother was unfit to parent.

Jeffrey Baldwin

I was reminded of this as I read an excellent review from Child Family Community Australia titled Rarely and Isolated Incident. One of their main conclusions:

Practice and policy responses to children who experience single maltreatment events should be different to those for children who experience multiple maltreatment events. Survivors of multiple maltreatment events are more likely to experience complex trauma and the negative effects of cumulative harm, both of which require more comprehensive intervention and treatment. 

They note that there is a lack of success in interventions with children when maltreatment or abuse are seen as isolated or single events. They identify that research shows quite the opposite - that the majority of children experience multiple events and often in multiple forms.  They also note that children who have these experiences inside a family are also quite vulnerable to experiencing them outside the family as well.

Drawing upon a wide body of research, the authors take time to share with the reader the various important categories that child protection workers must consider when assessing the histories of children:

  1. multiple type maltreatment which would include sexual abuse, physical abuse, psychological maltreatment, neglect along with witnessing domestic violence;
  2. polyvictimisation which outlines how a child may have various sources of maltreatment within the family and the community (including bullying);
  3. complex trauma which is greater than presently thought of through the lens of Post Traumatic Stress Disorder (PTSD). It involves disturbances to the cognitive, affective and behavioral dimensions of a person's life. This reflects the prolonged nature of the disturbance and the impact on multifactorial functioning on into adult life. Psychological and physical health are impacted. This is combined with high rates of subsequent victimization in adulthood;
  4. Cumulative harm describes both the cumulative harm of multi victimization along with the multiple harms of multiple types of maltreatment from multiple sources. However, cumulative harm can also occur with multiple victimizations to single perpetrator events (the victims of Ariel Castro come to mind).
The implications for practice are profound, not the least of which is that, given the high probability that single maltreatment events are low, that investigation should seek to consider a longitudinal view of the child and family. Maltreatment should not be seen as a discrete event. That a previous complaint led to investigation, services and file closure should not suggest that this meant the issues were resolved. Research keeps telling us that many of the interventions used in child protection are not leading to long term changes in many families.

For clinicians, this also means that there is a need to think about the ways in which therapy is approached. Psychological, behavioral as well as developmental concerns are likely requiring attention in the recovery process. My own work with assessing and treating those with addiction (both in and out of the child protection system) speaks to the validity of seeing these four categories as extremely relevant to our work.


Price-Robertson, R., Rush, P., Wall, L. & Higgins, D. (2013). Rarely and isolated incident: Acknowledging the interrelatedness of child maltreatment, victimization and trauma. Melbourne: Australian Institute of Family Studies


  1. Thanks Peter, that was an interesting read. I am always left with sadness in knowing that children die at the hands of those who should be the most caring and intimate with them. ~Tara. H.

  2. I agree, it was an interesting read. Esp in light of the fact that I will graduate with a degree in Social Work this August. What really stood out for me (and in essence revealed an almost naiveté that I possess) is the statement,
    "Maltreatment should not be seen as a discrete event. That a previous complaint led to investigation, services and file closure should not suggest that this meant the issues were resolved."
    That was a wake up call and reminder for me: never assume, keep on learning and contributing to my field and one size truly doesn't fit all.
    Thank you!