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Guide 7: Cumulative harm - RESILIENCE PRACTICE FRAMEWORK - PRACTICE RESOURCES - The Benevolent Society
PRACTICE RESOURCES

RESILIENCE PRACTICE FRAMEWORK

Guide 7: Cumulative harm
A framework to promote resilience in children and families

www.benevolent.org.au
Guide 7: Cumulative harm - RESILIENCE PRACTICE FRAMEWORK - PRACTICE RESOURCES - The Benevolent Society
We are The Benevolent Society
We help people change their lives through support and education, and we speak
out for a just society where everyone thrives.
We’re Australia’s first charity. We’re a not-for-profit and non-religious
organisation and we’ve helped people, families and communities achieve positive
change for 200 years.

Authors
Dr Leah Bromfield
Manager of the National Child Protection Clearinghouse and Communities and
Families Clearinghouse at the Australian Institute of Family Studies. Dr Bromfield
is now Associate Professor and Deputy Director of the Australian Centre for Child
Protection at the University of South Australia.
Alister Lamont
Research Officer for the National Child Protection Clearinghouse at the Australian
Institute of Family Studies.
Greg Antcliff
At the time of writing was Senior Manager, Research to Practice, Benevolent Society.
Greg is now Director, Professional Practice, Benevolent Society.
Robyn Parker
Senior Research Officer for the Australian Family Relationships Clearinghouse and
Communities and Families Clearinghouse at the Australian Institute of Family Studies.

Acknowledgements
This Practice Guide is an adaptation of the Cumulative Harm Specialist Practice
Guide written by Leah Bromfield and Robyn Miller for the Victorian Government
Department of Human Services (2007). The adaptation of the guide was dependent
upon generous feedback and valuable input from Benevolent Society practitioners.
The Authors also acknowledge the Benevolent Society’s National Staff Network for
Aboriginal and Torres Strait Islanders for their cultural consultation.
January 2014

The Benevolent Society
Level 1, 188 Oxford Street
Paddington NSW 2021
T 02 8262 3400
F 02 9360 2319

research.policy@benevolent.org.au
www.benevolent.org.au
©The Benevolent Society, 2013
All rights reserved. This work is copyright. Except under the conditions described in the Copyright Act
1968 of Australia and subsequent amendments, no part of this publication may be stored in a retrieval
system, communicated or transmitted in any form or by any means without prior written permission.
The Practice Resource Guides master materials may be produced by individuals in quantities sufficient
for non-commercial use. Requests and enquiries concerning reproduction rights should be directed in
writing to The Benevolent Society.
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                         Table of Contents

                         Overview                                                                       4
                         Resilience                                                                     6
                          ractice Tool: Working with children and families with
                         P
                         no previously identified concerns					10
                          ractice Tool: Working with children and families with
                         P
                         identified concerns			                                                       13
                             Phase 1: Assessment                                                      13
                             Phase 2: Planning                                                       22
                             Phase 3: Intervention                                                   23
                             Phase 4: Reviewing Outcomes                                             28
                         Closure                                                                      30
                         References                                                                    31

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Overview

In this Practice Guide we take a resilience-led approach to assessment and
intervention in cases involving cumulative harm. The Resilience Practice
Framework provides an overarching model for working with children and
families. Practice Guides are designed to provide additional guidance in
cases where specific complex problems exist or with specific vulnerable
sub-groups.

What is cumulative harm?                    What causes cumulative                       Chronic child maltreatment
Cumulative harm refers to the effects       harm?                                        Bromfield and Higgins (2005) defined
of multiple adverse circumstances and       Cumulative harm may be conceptualised        chronic child maltreatment as recurrent
events in a child’s life. The unremitting   very broadly to include the adverse          incidents of maltreatment over a
daily impact of these experiences on the    circumstances associated with poverty or     prolonged period of time (i.e. multiple
child can be profound and exponential,      the impact of adverse life events such as    adverse circumstances and events) and
and diminish a child’s sense of safety,     disability or chronic illness. However, as   argued that chronic child maltreatment
stability and wellbeing.                    this Guide is designed to assist practice    caused children to experience cumulative
                                            in child and family services, the focus      harm. Critically, they found that the
                                            will be on cumulative harm caused as a       majority of children who are abused or
                                            consequence of repeated incidents of         neglected experience multiple incidents
                                            abuse, neglect, witnessing family violence   and multiple types of child maltreatment.
                                            and unrelenting low level care (i.e.
                                            cumulative harm caused by chronic child
                                            maltreatment).

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How does cumulative harm                     Trauma                                      Attachment
impact children?                             The term ‘complex trauma’ has been          Human attachment relationships aim to
The main research and theories that          used by many researchers to describe        ensure that the ‘attached’ or dependent
have helped us to understand the way in      the experience of multiple, chronic and     child feels a secure bond with their
which cumulative harm impacts children       prolonged traumatic events in childhood     caregiver in order to learn and explore
are on early brain development, trauma,      (Bromfield et al., 2007). Whereas single    the social and physical world (Bacon &
attachment and resilience. Early brain       traumatic incidents tend to produce         Richardson, 2001). Babies and young
development, trauma and attachment           isolated behavioural responses to           infants exposed to cumulative harm are
theories provide different perspectives      reminders of trauma, chronic trauma         more likely to experience insecure or
on the processes and impacts adverse         can have long-term pervasive effects        disorganised attachment problems with
events have on children. Although each       on a child’s development (Van der Kolk,     their primary caregiver. For children with
theory focuses on separate aspects           2003). Exposure to chronic trauma           an insecure attachment, the parent/
of child development, key themes are         may lead to serious developmental           caregiver (who should be the primary
inter-related. Acknowledging the three       and psychological problems for              source of safety and protection) becomes
perspectives provides a well-rounded         children. Van der Kolk identified several   a source of danger or harm, leaving the
theoretical grounding that further assists   developmental effects of childhood          child in irresolvable conflict. Attachment
in understanding the developmental           trauma including:                           difficulties are likely to increase when
effects of adverse childhood experiences     • complex disruptions of affect             maltreatment is prolonged. Children’s
and why children may be behaving or            regulation                                responses will largely mimic their parents’
reacting in particular ways.                 • disturbed attachment patterns             and therefore the more disorganised
                                                                                         and inconsistent the parent, the more
                                             • rapid behavioural regressions             disorganised the child (Streeck-Fischer &
Early brain development                        and shifts in emotional states            Van der Kolk, 2000). Without the security
Disruptions to normal brain development      • loss of autonomous strivings              and support from a primary caregiver,
in early life may alter later development    • aggressive behaviour against self         babies and infants may find it difficult to
of other areas of the brain. Researchers       and others                                trust others when in distress, which may
investigating brain development              • anticipatory behaviour and traumatic      lead to persistent experiences of anxiety
have used the term ‘toxic stress’ to           expectations                              and anger (Streeck-Fischer & Van der
describe prolonged activation of stress                                                  Kolk, 2000).
management systems in the absence            • lack of awareness of danger and
of support (Bromfield, Gillingham &            resulting self endangering behaviours
Higgins, 2007). Stress prompts a cascade     • self-hatred and self blame and chronic
of neurochemical changes to equip us           feelings of ineffectiveness (Van der
to survive the stressful circumstance          Kolk, 2003).
or event. However, if prolonged (e.g. if
a child experienced multiple adverse
circumstances or events), stress can
disrupt the brain’s architecture and
stress management systems leading
to hypersensitivity and over activity.
Children who have experienced ‘toxic
stress’ or severe disruptions to early
brain development may find it difficult
to regulate their own behaviour or
emotional reactions. Toxic stress may
sensitise children to further stress,
lead to heightened activity levels and
affect future learning and concentration
(Shonkoff & Phillips, 2001).

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Resilience

There are two ways of thinking about resilience: point in time resilience
and a life course approach to resilience.

Point in time resilience                      Process or life course                    Understanding resilience
Taking this perspective you might ask         approach to resilience                    Infants are born with their own unique
“How resilient is this child now?” or         Taking this perspective you might         temperament – some are highly resilient
“How resilient or vulnerable was the          observe that “This child has adapted      while others are more fragile. Intrinsic
infant at birth?” This is reflected in this   relatively well to trauma and adversity   factors such as a child having an easy
definition by Gilligan: “Resilience can       over the course of their development”     temperament as a baby are highly
cushion an individual from the worst          or ask “What risks or strengths have      associated with resilience in infancy.
effects of adversity and help them to         surrounded the child to increase or       Other babies may have a more difficult
cope, survive and even thrive in the          decrease their resilience?” or “What      temperament and could therefore
face of great hurt and disadvantage”          interventions can we provide to           struggle to thrive without the optimal
(Gilligan, 1997).                             build resilience in this child who has    environment. However, an individual’s
                                              experienced adversity and trauma?”        level of resilience is not static, rather
                                              This perspective is reflected in this     it is dynamic and evolves and changes
The Benevolent Society’s                      definition by Luthar: “Resilience is      over time in relation to the individual’s
definition of Resilience:                     a phenomenon or process reflecting        life experiences.
                                              relatively positive adaptation despite
Strength in the face of                       experiences of adversity or trauma”
                                                                                        For example, all children have aspects
adversity. The capacity to                                                              of individual vulnerability and resilience.
                                              (Luthar & Zelazo, 2003, p. 6).
                                                                                        Outside the child are external forces or
adapt and rebound                                                                       life events comprising: (a) risk factors,
from stressful life events                                                              experiences of trauma and adverse
                                                                                        events; and (b) protective factors,
strengthened and more                                                                   positive experiences and potential
resourceful.                                                                            sources of strength. An individual’s

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experiences of these external forces         Figure 1: Domains of Resilience
can increase or decrease their levels of
vulnerability or resilience.

Resilience Practice
Framework
The Resilience Practice Framework
focuses your attention when making
assessments on gauging the child’s
vulnerability or resilience. Even the
most resilient child can struggle given
enough pressures in their environment.
Conversely, even the most fragile child
can thrive with the right care. The
Resilience Practice Framework focuses
your assessment on identifying the
strengths as well as the problems in
the child and family system (individual,
family, community) that may increase
or decrease the child’s resilience.
When working with children and their
families, use the Resilience Practice
Framework to guide your intervention
to increase the protective factors and
potential sources of strength as well as
addressing the problems and risk factors
in the child and family system. The          Figure 2: The Ecological Framework
underlying philosophy of a resilience-led
approach is that all children can survive
                                                                                Wider Community
and thrive despite experiences of trauma
and adversity if they are given the right
care and nurturance.
A resilience model developed by Daniel                                         Family Relationships
& Wassell (2002) highlights that there are
six domains of resilience (see Figure 1).
The Benevolent Society uses the
‘domains of resilience’ model as a means                                              Child
for driving assessment and intervention.
The model is used in combination
with an ecological framework that
demonstrates the levels at which
resilience factors can be located.
In practice this means that practitioners
focus on all three levels (child, family
relationships and the wider community)
when considering how to assess
and boost resilience in a child’s life.

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For example, when thinking about a          Cumulative harm and                          Working in a culturally
secure base (see Figure 1: Domains of
Resilience) one issue to consider for the
                                            resilience                                   sensitive way
                                            Cumulative harm can overwhelm                While many of the aspects of a
child might be “does the child appear
                                            even the most resilient child and            resilience-led approach are common
to feel secure?”. When considering
                                            particular attention needs to be given       across all cultures, it may be that
family relationships: “is the parent/
                                            to understanding the complexity of the       what is valued in one culture is not
caregiver able to make time for the
                                            child’s experience. Families in which        directly transferable to another and
child?”. When considering the wider
                                            children are exposed to cumulative           this should be taken into account when
community: “does the parent/caregiver
                                            harm often lack strong protective            working with families of different
have adequate emotional and material
                                            factors and are characterised by a range     ethnic and cultural backgrounds. For
resources to support him or her in the
                                            of complex problems that can break           example, research indicates that while
parenting of the child?”. Each of the six
                                            down a child’s resilience. These may         friendships are generally beneficial
individual domains of resilience should
                                            include social isolation, family violence,   for children across all cultures,
be considered in relation to the three
                                            parental substance abuse, mental health      the ways in which friendships are
levels of the ecological framework.
                                            problems, disability and socio-economic      conceptualised and levels of closeness
For more information about the              disadvantage. Even the most resilient        within friendships may vary depending
Domains of Resilience model see: Daniel     child can struggle to grow in such           on cultural expectations (French et
and Wassell, 2002.                          unrelenting conditions.                      al., 2005). Whilst there are certain
                                                                                         universal childhood needs, concepts
                                            For this reason, we must be cautious
                                                                                         of attachment and understandings of
                                            not to focus on resilience to the extent
                                                                                         who are the important people around
Cumulative harm can                         that we ignore the risks for the child.
                                                                                         children can vary across cultures.
overwhelm even the most                     Children who appear to be coping
                                                                                         Therefore it is important to respect
                                            well, but who in fact have internalising
resilient child.                            symptoms (e.g. depression, lack of
                                                                                         different kin and non-kin structures
                                                                                         for caring for children, whilst retaining
                                            self-worth), are vulnerable to being
                                                                                         a focus on the child. Culture has an
                                            overlooked (Luthar & Zelazo, 2003). In
                                                                                         important effect on the significance and
                                            cases where children have experienced
                                                                                         meaning of certain stressors, such as
                                            cumulative harm the focus of an
                                                                                         disability, health difficulties and divorce
                                            intervention must be on reducing the
                                                                                         (Luthar, 2003) as well as differing family
                                            adversity in the child’s life, assisting
                                                                                         formations, aspirations and beliefs
                                            their recovery and increasing their
                                                                                         (Schoon & Byner, 2003). Some ethnic
                                            resilience to future adversity.
                                                                                         groups will be disproportionately
                                            In gathering information, analysing,         disadvantaged and have limited
                                            intervening and reviewing our work           access to good housing, resources and
                                            with families where there is cumulative      employment.
                                            harm, we must be mindful of whether
                                            there is improved safety and wellbeing
                                            for children and adolescents. The short
                                            and long term effects on them matter,
                                            whether there is intent to harm or not.
                                            In conjunction with your supervisors,
                                            you will need to review the family
                                            support plan and at times this may
                                            mean involvement of child protection
                                            services.

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Aboriginal and Torres Strait               The Benevolent Society and                  The aim of this Practice Tool is to
                                                                                       provide specific guidance on what to
Islander children and families             cumulative harm                             consider in responding to cumulative
and cumulative harm                        Practitioners working for the
                                                                                       harm for both:
Cultural competence, sensitivity           Benevolent Society who work with
                                                                                       (a) children and families with no
and respect are essential in any           children, parents or families need to:
                                                                                       previously identified concerns; and
intervention with families. The impact     • be alert to signs that a child might be
of historical and ongoing dispossession,     at risk of cumulative harm even if they   (b) children and families with identified
marginalisation, racism, colonisation,       have no previously identified concerns    concerns.
poverty and the Stolen Generations has       (e.g. child care worker)
led to high levels of unresolved trauma,   • be able to make a “cumulative
depression and grief among Aboriginal        harm assessment” for children with
and Torres Strait Islander families          identified concerns (e.g. parenting
and communities (Human Rights and            support)
Equal Opportunity Commission, 1997).       • understand ways to intervene with
Some of the key individual, family and       children and their families to decrease
community vulnerabilities associated         the risk of cumulative harm and
with unresolved trauma have resulted         enhance children’s resilience, and
in heightened rates of child abuse
and neglect in Aboriginal and Torres       • review the effectiveness of their
Strait Islander communities (Berlyn &        intervention.
Bromfield, 2010). It is not surprising     The type of cumulative harm
that, without this crucial modelling and   assessment you undertake and the
positive parenting experiences, the        response you provide will differ
legacy for future generations is fraught   for different roles and services and
with difficulties in their parenting       may depend on how the child and
styles for many Aboriginal and Torres      family came to be involved with the
Strait Islanders who were removed          Benevolent Society.
from families and communities. In          • If you are in a child care setting and
this context Aboriginal and Torres           have identified signs that a child
Strait Islander children living in such      might be at risk of cumulative harm,
communities are more vulnerable to           the purpose of your assessment will
cumulative harm.                             be to identify if there is cause for
                                             concern and determine what the
                                             most appropriate service is to which
Culturally and linguistically
                                             you can refer the family (e.g. child
diverse families and                         protection or a parenting program).
cumulative harm                            • If you are working in a family support
Refugee and migrant communities              or therapeutic service (e.g. Child and
may be struggling with unresolved            Family or Early Years Centre), you
trauma, grief and loss after fleeing         might have accepted a referral from
from war, oppression, torture and            child protection authorities and your
trauma. Adjusting to a new culture and       cumulative harm assessment will be
way of life can also put further stress      undertaken to inform your planning
on families and increase children’s          and intervention with the child and
vulnerability.                               their family.

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Practice Tool: Working with children and families
with no previously identified concerns

Children experiencing multiple and ongoing low-severity adverse events
are more likely to be overlooked as we tend to think about our concerns
for children in terms of individual events. However, an ongoing pattern of
adversity can cause a child to experience cumulative harm. All professionals
working with children need to be aware of the impacts of cumulative harm
and alert to children who might be at risk of cumulative harm.

• Are there children you come into        summarise the information according         • Source of harm: To the best of your
  contact with where you have noticed     to the following dimensions:                  knowledge, who is responsible for the
  ongoing, minor events that, while not   • Type: Are there multiple types              things that you are concerned about
  optimal, are not cause for concern on     of events causing you concern               (e.g. mum, dad, both)?
  their own?                                (e.g. child’s behaviour, parent’s         • Severity: Does this seem to have
• If you are concerned about a child,       presentation, parent–child                  affected the child’s development?
  what is your primary concern? Are         interactions)?                              What would be the likely
  there other things that you have also   • Frequency: Has the issue(s) that            impact on the child if these
  observed which may be indicative of       you are concerned about occurred            circumstances continued?
  an underlying problem?                    repeatedly or was it a one-off event?     On balance, do you believe this child
• Talk to your colleagues, have they      • Duration: To the best of your             might be at risk of cumulative harm?
  noticed anything? (when considered        knowledge, how long has the issue(s)
  in isolation it may have seemed           you are concerned about been              Remember, cumulative harm refers
  insignificant).                           present? Is it an ongoing pattern         to the effects of multiple adverse
                                            in the child’s life or is it associated   circumstances and events in a child’s
Having gathered your own observations                                                 life, the unremitting daily impact of
and those of your colleagues,               with a current stressful situation
                                            or crisis for the family?                 which can be profound and exponential.

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If you believe a child to be at risk of         need to reassess whether or not a
cumulative harm, it is important that           report to child protection authorities
they are linked to appropriate services.        is warranted. Remember to keep
Services to support the child and family        children’s outcomes as central to your
might include parenting programs, family        assessment of risk and wellbeing.
support, the Brighter Futures program,
the Helping Out Families program,
mental health services, drug and alcohol      Mandatory Reporting Obligations
services, maternal and child health
nurses. Ensure that you discuss your          Cumulative harm and the NSW                   mandatory reporters from taking action
concerns with your supervisor. If you         Children and Young Persons                    in a way they believe is appropriate.
believe the child is at risk of significant   (Care and Protection) Act 1998
                                                                                            Cumulative harm and the Queensland
harm, then you will need to make a            The NSW Children and Young Persons            Child Protection Act 1999
report to child protection authorities.       (Care and Protection) Act 1998
                                                                                            Under the QLD Child Protection Act
                                              specifically addresses the issue of
You will come into contact with children                                                    1999 a matter must be reported to
                                              cumulative harm. Under the Act a
who you are concerned about, but who                                                        child protection authorities if it is
                                              matter must be reported to child
are not presently at risk of significant                                                    deemed that the child is at risk of
                                              protection if the child is at risk of
harm. It is important that they are given                                                   harm. Harm to a child is defined as “any
                                              ‘significant harm’ S.23 (1). The Act states
the opportunity to access appropriate                                                       detrimental effect of a significant nature
                                              that significant harm ‘may relate to
services.                                                                                   on the child’s physical, psychological
                                              a single act or omission or to a series
• Talk to the parent. Let them know                                                         or emotional wellbeing” S. 9 (1).
                                              of acts or omissions’ S.23 (2).
  that you are concerned for them and
  their child.                                                                              Mandatory Reporting (QLD)
                                              Mandatory Reporting (NSW)
• Engage them in a discussion about                                                         The QLD Child Protection Act 1999
                                              The NSW Children and Young Persons
  whether there are supports they                                                           requires that an authorised officer,
                                              (Care and Protection) Act 1998 states
  might find useful. You might provide                                                      employee of the department or a person
                                              that a mandatory reporter is
  them with information about other                                                         employed in a departmental care service
                                              “(a) a person who, in the course of
  services available through the                                                            or licensed care service is required to
                                              his or her professional work or other
  Benevolent Society (e.g. The Early                                                        report harm or suspected harm to a
                                              paid employment delivers health care,
  Years Centres, Partnerships in Early                                                      child in the care of a departmental care
                                              welfare, education, children’s services,
  Childhood program; supported                                                              service or a licensee S. 148. For further
                                              residential services, or law enforcement,
  playgroup); or provide them with the                                                      information regarding mandatory
                                              wholly or partly, to children, and
  contact details for a parent helpline                                                     reporting and how to make a report
                                              (b) a person who holds a management
  or a referral service.                                                                    to child protection authorities visit:
                                              position in an organisation the duties
                                                                                            www.communities.qld.gov
• Be careful when talking with parents        of which include direct responsibility for,
  not to sound accusatory, as this may        or direct supervision of, the provision
  alienate them and ultimately prevent        of health care, welfare, education,
  them seeking the help they need.            children’s services, residential services,
• Parents may decide that they do not         or law enforcement, wholly or partly,
  wish to access support at that time,        to children.” S.27.
  let them know that ‘your door is            Refer to the online Mandatory Reporter
  always open’ if they want to discuss        Guide http://sdm.community.nsw.gov.
  anything with you.                          au/mrg/screen/docs/en-GB/summary to
• If parents choose not to access             assist you to determine whether or not
  available support services, you will        to make a referral to child protection.
  need to monitor the situation. If the       Note: The Guide is not intended to
  problems appear to escalate you will        replace critical thinking or to stop

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     Case Study: Daniel and Linda
     You are a child care worker and are worried about four year old Daniel who has
     been attending the centre for the last 12 months for one day a week. Daniel is
     dropped off at the centre by his Mum Linda. Over the last few months you have
     started to put together lots of little things about Daniel and Linda and you are
     becoming concerned about Daniel’s wellbeing.

                                                                                           If you believe a child is at
                                                                                           risk of significant harm, you
                                                                                           need to make a report to
                                                                                           child protection authorities.
                                                                                           You will come into contact
                                                                                           with children who you are
                                                                                           concerned about, but who
                                                                                           are not presently at risk of
     Daniel                                    Linda
     • Daniel has always been shy and          • Linda often drops Daniel off or picks
                                                                                           significant harm. Ensure that
       withdrawn. He doesn’t tend to play        him up significantly later than the       you discuss your concerns
       with other children.                      times she had booked. Sometimes           with your supervisor. It is
     • He can be aggressive towards staff        she fails to bring him in at all. Linda
       and other children when disciplined       generally has explained that this         important that the family
       and/or asked why he does not want         is because “they have had a bit of        is given the opportunity to
       to play.                                  trouble getting ready”, “lost track of
                                                 time” or “slept in”.                      access appropriate services.
     • You’ve noticed that Daniel doesn’t
       tend to ‘try new things’ and that his   • Linda has always been difficult to
       language skills are not as developed      engage and has often appeared
       as most of the other kids his age.        distracted as if she has had other
                                                 things on her mind—she doesn’t
     • At times Daniel has been
                                                 tend to ask about how Daniel’s day
       inappropriately clothed for the
                                                 was.
       weather conditions.
                                               • Another member of staff
     • On some occasions you have
                                                 mentioned to you that she heard
       noticed that he appears quite
                                                 Linda telling Daniel in the car park
       hungry, having multiple serves at
                                                 that he was “bad” and that she
       lunch and snack times.
                                                 would “send him away to the home
                                                 for naughty boys”.

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Practice Tool: Working with children and
families with identified concerns

The aim of this tool is to provide some additional guidance to Benevolent Society
practitioners about specific things you might consider when a child might be at risk of
cumulative harm. The tool consists of four sections representing each phase of casework:
assessment (including information gathering and analysis), planning, intervention and
reviewing outcomes.

Phase 1: Assessment
In this part of the tool, we provide       should be individualised and respectful    single recurring adverse circumstances
specific tips and guidance for the         of families’ unique strengths and needs.   or events, or by multiple different
assessment phase of your work with         There are two steps involved in            circumstances and events, cumulative
children, parents or families where        assessment:                                harm may be a factor for any child
there is suspected cumulative harm.        (1) information gathering; and             who has experienced, or is at risk
Comprehensive assessment is an             (2) analysis.                              of experiencing, abuse or neglect.
ongoing process of gathering, analysing,                                              However, it is unlikely that a child will
comparing and synthesising information                                                be referred for services explicitly due
from various sources in order to come      INFORMATION GATHERING                      to concerns about ‘cumulative harm’.
to an understanding of family strengths    Families who self-refer or who are         This means that practitioners need to
and needs relating to the child’s safety   referred to the Benevolent Society         be alert to the possibility of multiple
and wellbeing (U.S Department of           for parenting or family support or for     adverse circumstances and events
Human Services, 2008). As all families     therapeutic services are vulnerable and    impacting children in all vulnerable
have their own unique strengths and        will often be experiencing multiple and    families with whom they interact.
needs, there is no ‘one size fits all’     complex problems. As cumulative harm
model for assessment. Assessment           may be caused by an accumulation of

The Benevolent Society                                                                          RESILIENCE PRACTICE FRAMEWORK 13
Practice Resource Guide

                                            Practitioners who engage effectively        Gather information from
Practitioners need to be                    with families:
                                                                                        multiple sources
                                            • treat family members with respect
alert to the possibility of                   and courtesy
                                                                                        Practitioners need to gather information
                                                                                        from multiple sources to form an accurate
cumulative harm in all                      • focus on building on the                  picture of the child and their family.
vulnerable families with                      family’s strengths
                                                                                        Case files and referral information can
whom they interact.                         • promote positive relationships among      provide a rich source of information
                                              parents and children                      about the child and their family, their
                                            • develop trust through sensitive           previous involvement with support
Engaging families                             and inclusive enquiry about their         services and provide a good starting
                                              circumstances                             point for information gathering. The case
While your role may be to gain an
                                            • take an active, caring, whole-of-family   history and referral will often provide
understanding of parenting constraints
                                              approach to their situation               the initial alert that a cumulative harm
and how these are impacting children,
                                            • link up with other relevant services      assessment is required.
starting a conversation by asking
about or raising parenting problems           and work together to avoid conflicting    Speak to other professionals and
is unlikely to create an emotionally          requirements and processes                services involved with the family:
safe environment for parents. This          • focus on the children’s needs, and        • Ask other professionals specifically
may adversely affect your capacity to       • maintain a continuous relationship          about the potential or actual impact
gather information effectively; at worst      with the family (McArthur, Thompson,        of family problems on children and
it may damage your ability to build a         Winkworth & Butler, 2009).                  the potential for cumulative harm.
relationship with the parent over time                                                  • How have other service systems
and reduce the efficacy of your practice.                                                 intervened in the life of the family?
Parents’ and children’s openness to         First impressions last, so                  • Have you consulted with other
engaging with services may also be                                                        cultural services if appropriate?
affected by their past experiences
                                            think carefully about how
                                                                                        • Keep in mind that any professional
with formal services and supports. For      you are going to engage                       opinion is of itself limited by the time,
example, in a recent study McArthur         the family to make your                       role and focus of the practitioner (e.g.
and colleagues (2009) found that some       impression positive. Effective                maternal and child health nurses who
of the barriers and disincentives to
parents accessing services were:
                                            engagement will require you                   only see the infant for brief periods
                                                                                          once a fortnight, or the drug and
• past experiences of feeling               to build a trusting relationship              alcohol practitioner who is focused
  discriminated against or treated          with all family members.                      on the adults’ recovery not their
  unequally due to their situation                                                        parenting capacity).
• feeling humiliated and embarrassed
                                                                                        Professional knowledge is just one type
  by their circumstances and fearful
                                                                                        of knowledge:
  their children would be removed
                                                                                        • Parents are experts about their family
• being judged as not needy enough or                                                     and their children and it is important
  not meeting set criteria                                                                to talk to them about their views of
• feeling it was up to them to make                                                       what are the strengths and stressors
  contact with the right person the first                                                 for their family.
  time.                                                                                 • Think broadly about extended family
                                                                                          and other key people in the child’s life.
                                                                                        • Last, but by no means least, it is
                                                                                          critical that the child’s subjective
                                                                                          experience be central to your
                                                                                          information gathering to identify the
                                                                                          impact of cumulative harm.

14 RESILIENCE PRACTICE FRAMEWORK                                                                                The Benevolent Society
Practice Resource Guide

Talk with and observe                       Refer to the following resources to aid      What are the family strengths
                                            your observations of child development,
the child                                   trauma and attachment:
                                                                                         and stressors?
You can get a good sense of what the                                                     At the beginning of your involvement,
family environment is like for the child    • Infant/Toddler Learning Foundations        it will be important to put together a
by watching and interacting with them,        Book and DVD, California Department        comprehensive and detailed picture
keeping in mind whether and how their         of Education                               of the family—its history and current
demeanour and presentation may              • Department of Human Services,              circumstances, strengths and needs
reflect the impact of cumulative harm.        Victoria Child Development and             and the impacts of those circumstances
• How does the child present? Watch           Trauma Guides                              on the safety and wellbeing of the
  for developmentally-appropriate           • Circle of Security Maps                    children. As the case progresses existing
  play, communication, and emotional        • Marte Meo child elements checklist         information will need to be updated and
  responses; comfort-seeking behaviour                                                   new information will need to be sought,
                                            • The Benevolent Society’s Resilience        and both assimilated into the family
  when distressed; parent-child
                                              Assessment Tool.                           support plan.
  interactions; and the child’s responses
  to strangers.                             If you observe signs that the child is not   Research has shown that families in
• Which toys are used in play and how       developmentally on track or is showing       which children experience cumulative
  are they used? How does the child         signs of trauma you may consider             harm are frequently characterised
  interact and play with other children?    referring the child to a specialist for a    by multiple and complex problems
                                            formal assessment.                           (Bromfield, 2005). Where families have
• Ask the children about their day. What
  are their routines? What happens                                                       multiple, chronic and inter-related
  after school?                             Talk to parents about                        problems, this can result in children’s
                                                                                         needs being unmet (Cleaver, Nicholson,
• Ask about their home and family life.     their child                                  Tarr & Cleaver, 2007; Cleaver, Unell &
  Who lives in their house? Who comes       Parents’ love for their children and
  to visit? Who looks after them? What                                                   Aldgate, 1999). Families with multiple
                                            motivation for them to be safe and well
  makes them happy? What makes                                                           and complex problems are frequently
                                            will be the primary reason parents come
  them sad? What is the child saying/                                                    socially isolated and lack strengths or
                                            to the Benevolent Society for support.
  not saying? What does this tell us?                                                    protective factors (Bromfield, 2005).
                                            Give parents space to talk about their
Make your observations and                  hopes and dreams, worries and fears
interactions with children purposeful.      for their children. You will get rich
What do your observations and               information about the child and start
interactions tell you about child           to build a relationship with the parent
development, trauma, attachment and         around your shared aim of achieving the
resilience? Keep in mind that parents       best outcomes for their child.
and children may behave differently         • Parents are experts about their
in the contrived and often stressful          children and will be an important
situation of an assessment. Avoid             source of information about whether
making definitive assessments about           children are developmentally
parent–child relationships too early.         ‘on track’ and able to relate, play,
It might be important to make multiple        concentrate, participate and belong.
observations in different settings/         • Are there any characteristics of
environments.                                 the child making it hard for the
• Is the child meeting developmental          parent to meet their child’s needs
   milestones?                                (e.g. disability, medically fragile,
• Is he or she displaying any signs           behavioural problems)?
   of trauma?                               • Ask parents, are there any
• Are there any indications that the          characteristics of this child that
   child has attachment difficulties?         may strengthen or undermine
                                              their resilience?

The Benevolent Society                                                                            RESILIENCE PRACTICE FRAMEWORK 15
Practice Resource Guide

What problems are being                     Context of the problem(s)                   Responses within families are diverse
experienced?                                Ask the parent about other aspects          and some are able to create supportive
Which are the primary problems              of their life. Is this family living        and nurturing environments despite
contributing to the parent’s current        within a broader context of poverty,        parental problems. What are the
circumstances? Identify the events or       disadvantage and social isolation?          strengths that families can build upon?
behaviours that have brought the family     Consider how a context of disadvantage      You might need to start small, such as
to the notice of your service — what        and exclusion might be compounding          recognising the parent’s love for their
happens and when, how often, who            the effects of other problems or creating   child and desire for them to be happy
is involved? What are the impacts on        barriers to the parent’s ability to deal    and well, even when parents themselves
the parent as an individual? How does       with their problems. Also explore what      cannot meet their child’s needs.
this situation impact their capacity to     steps or actions are being, or have         • How willing are the parents to seek
parent?                                     been, taken by the parent (alone or with      support services?
• What have the parent’s experiences        the aid of another service provider)        • Is there a strong parent–child
   been?                                    to address or manage their problems.          attachment?
• What is the repeating and/or current      Have these been effective?                  • How has the family tried to manage
   pattern around the concerning            • Does the family have adequate               the problems before coming to the
   behaviours?                                housing?                                    Benevolent Society?
• How is the parent’s mental, emotional     • Are the parent’s in employment?
                                                                                        For further information on gathering
   and physical wellbeing?                  • Are the parent’s struggling with          information to form your assessment
• Do they have ongoing issues that may        money problems? Can they pay their        refer to the Benevolent Society’s
   affect their parenting capacity (e.g.      bills and buy groceries?                  Resilience Assessment Tool and User
   disability or mental illness)?           • Does the family have access to            Guide.
• How have the parent’s circumstances         transport? Is this affecting their
   or problems impacted on their              capacity to meet their child’s needs?
   relationship with their child?           • Do they feel safe and supported in
• With appropriate support, is the            their neighbourhood?
   parent likely to be able to provide an   • Does the family have supportive
   adequate level of care to their child?     networks within their community (e.g.
                                              access to local services)?
                                            • Are the family support networks,
                                              or lack thereof, a source of stress or
                                              support?
                                            • What kind of relationship does
                                              the parent have with friends and
                                              extended family? Are the parent’s
                                              social networks making it hard for the
                                              parent to change (e.g. their friends
                                              also have substance addictions)? Is
                                              the parent isolated? Are the parent’s
                                              family or friends a potential source of
                                              support?
                                            • What strengths can the parent/family
                                              build upon?

16 RESILIENCE PRACTICE FRAMEWORK                                                                              The Benevolent Society
Practice Resource Guide

Tips for engaging parents
Parents may be struggling to meet           Ask parents:                                • What would you like for your family
their children’s needs, but this does       • What does a good day look like?             down the track? Do you have any
not mean that they do not love their          What does a bad day look like?              particular goals for your family?
children, want to be good parents           • In parenting your children, what things   • Who else in your family/kinship group
or that they do not have hopes and            do you think you do pretty well?            is involved in the care and upbringing
aspirations for their family. Experienced                                                 of your children?
practitioners suggest:                      • What do you see are the main issues
                                              of concern for your family?               Practitioners should demonstrate
• asking parents about their hopes,
  dreams and aspirations for                • What things would you like assistance     warmth and acceptance and avoid the
  their children                              with at the moment?                       ‘expert role’ by presenting ideas and
                                            • What might be barriers to you             strategies as choices or options the
• being honest with parents about                                                       family can choose to help them care
  your concerns.                              getting this help? E.g transport
                                              or child care issues.                     for their children.

Tips for engaging children
Remember that the child may be              • Don’t ask too many questions as it can      drawing) — they can choose when to
scared and confused about what is             shut a conversation down.                   make eye contact, and can take a bit
happening, but also aware of some of        • Ask specific questions “can you tell        of time to think about their answer.
the consequences of disclosure. Talking       me exactly what happened?”. Their         • If the child is engaged in play, name
with you may raise concerns for them          responses will suggest follow up            what they are doing. For example:
about being loyal to their parent — even      questions.                                  “Oh, I see you have the blue truck”,
an abusive parent.                                                                        then wait for their next initiative. This
                                            • Ask the child about events, feelings
• Meet the child at their level — kneel       and routines rather than themselves.        lets the child know that someone is
  on the ground with them, join them                                                      with them in their play and that they
                                            • Ask the child what they would like to
  on the swings.                                                                          have good play ideas, which is very
                                              happen — what would they like to
• Make eye contact.                                                                       important for social development.
                                              change?
• Ask open ended questions that invite                                                  • Offer simple, direct responses to their
                                            • Avoid asking the very difficult
  a conversation not a quick response.                                                    questions.
                                              questions too early in the
                                                                                        Sources: Noble-Carr (2006); the Raising Children
• After asking a question of a child          conversation.
                                                                                        Network (raisingchildren.net.au)
  ensure that you leave enough time for     • Let them know you are taking them         Aarts, M. (2008). Marte Meo Basic Manual (2nd
  the child to consider the question and      seriously — don’t interrupt.              Ed.) Arts Productions, Eindhoven, Netherlands
  make a response (active waiting).
                                            • Younger children in particular may
• Tell children why you are there and         feel more at ease if you talk with them
  working with the family.                    while taking part in an activity (e.g.

The Benevolent Society                                                                              RESILIENCE PRACTICE FRAMEWORK 17
Practice Resource Guide

   Case study: James and Diane
   James and Diane self-referred to           • Diane’s addiction to prescription         • Diane seems to have a good
   the family support program at the            drugs has meant that at times she           relationship with one of the Centre
   Benevolent Society’s Browns Plains           has been unable to get out of bed to        workers who initially suggested
   Early Years Centre (BPEYC) as Diane          wash, feed and dress James in the           she might access support from a
   was having difficulty staying on top         morning. She says that she finds this       family support worker. From her
   of daily routines and managing               a ‘chore’.                                  observations working with James
   James’s behaviour. You have been           • Her parenting style is unpredictable.       in child care, the centre worker has
   working with them over the past few          When on a ‘particular high’ she says        informed you of the concerns she
   weeks, assessing information to inform       she often plays with James and gives        has with James’s development.
   your planning and intervention with          him gifts. At other times she says she    • Although James has been a little
   the family.                                  ‘can be off in her own little world and     more withdrawn in the last few
   Over the course of two one-hour              forget that James is there’. On one         weeks, no further concerns have
   sessions with Diane at the BPEYC while       occasion she left James in a shopping       arisen since Diane sought further
   James is in child care, Diane has openly     centre.                                     support.
   discussed the parenting difficulties       • Diane says she has difficulty
   she is having and has revealed               managing James’s behaviour and has
   several personal problems that have          sometimes lost control and smacked
   been affecting her ability to provide        him harder than she intended.
   adequate care to James. From your          • Diane also revealed having a history
   sessions you have ascertained that:          of abuse and neglect in her own
   • Diane and James live in a public           childhood, culminating in her and
     housing unit in a neighbourhood            her sister being cared for by her
     they experience as unfriendly and,         grandparents when she was 15 after
     at times, scary.                           her mother overdosed for a second
   • Diane supports herself and James by        time. Her mother is deceased and
     receiving welfare support benefits,        she does not have any contact with
     however she is behind on the rent.         her father.
   • James has never met his father.          • Diane knows that the drugs are
     His father lives interstate and            not helping her, particularly her
     wanted nothing to do with Diane or         ability to cope with James, however,
     James once he found out Diane was          she says that when she is not on
     pregnant.                                  drugs she feels alone and worthless.
   • You suspect Diane suffers from             Sometimes she has felt like killing
     depression, the symptoms of which          herself.
     have intensified since James’s birth.    • Diane says she loves James with
   • Diane has been self-medicating with        all her heart and wants the best for
     prescription drugs by consistently         him. However, she is worried that
     changing doctors and often uses            if she does not get back on track
     marijuana to ‘numb the pain’.              and get support ‘that the same
                                                thing might happen to James that
   • The drugs she takes to ‘help her           happened to her’.
     through’ include Duromine and
     Xanax.

18 RESILIENCE PRACTICE FRAMEWORK                                                                                The Benevolent Society
Practice Resource Guide                                                                                     Practice Resource Guide

ANALYSIS                                    • Do children have a regular routine?      Talents and Interests
In analysing the above information, you       Having a routine is important            • What things do you really like to do
need to be a critical thinker and juggle      for children as it provides them           (in or out of school) – things you are
multiple competing needs prioritising         with consistency, and makes the            interested in (e.g. hobbies, sports,
the child’s safety and development.           world more predictable for them.           games, music/dance, art, craft)?
Careful attention needs to be given           However, having a routine is not the     • Where do you do it? How often?
to the balance of risk and protective         same as having a rigid or inflexible       Who do you do those things with?
factors, strengths and difficulties in        daily schedule.
                                                                                       • What things are you pretty good at?
the family. Synthesise the information      • Are parents spending time with
you have gathered about the current           children providing them with the
context and the pattern and history           nurturance, attention, love and          Social Competencies
and weigh the risk of harm against the        affection they need for positive         • Do you spend as much time
protective factors.                           emotional development?                     as you would like with other
                                                                                         children your age?
The signs that a child was experiencing     • What do you think the child might
                                              name as the good and bad things          • Do you usually get on OK with
cumulative harm are frequently
                                              about their daily lived experience?        other children?
evident with hindsight. A cumulative
harm assessment does not require                                                       • Do you find that you fall out with
practitioners to collect different or                                                    friends easily?
                                            Resilience-based analysis
additional information. Rather, it          To further assist in your analysis,        For further details see Brigid Daniel
requires careful analysis and re-analysis   practitioners can use a resilience-based   & Sally Wassell, 2002 and The
of the information you routinely collect,   analysis method to guide your              Benevolent Society’s Resilience
and the continuous re-assessment            assessment. Examples of questions          Assessment Tool – Child Resilience.
of information you gather over time         used for school-aged children in
through the course of your involvement
with children and families. Discuss the
                                            the Benevolent Society’s Resilience        Be alert to chronic neglect
                                            Assessment Tool include:                   It is particularly relevant to be alert
information and your analysis with
                                                                                       to the possibility of cumulative harm
your supervisor.
                                            Secure Base                                in cases of chronic neglect that are
                                            • Who is the person who most cares         characterised by an unremitting
Put together a picture of                     about you and loves you?                 low-level of care. The cumulative effects
what’s happening in the                     • Who are the people you really            of chronic low-level neglect are easily
                                              care about?                              missed as the term ‘abuse’ connotes a
child’s daily life                                                                     ring of urgency that ‘neglect’ does not
Put the pieces of your information          • Who do you see?
                                                                                       and the effects of neglect are usually
together to create a picture of the
                                                                                       not as obvious. Frederico, Jackson
child’s daily life. Imagine the situation   Education
                                                                                       and Jones (2006) caution “It is critical
through the child’s eyes, what are          • How are you going with school work?
                                                                                       that neglect is not considered a
the characteristics of their daily          • Who (adults) takes an interest in how    lesser problem than other forms
lived experience?                             well you do at school?                   of maltreatment” (p. 18).
• Are the child’s basic daily needs being   • Does (caregiver/s) come to stuff at
   met: sleeping, eating, hygiene?            school much? What?
• How are children spending their time?
   Are they playing and interacting?        Friends
   Going to school or child care?           • If you hear the word ‘friend’, what
   Spending extended periods without          does it mean to you?
   interaction in their pram or in front
   of TV?                                   • What things about you would make
                                              people want to be your friend?
                                            • How many friends do you have?

The Benevolent Society                                                                           RESILIENCE PRACTICE FRAMEWORK 19
Practice Resource Guide

Assessing parenting capacity                 It is critical that you do not assume          • Duration: Over what period of time
                                             culture is a risk factor — culture can be        has the child experienced these
in Aboriginal and Torres Strait              protective for children. For example,            adverse circumstances and events?
Islander and CALD families                   culture and the maintenance of                   Link this back to the child’s age and
Parenting practices are not universal        culture are central to healthy infant            developmental stage and whether
and practitioners must be careful not        development and identity formation               this makes them more or less at risk
to impose their own cultural practices,      in Aboriginal and Torres Strait Islander         of harm.
values and beliefs about parenting           communities. An Aboriginal child knows         • Severity: What has been the impact
onto families with whom they are             who they are according to how they               of the circumstances or events on the
working. Cultural consultations can          relate to their family, community and            child’s development and wellbeing?
play an important role in this part of       land (Victorian Government Department            What is the likely impact if the
the assessment — who can you call            of Human Services, 2008). Practitioners          adverse circumstances and events are
on for input in relation to this specific    will need to assess whether, in the              repeated over a prolonged period?
family? Your role is to assess whether       present circumstances, traditional,
children are safe from harm and are                                                         • Source of harm: Who is responsible
                                             cultural parenting practices are
receiving the physical care, affection                                                        for the child experiencing these
                                             contributing positively to the child’s
and emotional security they need. Be                                                          adverse circumstances and events
                                             safety and wellbeing, or putting them
cautious that you are not imposing                                                            (one person or multiple people)?
                                             at greater risk of harm and neglect.
upon families how they must parent to                                                         Does the situation make the child
                                             Be aware that culture and parenting
meet these needs. For example, in some                                                        vulnerable to other perpetrators of
                                             practices are not homogenous and
cultures the mother may not be the                                                            abuse or neglect (e.g. extra-familial
                                             can vary across families, communities
primary attachment figure for an infant.                                                      perpetrators)?
                                             and geographic areas. Practitioners
If there are multiple caregivers your role   will need to determine which practices         To explore these dimensions you might
is to observe the infant and “to assess      are applied in the family they are             ask yourself questions such as:
whether the infant seems confident of        working with (Neckoway, Brownlee               • Have you been aware of similar issues
who to turn to when in need, whether         & Castellan, 2007).                              in the past? If so, have the problems
there is a central person who holds the                                                       escalated?
infant and their needs in mind, and to
ensure that the infant does not have to      Make a cumulative harm                         • Are there indicators that the child has
                                                                                              experienced other types of adversity
attempt to get care from many people         assessment                                       in addition to those you are aware of?
to get their physical and emotional          Draw together all of the information you
needs met” (Jordan & Sketchley, 2009).       have collected. To identify whether a          • Have the alleged circumstances
                                             child is at significant risk of experiencing     caused, or are they likely to cause,
                                             cumulative harm it is important to               significant harm if they are repeated
                                             summarise the information along the              over a prolonged period?
Practitioners need to be
                                             following dimensions:                          Put the child at the centre of your
aware of their own values                    • Type: What are the range of adverse          assessment:
and how these might                            circumstances and events that                • How long have the problems in the
influence the way they work                    the child has experienced? Make                family been present?
with families from culturally                  particular note of any types of              • How are parental problems and family
                                               abuse or neglect that the child may
and linguistically diverse                     have experienced or be at risk of
                                                                                              circumstances impacting the child?
backgrounds.                                   experiencing.                                • Does the child’s development present
                                                                                              as being socially and physically
                                             • Frequency: From your knowledge of              on track?
                                               the child’s history, is there a pattern
                                               of these circumstances or events
                                               being repeated?

20 RESILIENCE PRACTICE FRAMEWORK                                                                                   The Benevolent Society
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