The
Wednesday, June 7, 1989.
Hospital staff 'in breach of guidelines'
by Cate Brett
Staff at
the centre of Christchurch Hospital’s child sexual abuse controversy were
inexperienced, unsupervised and breached child sexual abuse interviewing
guidelines, according to ward 24 investigator, Dr Les Ding.
The investigation supports allegations of deficiencies in child sexual abuse
interviews carried out on the ward and later presented as critical evidence in
the Family Court.
Personality conflicts, inadequate supervision by the director and other senior
clinicians, and unclear lines of accountability allowed these deficiencies to
go undetected despite concerns raised by other ward staff members.
The investigation sparked by a Television New Zealand programme on Ward 24’s
handling of two
But the report dismisses suggestions that ward 24 was operating as a centre for
the diagnosis of child sexual abuse, pointing out that evidence gathered by
ward 24 has been used in only seven court cases since 1988.
"
This caseload represented about 10 per cent of the ward’s total admissions and
in each instance the cause of admission was severe psychological and family
relationship problems.
While accepting that the ward’s evidential interviews were deficient, the
report makes it clear similar inconsistencies and lack of clarity between
therapy and fact finding plagued most workers in the field throughout 1988.
Serious allegations made by British child abuse experts about the quality and
ethics of therapy undertaken by ward 24 staff were rejected by Dr Ding.
The British experts interviewed in the TVNZ "Frontline" documentary
described the therapy sessions as “gratuitously painful for the child,"
“perverting the course of justice, corrupting the innocent, destroying the
self-confidence of the child and the stability of the whole family. "
Specifically, Dr Ding was asked to investigate allegations that:
§
Staff had re-enacted episodes of abuse with one of the
children in a ward dormitory.
§
Sweets were used to reward a child when she was prepared to
talk about sex.
§
Leading questions were used in the interviews.
§
The two children were subjected to 18 and 32 interview
sessions respectively, some lasting well beyond the recommended time.
§
Anatomically correct dolls were used inappropriately.
§
The interview sessions were inadequately and inaccurately
recorded.
The
investigation did not substantiate the re-enactment allegation, stating that
the therapist involved set proper limits in these therapy sessions.
The use of jellybeans in the course of therapy was judged to be acceptable but
inappropriate in evidential interviewing.
Similarly the use of leading questions repeated interviews and anatomically
correct dolls was found to be inappropriate for evidential inter viewing but
explicable in the context of ongoing therapy.
“I accept that the number of sessions can be explained by the intention of utilising the therapeutic sessions to seek evidential
information to support the diagnosis of sexual abuse.
“However even though . . . the interface between therapeutic and evidential
work was generally unclear at the time and the term “evidential interview” was
not commonly used, existing guidelines did recommend the avoidance of a large
number of sessions, and other precautions such as leading questions.”
Dr Ding condemns the use of manual recording methods but points out the ward’s
director had repeatedly attempted to obtain hospital board funding for
audio-visual equipment.
Contrary to claims made in the television programme Dr Ding found all staff
dealing with the child abuse suspect suffering from epilepsy and inoperable
brain tumors had been fully briefed on her medical condition.
Qualified
He emphasised that while the staff responsible for providing court evidence
were not trained in this area both were clinically qualified to provide therapy
for the children.
At the time the controversial cases came to light, ward 24 had lost five staff
members and was left functioning for six months with nobody qualified to carry
out evidential interviews with sexually abused children
While critical of the ward s evidential work the report implicates the hospital
board and other statutory agencies for failing to co-ordinate and adequately
resource child sexual abuse work in the Canterbury region. It supports earlier allegations
by the head of Christchurch’s Child Protection Team that ward 24 staff were
forced to take on the task of evidential interviewing because the Department of
Social Welfare was not fulfilling its own responsibilities in this area.
The ward's functioning was also hampered by inadequate hospital board funding
and support, forcing it to operate under constant threat of closure, with a
part time director and without the video recording equipment repeatedly requested
by ward staff.
The report portrays ward 24 as an invaluable and effective resource severely
disturbed children, plagued by high staff turnover as a result of continual
threats of closure, inadequate resources and general isolation from other
hospital board services.
It points out that had a closer liaison existed between the board’s,
out-patient Child and Family Guidance Centre and ward 24 the deficiencies in
the ward's child abuse work may have been rectified much sooner.
It notes that by December last year the ward had developed a clear set of guidelines
governing child sexual abuse work, directly addressing former deficiencies in
interviewing techniques.
A new social worker, experienced in child sexual abuse, has been
appointed to co-ordinate and oversee the management of any future child
sexual abuse cases presenting on the ward.
While accepting these changes should rectify past problems Dr Ding makes
several other recommendations relating to ward 24 and the Canterbury Area
Health Board, including:
§
A review of the ward's management structure, focusing on the
lines of accountability between primary and supervisory staff:
§
The formation of a single administrative body to co-ordinate
and resource ward 24, the outpatient Child and Family Guidance Centre and the
Adolescent Unit, all presently under different directors and administrations.
§
The adoption of a national policy to coordinate area health
boards in their management of child abuse.
These
recommendations arose from the finding that there is currently no mechanism to
coordinate the practical procedures between the hospital board units, or their
liaison with the police and the Department of Social Welfare.
Upgrade
The report also makes sweeping recommendations to upgrade the level of
coordination and accountability between the voluntary and statutory bodies
dealing with child abuse.
It calls for the urgent establishment of a regional structure with executive
authority to:
§
Establish, maintain and review local interagency child sexual
abuse guidelines.
§
Review significant issues arising from the handling of cases
and reports from inquiries
§
Review arrangements to provide expert advice and interagency
liaison.
§
Review progress on child abuse prevention work.
§
Review interagency training.
The
report also proposes the establishment of a regional child protection register,
initiated by the new regional coordinating structure.
While acknowledging that the Department
of Social Welfare and police have formally accepted responsibility for carrying
out evidential interviews, Dr Ding concludes there remain serious anxieties as
to whether the new DSW unit will have sufficient resources to meet the growing
demand for expert evidential interviewing.