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Cumulative harm

Updated: 23 September 2013

What's Important To Us

Children and young people exposed to repeated events of harm or neglect experience a profound and indelible diminution of their sense of safety, stability and wellbeing. As well as responding to the unique features of each event it is important that we recognise and assess the impact of cumulative harm on the child or young person in our response.

This key information discusses cumulative harm including its impact on children and young people, its relationship with neglect and family violence, and practice implications for social workers.

The material has been drawn from the publication 'Cumulative Harm: A Conceptual Overview' by Robyn Miller (2008).

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What is cumulative harm?

Cumulative harm refers to the effects of patterns of circumstances and events in a child or young person's life which diminishes their sense of safety, stability and wellbeing.

Cumulative harm is compounded experiences of multiple episodes of abuse or layers of neglect. Constant daily impact on the child or young person can be profound and exponential, covering multiple dimensions of their life.

The impact of cumulative harm on vulnerable infants

Information on the processes that support or disrupt an infant's developing brain indicates that disruptions to normal development in early life will fundamentally alter certain areas of the brain in later development. The chain of development suggests that a child's early life experiences have more relative importance in the organisation of the mature brain than that of later life experiences. For example, experiences that can be tolerated by a 12 year old can be life altering for an infant.

Practice implication:
The understanding of cumulative harm requires workers to thoroughly analyse the particular vulnerability of infants and young children exposed to repeat harmful events.

Cumulative harm and neglect

Chronic neglect and cumulative harm are independent terms, however the high reoccurrence of neglect as an abuse type and its often silent co-existence with other identified abuse types means that it is frequently a factor in causing cumulative harm. Patterns of low level care, particularly during early development, must be considered in terms of the cumulative harm they may be causing.

Practice implication:
Neglect must be considered an identified abuse type on par with all other forms of maltreatment given the evidence that its consequences can be damaging.

The cumulative impact of family violence

Family violence is a common factor in the lives of children and young people who are affected by cumulative harm. The presence of violence is highly damaging to the developing child, and a growing body of evidence suggests infants are particularly vulnerable.

Alongside the act of physical violence, other forms of maltreatment contribute to cumulative harm including emotional violence (e.g. humiliation, coercion, degradation), indirect impacts on parenting capability (e.g. anxiety and depression undermining a parent's ability to care for a child), and physical incapacitation as a result of an assault.

Practice implication:
Parents/caregivers must be assisted to understand the impacts of family violence on their children, on themselves as people and parents and on their relationships with others.

Broader practice implications

  • Social workers must assess each report of concern knowing that it brings new information relevant to the history of involvement with the child or young person. Each new report of concern must be understood in the context of the family/whānau's history and the outcome of previous involvement by Oranga Tamariki and other agencies
  • New reports of concern should be reviewed uninfluenced by the outcomes of prior reports of concern. Substantiated or not, prior reports of concern may indicate a cumulative pattern of harm
  • Early intervention linking vulnerable children to universal or specialist support services is required
  • Holistic practice is required at every phase of the intervention. This requires that a range of different services are utilised when working with vulnerable children, young people and families/whānau
  • Pay special attention to the impact of cumulative harm in children aged five years and under.