Child protection failures revealed in review after death of Kumanjayi Little Baby

WARNING: Aboriginal and Torres Strait Islander readers are advised that this article contains an image of a person who has died, which has been used with the permission of the family.

There are “highly interconnected shortcomings” across the Northern Territory’s child protection system, a review commissioned after the death of a five-year-old girl has found.

The independent review, written by former NSW Police commissioner Karen Webb and public servant Greg Shanahan, found extensive failings in the system, including several notifications of alleged domestic and family violence at the home of Kumanjayi Little Baby in Alice Springs.

Kumanjayi Little Baby was allegedly abducted and murdered by Jefferson Lewis in May.

Lewis is yet to enter a plea and will return to court in December.

The review was commissioned by NT Child Protection Minister Robyn Cahill and its findings were handed down in parliament on Tuesday, where repeated instances of abuse had allegedly occurred at Kumanjayi Little Baby’s home.

The Department of Communities and Families (DCF) had “received repeated notifications concerning the child’s exposure to domestic and family violence (DFV), the report read.

“The notifications span a number of years and include reports of verbal and physical violence, ... coercive and controlling behaviour and, on some occasions, the child’s direct or potential exposure to incidents of violence,” it continued, noting there was an “escalating and continuing pattern of behaviour”.

There were several notifications to DCF in the case of Kumanjayi Little Baby, with the first being while her mother was pregnant with her, and the last one in April, expressing concern for her exposure to domestic violence.

However, the report found some of these notifications were not immediately acted on, with one in August 2022 - ranked at a level of two on the DCF’s 0-10 scale - not closed for seven months.

On this scale - the Signs of Safety model - 0 indicates an identified "immediate risk" and 10 reveals "no immediate concerns".

"It is the review team’s opinion the inconsistent application of [the] Signs of Safety assessment, and the scaling safety goal, do not appropriately identify risks and treatments to improve child safety," the report said.

"In fact, the instrument in its current form is likely to lead to understatement of risk and overstatement of safety if not applied thoroughly and consistently."

The report raised questions as to whether the DCF properly took into account previous incidents and exposure to domestic violence when responding to individual notifications. 

"DCF also advised that it does not routinely undertake formal checks, such as police history or intelligence checks, on people nominated by families to form part of the natural network,” the report read.

The report also noted the Alice Springs child protection team had a 40 per cent vacancy rate at the time of Kumanjayi Little Baby’s disappearance.

“This placed increased pressure on existing resources,” it noted.

However, the report insisted the case of Kumanjayi Little Baby was not an isolated case, saying the tragic death was a sign that an overhaul was required in the territory’s child protection system.

“The Review found that the circumstances concerning KLB cannot be considered solely as an individual case management failure,” it said.

“They highlight interconnected shortcomings across the child protection system.”

It pointed to issues in communication, risk assessment and management, and organisation, management and governance.

“Taken together, the findings point to the need for a system-wide reset of DCF’s child protection function,” it concluded.

“The recommendations address immediate practice and operational weaknesses while establishing the foundations for longer-term reform.”

Support is available from the National Sexual Assault, Domestic and Family Violence Counselling Service at 1800RESPECT (1800 737 732).