A boy's life over 14 years comes down to 1100 pages - an agonising catalogue of misery and neglect. Julie Cleaver obtained and analysed the CYF file of a boy we have called Benjamin.
It is a grim glimpse of the front line of social work - an 1100-page dossier of abuse and misery cataloguing the life of Benjamin*.
The file is not easy reading.
Benjamin had it hard from birth. He was born early to a mother who was an alcoholic; an addiction which brought Child, Youth and Family into the boy's life for the first time at the age of 6 months.
A social worker arrived at his first home shortly after an alcohol and drug counsellor. There was Benjamin, "in bed with a drunken mother".
The CYF notes report Benjamin's mother as "aggressive or violent when bingeing" and that his father was "not always present in the home". There was no doubt as to the risk posed - "This is a young baby at risk from neglect or accidental harm from an alcoholic mother."
The contact continued, right through to the first signs Benjamin had suffered damage from a brain-bleed linked to his premature birth. Seizures at the age of 18 months put him in hospital. Both parents had been drinking when they arrived - there was "little confidence in parents' ability to care especially if Benjamin turns out to have medical needs", a social worker wrote.
Benjamin would be diagnosed with high needs, and that was before autism emerged. A social worker recorded that his mother was found to be repeatedly drunk during the hospital stay - there was "no guarantee of baby's safety if he was returned to parents' care".
Money appears to have not been an issue. Benjamin's maternal grandfather owned the house in which they lived and "funded" the continued presence of his father. There was even talk of hiring a nanny to get around his mother's drunkenness and father's inability to care for both.
The relationship between the father and the mother was disintegrating and known to be physically and verbally abusive. Benjamin's father told social workers, "24 hours out of seven days [Benjamin] is witnessing things that are not okay".
In July 2002, police were called when the boy's mother - "too drunk to hold him" - dropped Benjamin, inflicting head injuries. His mother was charged but eventually not prosecuted. CYF created a plan which included banning alcohol from the family home.
Shortly after, in 2003, the family moved to a remote part of New Zealand. One supervisor warned: "It is [our] experience some families tend to go to [the location] to escape monitoring by services."
She said oversight would be difficult and there were "concerns about both parents' ability to care safely for this child with special needs".
Concerns over monitoring seem well-founded, although patched over by the observant local police officer. CYF received reports of violence in the home, of Benjamin being in the car with his mother when she was drunk and of her driving off the road.
The final straw was in December 2004, just after Christmas. He had slipped out of the house and was absent for hours before his parents noticed he was missing. The alarm was raised and Benjamin was found "cold, wet and shivering" in a stream at 5am. The local police officer said the boy was "bordering on having hypothermia" and couldn't stress enough how he was "lucky to be alive".
His parents offered inconsistent explanations of the events leading up to his disappearance, and blamed each other. Police and CYF found both were at fault. No charges were laid.
CYF placed Benjamin in state care in January 2005, where he stayed for a year. The notes show Benjamin was reported as developing well but there was no apparent long-term plan.
Social work staff cited "limited resources" and suggested "some muscle" be used at a management level to get a parenting assessment done for an upcoming court review. One wrote: "While it may be the responsibility of the department, resources are severely stretched at present."
Staff changes had also put Benjamin in limbo. His regular social worker had left and the replacement was off work on sick leave, waiting on surgery. Frequent staff changes were a pattern in the file.
In 2006, Benjamin was placed in the custody of his father. The two years which followed seem a comparatively stable time for Benjamin, although the notes show inconsistent school attendance, and times Benjamin would be brought home from school to an empty home - and an anonymous complaint he was locked in a room while his father did drugs. The allegation was not confirmed.
CYF closed Benjamin's file in 2009. Sometime between then and the end of 2010 his father's care of Benjamin ended. The discovery brought CYF back into Benjamin's life, with "serious concerns about [his mother's] ability to care for herself, let alone a child".
Still in a remote part of the country, her drinking had isolated her from support services. One CYF source said she'd never been seen sober.
Her alcohol abuse was such that her father was paying for a caregiver. She once told a social worker: "I'm not sure if he's my friend or my boyfriend."
As the relationship between the two developed, CYF began compiling allegations of violence in the home. There were claims she pointed an air rifle at him, and that her partner had bitten her breast and - somehow - cut her vagina. He denied the claims. CYF noted she stopped complaining about violence. Social workers didn't believe it had stopped, but that she feared she would lose her son if her partner was removed from the home.
The threat of losing Benjamin saw her try, again, to stop drinking. It seems a temporary respite. In 2012, Benjamin came to school with bruise marks on his eye and on the side of his body. He also had burn marks on his stomach.
At his home, both his mother and her caregiver-partner had different stories. She blamed the dog, he claimed Benjamin had banged his head against a wall. He later admitted the injuries could have come from restraining Benjamin. There were claims he was locking the boy in a room by himself.
In 2013, a concerned member of the public called police saying a boy had his hands tied behind his back in a vehicle and looked distressed. That boy was Benjamin. His caregivers admitted doing so, saying he was difficult to move from place to place. It was about this time the principal at the school he attended raised questions over the involvement of other agencies. The pressure on his schooling was such he was moved back to a large, populated area.
Conflict between his two caregivers started to get worse. In July 2014, the boy's mother claimed her caregiver-partner had thrown a hammer at her, strangled her, and repeatedly raped her. No charges were laid in relation to the claim.
At the time of the incident, a visit to the house found Benjamin to be locked in a room smelling strongly of urine, sitting on a wooden floor playing with a plastic toy. There was a bed in the corner with no linen on it. There was an open fire going in his mother's room.
The social worker on the scene said neither party had any real interest in providing a nice environment for Benjamin. Being listed as his caregiver brought in up to $80,000 a year and the social worker said his caregivers saw the boy as their "cash cow".
"It would appear that it's more about receiving financial payment from government agencies, than actually providing a home for Ben."
Benjamin was again put into state care, where he proved difficult to manage. In less than a month, he was back in the custody of his mother's partner, from whom she had now separated.
She died in February this year from liver failure. In July, the boy's father once again took over his care. CYF remains involved.
*Names in this story have been changed for legal reasons.
'Known to CYF' has become a phrase with chilling implications
It's hard at the sharp end of Child, Youth and Family's business.
This is the place where children are at risk every day and where a good day means nothing bad happens.
On a bad day, it can be the worst imaginable. In the aftermath, the media carry the euphemism "the family was known to CYF" in reports of tragedies.
The boy with an 1100-page file, who we have called Benjamin and who features in today's Herald, was definitely "known to CYF". His father said he had found CYF handling of the case sporadic over the 14 years the agency had been involved. The current staff were engaged and involved, with enthusiasm and ideas.
But there had been less positive experiences at other branches in earlier years. There had been frequent staff changes, alleged miscommunication and a lack of depth. "The social workers wouldn't look over the complete file. We would get a new situation every six months."
Duwayne Pailegutu, 7, was also "know to CYF" - two earlier notifications but no concern about risk before he was was beaten so badly he was paralysed, incontinent and suffocating in this own blood. The family of Serenity Scott-Dinnington were also involved with the agency. She died in 2011 as a result of injuries inflicted by her mother's boyfriend - her older brother had previously been taken into care. Her younger sister, born after her death, was taken into care at birth.
A review panel led by economist Paula Rebstock was scathing of Child, Youth and Family in its report, released last week. It recommended CYF take an "investment approach" to children in need and intervene early in partnership with other agencies.
In effect, it would broaden the safety net for children across the public sector. It would also invest more money up front to avoid the inevitable costs down the track.
This followed a recommendation by Children's Commissioner Dr Russell Wills that CYF draw in other agencies to help shoulder the burden of protecting children. He said the Rebstock report - and his own office's "State of Care" report - showed "we all have a part to play in improving the outcomes of these children. It is not the responsibility of Child, Youth and Family alone".
It is hoped the scheme will broaden the focus on children across education, health and other sectors and cover gaps that become obvious only when too late.