Children’s Court of NSW Resource Handbook — Care and protection — articles

As social service and legal professionals are all too aware, decision making in child welfare is laden with risk and uncertainty. Determinations are frequently complicated by incomplete or disputed facts, time deadlines, and the unpredictability of future events. In the face of such challenges, caseworkers and lawyers sometimes turn to psychologists or other mental health professionals to provide clinical evaluations related to parenting issues.^[3]

Common referral questions in evaluations of parents focus on their cognitive, emotional, and social functioning; care-giving skills and deficits; the impact of substance abuse or mental illness on parenting ability; characteristics of the parent-child relationship; risk and protective factors in the family; and progress in response to mandated services. Parents may be referred to assist in service planning or to inform dispositional decisions such as placement, permanency goals, visitation arrangements, or termination of parental rights. At their best, parenting assessments can provide an informed, objective perspective that enhances the fairness of child welfare decisions.^[4] At their worst, they can contribute inaccurate, biased, and/or irrelevant information that violates examinees’ rights and/or impairs the decision-making process.

The current paper describes the background and components of a clinical practice model for mental health evaluations of parents in a child welfare context and provides two case examples of the model’s use. The objectives of the paper are to (a) describe recommended ingredients of clinical evaluations of parents, (b) identify what the evaluations can and cannot do, and (c) illustrate how parent evaluations can enhance caseworkers’ and attorneys’ understanding of issues related to case planning and disposition. The paper focuses on evaluation of parenting capacity in cases of physical abuse, neglect, or dependency. The terms evaluation and assessment are used interchangeably.

Evaluating parents in a child protection context is different from evaluation that occurs as part of clinical services such as parent training or psychotherapy, because there is a high likelihood that the evaluation will be used in legal proceedings. Many clinicians are not trained in forensic assessment (ie, assessment for a legal purpose) and, as a result, they often fail to follow forensic guidelines. For example, the Committee on Ethical Guidelines for Forensic Psychologists^[5] states that the forensic evaluator should have no other relationship with the examinee, whereas in clinical practice a mental health professional sometimes serves as both evaluator and therapist for a client. Further, in forensic evaluations, clinicians are obligated to inform the subject of limitations on the confidentiality of information, independently corroborate information obtained from a third party, and apply a higher standard of data documentation than is typically used in clinical practice.^[6]

Controversy exists as to the credibility of parent evaluations due to the methods and practices used by clinicians.^[7] In response to these concerns, the American Psychological Association (APA) Committee on Professional Practice and Standards established guidelines outlining professional competencies, procedures, and ethics of desired practice in child protection cases.^[8] Although other professional bodies^[9] also have developed recommendations for professional evaluators, the APA guidelines are the most specific with reference to evaluations of parents. Selected provisions of the APA guidelines are listed in the first section of Table 1.

Little empirical information exists about the extent to which parent evaluations in child welfare conform to recommended guidelines. However, two studies that have investigated this topic^[10] identified substantial limitations in the quality of evaluations, suggesting that clinical practice in the field has yet to reflect the recommended guidelines. In particular, Budd et al^[11] found that parent evaluations frequently evidenced numerous problems: vague referral questions; a single office session with the parent, with no direct information on the child or parent-child interactions; reliance on traditional psychological instruments not directly related to parenting; limited access to or use of written records; minimal collateral information from caseworkers or therapists; failure to warn parents of the purpose and limits of confidentiality of evaluations; and overstated conclusions and recommendations.

The clinical practice model described in this paper was developed by the first author and colleagues^[14] in an attempt to address discrepancies between recommended and actual practice in parent evaluations. It is informed by the literature on parenting assessment,^[15] as well as experiences the first author gained as part of a multi-disciplinary research and demonstration project. This project, called Clinical Evaluation and Services Initiative (CESI),^[16] was established with the goal of understanding and improving how clinical information is used in juvenile court proceedings. (In Cook County, the juvenile court includes both the child protection division, which deals with child maltreatment matters, and the juvenile justice division, which deals with juvenile offences.)

CESI began in the mid 1990s at the request of the chief judge of the court system in Cook County, IL, which encompasses much of the metropolitan area of Chicago. CESI’s initial purpose was to investigate the system’s acquisition and use of clinical information in Cook County’s juvenile court system and recommend target areas for change.^[17] Based on that knowledge, CESI devised a model for reform of that system,^[18] which it piloted for 3 years. Data from parent evaluations on child protection cases completed during the pilot period^[19] demonstrated timely and thorough evaluations of parents reflecting components recommended by professionals. In June 2003, the CESI model was adopted for court-wide use within a newly created Cook County Juvenile Court Clinic.^[20]

There are three core features of parental assessment in the clinical practice model described here. First, it should center on parenting. As Budd^[21] stated:

Second, it should employ a functional approach, emphasising behaviours and skills in everyday performance. Grisso^[22] described the term functional in reference to parenting assessment as investigating “what the caregiver understands, believes, knows, does, and is capable of doing related to childrearing”. Grisso emphasised that parenting skills should be assessed with respect to individual children’s needs. Functional assessment incorporates a constructive focus on identifying strengths and areas of adequate performance as opposed to only deficits.^[23] In addition, it seeks to identify the contextual conditions influencing parenting and the likelihood of remediation.

A third core feature of the current model is that it applies a minimal parenting standard. Rather than comparing parents to optimal functioning, the focus is on whether parenting is adequate to meet the basic safety and emotional needs of the child(ren). This entails considering the lowest threshold of parenting skills necessary to protect a child’s welfare, given the risks and protective factors present in the family. For example, maternal conditions such as low intellectual functioning or mental illness pose clear risks to parenting and child safety, yet these risks may be tempered by factors such as the child’s age and functioning, a supportive family network, the mother’s recognition of her limitations, and her participation in intervention services. Judgments about minimal parenting competence thus need to consider the individual circumstances of the case.

Applying a minimal parenting standard is tricky, because, as several authors^[24] have noted, the fields of child development, psychology, and law lack universal models or standards of minimal parenting competence. The guidelines that do exist, such as in legal statutes regarding parental unfitness as a basis for termination of parental rights, lack behavioural specificity and consistency across jurisdictions. Similarly, checklists^[25] designed for social workers lack empirical evidence of reliability and validity. Nevertheless, several authors^[26] recommend that clinicians strive to apply a minimal parenting standard in evaluations, given the lack of an empirical or legal basis to impose a higher criterion. The acceptability of parenting practices differs among cultural, ethnic, and economic groups,^[27] and evaluators have an ethical responsibility to respect individual differences with regard to culture, access to resources, and community practices of childrearing.^[28]

Building on the three core features of a parental capacity evaluation, the assessment process proceeds through three phases: planning the evaluation, carrying out data-gathering activities, and preparing the report. Key aspects of the process are discussed briefly below and exemplified later in two cases. Relatedly, Table 1 provides a checklist of recommended items to look for in parenting capacity assessments.^[29] Child welfare and legal personnel can consider these items in requesting and critiquing mental health evaluations.

The evaluator’s first step in preparing to conduct an evaluation is to clarify the assessment objectives. Budd^[30] found that most evaluations of parents in their analysis failed to describe specific referral purposes, which appeared to contribute to the limited usefulness of the reports. Clinicians often receive vague referral requests (such as, “determine this mother’s parenting ability” or “assess the father’s cognitive and emotional functioning”), which need to be translated into specific questions in order for the evaluation to be useful. When social workers or attorneys refer cases, it is important that they describe what exactly they wish to know about the parent’s functioning, the problems or events that have given rise to their concerns, and the outcomes or options that will be affected by the findings.^[31] It may be helpful for the clinician to speak directly with the referral agent prior to beginning the evaluation to clarify the referral questions. Once the referral questions have been determined, they form the basis for planning the scope and direction of the evaluation.

Another important aspect of planning the evaluation is the review of background records. Thorough review of existing records prior to conducting an evaluation provides the opportunity for the clinician to add to, correct, and clarify existing information as part of the assessment, rather than simply duplicate what is already known. Obtaining prior records often is difficult and time-consuming, but the efforts are worth it when clinicians use the prior records to plan their assessment and include relevant information from records (cited clearly to identify the source) into their evaluation write-up. In so doing, they can show how their evaluation converges with or diverges with previous reports and highlight discrepancies in the records.

The second phase, carrying out assessment activities, usually begins with a detailed clinical interview of the parent (or parents), which often extends over two to three sessions. The interviewer begins by clarifying the evaluation’s purpose and limitations of confidentiality, and then covers areas such as the history of allegations or parenting concerns, services the family has received, current living situation, personal background, description of children and parent-child relationship, and expectations regarding outcomes.^[32] Gaining the parent’s cooperation is essential to a productive interview, so clinicians must be sensitive to and respectful of the parent’s perspective.

Psychologists, and to a lesser extent other mental health professionals, typically administer tests or inventories as part of the assessment process. An important caveat in using psychological instruments is that, with few exceptions, they were not designed to assess parenting capability and have not been empirically tested regarding their validity in a child protection context. Thus, clinicians should select measures based on their appropriateness to the client and the referral questions; further, they should apply a conservative approach in interpreting the findings by seeking corroboration across sources.

An important and, in Budd’s analysis,^[33] under-utilised component of parenting capacity assessment is observation of the parent and child(ren) together. As Budd notes,^[34] direct observation serves two assessment functions: it provides an index of behaviour when the parent presumably is trying to use his or her best parenting skills, and it allows the examiner to perceive a range of parent and child behaviour under different conditions. Given the diversity of problems, parent and child characteristics, and observation contexts in parenting evaluations, there is no single method or set of behaviour categories for parent-child observation. Structured observation methods, using systematic coding systems such as the Dyadic Parent-Child Interaction Coding System II^[35] or the Home observation for the measurement of the environment: administration manual,^[36] can be used to record parent and child behaviours. They have advantages of focusing the evaluator on specific behaviours and allowing for comparison across observations and parents.

However, any standardised observation is limited in its applicability and requires substantial training prior to reliable use. Standardised coding often is not practical in parental capacity assessments, due to the individualised circumstances of the evaluation. For example, observations often occur at a social service agency or in a public place, include several children in the family, and vary in length, depending on prescheduled visitation arrangements. As an alternative to structured observation systems, clinicians often observe informally and record behaviours of interest. Thus, clinicians need to be well versed in child development, parenting and behavioural assessment methods, and they should select behaviours that fit with referral concerns.

Common areas of focus during parent-child interactions include how the parent structures interactions, shows understanding or misunderstanding of child’s developmental level, conveys approval and disapproval of the child’s behaviour, notices and attends to the child’s physical needs, responds to the child’s initiations, accepts child’s right to express his or her own opinions, follows through with instructions or rules, and spreads attention across all children present. Budd^[37] lists additional areas to observe regarding the parent’s behaviour, as well as relevant areas regarding the child’s behaviour. Several other writers^[38] also offer detailed suggestions for parent-child observations in parenting evaluations.

In addition to information gathered from prior records, parent interviews, tests or questionnaires and observations, interviews with collateral sources are an important source of information. Caseworkers, therapists, foster parents, extended family members, the parent’s partner, or other persons who know the parent and child can report on the parent’s progress in services, problems and strengths. They also can confirm or disconfirm assertions by the parent. Collateral sources need to be informed of the limitation on confidentiality of the information, and parent permission should be obtained prior to contacting the sources.

The third phase of the assessment process involves integrating findings and writing the report. These are challenging tasks, entailing organisation of multiple and often mixed findings, weighing the strength of data supporting various interpretations, and deciding which aspects to include in the written report. To make the report useful to referral sources, it needs to be accurate, written in “plain English”, emphasise description of findings over interpretation, and include a summary section that responds to each referral question, summarises the data used to formulate an opinion, and delineates the logical inferences that link the findings to the interpretation. Clinicians should strive for a balanced presentation by discussing parenting strengths as well as weaknesses, identifying possible precipitants and maintaining variables for parenting problems, suggesting potential interventions to address difficulties, and forthrightly addressing limitations in the assessment.

Professional opinions differ on whether forensic evaluators should directly respond to the legal questions (such as whether or not unsupervised visitation should be granted, or whether a parent is ready for reunification) underlying clinical referral questions. In keeping with the recommendations of Grisso^[39] and Melton,^[40] the current clinical practice model takes a conservative approach to this issue, in which the evaluator avoids making specific recommendations about legal questions that are the domain of the court. Instead, the evaluator offers behavioural descriptions, possible explanations, directions for intervention, and future issues to assess in regard to parenting adequacy.

Caseworkers and attorneys who request mental health evaluations on parents have differing reasons for referral and varying expectations about the report and its usefulness. Some referrals occur needlessly because prior evaluation reports have not been circulated or read, as a substitute for case planning, or as a “fishing expedition” with no specific questions in mind. Others occur when important gaps remain on clinical issues after review of existing information, when opinions differ on case direction, or in high profile cases for which a second opinion is desired. In the latter cases, assuming specific referral questions are clearly articulated, clinical evaluations can contribute relevant information for case planning or decision making. They do so by describing parent’s functioning, explaining possible reasons for abnormal behaviour and conditions likely to influence the behaviour, assessing the potential for change, recommending interventions, and/or describing the child’s functioning, needs, and risks in relation to the parent’s skills and deficits.

Alternatively, evaluations are not able to measure a parent against a uniform standard, determine parenting adequacy based on indirect evidence, conclusively rule out the impact of situational variables on the assessment process, or predict future behaviour with certainty. Neither are they able to answer questions unless they have been articulated by the referral source, which underscores the importance of having the issues of concern communicated to the evaluator in advance of the assessment. Table 2 summarises these points by listing outcomes that can and cannot be expected from parental capacity evaluations.

The following section provides two illustrations of the clinical practice model applied with parents in the child protection system. The examples are based on actual cases, with details changed to protect confidentiality. In both cases, the evaluator was a doctoral level clinical or counseling psychologist with experience in child development, parenting, clinical assessment and forensic issues.

This paper suggests how parenting capacity evaluations can facilitate better decision making in child welfare cases through the provision of objective, independent, relevant and timely information. Clinical evaluations are not designed to, nor can they, replace the informed perspective of caseworkers and other ongoing service providers who interact with the family over time. Instead, as Melton commented,^[45] mental health evaluators are most likely to be expert at asking the right questions so as to identify the precipitants and maintaining variables associated with parenting problems, articulate skills and behaviours in need of change, and speculate about interventions that may meet the needs of the family. To accomplish these goals, mental health evaluators need to have the requisite knowledge in child development, parenting and forensics, and be skilled in clinical assessment, including parent-child observation. Together with information from legal and social service sources, competently performed parenting evaluations can illuminate mental health issues relevant to current determinations.

Child welfare and legal professionals can influence the quality and usefulness of evaluation reports by prompting clinicians to use methods recommended in the professional literature, as outlined in Table 1. Strategies for prompting clinicians could include asking questions of potential evaluators about the methods they use in parenting evaluations, providing clinicians with background records on the family prior to the evaluation, suggesting knowledgeable informants who could serve as collateral sources during the evaluation, and offering to set up parent-child observation sessions as part of the evaluation process. Referral agents and consumers of evaluations also could prompt evaluators to use recommended methods by communicating with them after receiving parenting evaluation reports. They are in an ideal position to ask questions of clinicians when technical terms are not explained, when information is confusing or vague, or when it is unclear how the evaluator reached the stated conclusions. Evaluators rarely receive feedback about the accuracy or usefulness of their reports, yet they would benefit from knowing how the information is received by others. Based on these comments, clinicians can improve the effectiveness of their communication or address issues in need of further attention.

In addition to requesting and receiving reports from mental health evaluators, social service workers may find it useful to keep in mind aspects of the clinical practice model described here in their own interactions with parents. In particular, caseworkers have repeated opportunities to talk with parents and to observe them interacting with their children in a variety of settings. By recording these experiences in behaviourally specific progress notes, caseworkers can amass a valuable source of information for case planning and decisions. Documentation of pertinent details over time, based on actual conversations and observations, provides strong evidence at decision-making junctures.

Clinical evaluations of parents are one potentially valuable resource for coping with the inevitable risk and uncertainty surrounding child welfare determinations. The complicated issues of child welfare cases demand the best efforts that professionals can offer to help families and those who serve them.