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

Any significant abuse experienced by a child has a psychological component, and the extent of the psychological harm accompanying abuse is not always readily apparent. Child protection legislation and practice now reflect this situation by de-emphasising categorical definitions of abuse in favour of regarding children as having been abused when they are significantly harmed by parental behaviour. This changed position recognises that the degree of psychological harm is not determined by the category of abuse or the presence or severity of physical harm but by the degree of breakdown in the normal parental nurturing of that child inherent in any abuse. While it is now accepted that an evaluation of parenting is essential to decision making about child safety, treatment and reunification issues in confirmed cases of child abuse,^[4] many clinicians find the idea of assessing parenting uncomfortable because there is no widely accepted, simple, quantitative measure.

We assert that when harm to a child is able to be attributed to parental or carer behaviour, a parenting assessment should occur. Our position is that parenting assessments are best undertaken after abuse has been confirmed. However, we acknowledge that some practitioners will use parenting assessment as part of the overall assessment process which leads to abuse confirmation. We believe that confirmation of abuse is important prior to the commencement of the parenting assessment because then the focus is clear: namely, the parents’ reaction to and their level of acceptance of the harm their child has suffered as a result of their behaviour; and those aspects of the parent-child relationship (eg empathic regard for the child) central to assessment of parenting. Confirmation might be by forensic medical assessment; a child making a clear, reliable allegation of abuse by a parent/carer in the context of a forensic interview; a court finding that a child has suffered harm in the care of an individual (whether or not the parent/carer accepts that finding); or a parent/carer admitting that they have harmed their child.

Consequently, in this paper, we advocate for a parenting assessment that centres on the primacy of the parent’s capacity to provide empathic, child-focused parenting. Such an approach escapes from the limitations of those parenting assessments that infer judgments about parenting from too narrow an information base (for example: microanalysis of videotaped interactions;^[5] ratio of child-centred to child-directive behaviours;^[6] or those that focus on specific aspects of a parent-child relationship. For instance, the Adult Attachment Interview (AAI) has been used to assess parenting,^[7] and while the data generated in the course of the AAI will be useful in making judgments about parenting capacity, there is no clear relationship between attachment categories and parenting capacity. We agree with Reder and Duncan^[8] that it is unwise to speak of parenting purely in terms of attachment theory.

Further, recently published systematic approaches to the assessment of parenting^[9] concentrate more on factors which influence the quality of parenting rather than the prime task of parenting. The extensive checklists of positive and negative qualities of parenting provided by these approaches are broadly useful and informative, but there is no clear indication of their relative individual importance. For example, Gray^[10] reports on the British Department of Health’s Framework for the assessment of children in need and their families,^[11] consisting of 20 dimensions of parenting grouped into three domains: child’s developmental needs; parenting capacity; and family and environmental factors. Useful guidance is given as to how to assess each dimension and specific tools are provided to measure some parameters, but the approach does not seem likely to realise its aim to produce an “in-depth assessment that addresses the central or most important aspects of the needs of a child and the capacity of … caregivers to respond appropriately to those needs”. Rather, it will result in a grouped list of factors with no indication of the relative importance of particular dimensions. In spite of the list being configured as a triangle, there is no indication as to how the different dimensions interact.

Our approach canvasses three similar domains and our definition of parenting capacity is comparable to that of the Department of Health’s Framework.^[12] However, we differ radically in the emphasis that we give to parenting capacity, our first priority in assessing parenting being specifically to assess the adequacy of the emotional relationship between parent and child. We regard other dimensions of parenting as interacting to determine parenting capacity. Only when parenting capacity is either found to be adequate or plans are developed to address its shortcomings do the dimensions of parenting as listed in the Framework have relevance and use in planning parenting interventions.

Azar and colleagues^[13] share our reservations about existing methods of assessing parenting where children have been harmed by abuse. They note the “extreme caution” that needs to be exercised in view of the lack of a secure theoretical or empirical base for the work of parenting assessment and the potential for cultural and other bias in the assessor. They highlight the need to “link parent’s individual skills/deficits with their capacity to parent a particular child” at a particular developmental phase, within a specific environmental context. But from that starting point, they adopt a very different approach to the one we advocate. It is implicit in Azar’s model that parental empathy is central, but empathy is only listed by them as the second of six “social skills” desirable in a parent, while we focus explicitly on the parental capacity for empathy. Where we aim to deal with the inherent uncertainty of parenting assessment by emphasising the core issues, they take an exhaustive approach to assessment, including the use of “validated tools”. In situations of statutory intervention, they aim to put as much useful information and as many alternative interpretations as possible before the judicial officer. Effectively, their approach identifies the strengths and weaknesses of assessed parents but does not specifically relate these factors to the overall performance of the parents in their care of the child they have harmed. We are not convinced that decision making in relation to parenting is enhanced merely by the provision of more and more information. On the other hand, the assessment processes that we propose in this paper are not equivalent to a “short-cut parenting assessment”. Our approach builds on the currently used assessments that are utilised to form the basis of decision making for future management of children who have been harmed by their parent/carer. We propose that the information gathering which characterises many parenting assessments must be organised around an appraisal of the parent’s ability to recognise and adequately provide for their child’s current and anticipated needs, in the context of their level of empathic response to the level of harm experienced by their child.

Parenting assessments in the context of child abuse are of most use when abuse has been confirmed. In such situations, statutory authorities are more able to act upon the recommendations following a parenting assessment, for instance by obligating parents to partake in therapeutic work based on the parenting assessment or by imposing conditions on their access to their children. Potential for reunification is predicated on the absence of factors that would indicate that a child would be unsafe in the environment of care. For instance, clinical experience suggests that parenting cannot be effective when parents are severely depressed or intellectually handicapped, or subject to recurrent, uncontrolled domestic violence or incapacitating substance abuse (except in those cases where this primary issue can be resolved). Furthermore, when parents do not acknowledge that their caring is seriously compromised, it is not possible to begin the process of rectification, and the continuation of that particular parent-child relationship is untenable.^[14]

The quality of parenting is reflected in an adult’s ability to recognise and adequately provide for, in a developmentally and emotionally appropriate manner, a child’s current and anticipated needs. Adequate parenting is flexible enough to adapt to variability in those needs, and the particular child’s repertoire of responsiveness, in the context of their social environment. Therefore, while factors both in the child and in the environment shape the quality of parenting, the critical determinant of the experience for the child resides within the parent and is referred to by us as parenting capacity. We propose that misattribution of shortcomings in parenting to other causes, for example poverty or poor social supports, results in suboptimal decision making and management. We advocate an assessment process that addresses the standard three domains of parenting by the gathering of relevant information but which gives priority to parenting capacity, which is the product of the interaction of child, parent and environmental factors, not just a summation of separate problems. In our approach we ask:

Carers in whom parenting capacity is potentially adequate and who are responsible for a child who is difficult to parent may not achieve their potential because of a lack of adequate scaffolding or the presence of significant environmental adversity, both factors negatively influencing the psychological quality of the parent-child relationship.

Merely addressing the adverse components of each of the domains of parenting risks overlooking the primary components of parenting capacity. For instance, inadequate physical care of a child can result from such factors as a lack of economic resources or knowledge about children; or from a parent’s failure to recognise or give priority to the child’s psychological needs. The former should be seen as a problem of scaffolding for parenting, the latter as a problem of parenting capacity and therefore likely to be refractory to intervention by the provision of scaffolding alone. Thus, if a problem is attributed to a parenting domain deficit rather than a problem with parenting capacity, it will lead to the wrong type of intervention and expose the child to further harm. This error is most often manifest in an agency’s decision to devote considerable resources to scaffolding, without adequately assessing how the child’s psychological needs are being met. Strategies for augmenting scaffolding are more readily applied than interventions to enhance parenting capacity, and it is more comfortable to blame circumstances than to confront shortcomings in parental functioning. For example, in a case of reported neglect, finding the family’s house to be dirty and lacking in food will suggest attention to scaffolding issues such as poverty and lack of social support, with the risk of overlooking harmful parenting and incorrectly concluding that the problem will be solved by the provision of further scaffolding. Parenting capacity must still be considered even when issues such as poverty are clearly present.

Because parenting capacity is not a measure of how people go about the tasks of parenting but refers to the psychological qualities they bring to those tasks, the intervention required to improve parenting capacity is not solely to provide educational input about practical aspects of parenting or disciplinary practice (these skills merely “scaffold” parenting capacity). Therapists need to address the more elusive and challenging range of issues listed above, most importantly the evidence for empathic understanding of, and giving priority to, this child’s needs by the parent/carer. An attempt must be made to give parents who have harmed their child insight into their relationship and the shortcomings in their parenting capacity, particularly in their ability to anticipate, recognise and give priority to their child’s needs. Thus the primary thrust of therapy where there are significant concerns about parenting capacity will centre around parental acceptance of responsibility for past acts and any damage done, resolution of previous trauma, management of the parent’s own emotional feelings and their capacity to recognise and respond healthily to feelings in their children. Reder and Duncan’s^[18] notion of care and control conflicts can be helpful in identifying areas for intervention that may be productive in enhancing parenting capacity.

A common thread that runs through many published approaches to parenting is the attempt to define “threshold” (above the threshold a parent is good enough, below not good enough) by the prevalence of adverse factors identified in the parent. In our experience, there is a tendency to downplay the significance of adverse factors in parenting where the child is identified as being difficult to parent. For example, when a child is diagnosed as having ADHD, we often observe tolerance of a higher number of adverse factors identified in the parenting domain in recognition of the challenge posed by the child. We have found that rather than up- or downgrading adverse factors identified in the three domains, it is more useful to incorporate them into an assessment of parenting capacity as outlined above. This allows more reliable identification of those parents whose children must be considered to remain at an unacceptable risk of experiencing further harm, independent of how challenging the child is.

Once a statutory agency has confirmed that a child has been harmed by parental behaviour, the first step of the parenting assessment is to establish the carer’s initial level of acceptance of that fact and the degree of responsibility taken either for direct harm caused to the child or failure to protect the child from some other harmful influence. The detailed discussion with parents about their harmful behaviour will provide important data about parenting capacity. We are not looking for rote expressions of remorse, but rather for statements that indicate the parents’ capacity to see the experience from the child’s point of view and to realistically appraise what might need to change for the child to thrive in their care.

Because a significant time has usually elapsed between the harmful events and the assessment, we explore the parent’s current perception of the child and his/her needs.

We do not often observe access visits or other interactions between parent and child, as we do not think parenting capacity is tested by the task of interacting positively with children during limited contact. The important requirement is that the individual can parent in adverse circumstances that are an almost inevitable part of sustained parenting. Yet it is inappropriate for a parent to have prolonged care of a child before parenting is fully assessed. Therefore, we look to other intimate relationships.

We then feed back to parents our initial assessment and our appraisal of how we perceive their ability to recognise and give priority to their child’s needs. We are particularly interested in their response to any deficit in parenting capacity that we have identified and whether we can help them towards a fuller acceptance of their responsibility for harm done to the child.

On the basis of this response, we then provide an opinion which clearly sets out:

When parenting capacity is significantly compromised, we may recommend that reunification should not be pursued. More often, we recommend a plan that will focus on steps required to address shortcomings in parenting capacity, but will also identify any areas of the child’s parentability and/or scaffolding that require attention. The first step towards reunification will be some form of therapy, either individual or family/marital, to address the blocks to an empathic appreciation of the child’s needs. Thus the focus of intervention may be: unresolved issues from the parent’s own experience of being parented; mental illness in the parent; emancipation from a situation of potential domestic violence. We acknowledge that there is no approach to the treatment of damaged parents that is well supported by systematic evidence, but this should not distract from the fact that repairing such damage is essential if adequate parenting capacity is to be restored or established.

We believe that to develop a proper understanding of child maltreatment, and to be able to make informed management decisions, particularly in relation to child safety and levels of danger, a systematic assessment of parenting is required. The primary role of such parenting assessments should be to establish the parenting capacity of the child’s carers. Parenting capacity must be the foremost determinant of the design of the therapeutic programme and of the nature of care arrangements that should continue between the child and parents. It may be the case that some less experienced practitioners will feel daunted in formulating judgments about parenting capacity in the way that we use the term. However, the expertise available in established child protection or mental health services should enable practitioners who wish to follow this approach to receive adequate training and supervision.