Parenting Capacity Assessment in Child Protection Cases

The parenting capacity assessment is an important feature of child protection cases. Psychiatrists, psychologists, and social workers with an expertise in parenting typically complete these reports.

The process used for assessment must be rigorous, thorough, and defensible. This article, by Peter W Choate, now Associate Professor, Social Work at Mount Royal University, reviews the theoretical underpinnings and the major elements that go into a competent forensic assessment in these matters.

Psychiatrists, psychologists, and social workers with a specialty in parenting are frequently requested to conduct parenting capacity assessments (PCA) in child protection matters. The essential focus of these assessments is to determine whether or not the parents are able to safely parent the child(ren). If not, the assessor must determine the interventions that might be used to assist the parents in obtaining the requisite skills or consider whether the termination of parental rights is the appropriate direction. This is a significant responsibility given what is at stake for the family.

Family preservation is a fundamental principle of child protection legislation throughout North America (Wattenberg, Kelley, & Kim, 2001). U.S. Supreme Court Justice Ruth Bader Ginsberg wrote that the ultimate recommendation by an assessor- the termination of parental rights-is the "destruction of family bonds," and it is a "devastatingly adverse action" (M.L.B. v. S.L.J., 1996 as cited in Wattenberg, Kelley and Kim, 2001, p. 406). In Canada, Justice Abella of the Supreme Court of Canada wrote:

"Families are the core social unit. At their best, they offer guidance, nurture, and protection, especially for their most vulnerable members- children. When they cannot, and the child is at serious risk, the law gives the state the right, in appropriate circumstances, to remove the child from the rest of the family for his or her own protection." (Syl Apps Secure Treatment Centre, 2007, p. 6)

Thus, courts clearly recognize that disruption of the family unit may be justifiable on a temporary or permanent basis (although the goal of most child protection service [CPS] interventions is to preserve the family unit). The role of the state in this situation places the family and the state at odds (Haugaard & Avery, 2002). The assessor holds a neutral, but very influential, position between the two. Jamieson, Tranah, and Sheldrick (1999) have reported that the courts pay significant attention to the recommendations of assessors. They were followed entirely in 73% of the cases they researched.

The assessor represents neither side, thus playing a neutral role as a consultant to the various parties that include CPS, parents, legal counsel, and judges. That does not mean that the work of the assessor is not subject to careful review. The assessor's report must be able to withstand the scrutiny of the judicial process (Dale & Fellows, 1999).

The standard typically used to assess parents is that of "good enough" or "minimal parenting capacity." The lack of a research-based, empirically driven definition of what constitutes acceptable minimal parenting capacity is an important concern in this field (Budd, Felix, Sweet, Saul, & Carelton, 2006). Lennings (2002) points out that there is no gold standard for assessment in these matters. Nonetheless, the assessor must make clear what standards the parent is being measured against. Fortunately, there are a few helpful guidelines (Reder, Duncan, and Lucey, 2003a; Condie, 2003; Dyer, 1999; Pezzot-Pearce & Pearce, 2004; Polgar, 2001; Reder & Lucey, 1995; Steinhauer, 1991).

Even though assessments are something of a snapshot in time, the conclusions must address the capacity of the parent over the long term. This is as opposed to what the parents might be able to do in the short term, such as with supervision or supports (Conley, 2003/2004). A short-term view would be inconsistent with the impressive body of literature that shows there are life-long implications to maltreatment and neglect, the important issues that typically have brought these families to the attention of CPS (Wattenberg et al., 2001).

Regrettably, there remains a lack of consensus in the literature on what this minimal standard fully encompasses (Budd & Holdsworth, 1996). To be sure, it is not about expecting parents to meet optimal standards of parenting (Benjet, Azar, & Kuersten-Hogan, 2003). It is worth noting that each family possesses an internal definition of acceptable parenting with which they operate (Woodcock, 2003) and that the assessor should uncover during the assessment.

The literature offers some guidance on the features of acceptable parenting that include a positive emotional expression by the parent to the child as well as having a child-centered approach to the relationship between them. Parents also need to provide routines, predictability, safety, and appropriate boundaries (Hurley, Chiodo, Leschied, & Whitehead, 2003). These are useful factors to consider, but it is not clear whether they can be relied upon across a variety of cultural, community, or professional standards. They at least provide a starting point.

The assessment should be designed to determine if the parent, in respect of the child (or children), can provide a safe, stable, predictable environment that will support the child in both physical and psychological development (Steinhauer, 1991). As Dwyer (1997) has stated, a child's rights "should include a claim on the rest of society to ensure that persons who enjoy the privilege of acting as their parents carry out their role in a manner that is consistent with the children's interests" (p. 166).

It may well be possible that a parent can successfully parent one child, but the nature or demands of another child are beyond that parent's capacity. Parenting is a relationship that exists between the two people (Woodcock, 2003), and each relationship is unique and exists over time. This creates the consideration of the goodness of fit that exists between these two people (Azar, Lauretti, & Loding, 1998). The assessment must consider the relationship between the parent and each child and that child's specific needs (Pezzot-Pearce and Pearce, 2004).

It is vital that assessors be well acquainted with legislation in the jurisdiction in which they are conducting the assessment. There is no value in making recommendations that are not consistent with the legislative framework, for to do so is to minimize the value of the assessment, if not to nullify it. The solutions proposed must be achievable within the legislation.

Generally speaking, child protection assessments are very complex and involve a multitude of interacting dynamics. These families operate within a complex ecological system that includes not only the direct capacity of the parent but also the functioning of the whole family system. Environmental factors, including the community in which the family functions, and the child's specific developmental needs are part of the overall picture (Gray, 2001). Thus, consideration will need to be given to the family history, the personal history of the parent, economic and social connections, the capacity of the parent to provide a healthy attachment environment, and potential allied problem such as medical, mental health, or addiction concerns. Attention must also be given to the cultural issues specific to the particular family being assessed (D'Avanzo and Geissler, 2003; Azar et al., 1998). As can be seen, issues cannot be assessed in a vacuum but as parts of an interlocking environmental system.

Reder, Duncan, and Lucey (2003b), in their revised framework to guide assessment of parenting, focus on three broad areas:

1) parent and parent-child relationship (including personal functioning, relationship to the parenting role)

2) child and child-parent relationship (including evidence of significant harm, contribution to the parenting relationship, attitude to parental figures, and sufficient understanding)

3) context (such as family functioning, social stresses, potential for stability, and relationships with others) (p. 16)

As Balsky and Vondra (1989) point out, consideration is to be given to the strengths and the weaknesses that a family may possess. This strength-based approach allows the assessor to consider ways in which parenting capacity can be enhanced and may well increase the possibilities of sustaining the family unit. Trivette and Dunst (1990) have outlined qualities of strong families that might be considered in this work. These include such things as the commitment to the well being of family members; appreciation for what each member does; commitment to spend time together; a sense of purpose in the family allowing them to keep going in good and bad times; congruence amongst family members on values and commitment to family goals; the ability to communicate effectively and to see the positives; a clear set of family rules, values, and beliefs that are tied to expectations about acceptable and desirable behaviors; a variety of coping strategies; the ability to effectively engage problem solving; positive crisis management; flexibility, adaptability, and a balanced use of internal and external resources for coping and adapting to life events.

Harland (2006) has compared some of the various models for CPS assessments. (See Table 1). There are other models, such as the Toronto Parenting Capacity Assessment Project (Conley, 2003/2004; Steinhauer, 1991; Wolpert, 2002). In the United Kingdom, there is the Framework for the Assessment of Children in Need and Their Families (Gray, 2001). Risley-Curtiss et al. (2004) offer an approach that might be used with special populations such as the mentally ill.

There are professional guidelines such as those offered by the American Psychological Association (American Psychological Association Committee on Professional Practice and Standards, 1988) and the American Academy of Child and Adolescent Psychiatry (American Academy of Child and Adolescent Psychiatry, 2007).

These models help the assessor have a research or evidence-based approach to assessment. It also provides a way to think about the various factors that need to be considered by the assessor. A failure to have a solid framework with which to work leads to serious flaws in reports. Budd et al. (2001) have noted several problems in their review of 190 PCAs. These included assessments being conducted in a single session; rarely including a home visit; using few sources of data other than the parents; not reviewing prior assessments; failing to refer to the CPS or mental health records; emphasizing weaknesses instead of strengths; failing to describe the purpose of the assessment, limits to confidentiality, and believability of information; limiting the assessment findings; failing to address the parent's care giving qualities; as well as failing to describe the parent's relationship with the child. These are serious flaws when so much is at stake. Budd (2005) has outlined a series of criteria that can be used to evaluate PCAs. These include following American Psychological Association (1998) guidelines (or guidelines appropriate to the assessor's specific profession and locale) whether or not the methods and content address parenting directly; whether referral questions are identified and answered; and whether or not the report is thorough, clear, and understandable.

Referrals
The referral is a vital piece of the assessment process. It must clearly show what requires assessing and whom is to be assessed. The assessment should flow directly from the context of the case, which should act as the basis of the referral. If the referral is weak and inarticulate, it creates a foundational error in the assessment process. This is because it has not addressed what really requires assessing (Budd et al., 2006; Pezzot-Pearce & Pearce, 2004). Indeed, it is appropriate for assessors to resist referrals that do not lay out the questions to be answered. Clarity in the referral makes for clarity in the report. Recommendations need to be clearly related to the referral questions and should flow directly from the data collected. Cases can then be formulated in ways that are directly related to the context of the case and provide all parties with useful directions upon which to proceed. The consumers of the report need to be able to apply conclusions and do so at a very pragmatic level.

The referral should make clear whom is to be assessed. For example, this author has had instances where cases have been referred, seeking an assessment of a parent, only to discover that there is another parent in the home who has not been included in the assessment. In those situations, one is being asked to consider only half of the parental unit.

Consent
The consent process should meet the criteria of informed consent. Parents have the right to refuse to consent as long as they truly understand the consequences. They may often feel, however, that there really is no option but to go through the assessment, thus feeling disempowered (Budd et al., 2006). Nonetheless, many referrals are of a more cooperative nature, where the parent has agreed with CPS that an assessment should be conducted. By engaging in the informed consent process, it allows the assessor an opportunity to not only outline for the parent what the process is going to look like but also to tease out what the parent understands about CPS involvement and the issues. Consent should include recognition that there are significant limits to confidentiality. For example, the consent should note that the report will be provided to CPS but that it is also likely to be reviewed, should there be any form of a hearing, by legal counsel involved in the case for each of the parties as well as the court itself. The parent should explicitly acknowledge this limit to confidentiality within the consent.

The consent process should meet the criteria of informed consent. Parents have the right to refuse to consent as long as they truly understand the consequences. They may often feel, however, that there really is no option but to go through the assessment, thus feeling disempowered (Budd et al., 2006). Nonetheless, many referrals are of a more cooperative nature, where the parent has agreed with CPS that an assessment should be conducted. By engaging in the informed consent process, it allows the assessor an opportunity to not only outline for the parent what the process is going to look like but also to tease out what the parent understands about CPS involvement and the issues. Consent should include recognition that there are significant limits to confidentiality. For example, the consent should note that the report will be provided to CPS but that it is also likely to be reviewed, should there be any form of a hearing, by legal counsel involved in the case for each of the parties as well as the court itself. The parent should explicitly acknowledge this limit to confidentiality within the consent.

Should a parent refuse to sign the consent then the assessment should naturally come to a halt. The parent may then exercise his or her right to take the matter back in front of a judge or to further negotiate with CPS on what is and is not required in the case.

Records
Records are an essential part of understanding the case (Reder, Duncan, and Lucey, 2003c). These allow the assessor to understand what has taken place previously, including what therapeutic interventions may have been tried, as well as the degree to which they have been successful. Care should be taken to avoid bias when reviewing records (Budd & Holdsworth, 1996).

The child protection record should be reviewed, but so should medical, school, counseling, treatment, mental health, and probation records. They all contribute to a larger understanding of the family system and the ways in which the family has interacted with the community. In my view, parents should have an opportunity to comment upon the information within the record, because there should never be an assumption that records are infallible. Parents may wish to offer their perspective, including correcting information they perceive to be inaccurate or misleading.

There are occasions when it is appropriate to ask a parent for a criminal record check if such is allowable within the jurisdiction and it is relevant to the assessment questions. Again, we see the connection between the referral questions and the assessment process.

Psychometric Testing
Psychometric testing is a controversial area within child protection parenting capacity assessments (Budd & Holdsworth, 1996; Conley, 2003/2004; Heinze & Grisso, 1996). With the possible exception of the Child Abuse Potential Inventory (Milner, 1986), there are no commonly used assessment measures that have been normed on a child protection population. The Parenting Stress Index (Abidin, 1990) has fared reasonably well in research. Yet, the CAPI has a challenge with both false positives and false negatives, while the PSI has challenges with false positives (Heinz & Grisso). This means that there are definite limits to the utility of these and other assessment measures and their applicability to the assessment. Most measures are under some level of challenge as to their relevance to the particular field of child protection. Care should be taken as to how much weight is put on the results of these measures (Reder, Duncan, and Lucey, 2003c). As these authors note, the results can create the illusion of scientific validity where it does not exist. They further note that users of these tests can develop a belief that they uncover psychopathology that is not otherwise observable.

Those assessment measures that have validity scales are the best as they assist identifying "fake good" profiles that are common in this population (Carr, Moretti, and Cue, 2005; Budd & Holdsworth, 1996). In many respects this is quite understandable given how much is at risk for these parents; thus, it can be anticipated that parents will try to present themselves in the best possible light (Budd & Holdsworth, 1996).

Cultural issues are another area of concern. Very few assessment measures have been normed on many of the immigrant populations or the indigenous peoples of North America. This further strains the credibility of these assessment measures in many cases. Clearly, unless there is a version available in the native language of an individual who is not completely proficient in English, there are real ethical concerns as to whether assessment measures should be used in those cases.

A typical assessment battery includes a personality measure such as the Minnesota Multiphasic Personality Inventory (MMPI-2) (Butcher et al.,1989) or the Personality Assessment Inventory (Morey, 1996). In addition, the Parenting Stress Index (Abidin, 1990) or its adolescent version, the Stress Index for Parents of Adolescents (Sheras, 1998), the Child Abuse Potential Inventory (Milner, 1986), and the Adult Adolescent Parenting Inventory (Bavolek & Keene, 2001) are common measures used in these cases. Specialized assessment tools may also be used, such as those pertaining to addiction when the referral questions raise such issues.

Some assessors will also complete intellectual testing almost as a norm. This remains an area of significant debate, although it probably has relevance in circumstances where the intellectual capacity of the parent is at question.

Interviews
The interview is an area of extensive inquiry designed to consider multigenerational patterns, family of origin issues, the parent's own developmental trajectory, as well as the current status of the family. When possible, the data should be gathered over several interviews. This allows the assessor to see the parent in varying presentations. Many parents are able to offer a positive impression if they need only manage a single assessment meeting. More frequent interactions tend to offer a more realistic view of how the parent handles multiple contacts and the stress that goes with them.

Wattenberg, Kelley, and Kim (2001) have noted families involved in CPS matters, particularly those with the worst prognosis, have "interlocking constellations of problems that include substance abuse, mental illness, cognitive deficiency, maladaptive parenting behavior originating in the caregivers' childhood deficiencies, early and frequent childbearing, and criminal justice incidents" (p. 423). Thus, inquiry is complex. There are several examples of the wide range of topics to be reviewed (Budd, 2001; Pezzot-Pearce & Pearce, 2004; Kuehnle, Coulter, and Firestone, 2000; Reder, Duncan, and Lucey, 2003b; Steinhauer, 2001).

If there are concerns regarding domestic violence, it is advisable to interview the parents separately. Given the dynamics of abusive relationships, there may be resistance to seeing each parent alone. The assessor may need to simply state that is the way that the protocol is done. Either way, there are risks. Separate meetings can cause the abusive partner to be suspicious of what has been said without their presence. This can, in and of itself, create risks for the abused person.

If English is not the native language of the parent, and there is any doubt about competency in the language, a translator may be required. An exception is when the assessor speaks the parent's mother tongue fluently. There are a few guidelines if a translator is used. The translator:

• Should not be a friend or relative of the parent unless there is absolutely no other choice.
• Needs to be literal in their translation. They should not be interpreting the words in a way that is perceived to be culturally desirable to the assessor.
• Should have some qualification as a translator, such as being so qualified in court.
• Should understand the rules of confidentiality.

Benjet, Azar, and Kuersten-Hogan (2003) note that in gathering the history, it is important to question one's assumptions. For example, they argue that it is wrong to conclude that, just because there is a mental illness, a parent may be automatically limited in the capacity to parent. There is evidence, however, that mental health issues often are at play in these matters (Lewis & Creighton, 1999). Assumptions and biases of the assessor impact directly upon the interpretation and weight that is given to information gathered from interviews. The facts of each case require that its uniqueness be considered as opposed to assuming that any one presentation, such as this mental health example, direct a conclusion.

Interview of the Children

When age appropriate, children should be interviewed as part of the assessment. This would allow the child to describe the relationship he or she has with each parent and perhaps the role that each parent plays in his or her life and in the home. It is always interesting to understand how the child views boundary settings within the home and to hear from the child's perspective how consequences are managed.

It is informative to hear the child's observations of how people in the family get along. Children often have unique perspectives on how such things as domestic violence or family disputes have affected them. They can also describe how they react during such episodes- a behavior pattern into which parents frequently have poor insight. Care should be taken in how the interview is conducted. The American Bar Association has published a valuable, linguistically informed approach to questioning children (Walker, 1999). Drawings can be used as a way to illicit the child's thoughts, but the weight attached to them must be carefully considered (Reder, Duncan, and Lucey, 2003c).

The assessor should be cautious when handling information as children offer a different perspective on the facts than that of their parents. If these variations are put bluntly to the parents, this may place the child at risk, particularly if there has been a history of domestic violence. It can also cause the child to recant their story, deny what he or she has said, or learn that disclosure is unsafe.

Other areas of inquiry with children might include school and extracurricular activities as well as what they recall from any counseling or in-home interventions that have previously been tried. Children can also describe how other important adults are involved in their lives and the impact that these individuals have. This might include grandparents or other extended family as well as teachers or coaches. These people may offer a source of resilience not available from their parents. The question that arises is what happens when those people are not available?

Collateral Interviews
Certain collateral interviews are well worth undertaking. For the most part, personal references from parents are rarely illustrative, as they have often been chosen simply because they will support the parental perspective. It is not uncommon for these references to be coached. Yet, I have been surprised, on occasion, by the frankness of some of these references.

Valuable collateral interviews can be conducted with physicians, therapists, teachers, and those working directly with the family. When visits are supervised, interviews with visit supervisors can also be helpful, particularly in cases where the same visit supervisor has been involved over a period of time.

When conducting such interviews, it is imperative that the individual being interviewed understands that the information gathered will form part of the record. Therefore, it can be expected that the parent will see the information. Note this in your records if the interviews are done by phone. Consents should be signed by the parent before these interviews are undertaken.

Observation
Except in cases where it would create safety concerns for the child, observing parent and child together should always form part of the assessment process. Yet research has suggested that this is not done in the majority of cases (Budd, Poindexter, Felix, & Naik- Polan, 2001). In general, it is best if these observations can take place naturalistically. As a result, if CPS permits, the visit should take place in the home. This has several advantages, including allowing the assessor an opportunity to see the normal environment in which the child lives. Children will also generally be more comfortable in their home environment. If there are inter-parental abuse concerns, each parent should be observed on his or her own visit with the children.

If the child is age appropriate, have him or her conduct the tour of the home during which you can ask what goes on in various rooms.

Some authors suggest setting up structured tasks for the family that create a moderate degree of stress (Hynan, 2006). They feel that this offers the assessor the opportunity to see how parents interact with their children in more difficult situations. Others might suggest that such activities tend to be manufactured and are clearly open to difficult questioning in court. The evening meal can be a naturally stressful time and offers good observational opportunities.

When observing infants in the home, pay attention to proximity seeking, contact maintenance between parent and child, search behavior by the child during separation, eye gaze, avoidance, vocalizing, resistance to comfort, evidence of disassociation, and approach avoidance behavior indicative of a disorganized attachment. Dyer (2004) argues persuasively that attachment or, as he terms them, bonding assessments, are an important feature of understanding the relationship between parents and children, particularly with infants and toddlers.

Although some home observation checklists do exist, there are none that have been clinically validated specific to CPS issues. Hynan (2006) has offered a review of some tools that might be used. In addition, Budd (2001) has put together a list of potential areas for informally observing parent-child interactions (p. 12). Observations need to be culturally and developmentally based.

Case Formulation
The case formulation is a summary of what has been gathered in the course of the assessment and acts as the vehicle by which the initial referral questions are addressed and recommendations are made. In preparing a case formulation, the assessor might consider the following questions:

• Is it possible for the children to safely reside in this home? If not, what might be done for this to occur?
• Is that change realistic? In other words, are the deficiencies modifiable? (Budd & Holdsworth, 1996).
• What is the past record demonstrating the parent's capacity to change?
• Can change occur within a time frame that is in the interests of the child?
• Do the parents accept that change needs to occur?
• Are the parents realistically willing to try?

When making recommendations, assessors need to bear in mind that parents can only do so much. Overloading parents with a set of activities that is beyond their ability to cope is, in reality, setting them up to fail. Thus, it may be necessary to have a phased approach to recommendations when there are many things to be done. Recommendations must be realistic.

If the prognosis is poor, recommend honest efforts at rehabilitation for the parents while also suggesting a concurrent plan for alternate long-term placement so as not to place the child at risk of simply drifting within the system (Wattenberg et al., 2001). If the termination of parental rights is being recommended, do not hedge the point. Be clear and then articulate why rehabilitation efforts are not being recommended.

Useful frameworks for laying out the report can be found in Budd (2001) Pezzot- Pearce & Pearce (2004), Steinhauer (1991), and Polgar (2001).

Conclusion
Child protection assessments are designed to determine if a child can be safely raised by the parent being assessed. There remains the possibility in all CPS cases that the termination of parental rights may occur. Thus, this is an onerous responsibility to bear for an assessor as the implications of the recommendations have widespread impacts on many lives (Budd et al., 2006). All parties deserve a competent assessment from an unbiased professional who is well versed in the issues faced with these families. A practitioner in this field must be able to manage the complexities of these families, including domestic violence, mental health, and addictions. The burden is heavy, but the implications are enormous.

It is important for assessors to follow a rigorous approach to these assessments and to ensure that reports are written from a perspective that is defensible in court. If there is a hearing, it is vital for assessors to ensure that they represent their assessment and are not biased observers for either party. A good assessor in child protection matters is one who approaches the case from a neutral perspective, answers referral questions, and does not serve the interests of either child protection or the parent. In essence, in the assessment, the focus is the child and his or her right to have a safe, nurturing environment in which to develop.