Child Evaluations in Abuse, Neglect, and Dependency Cases

1. Child Evaluations in Abuse, Neglect, and Dependency Cases Mark D. Everson, PhD

2. Who is the Client? • For parental competencies, the client may be the Court or Department of Social Service. • For child evaluations, the client is most frequently the Department of Social Services.

3. What Are DSS Needs? • Objective expert opinion to aid their decision about the A/N/D issue in question. - Testimony and/or report that is admissible and legally defensible. • Expert input on treatment and intervention needs to aid case planning.

4. What Are DSS Needs? Forensic role: • Objective expert opinion to aid their decision about the A/N/D issue in question. - Testimony and/or report that is admissible and legally defensible. Diagnostic role: • Expert input on treatment and intervention needs to aid case planning.

5. Pitfalls in Meeting DSS Needs • Providing expert opinion w/o usurping DSS role and responsibility • Ensuring that evaluation supplements rather than supplants the DSS investigative process • Role of Crawford ruling in limiting admissibility of “forensic” evidence • Limitations of diagnostic process in identifying etiology and resulting limitations in treatment planning

6. Common Types of Child Evaluations in Abuse and Neglect Cases Diagnostic: • Child mental health evaluations • Developmental evaluations • Parent-child attachment evaluations Forensic: • Child forensic abuse evaluations Hybrid: • Child-Family Evaluation Program (CFEP)

7. Child Mental Health Evaluations • Purpose: identification of significant psychological or cognitive impairments • Components: psychological testing clinical interviews • Providers: MA level psychologist or higher • Limitations: diagnosis-driven reliance on client self report

8. Developmental Evaluations • Purpose: identification of developmental delays or irregularities in children yrs. 0-4 • Components: parent interviews developmental testing observations • Providers: MA level professional with specialized training • Limitations: reliance on parent report etiology not well addressed

9. DEVELOPMENTAL ASSESSMENT • BASC – 2 – Behavior Assessment System for Children, Second Edition. For children 2 and up comprehensive system that includes scales for parent, child and teacher, plus a student observation scale. • CBCL – Child Behavior Checklist. For children age 2 ½ – 18 years. Assesses behavior problems and adaptive behaviors. Rating scales for parent, adolescent and teacher.

10. DEVELOPMENTAL ASSESSMENT CONTINUED • ITSEA and BITSEA – Infant Toddler Social Emotional Assessment – for children 1 – 3 years. Completed by daycare provider and a parent. • TSCYC – Trauma Symptom Checklist for Young Children – for children ages 3 – 12 years to assess trauma specific symptoms. Completed by parent or caregiver. Separate scale for self report for 8 – 12 year olds.

11. Parent-Child Attachment Evaluations • Purpose: assessment of quality and security of attachment relationship • Components: observations of parent/child interaction parent interview • Providers: PhD or MA level with specialized training • Limitations: limited number of trained evaluators (Demand  Supply)

12. ATTACHMENT IS: • A biologically based need, separate from other needs, that cannot be delayed or deterred. • The process of creating a mental representation of the caregiver. • Template for future relationships including friendships, intimate relationships and parenting relationships.

13. WHAT FOSTERS AND MAINTAINS A SECURE ATTACHMENT? • Cumulative experience of responsive care in a variety of contexts. • “Time, well spent, together.”

14. INFANTS: • Typically form attachments to both parents by 6-9 months. • May form different types of attachments to each of their parents. • Cannot form an unlimited number of attachments – less than a handful.

15. ATTACHMENT ASSESSMENT • Strange Situation – primarily infants (12-18 months but can be used with preschoolers with modifications) • Attachment Q – sort – ages 1- 5 years • Narrative Story Stem Technique – preschool to elementary age • CAI – Child Attachment Interview – middle childhood • AAI – Adult Attachment Interview – adolescents and adults

16. “Answerable” Questions in Child Diagnostic Evaluations • Does the child have a mental health diagnosis or definable psychological impairment? • What are the strengths and weaknesses of the child? • What therapeutic or other intervention might be useful? • Does the child have a diagnosis/ impairment/ symptom pattern consistent with abuse or neglect?

17. “Unanswerable” Questions in Child Diagnostic Evaluations • Has the child been abused or neglected? • What is the cause of the child’s diagnosis/impairment?

18. Child Forensic Abuse Evaluations • Purpose: assessment of maltx allegations • Components: record review forensic interviews of child and caregivers collateral contacts • Providers: PhD or MA level with specialized training/supervision • Limitations: cooperation of various parties skill level of evaluator

19. Child/Family Evaluation Program (CFEP) • Replaces Child Mental Health Evaluation Program (CMHEP) (1986-2006) • Established in 2001 • Formerly called Child Forensic Evaluation Program (CFEP) • 100+ rostered providers throughout the state

20. Child/Family Evaluation Program (CFEP) Designed to assist CPS in decision making and case disposition Conducted using “forensic” standards in order to enhance potential utility as needed in civil A/N/D proceedings Limited to cases that have not been, or are unlikely to be, determined through standard CPS investigative process or through medical evaluation.

21. Premises Underlying CFEP • Knowledge of etiology is generally necessary for effective treatment planning. • DSS cannot make effective treatment or intervention plans without first addressing the likelihood of abuse or neglect • A “hybrid” evaluation that addresses both the likelihood of abuse/neglect and treatment needs is necessary

22. Typical CFEP Referral Questions 1a. Is it likely that this child has experienced abuse and neglect? If so, what is the likely nature and extent? Who is the likely perpetrator? OR 1b. Is this child at risk for abuse or neglect with current caregivers? 2. Given concerns about abuse: What are recommendations for intervention or treatment?

23. CFEP: Program Exclusions Child Mental Health Evaluations Custody Evaluations Psychological Treatment Court Testimony

24. CFEP: Standards of Practice Forensic Standards- Methods and procedures- Hypothesis testing- Documentation- Verification/corroboration- Avoidance of conflicting roles

25. CFEP: Standards of Practice (cont.) Expected Evaluation Components - Record review- Two or more child interviews and documentation- Interviews with primary caretaker(s) and collaterals- Interview with alleged perpetrator

26. Current Reappraisal of Appropriate Conclusions for CFEP Evaluations • General acceptance: - “Child’s statements and behaviors are consistent with ….” - Listing of relevant hypotheses with none chosen as most likely • Debatable: - Opinion about probability of abuse - Listing of relevant hypotheses with one chosen as most likely

27. Contrast Between Child Forensic Abuse Evaluations and CFEP Evaluations Identifying abuse for legal purposes vs. Identifying abuse for more effective treatment/ intervention planning

28. COMMON EVALUATION ERRORS One-shot interview of child “If I didn’t see it or hear it, it ain’t so”syndrome Failure to consider impact of unsupervised contact with alleged perpetrator on disclosure process Faulty analysis of child’s statements about abuse

29. CASE OUTLINE Family structure: 4 year old girl Mother Live-in boyfriend Allegation: Fondling by mother’s boyfriend during bath time, based on child’s spontaneous statement to preschool teacher: “Thomas washes me too hard and it hurts my peepee.”

30. Mother’s interview: Thomas occasionally bathes child in tub Doubts allegations Thomas’ interview: Bathed child in tub on only 1 occasion Has never touched child’s genital area

31. Child’s interview: Thomas has never given her a bath No one, including Thomas, has ever touched her genitals Evaluation Findings: No sexual abuse, based on child’s denial Any problems with this analysis?

32. COMMON EVALUATION ERRORS(continued) Failure to consider alternative explanations for recantation Interviewing parent figure regarding allegations in presence of child Failure to interview alleged perpetrator “He said/she said” surrender