Finally, ideally the consultant should be aware of the local laws and regulations governing child abuse and neglect matters and should try to determine at the time of refer-ral whether there are specific legal findings at issue.
Potential findings include determinations of parental fit-ness according to specific factors that may be articulated by statute or case law or of what treatment services might constitute “reasonable efforts” to make in trying to return a child to a parent’s custody (McCarthy et al.
1999). When such specific issues are at stake, the con-sultant is far more useful (and may have a much less com-plicated assessment to perform) if those issues are made clear at the start and if the assessment focuses on addressing them.
CASE EXAMPLE EPILOGUES
Case Example 1
The court temporarily awarded custody of the child to the agency but referred the case for clinical evalua-tion to a bilingual psychiatrist from Central America.
The psychiatrist enabled Ms. Alvarez to recount her traumatic experiences of immigration and her symp-toms of postpartum depression and helped her to engage in treatment supported by the agency. Her condition improved substantially with the help of treatment and encouragement for her developing
social supports, with specific improvements in energy, warmth, and relatedness with the baby observed at visits. The child was returned to her care after 3 months.
Case Example 2
Clinical evaluation of Mr. Brown found a history of neglect by his family in childhood and experiences of abuse when he was in foster care; mild mental retar-dation along with a somewhat guarded interactional style, but no other clear psychopathology, and close and caring relationships with each of the three chil-dren. Observation of Mr. Brown’s interaction with the agency caseworker noted the worker’s rapid, brusque manner and the elaboration of complex tasks in the service plan, which Mr. Brown did not understand.
Articulation of Mr. Brown’s cognition and background along with specific recommendations for communi-cating in a simpler and more supportive style led to some improvement in the relationship between Mr.
Brown and the agency, and marginal improvements in service compliance. The clinician could not make an ultimate recommendation as to custody but was able to articulate expectations regarding the children’s likely progress 1) if they remained in foster care or 2) if they returned to Mr. Brown. The court took those expectations into account in its ruling on cus-tody.
Case Example 3
Ms. Green maintained visiting contact with her child, but the child showed increasing anxiety at visiting times, withdrew from her mother, and showed more anxiety and regressed dependence with her foster mother, who hoped to adopt her. Careful evaluation of parental functioning showed that Ms. Green related well with her child at visits, but also found her continuing to be vulnerable to emotional disorganiza-tion. The consultant noted that her child had devel-oped a strong bond with the foster mother, and averred that Ms. Green would not be able to respond successfully to the emotional harm her child would experience if separated from the foster mother. The legal standard in the case allowed the court to find Ms.
Green unfit on this basis, and her child was adopted by the foster mother.
ACTION GUIDELINES
A. Establish the context and question(s).
1. Identify referral source; clarify and negotiate referral question(s).
2. Establish the expected database for the clinical evaluation.
3. Understand the legal issues and standard(s).
B. Conduct the evaluation.
1. Obtain existing records.
2. Meet with parent(s):
a. Establish expectations about confidentiality, dissemination, and legal use.
b. Establish comfortable and valid communica-tion.
3. Obtain additional records.
4. Meet with children and others, if indicated.
5. Arrange for specialized testing, if indicated.
6. Observe visits and home when possible.
C. Report findings, opinions, and recommendations.
1. Gather documents, notes, tapes, and other sources.
2. Write up clinical and forensic data sections.
3. Review what you have written, and write a clinical summary.
4. Write opinions:
a. Answer referral question(s).
b. Address the 4 H’s.
c. Avoid fact-finding and nonclinical recommen-dations when possible.
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