As with any other forensic evaluation, the most challeng-ing elements in the assessment of parental capacity con-cern the foregoing articulation of the specific functions in question. Once the forensic clinician has a sound grasp of the functional elements of parenting, the gathering of rel-evant clinical data is directed by that understanding. As in any other forensic evaluation, data gathering tech-niques are both clinical and investigative.
Interviewing Parents
The consultant’s interviews with the parent need to include a thorough clinical history and mental status examination to provide a sound basis for an overall clini-cal assessment. Beyond articulating cliniclini-cal history and diagnosis, interviews need to focus specifically on the variety of functional strengths and weaknesses that are relevant to parenting and to link specific weaknesses (if possible) to specific disorders. Clinical assessment needs to consider the prognosis (with and without treatment) of whatever disorders contribute to functional deficits and include in this consideration an exploration of the
parent’s own understanding of the disorder, its impact, and its treatment.
A variety of specific areas in the parent’s experience can be important to explore in taking a clinical history for a parenting assessment.
History of child abuse. It is important to explore the parent’s possible exposure to abuse or neglect in her own childhood. If there was such exposure, the interview needs to examine how she responded to it at the time, how it affected her subsequent development, and what lingering impact it may still have in symptoms of anxiety, depression, emotional instability, guardedness and isola-tion, or dissociation. A parent who experienced abuse in childhood that was recognized and that led to protective intervention and psychological treatment may have expe-rienced limited negative emotional consequences. In con-trast, a parent who experienced similar abuse but who did not get help and continued to suffer more lasting abuse, or simply contained a more limited abuse experi-ence in isolation, may have experiexperi-enced more compelling and lasting emotional consequences of the abuse.
Substance abuse and mental disorder. It is essential that the clinical evaluation of parents includes careful and thorough attention to questions of substance abuse and mental disorder. Substance abuse disorders are the most significant contributing factor to serious child abuse and neglect (Murphy et al. 1991). Mood disorders are also prevalent among parents who maltreat their children, and other mental disorders can contribute to specific parental failures as noted above.
Recent and current relationships. The parent’s rela-tionships within his or her own family of origin can be an important source of support or of ongoing disruption in emotional functioning. It can be important to explore relationships with both parents and with siblings, since in many cases there may be discord or isolation in some relationships but warmth and support in others. The par-ent’s network of friends and neighbors can be especially important. When these relationships are extensive and positive, they can have great value in providing both emo-tional and practical support in dealing with children.
When they are conflicted, suspicious, or distant, they may offer little in terms of practical or emotional help and may contribute to a parent’s overall stress and diffi-culty coping.
The parent’s relationships within the nuclear family are probably of greatest significance to parenting func-tion. The sharing of responsibility for raising children is always a serious challenge to any spousal relationship.
Partners bring different basic expectations about children
and parenthood to their relationship, and these may only emerge in the course of having children and dealing with them. A comfortable spousal relationship, with trust and good communication, can enable parents to resolve con-flicts about children in a calm and creative manner, improving their overall ability to understand and respond appropriately to their children’s needs.
The consultant should explore with each parent the history of the relationship with the other parent, includ-ing their meetinclud-ing and attraction to one another, the growth of their involvement with one another, and how they have dealt with conflict. The exploration should attend particularly to how they each have dealt with any differences regarding the children, and to how these differences have led either to increased conflict or to improved understanding and mutual support. If either parent has problems with mental disorder or substance abuse, then the other parent’s buffering of the impact of these problems on the children is especially important to explore.
Exploration of the parenting experience. Because the clinician will have limited opportunity to observe the parent’s overall dealings with the child over time and in a variety of contexts, it is important in the interview con-text to try to learn as much as possible directly from the parent about her own specific functioning as a parent.
This exploration is structured around a basic history of the child’s development and functioning.
The parent’s experience of the child’s conception can have an impact on the parent’s overall feeling about the child. If the child was unwanted, the parent may be more prone to relate poorly to the child; if the child was conceived by rape, the parent may face special challenges in establishing an emotional connection. At the other extreme, some parents of children conceived as a result of extraordinary efforts may experience high levels of stress around the conception and pregnancy, may have trouble relaxing with the child, and may set especially high expectations for the child, leading to ultimate frus-tration and conflict (Rojo-Moreno et al. 1996).
The nature of the parent’s initial attachment to the child may have an impact on the development of an enduring sense of closeness with the child (Kumar 1997;
Minde 1986). Exploration of the parent’s account of the infant period focuses on the parent’s adjustment to hav-ing a new baby, includhav-ing such challenges as getthav-ing enough sleep, establishing the child’s schedule, helping older siblings to adjust to the baby, and coming to appre-ciate the infant’s temperament. It is valuable to question parents about how they have coped with stresses, such as
a fussy or colicky baby, the child’s medical problems, and the parent’s own mood changes, and to ask for an account of the process of getting to know, understand, and relate to the baby as an individual.
In asking about toddler development, it is important to consider the parent’s recognition of basic progress in motor and language development. Insight into parental discipline comes from the parent’s account of how he or she has established regular behavioral routines with the toddler, taught the child about safety, and responded to the child’s discovery of saying no and temper tantrums.
A parent’s sensitivity to and response to the toddler’s insatiable curiosity can provide some indication of his or her support for the child’s cognitive development.
Examination of the parent’s experience with the school-age child focuses especially on support for school and social functioning and on the growth of independent responsibility in managing those tasks and chores at home.
Questioning the parent about the child’s interests and friends can provide information about the parent’s con-tinuing awareness of the child’s activities and about the degree of breadth and sensitivity in the communication between parent and child. Similar themes inform the par-ent interview regarding the adolescpar-ent, but with more focus on the parent’s means of developing an appropriate balance of independence with disciplinary supervision, and on the parent’s recognition and adjustment to indica-tors of the adolescent’s developing genuine independence.
Regardless of the child’s age, some specific issues are always worth exploring when interviewing parents. The consultant needs to ask the parent about his or her under-standing of the child’s progress in reaching developmen-tal expectations and about any special needs the child may have. How clearly and accurately does the parent understand the nature of any problems, and what is his or her plan for responding to them? If services for develop-mental delay, learning disability, develop-mental disorder, or med-ical problems are in place, how does the parent experi-ence and use those services?
It is always instructive to ask parents about their approach to discipline. What theoretical basis do they have for discipline, what specific practices do they use to shape the child’s behavior, and what expectations of the child inform these practices? Where did the parents learn this approach to discipline, and what is their sense of how well it actually works?
A useful approach to filling in details about parenting function is to ask the parent to describe some daily rou-tines in as much detail as possible. For example, on a school day, when and how does the child get up, get dressed, have breakfast, and get to school? What is the
parent’s specific role in those activities? What is the spe-cific routine for after school, dinnertime, evening, and bedtime? How are weekends different? What other vari-ations seem to make a difference? When does the child get together with friends and extended family, and how is the routine adjusted to those relationships? Asking the parent to describe both favorite and difficult times with the child can sometimes shed important light on the emotional quality of the relationship with the child.
A mother whose favorite times with the child are when the child comforts her when she is upset probably has a different overall emotional relationship from one whose favorite time involves the child posing questions about his experiences at school or with friends, which lead to them talking at length about the child’s concerns.
Finally, parent interviewing should always include specific attention to how the parent shares responsibility for parenting with others. How do the other parent, extended family members, friends, child care providers, and others contribute to the parent’s ability to provide for the child? Are they helpful and supportive or critical and undermining? What specific help do they provide and with what reliability? What problems (if any) charac-terize their relationships with the parent?
Interviewing Children
Ideally, thorough assessment of parent capacity will include directly interviewing the children involved. The child’s individual characteristics can be important to an appreciation of how the parent needs to deal with the child, and the child’s perspective on the relationship with the parent will usually add to the understanding of that relationship. The consultant should attend to the follow-ing concerns in child interviews.
Thorough history and mental status examination.
As with the parent, interviewing the child should include a thorough history and mental status examination. It is critical to determine what particular individual charac-teristics in the child the parent needs to understand and respond to. A child with a mental or developmental dis-order will present special challenges to the parent, in both advocacy for treatment and special education and socialization. In order to appreciate the nature and depth of those challenges, the assessment of the child needs to note the child’s overall cognitive and emotional function-ing and any special concerns regardfunction-ing discipline that may arise, such as with an impulse control problem or a dis-ruptive behavior disorder.
Children who have experienced trauma present additional challenges to the assessment process. Beyond
the issues of the specific nature of abuse or neglect a child may have experienced (which will be addressed below), the assessment needs to understand the child’s emotional response to the trauma in order to appreciate what parental response will be most important for the child’s recovery. If the child has suffered abuse or neglect by the parent in question, the assessment needs to take a careful account of the child’s emotional reaction to this abuse.
The child may experience continuing high levels of anxi-ety about the parent, which may be exacerbated simply by being in the parent’s presence. Alternatively, the child may experience a strong traumatic attachment to the parent or a sense of having to care for the parent to com-pensate for the parent’s problems. These different emo-tional responses would call for different responses from a parent to promote the child’s well-being.
Fact explorations. Sometimes the assessment of parental capacity needs to include clinical interviewing of the child in an attempt to clarify the basic fact questions about what sort of abuse or neglect the child may have experienced, and by whom. The technical issues in inter-viewing children for fact questions are covered in Chap-ters 14, “Reliability and Suggestibility of Children’s Statements,” and 15, “Interviewing Children for Sus-pected Sexual Abuse.” Key elements include establishing a supportive but objective relationship; encouraging the child to communicate without a sense of pressure; avoid-ing specific leadavoid-ing questions; askavoid-ing open questions, which encourage the child to describe his experience in his own terms; asking clarifying questions; and asking more specific questions if needed, recognizing that the more specific and leading the questions, the less reliable the child’s account will be, both legally and clinically.
Specific issues regarding parental functioning.In addi-tion to specific fact quesaddi-tions concerning the child’s abuse history, the interview of the child can address other aspects of the child’s relationship with the parent that may be relevant to parental functioning. The consultant can ask the child general questions similar to those asked of the parent, regarding favorite events, special times, problems in the relationship with the parent, and daily routines, as a way to gain general information on the qual-ity of the parent-child relationship. Appropriate ques-tions concerning discipline include asking the child about what rules apply in the family and what specific rewards and punishments (if any) apply to various behaviors. The child can also provide information about the parent’s role in helping with schoolwork, with daily tasks, and with other cognitive learning.
Medical and Psychological Tests
Medical. In cases in which clinical assessment suggests that medical or neurological problems may be contribut-ing to parent incapacity, it may be helpful to undertake specific testing to clarify the diagnostic issues. Tests of blood cell counts, thyroid and adrenal function, and other metabolic functions can contribute to the recognition of functional deficits in parental energy and emotional reg-ulation that may be quite treatable. In rare cases a par-ent’s deterioration in functioning may result from organic brain pathology requiring neurological assessment with special imaging techniques. As with other test results, the results of all such tests need to be made relevant to the specific functioning of the parent; abnormalities should not be understood as significant in themselves without such interpretation.
Psychological. The uses of psychological testing in forensic assessment are covered extensively in Chapter 6,
“Psychological Testing in Child and Adolescent Forensic Evaluations.” In assessing parent capacity, it is most important to appreciate the empirical validity of various tests and to ensure that test results are relevant to spe-cific areas of functional strength or deficit. Tests of per-sonality functioning may be especially helpful when a parent is not forthcoming in interviews, but results need to be interpreted cautiously.
Behavioral Observations
The final source of direct clinical assessment of parental capacity is direct behavioral observation of the parent engaged in specific activities in situ.
Home visits. A visit to the parent’s home can provide important information about elements of functioning that may not be otherwise available. Visits provide a more immediate sense of the parent’s neighborhood than the consultant might otherwise have and more direct cur-rent impressions of the pacur-rent’s housekeeping capacities than are available from a protective services investigation.
How the home is configured may provide some indica-tions of the parent’s style and priorities: whether a parent has made provisions for privacy in a crowded space pro-vides some information as to the parent’s respect for intergenerational boundaries; whether a child has a quiet space available to do schoolwork tells something about a parent’s concern for the child’s learning. The specific pic-tures of family members and others on display in a home can tell something about whom the parents care about.
Parent-parent interactions. When parents live together or otherwise interact significantly with one another
around the child, it is important for the assessment to include some direct observation of their interaction with one another. Such observation may be part of ordinary conjoint clinical interviewing, but if the interviewer is too structured or directive in the interview process, then spontaneous interaction between the parents will not be observed. The consultant should be especially interested in what specific attitudes about the child each parent conveys, how each contributes to the conversation with one another, how conflict between them emerges, and whether the parents explore and resolve conflict con-structively, ignore it, or build it into more substantial strife. The consultant should be cautious about encourag-ing conjoint interviewencourag-ing or other direct observation of parent-parent interaction in situations involving inter-parental violence (Lerman 1984).
Parent-child interactions. Direct observation of inter-action between the child and the parent can happen in an informal home visit. If the child is in foster care or other out-of-home placement, it can happen at a scheduled parent-child visit.
The consultant should notice as carefully as possible the specific interaction between parent and child. It is more useful in articulating parental functioning to describe how the parent initiates various interchanges and how the parent responds to various behaviors in the child than simply to characterize the interaction as
“good” or “warm” or “distant.” How do parent and child use the visiting time together? How does the parent structure the time, if at all? How well does the parent notice and respond to cues in the child of the child’s feel-ings and desires?
In attending to the quality of the emotional interac-tion between parent and child, the consultant should notice how the child and parent initially greet one another and how the interaction develops from there.
When a child is initially anxious or cautious about open-ing up with a parent, the parent may feel hurt and respond in a defensive manner, inhibiting further close-ness, or the parent may try to overwhelm the child with exuberant enthusiasm. Sometimes either of these extremes will lead to an overall interaction of consis-tently poor quality, but sometimes a different initiative by parent or child will succeed in breaking through; it can be helpful in planning further services for the family to notice what seems to work well and what does not in the repertoire of interactions.
It is important to note how well the parent super-vises the child. Does the parent simply allow the child to do what the child wants, or does the parent direct the child’s activities? Does the parent ensure that the child’s