Parenting capacity 001

∗ Correspondence to: Dr T. Donald, Director, Child Protection Service, Women’s and Children’s Hospital, 72 King William Road, North Adelaide, 5006, Australia. Tel: 618 8204 7245, Fax: 618 8204 6062. E-mail: donaldt@wch.sa.gov.au

Terry Donald*

Child Protection Service Women’s and Children’s Hospital North Adelaide, Australia

Jon Jureidini

Department of Psychological Medicine Women’s and Children’s Hospital North Adelaide, Australia

Parenting Capacity

We describe an approach to the assessment of parenting for families in which child abuse has been established to have occurred. Neither the category of abuse nor its physical severity adequately predicts the future wellbeing or safety of an abused child. The critical variable in determining the child’s future is the level of disturbance in parenting. We argue against the most common approach to assessments of parenting, which is to generate a non-hierarchical list of issues with the emphasis on relatively concrete and readily measurable dimensions such as social support, parental knowledge about parenting and the child’s developmental status. We enhance the standard approach to assessment by organizing it around parenting capacity. We do not attempt to operationalize parenting capacity, defining it as the parents’ ability to empathically understand and give priority to their child’s needs. Adequate parenting requires that the parents be able to meet the challenges posed by their particular child’s temperament and development (which may be shaped by the abusive experience) and also to accept and be prepared to address their own intrinsic characteristics which impede their parenting capacity. Parenting capacity is more difficult to assess than the more concrete and commonly measured aspects of parenting, but we argue that its assessment should be central to child protection management decisions. Copyright © 2004 John Wiley & Sons, Ltd.

KEY WORDS: parenting; reunification; assessment; empathy

A

ny significant abuse experienced by a child has a psycho-logical component, and the extent of the psychopsycho-logical harm accompanying abuse is not always readily apparent. Child protection legislation and practice now reflect this situ-ation by de-emphasizing categorical definitions of abuse in favour of regarding children as having been abused when they are significantly harmed by parental behaviour. This changed position recognizes 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 (Reder and Lucey, 1995), many clinicians find the idea of

‘The parents’

ability to

empathically

understand and

give priority to

their child’s needs’

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 ac-knowledge that some practitioners will use parenting assess-ment as part of the overall assessassess-ment process which leads to abuse confirmation. We believe that confirmation of abuse is important prior to the commencement of the parenting as-sessment 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 (e.g. 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 cap-acity to provide empathic, child-focused parenting. Such an approach escapes from the limitations of those parenting assessments that infer judgements about parenting from too narrow an information base (for example: microanalysis of videotaped interactions (Osofsky and Connors, 1979); ratio of child-centred to child-directive behaviours ( Jenner, 1992)), or those that focus on specific aspects of a parent–child rela-tionship. For instance, the Adult Attachment Interview (AAI) has been used to assess parenting (e.g. Adshead and Bluglass, 2001), and while the data generated in the course of the AAI will be useful in making judgements about parenting capacity, there is no clear relationship between attachment categories and parenting capacity. We agree with Reder and Duncan (2001) that it is unwise to speak of parenting purely in terms of attachment theory.

Further, recently published systematic approaches to the assessment of parenting (Browne, 1995; Gray, 2001; Azar et al., 1998) 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 rela-tive individual importance. For example, Gray (2001) reports on the British Department of Health’s Framework for the

‘The parent’s

capacity to provide

empathic,

child-focused parenting’

‘Unwise to speak

of parenting purely

in terms of

Assessment of Children in Need and their Families, 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 realize 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 appro-priately 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 Framework for the Assessment of Chil-dren in Need and their Families (Department of Health et al., 2000) However, we differ radically in the emphasis that we give to parenting capacity, our first priority in assessing par-enting being specifically to assess the adequacy of the emo-tional 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 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 high-light the need to ‘link parent’s individual skills/deficits with their capacity to parent a particular child’ at a particular develop-mental 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 emphasizing the core issues, they take an exhaustive ap-proach 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

‘Specifically to

assess the adequacy

of the emotional

relationship

between parent

and child’

identifies the strengths and weaknesses of assessed parents but does not specifically relate these factors to the overall perform-ance 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 pro-cesses 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 utilized 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 characterizes many parenting assessments must be organized around an appraisal of the parent’s ability to recognize 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.

The Primacy of Parenting Capacity

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 recom-mendations 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 ac-cess 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 in-capacitating 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 (Jones, 1997).

The quality of parenting is reflected in an adult’s ability to recognize 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 in-formation 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 prob-lems. In our approach we ask:

1. _{How well could these parent(s) perform the tasks required of}

them given optimal circumstances?

The information gained from the domain of ‘parental factors’ gives some guidance to the areas where parenting perform-ance might be impaired, for example a history of significant childhood abuse. Parenting capacity may indirectly refer to how people go about the parenting tasks required of them but it primarily relates to the psychological qualities they bring to those tasks. Therefore, the crucial concerns are:

•

The parent’s ability to create and sustain intimate rela-tionships with their child within which the needs of that child can be empathically recognized and met. Being able to identify the child’s needs does not guarantee adequate parenting. The parent must also be able to give priority to those needs, if necessary at the expense of meeting his/ her own needs. Thus a mother might have to exclude a potentially violent partner from her house to protect her children, even if this robs her of intimacy and support. An indication of the parent’s capacity for intimacy with the child can be gleaned from the quality of the intraparental relationship, particularly with regard to dependency, dis-harmony and levels of violence.

•

The parent’s awareness of the potential or actual effects of adverse relationship stresses on their child; in par-ticular, the various forms of family violence.

•

The parent’s ability to avoid dangerous impulsiveness and to take responsibility for their behaviour. The ability of an individual to take responsibility for their day-to-day activities might not be tested until they become parents/ carers.

These psychological qualities are relatively fixed, but not immutable. Change in parenting capacity is personal level change and therefore is unlikely to be achieved just by educational input. Someone who has undergone a signific-ant change in parenting capacity is likely to be perceived by self and others as a changed person. While having children might expose deficiencies, we have seen cases where a woman with apparently limited parenting capacity

‘How well could

these parent(s)

perform the tasks

required of them

given optimal

circumstances?’

‘Change in

grows through the experience of childbearing to the point that she is then able to provide good parenting.

2. _{How difficult is this child to parent?}

Some developmental phases are more demanding on parents than others, and some children are more difficult to parent than others. Of course, one reason a child is more difficult to parent is because harm has occurred through abusive parenting. Our assessment establishes the ‘parentability’ of this child in this family and identifies which aspects of parentability are most amenable to modification. Like Azar et al. (1998), we look to see if parents are able to operate in the child’s ‘zone of proximal development’, espe-cially when increasing desire for autonomy renders their child more demanding of their tolerance and containment. Factors affecting a child’s parentability are not always intrin-sic to the child, for example any idiosyncratic meaning that a particular child might have to a caregiver, such as reminding the mother of her former violent partner or sexually abusive father (Reder and Duncan, 1995). Such meaning will alter the parentability of that child for that mother, without imply-ing anythimply-ing about the primary intrinsic qualities of the child.

3. _{What is the level, nature and context of the}

socioenviron-mental structural support (‘scaffolding’) in which parenting is occurring?

Scaffolding includes such qualities as knowledge about practical parenting skills, as well as external factors such as the availability of family, community, professional and statutory supports. Adequate parental functioning is always at risk of being compromised when there is an inadequate parenting scaffold in place, and an important task of assess-ment is to establish whether parenting capacity will be sig-nificantly aided by scaffolding provisions. Giving priority to parenting capacity is not to diminish the importance of scaf-folding or to suggest that the two are independent. As Azar et al. (1998) point out, the expression of parental skills can be enhanced or diminished by environmental resources. However, it must be accepted that no amount of scaffolding can correct fundamentally flawed parenting capacity. For example, someone whose parenting capacity is compro-mised by drinking to the point of intoxication most days, will gain little from learning practical parenting skills. However, a mother living in poverty who has difficulty making sense of and meeting the needs of her demanding disabled child might have her parenting capacity enhanced to acceptable levels by the provision of, for example, respite care and financial support. (See Table 1.)

The Relationship of Parenting Capacity to the Child’s Parentability and Available Scaffolding

Carers in whom parenting capacity is potentially adequate and who are responsible for a child who is difficult to parent

‘No amount

of scaffolding

can correct

fundamentally

flawed parenting

capacity’

Table 1. Factors to be considered in assessing parenting 1.Primary domain: parenting capacity

•

Capacity to form healthy, intimate relationships, as manifest by:

⇒ recognition of the child’s needs and the ability to put them before parental needs and wants

⇒ awareness of the potential effects of relationship stresses on children

⇒ ability to take responsibility for personal behaviour, including the abuse

⇒ capacity to avoid dangerous, impulsive acts

•

Acceptance by the abusive parent of their primary responsibility for providing a safe environment for their child

•

Awareness by the parent(s) of the possible effects of their own experience of being parented

•

Provision of physical and emotional care appropriate to the child’s developmental status

2.Modulating effects: child’s parentability

•

Any disability, illness or emotional disturbance either prior to, or as a result of maltreatment

•

Degree to which the child’s emotional state has been compromised by the maltreatment. This will be influenced by the child’s preexisting wellbeing and developmental status, the nature and frequency of the abuse involved and the relationship between the child and the abuser

•

Developmental age of the child at the time of the abuse

•

Any idiosyncratic meaning that a particular child might have to a caregiver 3.Modulating effects: scaffolding for parenting

•

Knowledge base and parenting experience

•

Support that parents are able to give each other in parenting

•

Support or distress from extended family and other external sources

•

Use of alcohol and other drugs

•

Financial stresses

•

Positive and negative effects of involvement in the legal system

•

Relationship between parents and professionals (past and present), including readiness to accept professional help, and responses to previous professional attempts to help

may not achieve their potential because of a lack of adequate scaffolding or the presence of significant environmental adver-sity, both factors negatively influencing the psychological quality of the parent–child relationship.

•

The family of a young single mother with potentially ad-equate parenting capacity might need to be protected from the adverse influence of the mother’s own intrusive and demanding mother

•

Parenting capacity might be diminished by physical tiredness due to lack of practical support in the care of children who are difficult to parent

Merely addressing the adverse components of each of the domains of parenting risks overlooking the primary com-ponents of parenting capacity. For instance, inadequate phy-sical 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 recognize or give priority to the child’s psy-chological needs. The former should be seen as a problem of scaffolding for parenting, the latter as a problem of parenting

‘May not achieve

their potential

because of a lack

of adequate

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 as-sessing 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 overlook-ing harmful parentoverlook-ing and incorrectly concludoverlook-ing 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 educa-tional 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 relation-ship and the shortcomings in their parenting capacity, particu-larly in their ability to anticipate, recognize 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 recognize and respond healthily to feelings in their children. Reder and Duncan’s (2001) notion of care and con-trol conflicts can be helpful in identifying areas for interven-tion that may be productive in enhancing parenting capacity.

Practical Application

A common thread that runs through many published ap-proaches 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 toler-ance of a higher number of adverse factors identified in the parenting domain in recognition of the challenge posed by the

‘A tendency to

downplay the

significance of

adverse factors in

parenting where

the child is

identified as being

difficult to parent’

Process summary Step 1

Confirmation of harm due to abuse by a statutory agency Step 2

Establish carers’ initial level of: acceptance that harm has occurred; + responsibility taken for harm

Step 3

Conduct parenting assessment that establishes parenting capacity

Step 4

Elicit carers’ response to the negative aspects of parenting capacity

Step 5

Gauge the influence of the assessed parenting capacity on the carers’ level of acceptance of responsibility for harm (as de-fined in Step 2)

Step 6

Provide a final opinion which: — Reiterates the established harm

— States the initial level of responsibility taken by the carers for the harm done

— States the assessed parenting capacity and the consequen-tial carers’ response

— States the subsequent level of responsibility taken by the carers for the harm done to the child

child. We have found that rather than up- or downgrading adverse factors identified in the three domains, it is more use-ful to incorporate them into an assessment of parenting cap-acity 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, inde-pendent 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 im-portant 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.

Case 1. A mother was seeking custody of her 7-year-old child who had been in the care of his maternal grandparents for 4 years after she had grossly neglected him during years of heavy drug use. By the time we saw her, she was expressing strong positive feelings towards her son, had not used illicit drugs for 3 years, had been pronounced well by a senior psychiatrist; furthermore, the boy presented no particular parenting chal-lenges. Yet, in the course of our assessment, we were discour-aged by the fact that the mother did not see her son’s separation from his grandparents (were he to come into her care) as a potential problem for him. This observation sug-gested to us that, for all her other improvements, she had not learnt to recognize his emotional and developmental needs. We therefore recommended that a potentially lengthy phase of further therapy was required before reunification could proceed further.

Case 2. A young infant was admitted with a fracture disloca-tion of one elbow and several metaphyseal fractures. No ex-planation was proffered to account for the injuries, which were judged to be inflicted. A ‘standard parenting assessment’ which surveyed the three domains (parental factors, child factors and environmental factors) failed to identify the presence of any major adverse factors in any of the domains. The parents were

well educated, had good supports and the child had no handi-caps. When the injuries were reviewed with the parents, the child’s father was clearly distressed, seeking reassurance that the pain resulting from the fractures would not affect the baby long term. However, the mother seemed not to share his re-action, only expressing concern as to what disease the baby must have to cause such fractures. Further careful exploration failed to identify any capacity for the mother to feel what it must have been like for the baby. Thus, while the ‘standard assessment’ did not identify any grounds for concern, we concluded from the mother’s lack of empathy for the baby that her ongoing care of her infant, in the context of the un-explained inflicted injuries, would continue to expose the baby to high risk of further harm.

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.

Case 3. Our concerns about one mother who had severely damaged her son were attenuated by the fact that, in the 2 years since the abuse, she had developed and maintained her first satisfactory intimate relationship with a man who had successfully raised two older children. Scaffolding from this relationship seemed to have facilitated her ability to make fundamental change in a way that enhanced her parenting capacity. Thus, she could now talk with a degree of depth and empathy about her new partner and his children, and about her own child and the damage that she had done to him.

We then feed back to parents our initial assessment and our appraisal of how we perceive their ability to recognize 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:

1. The confirmed harm suffered by the child, the level of responsibility taken by parents and our assessment of parenting capacity

‘The individual can

parent in adverse

circumstances that

are an almost

inevitable part

of sustained

parenting’

2. The parent’s response to our assessment; and 3. A recommended management plan

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 appre-ciation 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.

Conclusion

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 es-tablish 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 arrange-ments that should continue between the child and parents. It may be the case that some less experienced practitioners will feel daunted in formulating judgements about parenting capacity in the way that we use the term. However, the exper-tise available in established child protection or mental health services should enable practitioners who wish to follow this approach to receive adequate training and supervision.

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‘The first step

towards

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Jones D. 1997. Treatment of the child and the family where child abuse or neglect has occurred. In The Battered Child, 5th edn, Helfer M, Kempe R, Krugman R (eds). University of Chicago Press: Chicago. Osofsky JD, Connors K. 1979. In Handbook of Infant Development,

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