Assessment of Parenting Capacity Mark Allerton

www.lawlink.nsw.gov.au/ccc

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The Big Picture •

Why are you here? Why do you need to know about this?

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Clinical, ethical and professional problems

•

What can/can’t mental health professionals offer? 2

The NSW Children’s Court Clinic • Set up by NSW Children &Young Persons (Care and Protection) Act 1998 • Conducts independent assessments for courts, mostly of children, and of parenting capacity • Both internal and contracted Authorised Clinicians (child psychologists, social workers and psychiatrists) conduct assessments, and are expert witnesses in court. 3

ye ar s 1 ye ar s 2 ye ar s 3 ye ar s 4 ye ar s 5 ye ar s 6 ye ar s 7 ye ar s 8 ye ar s 9 ye a 10 rs ye a 11 rs ye a 12 rs ye a 13 rs ye a 14 rs ye a 15 rs ye a 16 rs ye a 17 rs ye a 18 rs ye ar s

0

Number of children

Ages of Children Referred… 1200 1044

1000

800

600

400 749 658 583 545 508 488 440 417 424 401 300

200 261 238 137 75 25 19 7

0

Age of children 4

ch ild re n

24

9

ch ild re n

39

8

ch ild re n

117

7

ch ild re n

211

6

ch ild re n

ch ild re n

500

5

4

ch ild re n

ch ild re n

ch ild

1000

3

2

1

No. of Applications (Total: 3892)

Children per Order …

2500 2037

2000

1500

928 531 4 1

0

No. of children 5

Questions we attempt to answer (See the clinic website for more details*)

1.Parenting capacity/responsibility 2.Parent/caregiver–child relationships 3.Children and young persons’ individual characteristics, needs and wishes 4.Suggestions for steps to achieve desired outcomes -But we need an agreed case summary, and to know what specific problems the court needs to resolve. * www.lawlink.nsw.gov.au/ccc 6

Abusive Parents and their Children • • • •

Risks of parents’ drug and alcohol abuse Abusive parents (Denver Group) The abused child’s perspective (Martin) Children in abusive and neglectful families (Crittenden)

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Risk and Protective Factors in Vulnerable Families Fonagy (1998) (i) Biological factors (ii) Family and social factors (iii) Quality of parenting (iv) Quality of attachment status (v) The influence of non-maternal care Caregiver relationships are primary: practical parental empathy/ responsive caregiving 8

Areas Affected by Child Abuse and Neglect

Physical development  Emotional development  Behavioural development  Social development  Cognitive and cultural development Development not even, sequential or harmonious 

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What Children Need, and the Impact of Child Abuse and Neglect Area

A Child Needs

Problems…

Physical

Physical care and safety

Physical, nutrition, growth, dental, coordination

Emotional

Empathic Attention and Attachment Relationship

Attachment disorders, FTT, emotional and behaviour

Behavioural Emotional and behavioural Social

self-regulation

Attention, impulsivity, aggression

Role models

Social, language

Cultural Education Cognitive and Cultural

Attention, play, problemsolving, education, culture 10

Clinic Data: Child Problems School-Aged Children 20 18 16

Percent

14 Disability

12

Mental Illness

10

Violent Behaviour

8

School Non-Att

6 4 2 0 Infants (5-7y)

Primary (8-11)

High (12-18)

Total

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Parents’ Resources • Responsive caregiving and protection • Reflective Function • Bonding • Emotional availability • Strategic behaviour management • Ability to transmit the community’s cultural and social values. 12

Physical Care and Safety Empathic attention Attachment Relationship Emotional and behavioural self-regulation Role model To learn

Chronic Problem

Vulnerable

Appropriate

Parent Resources Chronic Need

Normal

Child Needs

Vulnerable

Assessment of Parenting Capacity

Responsive Caregiving and Protection Reflective Function Bonding Emotional Availability Strategic Behaviour Management Ability to transmit community values 13

Child Needs Assessment Physical Care and Safety

•Welfare and medical/ development history, •Developmental assessment, •Observation of behaviour, •Predictable developmental crises

Empathic attention Attachment relationship Emotional and behavioural selfregulation Role model

• Observation, attachment assessment

Cultural education

•Education, peer socialisation, recreation, cultural 14 and spiritual development

• Relationship history, attachment assessment •Behaviour problems and emotional symptoms, •Family observation, social interactions, school reports •Behaviour, peer socialisation, adaptive behaviours

Assessment of Parents’ Resources Responsive Caregiving and Protection

•History, observation of parentcraft (e.g., PSI long form) •Cognitive/language abilities •Adaptive behaviour (e.g., ABAS) •Risk Predictors (e.g., CAPI, SAARA)

Reflective Function

•Clinical interview, AAI, partner interviews, attachment assessment

Bonding

•Relationship history, attachment assessment, PCRI

Emotional Availability

•Mental health, interview about the child, observation of interaction (e.g., MSE, DASS, PAI, PSI, CAPI, SASSI-3, STAXI-2)

Strategic Behaviour Management

•Observation of interaction: management of behaviour, behaviour problems

Community values

•Social, educational and work history, •Extended family network, socialisation, community links, •Capacity to foster cultural/moral/spiritual development15

An Ordinary Assessment Model • Reason for the referral • Obtain a history of the family • Parent and child: – Cognitive aspects/Adaptive behaviours – Emotional/Personality/Psychiatric aspects – Social Interaction

• Specific tests of family functioning • Formulation (formulation tool) • Recommendations 16

Specific Risks and Challenges • • • • • • •

Intellectual disability Drug/alcohol problems Personality disorders Maternal health Mental health Domestic violence Cross-cultural, ecological factors 17

Clinic Data: Parent Problems Parents of children assessed by the CCC 100 90 80 65

Percent

70 60

45

50 40 29 30 20

11

10 0

Disability

Mental Illness

AoD Abuse

Violent Behaviour

Parent Factors (%) 18

Difficult decisions • • • •

Is the child in imminent danger? How inadequate or damaging is the family? Concrete evidence of a child’s vulnerability? How likely are supportive interventions to change things? • How adequate are the alternatives? • Placement factors

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The big question: Will the child benefit from restoration? Think: What is in the child’s best interests? •Yes? Immediate (unconditional)? or Conditional? – treatment, placement, contact: but can the child wait?

•No? What environment will be safe, nurturing, stable and secure for this child?

Contact visits Future prospects

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The End – Thanks 21