Assessment of Parenting

Psychiatric and Psychological Contributions

Dr Peter Reder, Clare Lucey, Dr Peter Reder, Clare Lucey

• Publisher: Routledge
• Year: 2014
• Print ISBN:
  9780415114530
• eBook ISBN:
  9781317835639
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

These are the sorts of questions that face mental health practitioners who are increasingly involved in complex child care cases which come before the courts. They have been given little guidance to date on how these assessments should be made, especially where a decision has to be taken as to whether a child has experienced `significant harm.'
In this much needed book senior clinicians consider the principles and practice of parenting assessments and how they guide courts' decisions about children's welfare. They describe a number of frameworks for assessment and discuss the factors which help predict the risk of future maltreatment or the likelihood of successful rehabilitation. Throughout the book the emphasis is on the need to integrate the assessments of all relevant professionals in order to serve the best interests of the child, while also addressing the parents' potential to improve their caretaking skills. Offering guidance in areas of crucial significance for child, family and professional alike Assessment of Parenting will be widely welcomed.

Part I

Introduction

Chapter 1

Significant issues in the assessment of parenting

Peter Reder and Clare Lucey

Introduction

The parenting children receive is a cornerstone for the development of their emotional, interpersonal and social well-being. The quality of relationships they form with others, including their own children when they become parents, will be shaped by their caretaking experiences. Therefore, as Bowlby (1988) put it ‘engaging in parenthood is playing for high stakes’. Perhaps not surprisingly, discussions about parenting problems tend to evoke very personal feelings and passionately held beliefs – about family, gender, society and so on. It is essential that professionals trying to help children and their families in crisis are not driven by personal bias, but are guided by up-to-date knowledge and experience. The purpose of this book is to add to that knowledge base through the contributions of mental health professionals experienced in the area of parenting assessment. More particularly, this book is about the expert evidence of psychiatrists and psychologists in court proceedings about children’s welfare.

These mental health professionals become involved in child care hearings for a number of reasons. Children depend on others to recognise their distress, to act to remedy it and to speak for them. Courts making decisions that permanently affect their lives have to weigh up complex issues and such difficult judgements rightly should be guided by informed opinion. Psychiatrists and psychologists lean heavily on research evidence, academic argument and clinical experience in their professional practice and have access to an accumulated body of knowledge about child development and family relationships. Their academic trainings also instil in them an ability to gather information in an unbiased manner, to generate and explore hypotheses and to arrive at balanced opinions. In particular, they are able to consider whether change is possible and what interventions, if available, might be helpful. They are skilled at talking with children and parents and making sense of their communications and observable behaviour. Finally, their independent professional role enables them to act as unbiased representatives of children’s views and needs.

In this first chapter we shall discuss the legal and social context for this work and comment on some of the ethical issues it raises. We shall suggest a theoretical framework for understanding problems of parenting and present a structure which has guided us through parenting assessments.

The Legal Context

Parenting assessments principally take place within the context of the 1989 Children Act. The Act is a radical piece of legislation which has already been analysed widely (e.g. White et al. 1990; Eekelaar and Dingwall 1990; Lindsey 1991). Core philosophies are that children’s welfare is paramount and that children are generally best looked after within their natural families. Professionals are required to work in partnership with parents and to ascertain children’s views about their future. Courts should not make orders unless it is clearly better for the children to do so and one guide is whether the child has suffered, or is likely to suffer, ‘significant harm’.

The definition of significant harm continues to exercise psychiatrists and psychologists (e.g. Adcock et al. 1991; Bentovim 1991). It is our view that the concept is essentially a legal one, introduced by the Children Act and one that sits more comfortably within the legal than the clinical domain. The legal process tends to dichotomise issues into ‘true’ or ‘false’ and such absolute distinctions are intolerant of the ambiguities faced by mental health professionals. We believe that clinicians should not allow themselves to be constrained by the limits imposed from another domain and must defend their areas of expertise. Mental health professionals are able to describe children’s developmental lines (i.e. physical, emotional, social, educational, relationship and behavioural), the interplay between them and how they may be adversely affected by experiences of care. Although prediction is difficult, we can hypothesise about the possible consequences of any particular events and whether they might harm the child’s development. Whether this constitutes significant harm is essentially a matter for legal debate.

Implementation of the Children Act has required mental health professionals to modify some aspects of their assessments. As well as discovering the children’s wishes about their future, assessors must consider whether the children have sufficient understanding about any proposed interventions and are capable of giving, or withholding, informed consent (Devereux et al. 1993). The assessment must also take account of families’ cultural and racial characteristics. New orders defining those with whom children can have contact or reside, together with revised criteria of parental responsibility, lead assessors to widen the net of family members interviewed. The intended difficulty in obtaining care orders has been particularly influential in compelling assessors to ascertain parents’ strengths as well as their limitations and consider whether treatment might help them meet their children’s needs. In addition, reports need to show that the likely effects of changing children’s circumstances have been addressed.

While mental health professionals are able to make valuable contributions to child care cases under the Children Act, it is not practical for them to be involved in all instances. In England, the names of 24,700 children were entered on child protection registers during the year up to 31 March 1993; in England and Wales, during the year ending 30 September 1993, applications were made for 5,628 care orders (3,000 of which were granted), 1,054 supervision orders, 2,508 emergency protection orders, 94 child assessment orders and 1,326 Section 8 (i.e. residence, contact, prohibited steps and specific issues) orders (Secretaries of State for Health and for Wales 1994). Decisions to refer for specialist assessment are as much determined by the resources available as considerations of need, but a reasonable guide is to seek an additional opinion when there are outstanding questions about the case.

A Theoretical Framework

Professional assessments need to be grounded in a valid theoretical framework. This is evident from the Department of Health (1988) guidance to social workers on their assessment of families at risk, which contains an extensive list of recommended questions but provides no theoretical framework to help them make sense of the answers.

The model to which we subscribe for understanding parenting behaviour is interactional. It derives from Winnicott’s (1960) observation that ‘there is no such thing as an infant’; in other words, that children and parents exist in relationship to each other. The feelings and behaviour of one affects the feelings and behaviour of the other in a circular manner and the feedback between them modifies each person’s participation in their relationship. As an example, an infant’s cry draws a parent nearer and evokes a comforting response. Eventually, the infant stops crying and gradually tolerates greater distance between them. However, if a second adult is present who resents the attention paid to the child, the first parent might react by withdrawing, resulting in renewed crying. These interactional sequences occur moment to moment and, over time, give rise to recurrent relationship cycles. Environmental factors will, in turn, influence family relational patterns. For example, a poor single mother living at the top of a high-rise block with two ill children is likely to have a lower frustration threshold when she realises that her social security book is missing, and so she more readily lashes out in anger.

Everyone has an innate biological ability to parent, which a child evokes, but the detailed form that this takes hinges on individual experiences (Bowlby 1988). Becoming a parent involves a fundamental change in identity from that of child (to one’s parents) into parent (to one’s child). The transition is liable to reawaken unresolved conflicts with one’s family of origin (Pines 1993) and these issues may need to be reworked before the new parent–child relationship can flourish. Resolution of such conflicts is also likely to facilitate development of the parental couple’s relationship. Other psychological conflicts will arise if the reality of the baby, its needs and development contrast with the parents’ expectations and fantasies about the child they wished for.

The parental role is, in essence, to facilitate the child’s developmental lines within a safe environment. Parents must respond to the child’s early helplessness and dependency, but also encourage the child to differentiate and acquire a separate identity. Balances need to be struck between the child’s need for socialisation and exploratory learning versus the need for protection and limit setting. The way a parent approaches these tasks will be influenced by the model of care that they experienced as a child and whether they continue to be troubled by conflicts around self-esteem, identity, self-control and so on.

Development of the attachment dynamic (Bowlby 1969; 1973; 1980) is particularly significant, in which the provision of a secure emotional base in early life facilitates the development of self-esteem, a capacity for autonomous functioning and empathy for others (Steele 1980). Interference with normal attachment processes, on the other hand, may lead to unresolved dependency conflicts which are carried into adult life and relationships, including the parent–child relationship.

Parenting breakdown, therefore, is also understandable in relationship terms. Severe child maltreatment has generated the greatest amount of research and clinical experience (e.g. Spinetta and Rigler 1972; Friedrich and Boriskin 1976; Steele 1980; Belsky 1984; Wolfe 1987; Dale et al. 1986; Greenland 1987; Roberts 1988; Quinton and Rutter 1988; Bentovim 1992; Reder et al. 1993) which has contributed to the model. There is now general consensus that child maltreatment is the end-result of interplay between predisposed caretakers who are caught in conflictual relationship patterns, vulnerable children, and external stressors, with no single factor ‘causing’ the abusive behaviour. Parents, or other primary caretakers, carry into adult life unresolved residues of adverse childhood experiences which may intrude into their relationships with partners and with their own children and can be exaggerated by social stress. Some children trigger the residues of these emotional conflicts, or can be the focus of the parents’ frustration in the face of acute external stress.

Contributory factors

Maltreating parents usually have experienced psychological deprivation and/or maltreatment as children and suffer persisting conflicts about care and control. In adult life, they form relationships in which these conflicts are re-enacted through excessive, but often ambivalent, dependency on others and undue sensitivity to loss, whether actual or threatened. They often look to their children for emotional comfort (sometimes referred to as role reversal) giving priority to their own needs instead of their children’s. Children who fail to meet the parents’ expectations are either punished violently or regarded as worthless and become neglected. Demands for caretaking from adults or infants readily provoke the parent’s anxiety, frustration and angry responses. Conflicts with control might appear as excessively aggressive behaviour, attempts to dominate others and intolerance of people (mis)perceived as controlling them. These parents tend to be rigid and inflexible, especially in child care activities, and have inappropriate expectations of their children. Low self-esteem, lack of empathy for, and mistrust of, others and conflicts about intimacy may follow from earlier experiences of insecure attachments and lead to brittle and unstable adult relationships and unresponsiveness to the child’s attachment needs.

Children are emotionally and practically dependent on their parents and therefore very young children are the most at risk from abuse and neglect. Children born prematurely, with physical or intellectual defects, who are poor feeders, suffer illnesses or experience early separations also make extra stressful, emotional demands on their parents.

Although child maltreatment occurs across the social strata, there is no doubt that adverse social circumstances, such as poverty, poor housing and ill-health, intensify the risk. In addition, maltreating parents are commonly socially isolated, having lost contact with their family-of-origin through geographical mobility, or make little use of social support networks. Suspicion of others, especially representatives of ‘authority’, and low self-esteem probably contribute to this picture.

This model proposes that parents can move into and out of abusive interactional patterns depending on circumstances. However, Steele (1980) has described 5–10 per cent of abusing parents who repeatedly and cruelly injure children. ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of illustrations
• Notes on contributors
• Preface
• Part I: Introduction
• Part II: Components of parenting assessments
• Part III: Specific circumstances
• Part IV: Conclusions
• Author index
• Subject index