Multicultural Child Maltreatment Risk Assessment

Effective Evaluation for Diverse Populations

Vassilia Binensztok

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9780367464035
• eBook ISBN: 9781000403022
• Topic: Psychology
• Subtopic: Developmental Psychology
• Index: Psychology

Multicultural Child Maltreatment Risk Assessment provides detailed descriptions of child maltreatment assessment and key strategies for culturally informed risk assessment in families.

The book presents a new model for evaluating families that includes cultural competence, a conceptualization of adequate parenting, and strategies for reflective decision making. Chapters address a range of factors including race, ethnicity, religion, gender, and sexuality. Ten case studies, each including discussion prompts, challenge the reader to apply forensic evaluation techniques for effective and ethical decision making in complex and ambiguous cases. Both experienced mental health providers and students will come away from the book with a deeper understanding of child maltreatment and its effects, models and modes of assessment, and factors that place families at greater risk.

Chapter One

Introduction to Multicultural Child Maltreatment Risk Assessment

Despite the progress made in child protection laws and child development education in the last few decades, child maltreatment remains an all too prevalent occurrence. Though rates of child maltreatment have been declining, there were 674,000 cases of maltreatment reported in the United States in 2017, with the youngest children representing the largest part of this demographic (US Department of Health and Human Services Child Welfare Information Gateway, n.d.). Children under three had a maltreatment prevalence rate of 15 per 1,000, outpacing every other age range. In 2018, 1,770 children died of abuse or neglect in the United States, with the majority of cases (70.6%) being children under three (US Department of Health and Human Services Office of the Administration of Children and Families Children’s Bureau, 2018).

Child protection has a rather short history as a concept in the United States. During the industrial era, many children were employed in dangerous conditions. These children were deprived of the right to a childhood, to attend school, and to a safe and adequate environment. Though some child cruelty laws existed in the early 20th century, no organized systems of child protection existed. The Keating-Owen Child Labor Act (1916) became the first federal law to limit how many hours a child could be made to work and a later law, the Walsh-Healy Act (1936), banned the purchasing of goods produced by child laborers. Yet, decades spanned with no comprehensive child protection laws until the Child Abuse Prevention and Treatment Act of 1974, the first United States law of its kind. This law bore the initiation of the Child Protective Services model and required states to form guidelines for child abuse prevention and intervention (Hyun & Adams, 2016).

The enactment of child protection laws has made this a topic with which all mental health and human services providers are now familiar. These providers, along with medical providers and teachers, join the list of mandated reporters, or those professionals whose professional license and ethical oath require them to report any suspected child abuse or neglect to their state’s child protection agency. Providers who fail to do so risk legal and licensing ramifications, as they knowingly allow children to remain in a potentially harmful situation. In 2016, roughly 4.1 million reports of child abuse were made to child protection agencies in the United States, representing 7.4 million children (US Department of Health and Human Services, 2018). Yet, while 65% of these referrals were made by professionals, only 5.9% came from mental health providers.

Counselors and other mental health professionals cite numerous barriers to reporting suspected child abuse and neglect. These can range from limited knowledge and training to fears of breaching confidentiality. Many counselors are unfamiliar with the laws related to child abuse reporting and studies have found those practitioners who lack knowledge are less likely to report abuse (Bryant, 2009). Counselors often lack training in risk assessment, abuse reporting processes and protocols, as well as an understanding of what their duties entail. Counselors can struggle with breaking confidentiality, though it is indicated in these cases, and report difficulty determining if and when to file a report, citing a lack of confidence (Kenny et al., 2018). School counselors were found to report only one case per year, on average, and often failed to report suspected cases of abuse and neglect (Kenny & McEachern, 2002).

Besides the hindrances from insufficient knowledge and lack of confidence, multicultural issues are another confounding variable in the assessment and reporting of child abuse. Because child abuse and neglect are primarily social problems, meaning they cannot be defined in medical terms, assessment of these issues remains largely subjective. Even when there are clear protocols for assessment and reporting in place, these are still based on a – typically Western – societal understanding of what constitutes abuse. Additionally, when applying protocols for child abuse assessment and reporting, practitioners are subject to allowing their personal morals and values into their reasoning process (Gillingham, 2006). Even researchers in this field are prone to having their personal values interfere with their work (McDermott, 1996). When conducting an assessment of child abuse and risk in multicultural settings, clinicians are prone to making more Type I and Type II errors, or false positives and false negatives, respectively. In some cases, false positives are made when clinicians impose their own values when assessing practices that are culturally sanctioned. On the other hand, clinicians risk false negatives when using culture to excuse behaviors that are harmful to children (Fontes, 2005).

This text will inform counselors and other mental health professionals of the protocols used in assessing child maltreatment and risk of future harm. Decision making strategies are explored to guide providers and increase confidence in assessment and reporting. Particular focus will be given to how helping professionals can apply these strategies to effectively evaluate harm and risk for harm.

Purpose of Risk Assessment

Child maltreatment risk assessment can serve several purposes. Referrals for risk assessments and parenting evaluations are often made to help professionals determine if a family needs intervention, the forms of intervention a family needs, if children should be removed from their parents, if it is safe for children to be reunified with parents, if it is safe to allow unsupervised visitation between a parent and children, and other reasons. To complete an assessment providers must determine both if harm has occurred and if there is risk of future harm. Harm is defined as any detrimental act inflicted on a child. This can include psychological abuse, physical abuse, physical neglect, and sexual abuse. Risk assessment is defined as objective assessment for the risk of future harm to a child. Assessing current or past harm is critical in gaging risk of future harm. Assessment findings and recommendations can also help other providers, like therapists, effectively conceptualize cases and select appropriate treatment goals and interventions.

Benefits of Risk Assessment

Determining if children are at risk is an important step in providing early intervention services. Countless research studies have confirmed the short-term and long-term effects of childhood maltreatment, including chronic mental and physical health detriments (Kenny et al., 2018). Risk assessment is critical for preventing future harm as well as selecting mental health treatments and implementing early interventions. Early intervention has been cited as crucial for recovery from childhood maltreatment (Cyr et al., 2013).

There are many limits to determining child safety and risk for future harm. These include the evaluator’s subjectivity, lack of clear global definitions of maltreatment, and the possibility for false negatives and false positives (Pecora et al., 2013). False negatives occur when there is no determination of risk or harm, but risk or harm exists. False positives occur when there is a determination of risk or harm, but no risk or harm exists. Effective assessment and decision making models serve to avoid such pitfalls and lead to a greater likelihood of identifying and responding to risk and harm.

Risk Assessment Goals

The goals of risk assessment include determining if harm has occurred, determining risk of future harm, identifying risk and protective factors, and identifying possible interventions. Information collected about past incidences of maltreatment or family violence can help providers assess the current level of risk as well as which interventions are indicated. Some families can display many risk and protective factors simultaneously. For these families, accurate risk assessment can determine which preventative interventions can help decrease risk. Risk assessment is also a thorough and structured process which helps reduce provider subjectivity and bias. Increasing objectivity also applies in respect to cultural factors. The goal of risk assessment is not only to evaluate family functioning, but also to do so within the context of a family’s culture. Goals are presented in Figure 1.1.

Figure 1.1Risk Assessment Goals

Challenges in Risk Assessment

Numerous challenges arise in the assessment of harm and risk. Challenges can include the confluence of symptoms and incidents, difficulties in assessing risk of violence using the base rate fallacy, provider lack of knowledge or subjectivity, and cultural factors. All of these factors interfere with the ability to make clear and objective judgements about the occurrence of maltreatment and the potential for future harm.

Symptoms vs Incidents

Assessing past and current maltreatment is necessary for evaluating risk for future harm. When assessing maltreatment, however, providers are often tasked with assessing symptoms rather than incidents. Childhood maltreatment events, including physical abuse, sexual abuse, exposure to family violence, and psychological abuse, are considered incidents. Incidents are difficult to identify and evaluate for their veracity and level of harm. Therefore, providers must resort to evaluating the resulting symptoms of these incidents, rather than the incidents themselves (Binensztok & Vastardis, 2019). Symptoms must be evaluated according to the guidelines of the Diagnostic and Statistical Manual-5 (DSM-5). Child maltreatment, however, does not constitute any psychological disorder outlined in the DSM-5, and the symptoms associated with it do not typically meet criteria for any DSM-5 Disorder. The diagnosis for posttraumatic stress disorder (PTSD) was created based on the symptom presentation of Vietnam War veterans, so children may exhibit some PTSD-related symptoms like an increased startle response and nightmares, but rarely meet all criteria for this diagnosis (Olafson & Connelly, 2012).

While diagnoses for Developmental Trauma and Complex Trauma have been proposed for inclusion in the DSM, these syndr...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• List of Figures
• List of Tables
• Preface
• Chapter One Introduction to Multicultural Child Maltreatment Risk Assessment
• Chapter Two Defining Child Maltreatment
• Chapter Three Effects of Child Maltreatment
• Chapter Four Families at Risk
• Chapter Five Assessing Families for Risk
• Chapter Six Assessing Children for Maltreatment
• Chapter Seven Multicultural Considerations in Assessment
• Chapter Eight The Adequate Parent
• Chapter Nine Decision Making in Child Maltreatment Risk Assessment
• Index