37.1   Types of Assessments

Permanency planning for children in the state's custody has many challenges.  Psychological evaluation is one tool used to identify the needs of both parents and children.  The type of evaluation required (if any), the local availability of such, the quality of the evaluation done, and proper use of the information and recommendations arising from the reports are all elements which need to be considered in deciding what services children and families need.

From the psychologist's point of view, it is important to know why the individual and/or family is being referred and what it is that the evaluation audience wants to know.  It is not really enough for a social worker or judge to order a "psych eval" and to have the psychologist proceed without a specific referral question. If the attorneys and permanency planning workers have not identified the specific information needed, the court can use its role in moving the process along by asking precise referral questions and requesting the kind of evaluation that addresses the questions at hand.  In forensic settings, especially those that relate to permanency planning, the most likely needed types of evaluations are:

• Psychological evaluation with a specific question.
• Neuropsychological assessment.
• Bonding or interactional study.
• Custody evaluation (although these are less appropriate)
• Psychosocial, pre‑placement or home study.

37.1.1   Psychological Evaluation with a Specific Question

The psychological evaluation with a specific question is the kind of evaluation on which psychologists receive the most training. Many courts and most state custodial agencies have criteria for requesting psychological evaluations.  However, a review of these criteria produced few useful pointers for permanency planning.  For example, whether parents are suicidal or even psychotic may not relate to their candidacy for having their child returned to them. The information can be useful, however, in determining exactly which services parents need to improve their parenting. A question about the extent to which the depression or the psychotic features are a barrier to improvement might be needed.

Another frequently cited criterion is the presence of an antisocial personality disorder.  For good reason, the court needs to be cautious in returning a child to the home of a psychopath (Hare & McPherson, 1984; Harris et al, 1991; Klassen & O'Connor, 1988).  The critical  information to know with such parents would be whether or not they can function as responsible and consistent caretakers for their children.  A single diagnosis or condition is seldom an impediment to adequate parenting.  The question for the psychologist needs to be framed in terms of the relevance of the condition to the capacity to parent.

In this same category are evaluations of children.  From the perspective of the psychologist, it is insufficient to determine whether the child has suffered psychological harm as a result of physical or sexual abuse or neglect.  The question to be asked is whether the child is exhibiting any symptoms or behaviors that would require a level of care which the parent or other caretaker may not be able to provide.  In deciding on a permanency plan, the question must focus on the interaction between the child's needs and the parent's ability.

Sometimes the psychologist is asked to estimate the intelligence (IQ) of a parent or child, or to determine the existence of a developmental disability.  The existence of low intelligence cannot be used by itself to decide on custody or permanency.  It is important to know whether or not a parent can be trained to recognize developmental milestones in a child and respond as needed. The question for the evaluation would be whether or not the parent has such capacity or can be trained to competence and how best to do that.  If a child is failing in school and the parent is not responsive, it may be that the parent cannot provide the stimulation or limit-setting which the child requires.  This would be especially relevant if the child's evaluation demonstrates the capacity for normal intelligence.

The final reason to request a psychological evaluation would be to establish a differential diagnosis or to argue a disputed diagnosis.  In this case, the question would be to determine if there was evidence in the psychological profile to support an alternative explanation of the subject's behavior or symptoms.

37.1.2   Neuropsychological Assessment

Neuropsychological assessments help specify behavioral deficits and strengths, and they can propose detailed training programs for motor, sensory and cognitive deficits.  These assessments are most useful in planning the remediation of impairments, and they should only be requested following other assessments.  If only a neurological assessment can be obtained, then the referral questions must be specific.

37.1.3   Bonding or Interactional Study

The purpose of a bonding study is to determine whether a bond or attachment exists between a parent and a child and what, if any, steps can be taken to improve a deficient bond.  This kind of study is frequently confused with a custody evaluation, or it is seen as a part of either a custody or psychological assessment.  Instead, a bonding study should stand alone and be requested because it makes a unique contribution.  The bonding issue in permanency planning is the extent to which the parent is capable of caring for the child from the perspective of bonding and attachment (Ainsworth, et al, 1978).  The bonding study draws data from observation, from social and interpersonal reports, and from cognitive and emotional assessments (Bowlby, 1946; 1953; 1960; 1969; 1973; 1980; 1984).  The bonding study moves in two directions.  One track is the child's bonding issues with the parent.  The other track comprises the bonding and attachment issues of the parent.  At times, the child can bond and the parent cannot.  The parents, usually because of their own bonding and attachment issues, cannot respond or bond adequately with the child (Zeanah & Zeanah, 1989).

Most relevant to permanency planning is the fact that bonding and attachment can be assessed and described.  The assessment of bonding and attachment can rest on psychological tests and a growing body of research that demonstrates the connection between specific variables and the existence of a bond (Clark, 1985; Grossman & Schwan, 1986; Jernberg & Booth, 1979; Main & Westen, 1981; Waters, 1985).  It is also becoming clear in the research that the absence or unhealthy quality of a bond correlates highly with the incidence of neglect, and that it is more difficult to treat the neglectful parent than it is to rehabilitate the parent who abuses a child (Hare, 1980; 1984; Sroufe, 1985). At the same time, a child can have a strong bond to an abusing parent, in which case the abuse bond needs to be distinguished from the normally occurring nurturing bond (James, 5 1994; Meloy, 1997; Symonds, 1984).  The request for a bonding study needs to address these questions specifically.  

Bonding studies may be useful at the beginning of a case in which there are concerns about a parent/child connection because specific, prescriptive recommendations can be made to improve or support such relationship in the face of the separation which occurs when a child is in foster care.

37.1.4   Custody Evaluation

Traditionally, courts may ask a psychologist to consult about a private custody dispute, where the parties have failed to resolve the custody issue between themselves.  The outcome is usually some form of shared custody.  The psychological literature contains hundreds of references about the conduct of custody evaluations, although there is relatively little about the use of this type of evaluation in permanency planning.  A custody evaluation is rarely used in an abuse and neglect cases but, if it is, the referring agency should be extremely specific about the information needed and ask the proposed professional if it is the most appropriate type of evaluation.  At a minimum, the following issues should be included:

• Mental and physical health of the parties involved;
• Interactions and interrelationships of the child with the parents and other family and important people in the child's life;

• Age and sex of the child;
• Child's wishes about the custodian; and
• Child's adjustment to home, school and community.

37.1.5   Psychosocial, Pre‑Placement or Home Study Report

Psychosocial evaluations provide a general history of a child and a family.  Usually produced by social workers or juvenile justice personnel, the psychosocial evaluation historically has been used to evaluate the home environment or to assess the treatment needs of the child and the family at the outset of a case.  In adoptions and foster care situations, the psychosocial takes the form of the home study or pre‑placement report.  This evaluation focuses on both the home and the family's ability to take care of a child.  In permanency planning, the psychosocial evaluation looks at child and family treatment needs and the family's readiness to provide for the child.  The primary evaluation question in a permanency planning matter relates to the factors that contributed to the abuse or neglect that originally brought the family to the attention of the authorities.  Psychosocial evaluations assess medical and mental health histories, previous legal and treatment involvement, housing, recreation, school and community factors, family constellation, discipline and parenting skills.

Most mental health professionals have some training in the conduct of psychosocial evaluations. For many aspects of permanency planning, the psychosocial evaluation can provide satisfactory information to the foster care agency or the court.  Decisions about who may perform these evaluations should be based on training and supervision rather than on professional affiliation.  Although a high degree of specific training is required, it is usually possible to assign these evaluations to a class of mental health care providers with appropriate training but whose time is less expensive than, for example, that of the psychologist.  In addition to training, however, there should be competent supervision of the people doing the evaluations.  This should include professional review of the reports before they are submitted to the court.

37.2   References

• Meloy, J. Reid. (1997). Violent Attachments. New Jersey: Jason Aronson, Inc.
• Ainsworth, M.; Blehar, M., Waters, E., Wall, S. (1978). Patterns of Attachment: A Psychological Study of the Strange Situation. New York; Wiley.
• Bowlby, J. (1946). Forty‑Four Juvenile Thieves: Their Character and Home Life. London: Bailliere, Tyndall, and Cox.
• Bowlby, J. (1953). Some Pathological Processes Set in Train by Early Mother­ Child Separation. Journal of Mental Science 39: 350‑373.
• Bowlby, J. (1960). Separation Anxiety. International Journal of Psycho‑Analysis 41: 89‑111.
• Bowlby J. (1969). Attachment and Loss. Volume I, Attachment. New York: Basic Books.
• Bowlby J. (1973). Attachment and Loss. Volume II, Separation, Anxiety, and Anger. New York: Basic Books.
• Bowlby J. (1980). Attachment and Loss. Volume III, Loss, Sadness, and Depression. New York: Basic Books.
• Bowlby J. (1984). Violence in the Family as a Disorder of the Attachment and Care Giving Systems. American Journal of Psychoanalysis 44: 9‑27.
• Di Maio, V. J. M. (1985). Gun Shot Wounds: Practical Aspects of Firearms, Ballistics, and Forensic Techniques. New York: Elsvier.
• Geberth, V. J. (1990). Practical Homicide Investigation: Tactics, procedures, and Forensic Techniques. 2nd ed. New York: Elsvier.
• Grossmann, K., Schwan, A. (1986). Capturing the Wider View of Attachment: A Reanalysis of Ainsworth's Strange Situation. In Measuring Emotions in Infants and Children, Volume II, ed. C. Izard P. Read, pp. 23‑64. New York: Cambridge University Press.
• Hare, R. (1980). A Research Scale for the Assessment of Psychopathy in Criminal Populations. Personality and Individual Differences 1: 111‑117.
• Hare, R. (1991). The Hare Psychopathy Check List Revised. New York: Multi­Health Systems, Inc.
• Hare, R., McPherson, L. (1984). Violent and Aggressive Behavior by Criminal Psychopaths. International Journal of Law and Psychiatry 7: 35‑50.
• Harris, G., Rice, M., Cormier, C. (1991). Psychopathy and Violent Recidivism. Law and Human Behavior 15: 625‑637.
• Klassen, D., O'Connor, W. (1988). A Prospective Study of Predictors of Violence in Adult Male Mental Health Admissions. Law and Human Behavior 12: 143‑158.
• Main, M., Westen, D. (1981). The Quality of the Toddler's Relationship to Mother and to Father Related to Conflict Behavior and the Readiness to Establish New Relationships. Child Development 52: 932‑940.
• Sroufe, L. (1985). Attachment Classification from the Prospective of Infant­ Caregiver Relationships and Infant Temperament. Child Development 56: 1‑14.
• Symonds, M. (1984). Discussion of "Violence in the Family as a Disorder of the Attachment and Care Giving Systems." American Journal of Psychoanalysis 44: 29‑31.
• Waters, E., Deane, K. (1985). Defining and Assessing Individual Differences in Attachment Relationships: Q‑Methodology and the Organization of Behavior in Infancy and Early Childhood. In Growing Points in Attachment Theory and Research. Monograph of the Society for Research in Child Development Serial 209, ed. l. Bretherton E. Waters, pp. 41‑65. Chicago: University of Chicago Press.
• Zeanah, C. Zeanah, P. (1989). Intergenerational Transmission of Maltreatment: Insights from Attachment Theory and Research. Psychiatry 52: 17‑196.

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