The Process of Conducting a Parenting Capacity Assessment From a Multidisciplinary Team Approach
By T.M. Abraham, Peter Bonsu and Sebastiano Fazzari

Preamble

Why use a multidisciplinary team rather than one individual? Many psychiatrists and other clinicians have assessed and still assess individuals from a unilateral perspective. A parenting capacity assessment is not a psychiatric, nor a psychological, nor a medical assessment per se. There are a multitude of factors that interplay when determining whether an individual has the capacity to be a good parent. There are cognitive, social, emotional, personality and biological factors that impinge on one’s capacity to parent effectively. Professionals with varied areas of expertise coming together to collect, evaluate and interpret data may have a greater probability of arriving at conclusions that are more objective and multidimensional, based on the fact that each brings a diverse area of knowledge and a diverse perspective.

From a multidisciplinary approach, the undersigned subscribe to the belief that development is (a) lifelong — no age period dominates development; (b) multidimensional — consisting of biological, cognitive and socio-emotional dimensions; (c) multidirectional — some dimensions or components of a dimension expand while others shrink; (d) plastic — the degree to which characteristics change or remain stable; (e) multidisciplinary — psychologists, sociologists, anthropologists, neuroscientists and medical researchers study human development and share a common interest in unlocking its mysteries; (f) contextual — an individual continually responds to and acts on contexts such as biological makeup, physical environment, cognitive processes, historical contexts, social contexts and cultural contexts. Individuals are thought of as changing beings in a changing world; (g) growth, maintenance and regulation — the mastery of life often involves conflicts and competition among these three goals of human development. (Santrock, 2004).

Throughout the ages, philosophers have speculated about how children develop and how they should be reared. Three philosophical views have emerged:

• The original sin view, which was advocated during the Middle Ages, advanced the belief that children are born into the world as evil beings and are basically bad. The goal of child rearing was salvation which was believed to remove sin from the child’s life.
• The tabula rasa view was proposed by John Locke. This point of view purports the belief that children are like a “blank tablet” and acquire their characteristics through experience. Locke believed that childhood experiences are important in determining adult characteristics. He advised parents to spend time with their children and help them become contributing members of society.
• The innate goodness view, presented by the Swiss-born French philosopher Jean-Jacques Rousseau stressed that children are inherently good, and because they are basically good they should be permitted to grow naturally with little parental monitoring or constraints (Santrock, 2004).

The undersigned conduct Parenting Capacity Assessments as a multidisciplinary team. In this approach, the assessors review documents, interview clients, observe parent-child interaction, diagnose, and make recommendations as a team. In addition, the team writes the report. Once the report is completed, the team distances itself from it for a week, after which the team reconvenes and reviews the report critically. Discussions occur; questions are asked and are thoroughly answered. Once the team is fully satisfied, the report is edited and finalized.
Making decisions as a team is never easy. The task of making recommendations about a child’s life deserves professionals who are willing to dedicate energy and time.

Who Should Assess?

Children’s Aid Societies seem to have a preference to utilize psychiatrists and psychologists to conduct Parenting Capacity Assessments. These individuals are highly qualified, particularly if a DSM diagnosis is required. The undersigned have come to the realization, based on conversations with other professionals, that many assessors are reluctant to conduct these types of assessments. Their reluctance sometimes leaves the Children’s Aid Societies wondering who is available to conduct an assessment competently in a timely fashion (Fazzari, 2002). The Societies have the freedom to choose assessors trained in the following: life-span development, normal and abnormal behavior, family dynamics, attachment theories, functional and dysfunctional relationships, testing and measurement, social work and social welfare procedures, counseling and report writing (Fazzari, 2002).

The undersigned prefer to conduct an assessment when it is ordered by the Court and they are named as assessor. By this process, the assessor’s role now consists of assisting the Court in the decision-making process by providing information and making sense of it (Fazzari, 2002). As assessors, the undersigned wish to eliminate any possible confusion or implication that they are “the hired guns” of the Society. This procedure may also eliminate any possible contention as to whether an assessor is an “expert witness” (Fazzari, 2002). Section 7 of the Canada Evidence Act provides for the use of professionals or other experts at a trial, but it does not specify who such persons are (Schiffer, 1951). The general rule regarding qualifications of experts is that expert testimony will not be admissible unless:

• The subject matter of the trial or inquiry involves issues beyond the competence of a lay jury to determine if unaided by such experts; and
• The witness’ expertise was gained through a course of study or habitual practical experience (Schiffer, 1951; Fazzari, 2002).

During the past fifty years, society has come to value childhood as a special time of growth and change and, as a society, we have come to invest great resources in caring for and educating our children. We protect them from the stresses and responsibilities of adult work through strict child labor laws. We treat their crimes against society under a special system of juvenile justice. We have government provisions for helping them when ordinary family support systems fail or when families seriously interfere with the child’s well-being. When this occurs, we, as a society, have empowered Children’s Aid Societies to intervene and to protect children from harm.

The Parenting Capacity Assessment

A Parenting Capacity Assessment is usually conducted at the request of a Children’s Aid Society through the Court in order to determine the capacity, or measure of competency, of an individual — a parent — to implement certain parenting skills or abilities with such consistency on an ongoing basis as to optimally raise a child into a capable and autonomous adult. A Parenting Capacity Assessment while read by various individuals with different academic backgrounds, is, first of all, conducted to assist a judge in making educated adjudications that will impact considerably on the lives of the people being assessed (Polgar, 2001). It cannot be understated that assessors must keep in mind that the assessment is being prepared for the judge. Consequently, assessors undertaking the task of conducting such assessment must insist that they be appointed by the court (Polgar 2001). Given such an onerous task, then, it is imperative that the assessors use a standardized methodology that is logical, relevant to the task at hand, informed with respect to development and behavior and research based (Polgar, 2001).

The Rationale

It is imperative that the rationale and basis on which conclusions are made be well-defined and substantiated with empirically determined findings (Fazzari, 2002). In addition, the presentation of the information requires a format that will produce optimal comprehensiveness and clarity and formulated opinions ought to be based on well defined clinical parameters (Fazzari, 2002).

There are guidelines available for those who wish to conduct Parenting Capacity Assessments. Dr. Paul Steinhauer spearheaded the Toronto Parenting Capacity Assessment Project in 1988, a cooperative project of the Children’s Aid Society of Toronto, The Catholic Children’s Aid Society of Toronto, the Toronto Family Court Clinic and the Department of Child Psychiatry, The Hospital for Sick Children (Wolpert, 2002). These “Guidelines” are well presented by Rhonda Wolpert and are published in Volume 46, Number 1, April 2002 of the OACAS Journal. Interested assessors and readers may also benefit from reviewing the May 2006 “Effective Parenting Capacity Assessment: Key Issues” (Centre for Parenting and Research, NSW Department of Community Services), as well as Waterman & Associates (2003) “Guidelines for the Conducting of Parenting Capacity Assessments.”

The Methodology

The methodology utilized by the undersigned has been extensively studied and researched by Alexander T. Polgar, Ph.D., in his scholarly manual Conducting Parenting Capacity Assessments: A Manual for Mental Health Practitioners (2001). The subjects of Parenting Capacity Assessments are parents whose children have been apprehended or placed in care on consent. Children’s Aid personnel have determined through direct observations that the parents lack the parenting skills to properly raise their children, lack the potential to learn the skills or lack the competence to apply  the skills acquired effectively on a consistent basis, in order to promote a child’s development during the various phases of human development. In order to learn, an individual must be able to conceptualize — a function of cognitive intelligence. Hence it is important to determine whether an individual can learn the parenting concepts being taught. On the other hand, the ability to apply the skills learned on a consistent basis is a function of emotional intelligence. It is important to keep in mind that sometimes learning can be negatively impacted by emotional disturbances, while application of the skills can be obstructed by deficits in cognitive intelligence (Polgar, 2001).

From time to time, assessors are asked to assess the capacity of parents whose children have special needs. While all mental health practitioners have training in assessing children, assessing a special needs child requires additional expertise. The importance of having the required expertise to assess a special needs child cannot be over-emphasized, since parenting such a child requires special parenting attributes: tenacity, high frustration tolerance and creativity (Polgar, 2001). Ultimately, the assessors must be able to assess whether the parents’ capacity is absent and therefore requires compensatory strategies or whether the parents’ skills are obstructed by any number of conditions, or both. In addition, assessors must determine whether remedial programs can be undertaken in time to benefit the child at risk before such a child will have gone through the so-important and crucial formative stage of life.

Ultimately, a Parenting Capacity Assessment is conducted to assist a judge in the process of arriving at a disposition that is just (Polgar, 2001). The concept of “pursuit of justice” has nothing to do with winning or losing a case. When a client hires a lawyer, that client expects that lawyer to subscribe to the principle that his/her function is to strongly advocate for the client’s position, rightly or wrongly (Polgar, 2001). Based on this principle, the lawyer’s focus is on procedures, rules and regulations rather than justice. Such a process leads to the path of least resistance and is consistent with the adversarial process with which lawyers are trained. The goal of the lawyer is to win (Polgar, 2001). It is imperative that assessors remain impartial and objective in their pursuit of arriving at a just disposition. Assessors must remember that in each assessment there are conflicting needs and hence must respect the legitimate desires of all parties (Polgar, 2001). Ultimately though, assessors must arrive at a conclusion by using a research-based methodology that will assist them in arriving at a determination that a vulnerable child’s right to develop optimally supersedes the parents’ right to have custody of that child (Polgar, 2001). If a parent has the capacity to parent on his/her own, or with the assistance of community resources, then it is a just solution to recommend such disposition since there is an “empirically established probability of being in the child’s best interest” (Polgar, 2001).

Method of Conducting the Parenting Capacity Assessment

While a Parenting Capacity Assessment is done in the context of “Child Welfare,” the focus is primarily on the adults: the parents (Polgar, 2001). Considerations of a child’s development become relevant in instances when an apprehension has occurred and the child’s condition becomes an additional indicator of the primary caregivers’ capacity to promote growth and development, physically and emotionally, in an environment of safety. The nature and extent of harm sustained by a child in such instances is relevant with respect to defining the type of remedial intervention required for the child and with respect to defining the extent to which a primary caregiver was negligent and/or abusive while in his/her care (Polgar, 2001).
The approach, therefore, to conducting a Parenting Capacity Assessment is based on the premise that for optimal cognitive, emotional and behavioral development, a nurturing relationship with emotionally competent primary caregivers. More importantly, a Parenting Capacity Assessment is based on the premise that it is through such a nurturing relationship that children develop into adaptive individuals and thus optimize their true potential (Polgar, 2001).

Parenting Capacity Assessments are based on determinations of emotional adjustment, cognitive development and intellectual capacities, as these are predictors of consistent and proactive positive conduct including the willingness and ability to learn and apply effective parenting techniques (Polgar, 2001).

The body of the assessment report is organized under four headings that address the issues as defined by the Society in the context of clinical parameters used to formulate opinions. While the four categories of analyses are presented separately for the purposes of clarity, in reality they are interrelated to form a complex system that impinges on the growth and development of a child. The four categories of analysis pertain to:

• Reciprocal emotional attachments;
• Criteria of a good parent;
• Evidence-based expectations of present and future parenting behaviors; and
• Social support network (Polgar, 2001).

Under each heading, a literature review is provided which establishes the relevance of the issues. This literature review is then followed by the specific conclusion pertaining to the issue being examined and a delineation of the evidence that supports the conclusion and recommendations (Polgar, 2001).

The Four Categories of Analyses

Category One: Reciprocal Emotional Attachment

The salient issue is that personality development is determined by the quality of attachment between the child and the caregiver. More importantly, this is essentially a formative years’ phenomenon and, as such, takes place from birth through the first few years of a child’s life. There is some debate in the literature as to the length of this timeframe. In general, an averaging of the various ranges produces a consensus that at approximately the age of five, much of the characterological traits of an individual are established and become lifelong defining features of that person (Bowlby 1980). Consequently, there are profound later effects of early attachment issues. Empirical findings have demonstrated that early experiences become the basis for the person’s conceptualization of what to expect in relations with other people throughout life. Furthermore, the effects of attachment patterns pass from one generation to another and shape the caregiver-infant relationship (Sroufen, Fleeson 1986).

Attachment is the result of the bonding process that occurs between a child and a caregiver during the first couple of years of the child’s life. Generally speaking, the first year of a child’s life is considered the year of needs. During this time, an infant’s primary needs pertain to touch, eye contact, movement, smiles and nourishment. Usually, when an infant has a need, he/she expresses the need through crying. If the caregiver is attuned to the infant’s crying, he/she will be able to recognize the different cries and then satisfy the child’s need. Through this interaction, which occurs numerous times per day, the child learns that the world is a safe place and as a consequence trust will develop. In addition, an emotional connection takes place which allows the child to feel empowered in his/her environment and allows him/her to develop a secure base from which he/she can confidently and effectively explore the world. Attachment must be reciprocal in order for the baby and the caregiver to create a deep, nurturing connection because it takes at least two individuals to make a connection. This reciprocal emotional bond is absolutely necessary for optimal brain development and for emotional health. The effects of this reciprocal bond are felt physiologically, emotionally, cognitively and socially.

When this initial bond — attachment — is lacking, children lack the capacity to form and maintain loving, intimate relationships. They will grow up with an impaired ability to trust others and with a belief that the world is an unsafe place where others will not take good care of them. Without a sense of trust, children come to believe that they must be hyper-vigilant about their own safety. As a result, the children’s distrust and hyper-vigilance about their safety prevents them from allowing others to take care of them in a loving, nurturing manner. Consequently, children become extremely demanding and controlling in response to their fear. Emotionally, they come to believe that if they do not control their world, they will die.

Researchers in the field of attachment state that children without proper care in the first few years of life have an unusually high level of stress hormones which adversely affect the way crucial aspects of the brain and body develop. Conscience development is dependent upon brain development and follows attachment. As a consequence, these children lack pro-social values and morality,  and demonstrate aggressive, disruptive, and antisocial behaviors.

Impaired attachment may be caused by the following: a premature birth, the use of drugs and alcohol by the mother during the pregnancy, an unwanted pregnancy, a separation at birth from the mother, a postpartum depression on the part of the mother, severe abuse and/or neglect in the first years of life, multiple caretakers, hospitalizations, unresolved pain, painful or invasive medical procedures and insensitive parenting.

Under this category of analysis, assessors would be wise to take into account the following:

1. The quality of the relationship between  child and parent is more important than “the goodness of the parent.”
2. The well-being of the child is impacted in a greater way by the parent-child interaction.
3. The quality of the parent-child relationship is related to the personality structure of the parent.
4. The interpersonal stability and continuity between the parent and the child is more important than a stable physical environment. In order for such stability and continuity to occur, the parent must (a) have the ability to recognize the unique needs and characteristics of the child at different developmental stages; (b) possess different possible approaches to handling children’s behaviors; and (c) possess the ability to structure demands and expectations according to the child’s ability and temperament while accurately interpreting the child’s behavior.
5. Grief at separation from the parent impacts the child’s emotional relationship in infancy. Attachment results from day to day attention to the child’s needs for physical care, nourishment, comfort, affection and stimulation. In essence, this is the psychological relationship that develops between the parent and the child and, if developed appropriately, gives the child a feeling of being valued and wanted.
6. The child’s attachment to the parent is a reflection of the child’s sense of his/her value in the parent’s eyes.
7. The personality development of the child is determined by the quality of attachment between the child and the caregiver during the formative years. The early experiences in life become the basis of the person’s conceptualization of what to expect in relations with others throughout life. Furthermore, the effects of attachment patterns pass from one generation to another and shape the caregiver-infant relationship.
8. The disturbance of poor early attachment expresses itself during later developmental periods — most likely during adolescence and it presents itself as deficits in morality, empathy, caring and commitment. Infants learn from caretakers how to evaluate their own behavior, how to regulate their impulses to react and how to soothe themselves in distress. Failure to learn these tasks results in increased risk at turning to maladaptive means of soothing, such as drugs and alcohol abuse or promiscuous sexual activity. Assessors should look for impaired morality, disruptive behavior and the presence of a borderline personality disorder.
9. Attachment may be secure, anxious, avoidant, ambivalent or disorganized.
10. If there are signs of an insecure attachment, wardship is appropriate between the ages of birth and five or six years; wardship is not appropriate past the formative years (Polgar, 2001).

Category Two: The Criteria of a “Good Parent”

Effective parenting that produces adaptive adults has been well researched and adequately described in the literature. Maccoby and Martin (1993) reviewed the research in the areas of: parenting and children’s competence; parenting and moral development; and parenting and self-esteem. Fisher and Fisher (1986), in their empirically based summary, conclude that open, straightforward, two-way communication is crucial, along with a consistent, fair disciplinary style. Schetky and Menedek (1980) described the positive parent as one who demonstrates the capacity for empathy, regards the child as a separate being, provides reasonable and consistent discipline, acts as a buffer between child and environment when appropriate, sets limits, shows flexibility and provides a good behavioral model.

Belsky, Learner and Spanier (1984), in their review of the parental influences in childhood, arrive at some of the same conclusions. They found, for example, the child’s school success and overall intellectual development are enhanced by parents who are “nurturant without being too restrictive, responsive yet not overly controlling, stimulating yet not too restrictive”. Such parents were reported to provide “an orientation toward independence, and a family structure that expects and rewards independent behavior”. They further conclude that Baumrind’s (1967, 1968, 1971) authoritative parenting of setting clear limits and expectations results in enhanced self-esteem and socio-emotional competency and that discipline is most effectively provided by loving and nurturant parents and when “it relies upon process of reasoning or induction, is consistently enforced and varies systematically”.

Derdeyn and his colleagues (1982) constituted the American Psychiatric Association’s task force on clinical assessment of child custody. They concluded that the most significant variables to be considered are first and foremost attachment and then the child’s needs and the parent’s capacity to parent, as well as their personality structure. Chess and Thomas (1987) introduced the concept of “goodness of fit”. They defined six styles of parenting of which the “secure parent” or the best-adjusted parent is most likely to enhance goodness of fit.

The preceding criteria of a “good parent” appear repeatedly in the literature. Current studies reinforce the earlier findings and further describe and expand the profound responsibility, skill knowledge and sensitivity required to raise children to become adaptive adults. One example of predominant thinking in this area is Coloroso (1994). She describes three kinds of families: the brick wall, the jellyfish, and the backbone, the most effective being the backbone. Tenets of this family structure are firmly grounded in the literature of the past two decades and define parents who are like the backbone of a living, supple, spine that gives form and movement to the whole body with a structure that is present and firm, but also flexible and functional.

Parenting is no simple task. To be effective, it cannot be instinctive or a repetition of the parents’ own experiences of being a child. Moreover, it cannot simply rely on what the parent thinks or believes. Because it is an onerous responsibility, the parent must be informed with good knowledge and practical skills, as well as possess a willingness to develop these attributes continuously (Polgar, 2001).

A “good parent”, therefore, is an individual who has a cognitive developmental perspective that is at least conventional and an emotional state that is well adjusted. Parents with average or better “emotional quotients” are ideally disposed (a) to recognize the enormous responsibility of parenting; (b) to acknowledge their deficiencies in this regard; and (c) to deliberately seek means by which to continue to develop their knowledge and skills as parents. Similarly, parents who are mature are far more likely to recognize the reality of their limitations and to act constructively to rectify their personal and parental deficiencies (Polgar, 2001).

Assessors must also take into account an examination of the literature that pertains to groups of individuals who are high risk for deficient parenting. Specifically, these groups are alcohol and drug addicted parents and severely emotionally disturbed parents. Such parents are identified as running a higher than average risk of producing inadequate or dysfunctional children. There is, however, a consensus that a DSM label per se should not automatically disqualify a parent. No label is able to convey the specific individual manifestations of a disorder, nor can a label accurately describe the severity of that disorder or the conditions under which symptoms are likely to manifest themselves. Rather than relying on a diagnostic label, the literature recommends considerations with respect to precipitating factors, chronicity of the disorder, how the particular set of symptoms affect parenting and, most notably, what supports are available to a parent and how remedial is the disorder. Motivation of the parent to seek assistance is also considered to be a key variable (Schutz, Dixon, Lindenberger, and Ruther 1989).

In the process of investigating the pattern of parenting that negatively impacts on the child, Russell, Anderson, and Blume (1985) have clearly identified through their review of the literature that alcoholic families are generally characterized by chaotic organization, unpredictable parental behavior, poor communication patterns, inconsistent discipline, inadequate attention given to the socialization of children, tense home atmosphere, increased probability of violence and neglect and higher than normal rates of sociopathic behaviors. The parenting of drug addicted individuals is similarly generalized.

The parenting characteristics of deficient/abusive parents have been defined and validated by the work of Garbarino and Gilliam (1980) and Gaines, Sandgrund, Green and Power (1978). The pattern that emerges is consistent. Deficient/abusive parents, as a rule, are prone to depression, are immature and dependent, lack self-esteem and are likely to use anxiety and guilt provoking techniques with their children. They also prove to have poor child management skills, are inconsistent in discipline and make unrealistic demands of their children. Furthermore, this profile includes impulsivity, higher than normal levels of emotional distress, poor frustration tolerance, physical and psychological unavailability, an immature need for love and affection which the child is frequently expected to fill and deficits in awareness of the child’s needs. In brief, these deficiencies are remarkably parallel in content to the positive parenting characteristics identified, and establish a sound foundation on which a determination of a good parent is based.

Category Three: Considerations of Present and Future Parenting Behavior

The axiom that people become more like themselves with the passing of time is grounded in the empirically demonstrated phenomenon of characterological traits. Most psychometric instruments, including the MMPI-2, incorporate several indicators that address long-term personality characteristics or traits. Cattell in 1966 and later elaborated by Spielberger (1979) expanded on this aspect of personality structure by adding the phenomenon called state. In general, personality states are transitory, while personality traits are enduring and tend to approach situations in a certain way and to react or behave in a specified manner with predictable regularity. Campbell referred to this as “acquired behavioral dispositions”. According to him, these dispositions are the result of early life experiences that dispose an individual both to approach the world in a particular way and to manifest consistently predictable tendencies. In addition, transitory personality states (like manifestation of anxiety, anger, impulsivity, introversion, obsessiveness, dominance and cynicism to name a few) can reoccur when evoked by specific stimuli and they may endure over time when the evoking conditions persist.

Clinicians in the business of promoting personality change, in recognition of this phenomenon, have constructed predictive measures otherwise known as prognosis. The better instruments, such as the MMPI-2 and the Millon Multiaxial Inventory-III, incorporate into all the clinical scales a probability statement regarding prognosis, specifically with respect to an individual’s response to growth oriented clinical intervention. Invariably, characterological traits are designated as having a poor prognosis as evidenced by the lack of gains made by similar patients over the past fifty years of use, specifically the MMPI.
The prognosis for change is dismally poor for characterological traits, some traits being more resilient than others. For example, intelligence, sexual orientation, anger/hostility and addictive propensities are some of the most resilient permanent characterological traits. Nevertheless, some individuals, in spite of the poor prognosis, appear to be no longer plagued by a dysfunctional trait. The best examples are individuals who achieve and maintain abstinence from all intoxicants for decades. It is vitally important to note that the change in behavior is not indicative of a change in the addictive propensity trait. It is attributable to specific deliberate and persistently applied well-defined tactics with which the individual gains control over the behavioral manifestation of a trait. If the tactic is abandoned (participation in self-help twelve step program), invariably the individual relapses.

Therefore, without evidence of a significant, deliberate and persistent tactic to override the debilitating behavioral manifestation of a trait, with the passage of time, individuals do become more like themselves than they were before. People do not ‘mellow’ with age unless they were ‘mellow’ to start with. In contrast, pugnacious individuals may become less so with age due to diminishing physical capacity but will continue to act out, even in nursing homes, as long as they are alive.

The motivation to gain control over the dysfunctional behavioral manifestation of a trait is significantly determined by an individual’s development of a capacity to experience a broad range of emotions. A conscience or an empathic capacity is a significant requirement. In Alcoholics Anonymous there is a saying that “a sober alcoholic is a drunk with a conscience.” Individuals with diminished capacity to experience all but the most severe emotions (psychopathy) invariably cannot sustain their effort to use an override tactic such as a commitment to participation in a twelve-step program (Rada, 1978, Grinspoon and Bakalar, 1978).

A crisis plays a very important role in determining present and future parenting behavior. Each crisis situation presents a classic example of the danger or opportunity phenomenon inherent within it. When a significant event disrupts the normal functioning of individuals, specifically their defense mechanisms to restore that which has been lost, they often exert a myriad of dysfunctional tactics to force a restoration. This is considered to be the danger inherent in a crisis. It is the basis of many tragedies, not the least of which are murder-suicides in instances of sudden marital discord. Alternatively, in a state of vulnerability, people in crisis are open to new ways of thinking and behaving, as well as to the positive influence of trained counselors. This is the opportunity inherent in a crisis. Even though some parents do participate successfully in some programs made available to them, they must consistently and purposefully continue to seek proper assistance in order to resolve their personal, relational and familial conflict. Without involvement in corrective programs and without the assistance provided by a Children’s Aid Society, the dysfunctional patterns of behavior will continue to persist.

Category Four: Social Support Network

Research on child abuse is virtually unanimous in revealing that abusive parents can be characterized as living in social isolation, having unmet emotional needs and unable to maintain composure under stress. An adjunct to being isolated and unable to trust people is an inability to ask for help (Helfer and Kempe, 1976, Spinetta, 1978). Without a social network, individuals do not thrive; do not learn new information and related skills or develop a more  comprehensive cognitive perspective of their world. An insular lifestyle and concomitant lack of stimulation invariably produces a deterioration of functioning and increasingly places children in  their care  at high risk. To become involved and stay involved in a social network that is supportive requires aptitudes and a sense of self that is acquired during the formative years in an individual’s life. In fact, recent literature has identified the  capacity to engage in cooperative activity to be determined very early in life. Without such experiences, the neurological capacity is lost forever (Wright, 1998).
Because many abusive parents do not trust people. They do not share their problems with others and do not ask for help when they need it. As a consequence, stress builds up to unmanageable levels and dysfunctional behaviors are exhibited. A temporary social network created by Children’s Aid involvement in the life of parents, however, is not sufficient (Breton, 1979). A true facilitative social network must be permanent or a quasi-permanent support system to which a parent can turn in times of stress.
Research has, in fact, demonstrated that the incidence of child neglect and abuse is significantly lower for individuals and families who are active participants in a broad social network. Moreover, in the long run, getting non-coping parents involved in a positive social network has been demonstrated to produce a higher return than by involvement of professionals or social welfare funded services (University of Toronto, 1980).

Establishing and maintaining a supportive social network requires a well-defined level of interpersonal skills of the same order that is required for establishing an emotional bond with an infant. Empirical studies of infant-mother interaction suggest that skills for relationship building are already activated, developed and in use at the point of achievement of interpersonal attachment in the very young infant. If this emerging capacity is nurtured environmentally, it forms the basis for the development of social skills for interpersonal relationships.

Insofar as the attachment process establishes the first interpersonal relationship in an individual’s life, it is considered to influence all subsequent relationships (Schaeffer, 1971). This, in turn, determines the individual’s growth and development since this process requires exposure to a variety of experiences that challenge individuals to construct meaning from their experiences that are increasingly more comprehensive and thereby adaptive.

Parents with a weak or virtually non-existent supportive social network among many deficiencies will certainly lack interpersonal skills, which are also manifested in the quality of the interpersonal relationship they have with their children.

A parent  who demonstrates the capacity to disassociate sufficiently from a dysfunctional environment and to affiliate with a positive social support network, other than with professionals, which values and encourages her effort to be a competent parent.

The Pediatric Component

The primary role of the pediatrician is to look after the health of children and their families. In this process, pediatricians promote self-esteem, confidence and a sense of competence which are important for optimal adaption for both children and families. This will ensure continuity and accessibility for ongoing nurturing and health care. Thus the clinical interview questionnaire used by the undersigned deals with the parents’ preparedness for the pregnancy whether planned or accidental, precautions taken during the pregnancy, i.e. use of drugs whether prescribed or recreational, and the parents’ desire to acquire new knowledge for the unborn child. The assessors explore the parents’ background, upbringing, attitudes and the interaction between them, their parents and other siblings in their families and in the extended family as well. The assessors also explore the goodness of fit between the child’s characteristics and the parents’ caretaking abilities and attitudes.

Inappropriate expectations on the part of parents for their children result in poor fit and thus poor interactional problems arise. The assessment process explores how parents deal  with this stress and other concurrent stresses, e.g., finances, housing, community support and homemaking arrangements. The assessors observe parents and children for at least two hours in a familiar environment and when appropriate in the family home, in order to provide guidance about specific stress alleviating strategies and to acknowledge mutual parent-child relations. The assessors further observe how infants communicate their needs to their parents, how the parents interpret these needs, and how the parent responds to them. This helps children develop a sense of trust in their parents that their needs are being met and will continue to be met in the future. At the same time, parental personality, insight and coping abilities are observed and evaluated.

If single parents are involved, either by choice or otherwise, the assessors explore the social network and support system available in the community and look for signs of difficulties associated with this type of family.

The questionnaire also explores parental dysfunction and how this affects attachment or detachment and autonomy issues. The assessors explore psychopathology in the parents and the children, as well as vulnerabilities in the children. Thus, factors that create increased risk for physical, developmental and psychosocial disorders are explored and if intervention is needed, it is recommended. Thus through this questionnaire the four categories of analysis are explored to assess the parenting capacity of the individual being assessed.

The Psychiatric Component

The psychiatric component determines the presence of psychopathology in the parents and/or the children which is then presented in the form of four categories, as follows:
1. Etiological
2. Diagnostic
3. Treatment
4. Prognosis

Etiological 

Etiological factors causing dysfunction or psychopathology are carefully examined from a bio-psycho-social aspect. Mental illness, severe personality disorders, criminality, alcohol and substance use disorders are some of the examples.

Diagnostic

Diagnostic conclusions are made using the “DSM-IV Revised” format. This format is easily understandable to the lawyers and judges. As mentioned elsewhere, DSM labels in themselves are not a reason for incapacity. Diagnosis should also be in the form of a diagnostic formulation using the previously mentioned four categories of analysis, examining them both microscopically as well as macroscopically.

Treatment 

Treatment recommendations are made to the court, once again using the multi-dimensional bio-psycho-social approach. One could possibly summarize them as follows:

• Psychotherapy—mainly Cognitive-Behavioral Therapy and Interpersonal Therapy.
• Psycho-pharmacological Therapy.
• Family Therapy.
• Marital Therapy.
• Parenting education
  

Prognosis 

The finality of the whole Parenting Capacity Assessment process falls in the prognosis. As personality traits are stable throughout life they tend to respond poorly to treatment. The actions and recommendations respectfully delivered to the Court are based on the prognosis of the various difficulties diagnosed in the previous section. The recommendations may include removal of the child from the home either on a temporary or permanent basis. Sometimes when the results of the four categories of analysis warrant it, a child is returned to the parent on a supervision order. Other times a recommendation is made for Crown wardship with access, in which case there are contacts between the child and the biological parent or parents. Other times still, recommendations are made for Crown wardship without access to the parents so that the child can be placed for adoption. These actions are always made in the best interests of the child.

About the Authors:

T. M. Abraham, M.D., F.R.C.P. (C), served as Regional Chief of Psychiatry and as President of Medical Staff while serving at the Welland County General Hospital. He initiated the establishment of a Day Treatment Program and Crisis Intervention; conducted individual and group therapy; provided consultation services to alcohol and drug services; provides psychiatric education as part of in-service at the Welland County General Hospital; and provides support and treatment at a homeless shelter. Dr. Abraham published in the Canadian Journal of Psychiatry in the area of Cimelidine induced psychosis and on the treatment of acute mania. Dr. Abraham was awarded the YMCA peace medal for humanitarian service.

Peter Bonsu, M.D., F.R.C.P. (C), has been serving as Chief of Pediatrics at the Welland County General Hospital and as Assistant Clinical Professor at McMaster University. Dr. Bonsu has a very busy practice in the City of Welland and dedicates his professional life for the betterment of children and families.

Sebastiano Fazzari, Ph.D., (C)O.A.C.C.P.P., R.S.W., was given the Counselor of the Year Award by Niagara University where he also served as an Adjunct Professor at the Graduate School in the area of School Counseling, Mental Health Counseling, and School Psychology. He has published previously in the area of Parenting Capacity Assessments. In addition to teaching in Graduate Programs, S. Fazzari was employed by Family and Children’s Services of Niagara, and by the Niagara Catholic District School Board, his current employer.
Abraham, Bonsu, Fazzari may be reached by email: sebastianf@primus.ca or by calling (905) 788-1777 (Dr. Bonsu).

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