Assessing parenting competence in child protection cases: a clinical practice model.

Evaluating parents in the context of possible abuse or neglect involves unique challenges. This paper describes a practice model for conducting clinical evaluations of parents' ability to care for young children (under age 8). Core features of the model include (a) a focus on parenting qualities and the parent-child relationship, (b) a functional approach emphasizing behaviors and skills in everyday performance, and (c) application of a minimal parenting standard. Several factors complicate the assessment task, namely, the absence of universally accepted standards of minimal parenting adequacy, the coercive context of the assessment, the scarcity of appropriate measures, difficulties predicting future behavior, and the likely use of the evaluation in legal proceedings. In the proposed model, the evaluator (a) clarifies specific referral questions in advance; (b) uses a multimethod, multisource, multisession approach; (c) organizes findings in terms of parent-child fit; (d) prepares an objective, behaviorally descriptive report that articulates the logic for the evaluator's clinical opinions regarding the referral questions; and (e) refrains from offering opinions regarding ultimate legal issues. The paper describes requisite skills needed to conduct parental fitness evaluations, sample methods, and a protocol for writing the evaluation report.

Clinical assessment of parents in child protection cases: an empirical analysis.

We investigated the content and legal relevance of clinical evaluations of parents conducted in child abuse and neglect cases. The sample consisted of 190 mental health evaluation reports, randomly selected from major providers, that had been completed on parents involved in a large, urban juvenile court system. We coded evaluations on 170 objective and qualitative characteristics in order to assess for criteria recommended in the forensic literature. We compared evaluations across groups categorized by type (e.g., psychological, psychiatric, bonding/parenting, substance abuse) and where the assessments were performed (outside or inside the court). We found numerous substantive failures to meet those criteria for forensic relevance. Evaluations of parents typically were completed in a single session, rarely included a home visit, used few if any sources of information other than the parent, often cited no previous written reports, rarely used behavioral methods, stated purposes in general rather than specific terms, emphasized weaknesses over strengths in reporting results, and often neglected to describe the parent's caregiving qualities or the child's relationship with the parent. Some relevant differences were evident across assessment groups, pointing to examples of more thorough, parenting-specific evaluation practices. We recommend ways to improve current practices in forensic parenting assessment.

Psychosocial correlates of child abuse potential in multiply disadvantaged adolescent mothers.

OBJECTIVE: This study had two aims: First to examine psychosocial correlates of child maltreatment risk, and second to assess the validity of the CAP Inventory (Milner, 1986) with multiply disadvantaged teenage mothers. METHOD: Participants were 75 adolescent mothers who were wards of the Illinois child protection system. Mothers (aged 14-18) and infants participated in home-based psychosocial assessment of personal and parenting functioning. Group comparisons examined differences for mothers with elevated versus normal versus invalid CAP scores due to faking good. RESULTS: Findings indicated that abuse risk groups differed on emotional distress, social support satisfaction, reading achievement, and years of education, but not on parenting beliefs or quality of child stimulation. Differences favored the normal over the elevated risk group in all significant comparisons, whereas mothers with elevated faking good differed from normals only in lower reading achievement. Multiple regression analysis highlighted emotional distress, support dissatisfaction, and low achievement as significant predictors of greater abuse risk. CONCLUSIONS: Despite sharing multiple disadvantages, adolescent wards are a heterogeneous group who show different levels of psychosocial functioning corresponding to levels of child maltreatment risk. The findings provide support for the concurrent validity and clinical applicability of the CAP Inventory with disadvantaged teenage mothers.

The Children's Headache Assessment Scale (CHAS): factor structure and psychometric properties.

This study investigated the content validity, factor structure, and psychometric properties of the Children's Headache Assessment Scale (CHAS), a parent rating scale for identifying environmental variables associated with pediatric headache. In Study 1, input from physicians and psychologists was obtained to develop a revised set of 44 items receiving high endorsement. In Study 2, the questionnaire was administered to parents of 92 child headache sufferers, ages 6-16, and readministered 2 weeks later. An exploratory factor analysis revealed five factors (Disruptive Impact, Social Consequences, Stress Antecedents, Physical Antecedents and Quiet Coping, and Prescription Medication Use) that reflect distinct environmental concomitants of childhood headache. Scale reliabilities (alpha, .64-.82) indicate acceptable internal consistency, and test-retest reliabilities indicate relatively stable factors and items. High scores on the Disruptive Impact factor were associated with more severe, lengthy, and infrequent headache occurrence, lending initial support for the validity of this factor. Overall, the findings support the clinical and research utility of the CHAS in behavioral treatment of childhood headache.

Treating chronic food refusal in young children: home-based parent training.

We evaluated the effects of behavioral parent training program on parent and child feeding-related behaviors in the home. We trained mothers to initiate regular offerings of previously rejected (target) foods and to provide contingent attention (i.e., specific prompts, positive reinforcement) to increase their child's acceptance of nonpreferred foods. For 1 subject, we also directed training at increasing self-eating. Results of a nonconcurrent multiple baseline design across 3 mother-child dyads demonstrated that, with training, all mothers increased offerings of target foods and use of specific prompts, and 2 mothers increased levels of positive attention. In turn, children increased their acceptance of target foods and self-eating, thus demonstrating the functional effects of parent training on in-home meal times. Temporary increases in food refusals occurred when treatment was initiated but declined as treatment continued. We discuss the results in terms of the potential benefits and limitations of a home-based treatment model.

Psychosocial concomitants of children's feeding disorders.

Compared behavior problems, child developmental skills, home environment, and parent emotional distress for 50 families of children aged 11-70 months with differing etiologies of feeding disorders (FD). Results showed that psychosocial functioning differed across FD classifications. Children with nonorganic characteristics to FD had more behavior problems compared to those with only organic FD. Children with primarily or only organic FD displayed lower developmental skills and their parents had higher emotional distress than children with primarily nonorganic FD. High parent distress was associated with older children who had poor feeding skills, less positive disciplinary practices, and higher social status. The findings imply that clinical services to families often are warranted and that service needs vary depending on the nature of FD. Mixed organic and nonorganic FD occurred in the majority of children, which supports the need for more detailed classification than an organic-nonorganic dichotomy used in prior research.

Investigation of environmental factors in pediatric headache.

This study assessed the environmental conditions surrounding headache for a clinical sample of 38 pediatric headache patients. A parent rating questionnaire, the Children's Headache Assessment Scale (CHAS), was developed and pilot tested as a means of identifying particular environmental events or situations impacting on children's headaches. CHAS items are organized into six functional categories (Stress Antecedents, Physical Antecedents, Attention Consequences, Escape Consequences, Coping Responses, and Medication Use) potentially related to headache activity. Parents filled out the CHAS at an intake evaluation for behavioral medicine treatment, and parents of children who completed treatment filled out another CHAS after therapy. Results showed that the frequency of specific CHAS items varied widely both within and between functional categories, suggesting that headache is affected by a variety of situational factors, some of which are common across many children and others of which are pertinent only for a small proportion of children. The results further suggest that the environmental conditions of headache are open to change by behavioral medicine treatment. In the present study, items reflecting social attention to headache, interference of headache with school attendance, and use of relaxation procedures changed after treatment. The potential value of the CHAS for treatment planning is discussed.

Changes in stuttering in relation to children's locus of control.

The locus of control of stuttering children before, during, and after treatment for dysfluency was investigated. Subjects participated in a one-week program combining delayed auditory feedback and training of parents to negotiate and implement contracts for their child's practice of stutter-free speech skills. The Children's Nowicki-Strickland Scale was used to measure locus of control before, immediately after, two months after, and six months after the training. Measures of speech dysfluency were available at each of these times and documented the effectiveness of treatment in reducing stuttering. The locus of control scores for stuttering children prior to treatment were comparable to normative groups. Internality on the locus of control measure prior to treatment was directly related to degree of change in dysfluency immediately following the one-week clinic, but not to dysfluency levels at the 2-month or 6-month follow-up sessions. Concomitant with improved speech, the children became progressively more internal following treatment. The results suggest that participation in a behavioral program for the treatment of stuttering increases internality.

Teaching behaviorally handicapped preschool children to share.

We examined the effectiveness of Barton and Ascione 's (1979) package for training sharing in a classroom setting with six behaviorally handicapped preschool children, four of whom were also developmentally delayed. Individual responses in sharing and not sharing were examined. Training consisted of initial instructions, modeling, and behavioral rehearsal, followed by teacher prompts and praise regarding sharing directly in a classroom free play period. Introduction of training in a multiple-baseline design across three pairs of children resulted in substantial increases in sharing for five of the six children. Results for negative interactions were less clear but suggested that concomitant decreases occurred for the same five children. The response analysis indicated that (a) individual components of sharing (offers, requests, and acceptances ) all increased with training; (b) most children were more likely to initiate sharing through requests than through offers; (c) the proportion of sharing initiatives accepted by peers increased with training despite a much greater absolute number of initiatives; and (d) of the three negative behaviors (opposing play, taking without asking, and aggression) examined as incompatible with sharing, the most prevalent response was opposing other children's play. Individual differences in initial social repertoires and responsiveness to training were examined with respect to their implications for research and practice. Overall, the findings provide an encouraging indication of an intervention program for children with behavioral, social, and developmental handicaps.

The effects of a child's self-evaluation program on compliance with parental instructions in the home.

A self-evaluation program was implemented with a kindergarten-aged boy in the home to increase compliance with parent instructions and decrease inappropriate verbal behavior. The self-evaluation package included the child's assessing the appropriateness of his behavior in 5-min intervals, receiving chips for positive self-evaluations, and exchanging chips for a reward following experimental sessions. In a reversal design, analyses were conducted of the effectiveness of the self-evaluation program, the requisite conditions for effective child behavior change with a self-evaluation approach, and the parent's efficiency in using the self-evaluation package. The self-evaluation procedures typically resulted in increased compliant behavior and decreased inappropriate behavior, although the effects generally weakened with time. Behavioral gains were greater and better maintained when the self-evaluation procedures were preceded by a phase of external evaluation via the mother than by baseline, suggesting that self-evaluation procedures may serve more to maintain the effects of external evaluation rather than to induce their own changes. The parent generally was efficient in implementing the procedures. Research and clinical implications for using self-evaluation procedures in a home setting are discussed.

Self-instructional training to increase independent work performance in preschoolers.

The generalized effects of self-instructional training on the classroom performance of three "impulsive" preschool children were investigated using a multiple-baseline design across subjects. Measures of child and teacher behavior in the classroom were obtained through direct observations during a daily independent work period. Self-instructional training followed Meichenbaum and Goodman's (1971) approach, except that training materials consisted of naturalistic task worksheets rather than psychometric test items and training sessions were of shorter duration. For all three children, self-instructional training resulted in increased levels of accuracy on worksheets in the classroom that were similar to those used in training. Results related to several supplementary measures were less clear; however, they suggested that rates of on-task behavior may also have improved, and that a mild classroom intervention further strengthened on-task rates and effect consistent work completion for all three children. The findings suggested that generalized increases in accuracy on classroom worksheets were related to the naturalistic format of the self-instructional training sessions. The level of teacher attention was controlled to rule out its effect on changes in child behavior.

Teaching a parent to train a spouse in child management techniques.

This study analyzed several aspects of the training of a mother and father in child management techniques for use with their 6-year-old severely developmentally delayed son. The mother received clinic training in procedures for increasing her son's independent dressing skills; subsequently, she was asked to teach the same procedures to her husband with no assistance from the trainer. For both parents, procedures were introduced sequentially across two components of parent behavior in a multiple baseline design. Examinations were made of (a) the effectiveness of initial child management training on the mother's behaviors, (b) her ability to teach the same techniques to her husband independently, (c) the generalization of both parents' skills from the training setting (a dressing task) to two untrained activities (eating and toy use), and (d) the impact of training on the child's behavior. Results showed that the mother learned to implement the trained procedures and successfully communicated them to her husband, as evidenced by substantial positive changes in both parents' behaviors after being introduced to the child management skills. Both parents showed some generalization to the untrained activities, and their written comments following training indicated they understood the procedures. Clear-cut improvements were observed in the child's attending and independent performance of dressing and toy use skills concurrent with parent training. A 2-year follow-up report indicated that both parents retained their knowledge of skills taught, continued to use the procedures, and rated the training as very helpful in teaching the child self-help skills.

An analysis of multiple misplaced parental social contingencies.

This study analyzed the training of a mother to modify five subclasses of her attention to her young child's noncompliance with instructions, and also displayed the changes in her child's behavior correlated with these events. Training in four subclasses consisted of teaching the mother to withhold various forms of social attention to her daughter's undesired behavior; training in the fifth subclass involved introduction of a brief room-timeout procedure for noncompliance. The effectiveness of the parent-training procedure, consisting of initial instructions and daily feedback, was demonstrated through a multiple-baseline design across the five subclasses of parent behavior. Sequential decreased in the first three subclasses of the mother's social attention to undesired child behavior resulted in incomplete improvements in some child responses; however, a decrease in the fourth subclass resulted in a significant increase in undesired child behavior. Complete remediation of all child behaviors was achieved following the training of a timeout procedure for noncompliance. Postchecks conducted up to 16 weeks later showed that these effects were durable.