Evaluating Evaluations

 

In 2001, Karen S. Budd wrote a paper titled “Assessing Parenting Competence in Child Protection Cases: A Clinical Practice Model.” In that paper, Budd cites a study of 190 mental health evaluations completed on parents in child welfare cases in a large urban environment. The study identified “numerous substantive limitations in the content and comprehensiveness of assessments.” The evaluations were completed in a single session, used few sources of information other than the parent, rarely included parent-child observation, and often failed to describe the parent’s caregiving qualities, the child’s feelings about the parent’s caregiving ability, or the child’s relationship with the parent. As a result, Budd found that the evaluations fell short of the American Psychological Association’s guidelines for child welfare evaluations. 

Although Budd’s paper was published in 2001 we have not made much, if any, progress in implementing meaningful changes to either the content or context of these evaluations. Despite their glaring and documented deficiencies, judges, guardian-ad-litems and other stakeholders in dependency cases often place a premium on these evaluations and their recommendations. Tragically the evaluations are often the final nail in the coffin of a dependency adjudication or a termination hearing. And while an attorney may be able to attack the validity of an evaluation in any single case, it is time for a larger shift in child welfare’s acceptance of these problematic evaluations.   

As a parent attorney for nine years, I have had the opportunity to review dozens and dozens of parental fitness and psychological evaluations, but I have never seen one that recommends that a child return home (even under any conditions) or that a parent have unsupervised visitation. Instead, I have seen evaluations missing key evaluative components, relying on incorrect information, or copying and pasting paragraphs with other individual’s information. I have also seen evaluations recommending parents lose weight, maintain housing for six months prior to unsupervised visitation, or obtain a GED or high school diploma. A “therapeutic” recommendation is often that parents “comply with their case plans” without the evaluator ever seeing those case plans. And I have seen the same evaluators marched into court over and over and over again to produce the same findings, give the same recommendations, and receive the same payment from the Department. When does this become just an “expert for hire”? 

            Along those lines—a word to the profession. While APA guidelines are aspirational, all states have licensing rules, requirements, and standards, some of which speak directly to conduct governing these types of evaluations. For an example in Georgia, professional licensure mandates compliance with the Code of Ethics for psychologists and counselors. One such code requirement is that psychologists base the opinion in their reports on information and techniques “sufficient to substantiate their findings.” Thus, while APA Guidelines are not mandatory, licensing requirements are, and yet many evaluations fall far short of these guidelines. In fact, the agency in Georgia used two evaluators in dozens of cases who had been sanctioned by the licensing board for failing to meet their ethical requirements. 

And to the evaluators: your client might be the agency, but your moral obligation is certainly to the families. Do not cut corners, make sure you question “informed” consent, ask what the forensic question is, identify limitations in your recommendations, and get to know the family. Your work does not exist in the vacuum. An evaluation can follow families for years, even if you never testify in a courtroom. Child welfare is a complex and nuanced area, so do not function only as a check-mark for agencies. Agencies remove children unnecessarily and illegally. The very fact that a parent has a foster care case, or is involved with the agency, does not make them a danger to a child. As Budd writes, “[p]sychologists who provide evaluations in a forensic context must approach the task with an open mind, tolerance for ambiguity and confidence that full information enhances decision making.” If you can’t do this, please decline to offer services. 

            As Budd’s paper reaches twenty years since publication, it is past time to revisit and, at a minimum, actually implement her three recommendations for improving these evaluations (when they “must” be utilized): (1) put “emphasis on the parent’s functioning as a caregiver and on qualities of the parent-child relationship”; (2) “focus on functional skills and deficits involved in everyday parenting patterns”; and (3) include “. . . measurement of parenting advocacy in light of what would be minimally necessary to protect the safety of the child” (all emphasis is my own). Budd further proposes that evaluators should offer a conservative approach when offering opinions on legal issues. Lastly, the three recommendations simply represent a good start. We should also engage the ideas and strategies of other professional groups who are currently looking at measuring and accounting for­ parental trauma, resilience and cultural relevance in child welfare evaluations. 

There is no doubt in my mind that years from now when we look at back at senseless adjudications and terminations, we shall deeply question the “experts” that recommended and approved such drastic and harmful measures. But why wait until then? It would be my hope that in light of the glaring and significant issues with these evaluations, child welfare practitioners would reconsider the need for these evaluations at all. As Vivek Sankaran points out in his blog post from July 20, 2021 “Reframing How We View Families,” there are immediate changes to the system that we can implement to improve outcomes simply by challenging our underlying values about these families and our business-as-usual approach. To me, one simple step we can implement immediately would be to cease the overreliance and over utilization of deficient evaluations. After all, a system built on deficiencies will also be defective.