Masterclass: Assessing Families and Report Writing
The VFLPN (Pathways) held a masterclass entitled “Assessing Families and Report Writing” on Wednesday the 8th of November. The event was the final of a tripartite series presented by clinical psychologist Dr Jennifer Neoh. The theme of the masterclass focused on the topic of family reports, outlining some of the different approaches employed to assess families in preparation of such reports and common strengths and weaknesses in their composition.
Note: The event summary is a generalised account of the forum speaker’s presentation, not a verbatim transcript. This report is designed for readers to get an idea of the forums content in lieu of a reliable audio recording
Dr Neoh began her talk by acknowledging the complexities inherent to family relationships. Drawing a comparison with a kitchen sink, she explained that family report writing simply involves everything; mental health issues, complicated family dynamics, external influences and parties, socioeconomic considerations and more. Accordingly, it is vital that report writers take a broad view and hold no preconceptions about the family being assessed.
Modes of Assessment
Dr Neoh then outlined the different modes of assessment, beginning with forensic assessments. Forensic assessments employ a neutral, objective position in order to generate and test multiple hypotheses. Multiple assessments can be included in one report to address different layers of the family dynamic. For example, one assessment might focus on the individual-level (parents, children, and other significant parties), another on relationships and/or practical outcomes. The triangulation of data is then collected using different methodologies, such as via interview (interview data), behavioural observations (behavioural data), psychometric testing and through collateral information such as subpoenaed documents. Dr Neoh stressed the importance of measuring the validity of the information collected and collecting more than one type of data to ensure a holistic, accurate assessment is conducted. On that note, she re-iterated that both parents must be interviewed; although it may seem obvious, it is too often an unemployed practice.
Scientist Practitioner Method
Next the Scientist Practitioner Method was explained. It employs a hypothetico-deductive method, whereby hypotheses are formed from data that has been gathered, and in turn predictions are deduced from those hypotheses. The method checks validity by testing the hypotheses against the data that has been collected, looking for information that disproves the hypotheses or suggests plausible alternatives. In practice, this method should underpin all other forensic assessments.
The Parent Interview
She then turned to the all-important parent interview. Before outlining the processes, Dr Neoh suggested three basic ways to critique parent assessments in the pursuit of ensuring validity. Firstly, the qualifications and expertise of the writer must be considered. The writer themselves should be well-known and tested to verify their professional credibility. Secondly, the methodology employed ought to be analysed. Any flaws must be flagged and deconstructed to determine whether there has been an adverse impact on the data. For example, failure to use best practice techniques could skew the data collected from an interview. Finally, the logic and reasoning in the report must be thoroughly checked to ensure the data is soundly tied to the conclusions that have been made.
The parent interview should be the first data collection method employed. Dr Neoh advised that assessors commence by undertaking a mental state exam, observing the parent’s body language, emotional behaviour and displays, presentation and so forth. The interview itself should be semi-structured in style, balancing formal questions and spontaneous conversation at the direction of the interviewee. Assessors should allow individuals to guide the conversation, noting that what a person chooses to talk about is telling of their personality and priorities. Furthermore, background information (for example, occupational and relationship history, relating to developmental background, forensic history, child protection history, psychiatric and psychological history, etc) should be collected in order to identify and expose any behavioural patterns and problems. Interviewees cannot always be relied upon to divulge all important information, therefore external investigation is imperative. Here Dr Neoh urged assessors to ask the obvious questions, follow the anomalies and directly address the allegations being made (ideally at the end of the interview). Questions must be appropriately tailored to suit the circumstances.
Important data can also be garnered by measuring the parents’ understanding and descriptions of their child/ren, and their relationship with them and the other parent. Basic questions such as “what is your child like?” in terms of personality, strengths and weaknesses, etc. can reveal inconsistencies in parenting narratives. The assessor can compare both parents’ judgements of their children against how the child presents to measure the parents’ capacity to understand their children’s needs. This also provides insight into how the child interacts with both parents. This analysis essentially amounts to a verbal measure of the attachment relationship, which is invaluable data considering that formal attachment measures do not fit well with family law procedures and/or reports.
The Child Interview
The child interview provides vital data that cannot be collected elsewhere, as there is generally no comparative data to test against; children cannot assess their own behaviour.
The main objectives of interviewing children are:
· To obtain valid and accurate data
· To make assessments of their maturity, developmental stages and the interplay of these on their experiences over their lifetime
· To gain an understanding of their interests, temperament and personality
· To understand their situation, worries, fears and pleasures
· To collect children’s verbalised wishes and preferences
She cautioned that inviting children to talk about their parents is often an emotional minefield, and consequently prompted assessors to build rapport with children and ensure their comfortability throughout the interview to safeguard against harm as much as possible. As such, assessors must be aware of the power dynamics at play between themselves and the child interviewee, and remain cognisant of the emotional turmoil these children have likely been subjected to.
The line of questioning directed at children must be highly considered. It is essential that assessors avoid leading questions and encourage a neutrally prompted, free flow of dialogue from the child themselves. Young children find free recall considerably more difficult than cued-recall/recognition and are particularly deferential to adults’ beliefs, consequently they are more likely to provide honest, unbiased responses in a neutral interview context. Assessors also must remain sensitive to implied messages from children (e.g. through behavioural cues), and unpack answers provided to ensure they reflect what the child actually feels, thinks and experiences. Some behavioural cues can be indicative of anomalies or ‘touchy subjects’, such as when children exhibit some kind of resistance to answering a question - for example by ‘forgetting’ something, making a joke or asking to go to the bathroom. Assessors should navigate these cues to appropriately tailor their questions whilst continuing to employ a least-harm approach.
The questions posed inevitably have an impact on the children, therefore assessors must be cautious not to introduce new ideas, skew pre-existing thoughts or trigger extreme distress. Similarly, the present assessor should analyse the way the child speaks and answers questions as it may indicate that they’ve already been asked the question, and are providing a response they believe to be desirable. Dr Neoh here advised assessors to test a child’s suggestibility and attempt to identify the source of their beliefs by asking questions such as “how do you know that?”
As with all interview data, the accuracy of the child interview and the data collected must be examined. Free narrative provides the highest likelihood of accuracy, therefore children should be encouraged to talk uninterruptedly. A good level of rapport with the child also enhances the likelihood of accurate data collection, however Dr Neoh flagged that some children are eager to please and assessors should be mindful of compromised information. Assessors should further triangulate the data collected with other sources, such as information provided by other family members, documentary information, teacher’s reports and so forth. This will put the information in context, which is vital as ultimately no information is significant on its own. Cross-comparing information will also highlight any discrepancies in the narratives provided and any inaccurate data.
During the interview, assessors should explain how the information children provide is going to be used. This exhibits respect and will assist to build rapport with the child, for example by asking the young person to get ‘permission’ to use the information and paraphrasing the answers provided. This practice will not only act as a validity check, but also potentially empower children as they often feel their point of view is being heard and acknowledged.
Dr Neoh then explained that different topics will require a different level of ‘rigour’; referring to interrogatory depth. Using a hierarchical pyramid structure, she illustrated that more sensitive topics – such as obtaining an eye witness account from a child about a sexual assault – require a higher level of rigor, whereas more generalised topics, such as those based on assumptions that children have a ‘good enough’ relationship with both parents, should employ the least intrusive methods possible. Please refer to the below diagram.
In summary, Dr Neoh noted that information obtained from children must be understood from within the context of their family and their situation. In some instances, the strength of a child’s overt opinion may not always be as meaningful as it may first seem once put in context. Assessors must also be cautious not to always listen to children’s verbalised wishes as it can perpetuate alignment from one parent. Finally, she noted that chronological age is not always an indicator of maturity and to assess children without any preconceptions about their development and mentality based on a numerical figure.
Another vital source of data is that obtained through observation. Assessors can manoeuvre spatial dynamics to allow for behavioural observations, such as by pairing the child with each parent separately, then together, and vice versa. In any event, the child must be observed with both parents, the only exception being if they have never met before. Whether the parents are put into the same room together is at the discretion of the assessor, however one must consider the level of risk involved and whether there are any existing Court orders which would render such an arrangement inappropriate.
Parent behaviour regarding the assessments and appointments, for example how they behave in the waiting room, should be considered. Meaningful insight can also be gained from observing separations, reconciliations and transitions between/with parents. Dr Neoh advised assessors to look for subtle cues when undertaking observations, such as a child ‘dancing around’ a parent to avoid physical contact. Furthermore, how children and parents behave while describing their relationships with one another can also be insightful. Assessors should be attuned to look for minute behaviours such as eye contact, looks of fear, acts of avoidance etc.
The context in which observations are undertaken is an important factor, there being arguments for and against naturalist versus structured formal observations. Naturalistic arrangements such as home visits may allow the interviewee to feel more comfortable, however there is the risk of a loss of standardisation. Conversely, structured environments provide greater standardisation but less comfortability. Which structure is employed will ultimately depend on the circumstances and the needs of the parties involved.
Different observational methods may also be used in combination, such as:
· Time sampling – observing subjects at different time intervals
· Event sampling – recording unusual events
· Situation sampling – utilising a variety of environments to ensure that results are not linked to the environment.
The use of psychometric testing (techniques of psychological measurement) may be appropriate in some circumstances. The purpose of such tests is to generate data, for example regarding the presence of psychopathology or personality styles. Psychometric testing techniques are most effective when used to compliment other data to corroborate hypotheses, or to promote alternate hypotheses for consideration; however they should not be used in isolation.
Such tests are particularly useful to help explain observed functional deficits, allowing assessors to differentiate between situational and chronic behaviours and state versus trait based behaviours. They can also be used to test allegations such as mental health symptoms. Notwithstanding the utility of psychometric testing, assessors must understand that test results don’t link directly to behaviour, nor do attitudes always translate into actions; therefore they are best employed in conjunction with other data collection methods.
An ancillary but essential form of information is collateral data. Obtaining documentation from external sources is vital to obtain a complete picture of the family situation. Dr Neoh encouraged assessors to obtain information from numerous sources, such as schools, other professional contacts, subpoenaed documents and other family members/important parties. If appealing to a school to obtain information, she advised that assessors favour teacher interviews over reports, to ascertain a sense of the teacher’s capability to provide valuable information. Other family members can also provide insight, however assessors must be mindful of biased information and/or skewed beliefs according to which parent they align with.
Obtaining a holistic set of valid data is the ultimate aim when assessing families. It is best practice to utilise the whole story method by looking at the evidence, conducting different interviews, collecting various types of data, etc. in order to identify a convergence of information from which the assessor can draw legitimate hypotheses. Assessors must always remain open to consideration of alternate hypotheses and include information that may counter the main hypotheses. They must also make time for the consideration of risks, and employ both formal and informal risk assessment measures to ensure the safety of the families being assessed.
When writing the report itself, assessors must identify where the data came from and should directly note the source, whether by direct observation, inference or pinpointing the individual- ‘he stated’, ‘she argued’, etc. Opinions held by the assessor should likewise be clearly outlined, using language such as ‘In my opinion’, etc.
In conclusion, Dr Neoh stressed that family reports must be readable, urging writers to simply articulate the relevant information they have collected in a clear and concise manner. Legal jargon is inappropriate in a family report. Her final piece of advice was to “remain open minded to all hypotheses and all outcomes and re-evaluate everything when you receive new information”.