Professional Psychology: Research and Practice Copyright 2006 by the American Psychological Association

2006, Vol. 37, No. 6, 666 – 675 0735-7028/06/$12.00 DOI: 10.1037/0735-7028.37.6.666

Evaluating Parents in Child Protection Decisions: An Innovative

Court-Based Clinic Model
Karen S. Budd, Erika D. Felix, Samuel C. Sweet, Andrea Saul, and Russell A. Carleton
DePaul University

Providing relevant, timely forensic evaluations is challenging because of the differing worlds of mental
health and law. In this study, the authors evaluated an innovative, court-based clinic model for improving
acquisition and use of clinical information in juvenile court in a 3-year pilot project prior to wide-scale
implementation. The authors investigated the extent to which 170 evaluations of parents in the child
protection division met criteria recommended in the forensic literature by comparing reports across four
groups categorized by source (inside or outside court; part of pilot project or not). Findings suggested
greater use of recommended practices and more timely, consistent reports by the pilot clinic. The findings
provide preliminary support for the model and guidance for improving forensic evaluations in child
protection.

Keywords: parents, evaluations, juvenile court, forensic assessment, child maltreatment

Psychologists and other mental health professionals who pro- such evaluations can provide an informed, objective perspective
vide clinical evaluations in juvenile, dependency, or family courts that increases the fairness and accuracy of legal decisions (Amer-
accept a sobering responsibility. Judges and attorneys typically ican Psychological Association [APA] Committee on Professional
lack formal training in psychological and mental health issues Practice and Standards, 1998). At their worst, they can contribute
(Children and Family Research Center, 2004), and thus they often inaccurate, biased, or irrelevant information that violates examin-
turn to clinicians for guidance in understanding the functioning ees’ rights and/or impairs the decision-making process (Budd,
and needs of youth and parents involved in court proceedings. 2005).
Evaluations conducted in a legal context are complicated by fre- In this article we describe an innovative, system-wide model for
quently vague referral questions, the coercive nature of the assess- improving the quality and usefulness of clinical information in
ment, difficulties predicting future behavior, and the gravity of metropolitan Chicago’s Cook County Juvenile Court, which in-
decisions for which the evaluations are used (Budd, 2001; Grisso, cludes both juvenile justice and child protection divisions. The
1986; Melton, Petrila, Poythress, & Slobogin, 1997). At their best, term clinical information as used in this article refers to mental
health evaluations (e.g., psychological, parenting capacity, psychi-
atric, or psycho-educational assessments) and therapist reports on
youth, parents, and families. In response to problems associated
KAREN S. BUDD is a professor of psychology at DePaul University. She with the acquisition and use of clinical information, a multidisci-
conducts research on parent training interventions, parenting competence, plinary team conducted a comprehensive evaluation, identified
and child maltreatment. system limitations, and proposed a model for reform. After sum-
ERIKA D. FELIX is now at the Center for School-Based Youth Development
marizing the problems precipitating reform, we describe a 3-year
at University of California, Santa Barbara. Her research interests focus on
assessing and preventing bullying victimization and on disaster mental
(2000⫺2003) pilot study evaluating the effectiveness of the model
health. prior to its full-scale implementation. Using evaluations of parents
SAMUEL C. SWEET, ANDREA SAUL, AND RUSSELL A. CARLETON are doctoral in the child protection system, we show the extent to which
students in Clinical Psychology at DePaul University. Samuel C. Sweet’s evaluations from the pilot clinic included characteristics recom-
research involves enhancing collaboration between community-based ser- mended in the forensic literature, as well as the timeliness and
vice providers, particularly schools, and mental health professionals. An- consistency of these evaluations, compared with evaluations from
drea Saul’s research focuses on assessment and treatment of high-risk other sources. By highlighting key components of the reform
youth and families and posttraumatic stress disorder among youth. Russell model, the study demonstrates how psychologists and other mental
A. Carleton investigates adolescent stress, coping, and symptomatology in health professionals may aid decision making at both practice and
youth, as well as their religious development.
systems levels, as well as challenges inherent in the process.
WE SINCERELY THANK our colleagues at the Cook County Juvenile Court
Clinic, directed by Julie Biehl, and research assistants, especially Katherine
Oldham, Brian McManus, and Ginger Apling, for their support and assis- Background and Setting: Cook County’s Juvenile Court
tance. We gratefully acknowledge the John D. and Catherine T. MacArthur System
Foundation, Northwestern University, DePaul University, and the Juvenile
Court of Cook County, Illinois, for funding this project. The Juvenile Justice and Child Protection Department of the
CORRESPONDENCE CONCERNING THIS ARTICLE should be sent to Karen S. Circuit Court of Cook County, Illinois (hereinafter referred to as
Budd, Department of Psychology, DePaul University, 2219 North Ken- Juvenile Court) is the largest and oldest juvenile court system in
more Avenue, Chicago, IL 60614. E-mail: [email protected] the nation, serving the city of Chicago and surrounding suburbs. It

666
 EVALUATING PARENTS IN CHILD PROTECTION DECISIONS 667

consists of a child protection (abuse and neglect) and a juvenile judge endorsed and approved for pilot study in selected
justice (delinquency) division, each of which has approximately 15 courtrooms.
courtrooms. The Juvenile Court’s size and stature amplify the
difficulties of a dysfunctional court system as well as the benefits The Reform Model
of a functional system.
In the early 1990s, the Juvenile Court was beset by high case- The reform model was designed to build on the strengths of the
loads, insufficient intervention resources for youth and families, existing system, minimize or remove system-wide constraints, and
and ineffective communication and administrative mechanisms. respond to the court’s needs (see Scally et al., 2001⫺2002, for a
The highly publicized Joseph Wallace case, in which a 3-year-old detailed description). It consists of four units with distinct but
boy was hanged by his mother shortly after being returned to her interdependent functions and purposes: clinical coordination, ed-
care, demonstrates the tragic consequences of these systemic prob- ucation and resource, administration, and program evaluation. (A
lems (McWhirter & Gottesman, 1993). Ms. Wallace had a history fifth unit, credentialing, was envisioned as a future addition.) The
of chronic violent behavior and severe mental illness, yet clinical units operate across both the juvenile justice and child protection
reports and lay advocate accounts, which contained erroneous and divisions under a single director, with variations in operation
incomplete information about her functioning, served as the basis across the two divisions. Units are staffed by social workers,
for crucial legal decisions. An independent investigation of the psychologists, psychiatrists, lawyers, and support personnel.
case cited numerous errors in judgment and practice by parties
(judges, attorneys, caseworkers, clinicians, lay advocates). Further, Clinical Coordination
the investigative report stated, “the absence of any procedure to
integrate mental health and criminal records with abuse and de- Clinical coordination is the unit with the most direct interface
pendency actions promises to occasion a repeat of this outcome” with the court system, designed to provide services that facilitate
(Report of the Independent Committee to Inquire into the Prac- acquisition and use of clinical information in response to court
tices, Processes and Proceedings in the Juvenile Court as They requests. These services include the following:
Relate to the Joseph Wallace Cases, 1993). • Screening inquiries from court personnel about clinical
information
The Wallace case was one of several high-profile cases in
• Diverting inappropriate requests
Chicago and other urban areas that generated a “culture of fear”
• Formalizing requests for clinical information using a standard
surrounding juvenile court decisions to return youth to their fam-
protocol
ilies (Merry et al., 1997). In Cook County’s Juvenile Court, these
• Directing requests to appropriate providers
conditions contributed to the evolution of an “assessment-driven”
• Efficiently identifying and gathering existing records
system, in which youth and parents were referred for multiple
• Communicating information to court personnel and clinicians
clinical evaluations, often redundant in nature, while services and
• Providing high quality responses to requests for clinical
legal decisions were delayed. All parties, including attorneys, child
information
welfare workers, probation officers, and mental health profession-
The clinical coordination unit consists of clinical coordinators,
als, agreed that the practices of requesting and using clinical
intake workers, and clinical evaluators. Clinical coordinators are
evaluations needed to change; yet change was thwarted by the master’s level professionals in social work or related fields who
multifaceted and systemic nature of the problems. receive extensive forensic training. Each clinical coordinator is
In response to these concerns, the chief judge of the court assigned to specific courtrooms and serves as a liaison between the
system in Cook County invited a multidisciplinary team to study court and the clinicians. Depending on the nature of referral
and improve the clinical information system in Juvenile Court. questions and individuals to be evaluated, requests for clinical
From 1997 to 1999, the Clinical Evaluation and Services Initiative information are directed either to the court-based clinic or to other
(CESI; 1999) conducted a comprehensive evaluation and identi- providers.
fied three key areas for change: (a) the process of acquiring clinical For requests directed to the court-based clinic, intake workers
information (e.g., vague referral questions, repeated and unneces- meet with the individual(s) on whom clinical information is re-
sary evaluations, lack of timeliness); (b) the content and quality of quested to gather background information and obtain releases of
the clinical information obtained (e.g., use of invalid or unreliable information. The intake process is initiated on the day the request
assessment methods, failure to include relevant information from for clinical information is made. Doctoral level clinicians (psy-
records or collateral sources, undifferentiated recommendations); chologists or psychiatrists) respond to requests for clinical infor-
and (c) system-wide constraints (e.g., varying practices among mation using recommended forensic assessment guidelines. Clini-
courtrooms, general lack of knowledge among attorneys of what cians strive to complete reports within 6 weeks or before the next
constitutes a competent evaluation, poor communication). CESI’s court date.
research also found a number of strengths, including the court-
based clinic’s presence on the grounds of the juvenile court, strong
Supporting Units
interest on the part of the academic and clinical community in
providing quality assessments and interventions, court personnel’s The remaining three units support the operation of the clinical
view that clinical information is valuable for decision making, a coordination unit.
supportive court administration including the chief judge, and Education and resource. This unit conducts orientation and
funds available for providing quality clinical information. On the training of court and clinic personnel and consults on intervention
basis of its findings, CESI devised a reform model, which the chief resources for youth and/or families.
668 BUDD, FELIX, SWEET, SAUL, AND CARLETON

Administration. Administration maintains personnel and man- conducting an evaluation adequate to support the conclusions, and
agement systems for clinic operation. recognize the need for timeliness. Complementing the APA guide-
Program evaluation. Finally, the program evaluation unit an- lines, a small literature (e.g., Azar et al., 1995; Azar, Lauretti, &
alyzes program activities and products, ensures accountability, and Loding, 1998; Baerger & Budd, 2003; Barnum, 1997; Budd, 2001,
communicates information about performance and promising 2005; Budd & Holdsworth, 1996; Condie, 2003; Dyer, 1999;
practices. Kuehnle, Coulter, & Firestone, 2000; Otto & Edens, 2003) pro-
The reform model incorporates responses to the three main areas vides recommendations for parent evaluations in child protection
of problems identified in CESI’s initial research, namely (a) the cases.
process of acquiring clinical information, (b) the content and Little empirical information exists about the extent to which
quality of clinical information obtained, and (c) system-wide con- parent evaluations in child protection cases reflect recommended
straints. Many problems associated with acquiring clinical infor- guidelines. However, as part of CESI’s initial research, Budd,
mation have stemmed from failure to articulate requests for clin- Poindexter, Felix, and Naik-Polan (2001) examined 190 randomly
ical information clearly, screen requests for appropriateness, direct selected evaluations completed on parents in Juvenile Court and
requests to an appropriate provider, and respond to requests in a found numerous shortcomings. Specifically, evaluations fre-
timely manner. The reform model provides for clinical coordina- quently listed vague referral questions; consisted of a single office
tors who facilitate these functions, as well as several procedures to session with the parent, with no direct information on the child or
expedite case progress. The model responds to problems in the parent⫺child interactions; relied on traditional psychological in-
content and quality of clinical information by hiring qualified struments not directly related to parenting; made limited use of
clinicians, providing specialized training in recommended forensic written records or collateral information from caseworkers or
practices, and providing supervisory support and resource consul- therapists; failed to state whether parents were warned of the
tation. It reduces systemic constraints, such as differing practices evaluation’s purpose and limits of confidentiality; emphasized
across courtrooms and lack of communication, through the use of parents’ personal weaknesses over strengths; and neglected to
a standard procedure for requesting clinical information, clinical describe parent⫺child relationships. Moretti, Campbell, Samra,
coordinators who act as liaisons between the court and clinicians, and Cue (2003) reported some of these shortcomings and other
coordination with other systems (e.g., child welfare, police) that concerns in their study of parenting capacity evaluations in the
interface with the court, educational activities, and program eval- Canadian Province of British Columbia. Further, Carr, Moretti,
uation to assess the adequacy of services. and Cue (2005) examined self-presentation bias in parents under-
Before describing the pilot study and its outcomes, we review going evaluations in termination-of-parental-rights cases in British
the specific challenges associated with evaluating parents. Columbia. They found a positive bias on parents’ psychological
test responses, which raises questions about the veracity of the
Challenges of Evaluating Parents in Child Protection data, particularly on instruments that do not have validity scales.
Cases These studies, although limited, suggest that clinical practice in the
field of parent evaluations has not yet incorporated the recom-
In the child protection division, most court requests for clinical mended guidelines.
information focus on parents. Considerable controversy exists as to
the credibility of parent evaluations in child protection cases, in Goals of the Pilot Project
part because of the methods and practices used by clinicians (Azar,
Benjet, Fuhrmann, & Cavellero, 1995; Budd, 2001; Budd & Holds- The current investigation of the reform model compared parent
worth, 1996; Grisso, 1986; Melton et al., 1997). Whereas all evaluations by the court-based pilot clinic to those completed by
forensic evaluations are subject to bias because of the coercive and three other provider sources (an existing court clinic and two
stressful circumstances in which they are conducted, evaluating external sources) to assess for criteria recommended in the forensic
parents in a legal context is complicated further by the lack of literature. In particular, the research addressed five questions: (a)
accepted standards of minimal parenting capacity and the scarcity Who is evaluated, in what types of evaluations, and how compre-
of appropriate measures. hensively? (b) How specific and detailed are the referral questions
In response to these difficulties, the APA Committee on Pro- articulated in reports? (c) To what extent do evaluations include
fessional Practice and Standards (1998) developed guidelines out- multiple measures and sources, warning of limitations on confi-
lining professional competencies, procedures, and ethics of desired dentiality, and references to the reliability and validity of data? (d)
practice in child protection cases. Other professional entities (e.g., What findings are described regarding the parents’ strengths,
American Academy of Child and Adolescent Psychiatry, 1997) weaknesses, and relationship with the child? and (e) How quickly
also provide recommendations for evaluators; however, the APA and consistently are evaluations completed in response to court
guidelines are the most specific with reference to evaluation of requests?
parents. APA recommends, for example, that clinicians determine The research used a quasi-experimental design, necessitated by
the scope of the evaluation on the basis of the nature of the referral the study’s applied nature. All evaluation requests were generated
question; inform participants about the limits on confidentiality; in pilot courtrooms, and clinical coordinators screened requests
use multiple sessions, methods, and sources of data gathering; and and assisted court personnel in framing referral questions. Re-
make efforts to observe the child together with the parent(s), quests were directed to provider sources on the basis of the nature
preferably in natural settings. In regards to preparing reports, APA of referral issues and parent characteristics rather than by random
recommends that clinicians neither overinterpret nor inappropri- assignment. These factors limit experimental control over the
ately interpret assessment data, provide an opinion only after variables responsible for group differences. Because of the lack of
 EVALUATING PARENTS IN CHILD PROTECTION DECISIONS 669

prior research, the study sought to describe group differences conducted evaluations in response to a narrow set of forensic
rather than test hypotheses. requests (e.g., parental competence to surrender parental rights or
The problems experienced with past parent evaluations are not consent to adoption, or determinations of mental impairment,
exclusive to this court but rather reflect an ongoing problem facing mental illness, or mental retardation as a basis for termination of
many court systems. This study provides initial data on an inno- parental rights).
vative, multifaceted reform model. It also provides comparative
data on three other evaluation models operating in the court, which Parenting Assessment Team (PAT)
allows examination of the strengths and weaknesses of alternative
models. The results shed light on the impact of evaluation reform The third group was PAT, a multidisciplinary team designed to
for juvenile court settings and suggest methods for improving provide comprehensive evaluation of parents with severe mental
forensic evaluation practice in child protection cases. illness. DCFS established PAT in 1994, in response to the Wallace
case, to provide in-depth information and service recommenda-
The Pilot Project tions to caseworkers (Jacobsen, Miller, & Kirkwood, 1997). PAT
consisted of a psychiatrist, psychologist, social worker, and child
Our sample consisted of all 170 mental health evaluation reports development specialist and involved more extensive assessment
completed on parents in response to requests for clinical informa- procedures than most other evaluations. For evaluation requests to
tion from child protection courtrooms. Depending on the referral be directed to the PAT, parents needed to have been psychiatrically
issues, requests for clinical information were directed either to hospitalized for severe mental illness within the past 5 years.
evaluators for assessment or to current or former therapists in lieu
of new assessment; reports from therapists were excluded from the DCFS Clinicians
sample. The number of courtrooms participating in the pilot in-
creased from three to six over the 3-year period. DCFS contracted with individual clinicians (primarily psychol-
Attorneys, judges, and/or caseworkers in pilot courtrooms ini- ogists) to conduct evaluations of parents and/or children. DCFS
tiated requests for clinical information, and, following screening clinicians conducted evaluations on a wide variety of referral
and consultation by a clinical coordinator, appropriate requests for issues. Evaluation requests not meeting criteria for another source
evaluation were directed to one of four provider groups. Two were referred to DCFS clinicians. In 1997, DCFS implemented
provider groups were within the court, and two other provider administrative and policy changes to reduce the number of psy-
groups operated outside the court through the state’s Department chological evaluations, tighten criteria for authorizing evaluations,
of Children and Family Services (DCFS). Assignment to a pro- and improve the quality of evaluations (Brenner & Holzberg,
vider group depended on the questions asked, the characteristics of 2000). In some cases, DCFS contracted with a child welfare
parents, and whether the clinical information was for use by a agency that hired its own clinicians. In the present study, evalua-
judge in making a legal decision (forensic requests) or for use by tions completed either by DCFS contracted clinicians or child
a caseworker in determining service provision (service requests). welfare agency clinicians are referred to as DCFS clinicians.
Forensic requests generally were directed to court-based providers,
whereas service-only requests were directed to noncourt providers. Coding Procedures
Decisions were based on a joint agreement between the Juvenile
Court and DCFS, which took into account the providers’ mission, We coded evaluations using the Clinical Assessment Code
clinician expertise, and funding. The four provider groups are Book: Parent Evaluations—Revised Pilot Version (Budd, 2003),
detailed in the following sections. which contains coding criteria and scoring rules for 175 objective
and qualitative items. We modeled the coding system on an anal-
Pilot Clinic ogous system developed by Budd et al. (2001) for coding evalu-
ations of parents in the initial CESI research. Summary categories
The first group was the pilot clinic—the innovative court-based (and number of items contained in each category) are as follows:
clinic is described above under The Reform Model section. The case identification and demographics (8), evaluation context and
pilot clinic conducted evaluations on a variety of referral issues, referral source (15), purpose and intended use of information (27),
including parents’ cognitive or emotional functioning, caregiving records and background information (33), methods and measures
capacity, service planning, the parent⫺child relationship, and the (45), reliability and validity information (11), findings (8), inter-
impact of mental health issues on parenting. For evaluation re- pretation of findings and recommendations (16), and evaluators
quests to be directed to the pilot clinic, one or more referral (12). Selected behavioral definitions that relate to the research
questions needed to be forensic (i.e., for use by a judge). Evalu- questions are provided in Table 1.
ators typically were psychologists, although psychiatrists were Seven research assistants (six graduate students in clinical psy-
used when the referral questions (e.g., regarding medication or chology and one bachelor’s level psychology graduate) were
diagnostic issues) required psychiatric expertise. trained as coders by having them study the code book, score
practice evaluations, and meet weekly for supervision on coding
Forensic Clinical Services (FCS) procedures. Two research assistants independently coded 104 eval-
uations (61% of the total sample) to assess coder reliability on
The second group is FCS, an existing county-wide, court-based individual items. To be counted as an agreement, both coders had
forensic clinical services department consisting of evaluators to agree that a characteristic was present, absent, not applicable (an
(mainly psychologists) serving adult and juvenile divisions. FCS option for only a few items), or code the same value for it.
670 BUDD, FELIX, SWEET, SAUL, AND CARLETON

Table 1
Behavioral Definitions Related to the Current Research

Category Behavior description

Evaluation context
Evaluation types Psychological—clinical interviews and measures of cognitive, personality, social, behavioral, and/or parenting
functioning
Psychiatric—clinical interviews and mental status examinations
Multidisciplinary—assessment of parents (and possibly children) by professionals from more than one discipline
Other—substance use, mental health intake, neuropsychological, or other evaluation
No. of sessions Single in-person sessions
Location of sessions Office or clinic
Home
Naturalistic environment—for example, visitation room at an agency, foster home, or park
Other—for example, inpatient facility
Referral context
Content area(s) identified in Cognitive or emotional functioning
referral questions Parenting ability
Parent–child relationship
Substance use
Service needs
Specificity of referral General—global statement of content area to be assessed (e.g., evaluate parent’s emotional functioning)
questions Specific—lists one or more parent behaviors, areas of functioning, childcare circumstances, or service issues to be
assessed (e.g., questions about parent’s psychiatric diagnosis or need for medication management, ability to provide
for children’s special needs or to discipline children appropriately, degree of attachment with child, or therapeutic
needs to manage depression)
Additional referral Presenting problems for current evaluation—for example, child upset upon returning from visits with biological parent,
information new child abuse allegations
Permanency options or legal decisions being considered at the time of the referral—for example, family reunification,
change in visitation arrangements, termination of parental rights
Methods used
Instruments administered Cognitive
Achievement
Objective personality
Projective personality
Symptom questionnaire
Parenting questionnaire
Parent–child observation
Background sources used Client
Child(ren)
Worker/therapist
Collateral informant
Written records and source—for example, child welfare or mental health agency, police, or hospital
Explained purpose of Statement that examiner explained the reason(s) why the evaluation was conducted and/or who can have access to the
evaluation and/or limits results of the evaluation
of confidentiality
Reliability/validity of data Statement about the believability of the information obtained in the assessment or the effectiveness of methods used to
produce an accurate account of the parent’s functioning (e.g., confidence ranges of IQ scores, lie scales, or social
desirability indexes)
Report of findings
Parent’s personal attributes Strengths—for example, ability to handle stress, coping style, cooperation with treatment
and behavior (must be Weaknesses—for example, impulsive, impaired capacity to direct and control own behavior
offered as examiner’s How attribute impacts on parenting—for example, parent’s impulsive behavior limits ability to be patient with the
opinion or as information children
received from sources
other than the parent)
Parent’s caregiving skills Strengths—for example, developmentally appropriate expectations, responsive to child’s physical and emotional needs
and beliefs (offered by Weaknesses—for example, inconsistent discipline, unaware of danger in allowing child to throw scissors
someone other than Individualized to children—for example, relates characteristics to number or age of children, child’s developmental
parent) level, or special needs
Child’s relationship with Strengths—for example, expresses affection toward parent, responsive to parent’s initiations
parent (offered by Weaknesses—for example, child says he does not want to live with parent, appears fearful of parent
someone other than
parent)
 EVALUATING PARENTS IN CHILD PROTECTION DECISIONS 671

Item-by-item interrater agreement was calculated as the percentage Evaluation types are displayed at the top of Table 3. Most
of agreements divided by the total number of agreements plus evaluations were identified as psychological, except for PAT eval-
disagreements. Although percentage agreement is less rigorous uations, which were multidisciplinary. Evaluators had a variety of
than some other methods (e.g., kappa) for calculating reliability for professional degrees, with psychology being the most common
very high or very low rate behaviors, it has an advantage of discipline. Eighty-eight percent of the reports listed a doctoral
simplicity and has been used in prior forensic research (e.g., Budd level professional as primary examiner. All reports by the pilot
et al., 2001; Moretti et al., 2003). clinic, FCS, and PAT listed a doctoral level primary examiner, as
In addition to coding the content of evaluations, we calculated did 72% of evaluations by DCFS clinicians.
three measures relating to the timeliness and consistency of eval- The comprehensiveness of evaluations, in terms of number and
uations: (a) the number of days from the court’s request for clinical location of sessions, also is displayed in Table 3. PAT evaluations
information until the evaluation report was completed (indicated had the highest mean number of sessions, followed by pilot clinic
by the date on the report), (b) the proportion of total requests for evaluations, which averaged twice as many sessions as FCS and
clinical information resulting in completed evaluations, and (c) the DCFS. PAT evaluations were most likely to include sessions in the
proportion of evaluations completed prior to the next court date. home or naturalistic environment, followed by the pilot clinic, and
For the latter two calculations, we excluded from the denominator then DCFS. By contrast, FCS evaluations occurred only in the
requests that became moot before they could be fulfilled (as when office. These findings are consistent with the stated practices and
the referral question was answered via testimony or the judge expectations of the provider groups. DCFS had a cap on its
closed the case). Failure to complete evaluations typically was due reimbursement to clinicians that likely limited the number of
to scheduling difficulties or lack of parental cooperation with the sessions.
assessment.

Referral Context
What We Found
Answers to our five major questions were based on over three The lower portion of Table 3 displays the extent to which
fourths (137) of the 175 items on which coders agreed with one evaluations specified information about the referral context in
another 90% or more of the time; 32 items that had agreement reports. Because this information was provided to clinical evalu-
levels of 80%⫺89%; and on the remaining 6 items, with agree- ators by the pilot project’s clinical coordinators, the data reflect the
ment levels of 70%⫺79%. extent to which evaluators included the information in their re-
ports. The pilot clinic’s evaluations always articulated one or more
specific referral questions, and over 90% of its referral questions
Characteristics of Parents and Evaluations
were specific. FCS evaluations also listed specific referral ques-
The 170 evaluations focused on 154 individual parents and 16 tions in nearly all reports, and PAT and DCFS evaluations often
couples. Table 2 displays demographic characteristics of the par- did so. The pilot clinic was much more likely than other provider
ents evaluated by provider source. The target usually was the groups to describe the presenting problems giving rise to the
mother, although in the pilot clinic, nearly one quarter of evalua- evaluation. Similarly, pilot clinic evaluations most often stated the
tions included both parents. When parents’ ethnicity was identi- permanency options or legal decisions under consideration,
fied, it was most often African American. whereas FCS evaluations were somewhat less likely to do so, and

Table 2
Demographic Characteristics of Parents Evaluated by Provider Source (N ⫽ 170)

Provider source

DCFS
Pilot clinic FCS PAT clinicians
Characteristic (n ⫽ 58) (n ⫽ 20) (n ⫽ 17) (n ⫽ 75)

Target individual(s) (%)

Female 62.1 85.0 88.2 81.3
Male 15.5 10.0 5.9 17.3
Couple 22.4 5.0 5.9 1.3
Ethnicity (%)
African American 35.2 28.6 61.1 54.5
European American 11.3 4.8 5.6 16.9
Latino/a 23.9 0 0 9.1
Other 1.4 0 1.1 0
Not stated 28.2 66.7 22.2 19.5
Age, years (M) 34.1 37.1 30.1 39.1
No. of children (M) 3.5 3.4 3.7 3.4
Age of children, years (M) 8.2 8.1 6.9 8.9

Note. FCS ⫽ Forensic Clinical Services; PAT ⫽ Parenting Assessment Team; DCFS ⫽ Department of
Children and Family Services.
672 BUDD, FELIX, SWEET, SAUL, AND CARLETON

Table 3
Evaluation Characteristics by Provider Source (N ⫽ 170)

Provider source

DCFS
Pilot clinic FCS PAT clinicians
Characteristic (n ⫽ 58) (n ⫽ 20) (n ⫽ 17) (n ⫽ 75)

Evaluation type (%)

Psychological 94.8 100 0 72.0
Psychiatric 1.7 0 0 14.7
Multidisciplinary 3.4 0 100 1.3
Other 0 0 0 12.0
No. of sessions
M 2.7 1.3 3.5 1.4
Mdn (range) 3 (1–6) 1 (1–2) 4 (1–7) 1 (1–5)
Location of session (%)
Office/clinic 94.8 100 100 92.0
Home 27.6 0 76.5 10.7
Naturalistic environment 29.3 0 11.8 4.0
Other 0 0 0 2.7
One or more specific referral questions (%) 100.0 95.0 70.6 65.3
Proportion specific of all referral questions 91.0 88.9 76.3 63.8
Description of presenting problems (%) 86.2 30.0 41.2 57.3
Options or decisions under consideration (%) 86.2 65.0 0 16.0

Note. FCS ⫽ Forensic Clinical Services; PAT ⫽ Parenting Assessment Team; DCFS ⫽ Department of
Children and Family Services.

DCFS and PAT evaluations rarely or never did so. These differ- clinic and PAT were much more likely to report having inter-
ences across provider groups likely reflect differing levels of viewed caseworkers or therapists, other collateral informants, and
involvement and familiarity with the Juvenile Court. the parent’s children. Written records were the most frequently
cited background source across all groups.
Methods Used by the Provider Groups The types and frequencies of measures administered to parents
varied across groups. In Table 4, we display several common
Table 4 displays the methodological features of evaluations categories of measures, excluding those used infrequently (e.g.,
across provider groups. Compared with FCS and DCFS, the pilot visual motor, substance use) and the clinical interview, which was

Table 4
Percentage of Methodological Features Present in Evaluations by Provider Source (N ⫽ 170)

Provider source

DCFS
Pilot clinic FCS PAT clinicians
Feature (n ⫽ 58) (n ⫽ 20) (n ⫽ 17) (n ⫽ 75)

Background sources
Worker/therapist 91.1 20.0 58.8 28.0
Collateral informant 70.7 30.0 82.4 20.0
Child(ren) 34.5 0 52.9 12.0
Written records 100.0 85.0 100.0 74.7
Measures
Cognitive 13.8 40.0 23.5 54.7
Achievement 6.9 20.0 0 45.3
Objective personality 17.2 5.0 0 45.3
Projective personality 6.9 20.0 29.4 58.7
Symptom questionnaire 48.3 15.0 58.8 32.0
Parenting questionnaire 69.0 30.0 88.2 61.3
Parent–child observation 81.0 25.0 100.0 21.3
Proportion when referral question was parenting 84.6 71.4 100.0 31.3
Purpose/confidentiality 98.3 100.0 23.5 5.3
Reliability/validity issues 82.8 35.0 52.9 68.0

Note. FCS ⫽ Forensic Clinical Services; PAT ⫽ Parenting Assessment Team; DCFS ⫽ Department of
Children and Family Services.
 EVALUATING PARENTS IN CHILD PROTECTION DECISIONS 673

used by all examiners. (The one exception to the latter occurred in than strengths by all provider groups, except that the pilot clinic
a pilot clinic case in which the parent repeatedly failed to show for was equally likely to describe parents’ caregiving strengths and
an interview, but the caseworker and children were interviewed.) weaknesses. Again, these differences are consistent with a greater
Parent⫺child observation was used much more frequently by the tendency for the pilot clinic and PAT to display recommended
pilot clinic and PAT than by FCS and DCFS. To check whether forensic features.
use of observation varied with the type of referral question, we
examined the subset of evaluations for which parenting ability or Timeliness and Consistency of Reports
the parent⫺child relationship was included as a referral question.
Use of parent⫺child observation in these cases was much higher Table 6 shows the timeliness and consistency of reports across
for FCS but only slightly higher for DCFS. provider sources. The pilot clinic had a substantially shorter turn-
Table 4 also shows that the two court-based providers (pilot around time for completing evaluations than all other provider
clinic and FCS) virtually always reported describing the assess- sources, and 90% of its reports were completed by the next court
ment purpose and limits on confidentiality of information to the date. By contrast, the mean completion time for other three sources
parent, whereas the other two groups did so infrequently. Pilot ranged from nearly 2 to 4 times as long, and only a minority of
clinic evaluations were more likely than other groups to include a evaluations were finished by the next court date. PAT is notewor-
statement about the reliability and/or validity (i.e., believability) of thy for its extended time interval (M ⫽ 7.5 months). Table 6 also
the findings. shows that the pilot clinic completed evaluations in response to
In summary, comparing methodological practices across groups 95% of the total requests directed to it, whereas the other provider
indicates that the pilot clinic and PAT were more likely to report groups completed between 65% and 83% of requests.
information from varied background sources and include The pilot clinic’s superior performance in timeliness and con-
parent⫺child observation in parent evaluations, and they tended to sistency presumably was due to features of the reform model,
use symptom and parenting questionnaires more often than other which was designed specifically to support clear communication
measures. By contrast, the pilot clinic and FCS were more likely to of referral issues to clinicians, efficient mechanisms for gathering
report describing the assessment purpose and limits on confiden- records, and prompt completion of evaluations. However, this
tiality of information to the parent, a recommended feature specific research cannot ascertain the variables responsible for differing
to forensic as opposed to therapeutic evaluations. In general, the group patterns, because evaluation requests were assigned on the
pilot clinic was more likely to include recommended forensic basis of referral questions and parent characteristics rather than on
features in its evaluations than other provider groups. a random basis. For example, PAT served only parents with severe
mental illness, which suggests that evaluations addressed compli-
cated issues. Nevertheless, all provider groups evaluated a high
Report of Findings
proportion of parents with mental illness, chronic substance abuse,
Table 5 displays information regarding findings by provider and other multifaceted problems, and the pilot clinic evaluated
group. We found two noteworthy patterns. First, reports by the parents as couples more often than other providers.
pilot clinic and PAT were more likely than those by FCS and Rather than characteristics of parents referred, it is likely that
DCFS to describe strengths (parents’ personal and caregiving other variables, such as the priorities, structure, and support of
qualities, and child’s relationship with the parent) and to articulate provider groups, clinician training, workload, and resources con-
how the findings impacted parenting ability and applied to indi- tributed to the differences in timeliness and consistency. FCS and
vidual children. Second, weaknesses were reported more often DCFS evaluators functioned independently, and DCFS evaluators

Table 5
Percentage of Reports Describing Findings by Provider Source (N ⫽ 170)

Provider Source

DCFS
Pilot clinic FCS PAT clinicians
Feature (n ⫽ 58) (n ⫽ 20) (n ⫽ 17) (n ⫽ 75)

Parent’s personal attributes/behavior

Strength 63.8 0 47.1 33.3
Weakness 75.9 75.0 88.2 73.3
Impact on parenting 55.2 30.0 82.4 42.7
Parent’s caregiving skills/beliefs
Strength 72.4 20.0 88.2 32.0
Weakness 72.4 30.0 100.0 62.7
Individualized to child(ren) 44.8 15.0 76.5 29.3
Child’s relationship with parent
Strength 58.6 15.0 58.8 13.3
Weakness 24.1 5.0 41.2 9.3

Note. FCS ⫽ Forensic Clinical Services; PAT ⫽ Parenting Assessment Team; DCFS ⫽ Department of
Children and Family Services.
674 BUDD, FELIX, SWEET, SAUL, AND CARLETON

Table 6
Timeliness and Consistency of Evaluations by Provider Source (N ⫽ 170)

Provider source

DCFS
Pilot clinic FCS PAT clinicians
(n ⫽ 58) (n ⫽ 20) (n ⫽ 17) (n ⫽ 75)

Days from request to report

M 56.6 121.0 225.9 100.2
Mdn 53 117.5 268.0 97.0
SD 20.6 74.4 136.8 63.1
Proportion of reports completed by next court
date (mean days to next court date) 89.7 (67.7) 25.0 (53.0) 23.5 (73.7) 41.7 (70.0)
Proportion of requests resulting in reports
(requests, n) 95.1 (61) 74.0 (27) 65.4 (26) 83.3 (90)

Note. FCS ⫽ Forensic Clinical Services; PAT ⫽ Parenting Assessment Team; DCFS ⫽ Department of
Children and Family Services.

had a more stringent cap on reimbursement for evaluations than The long time interval (a mean of 7.5 months) substantially re-
other provider groups. PAT evaluators functioned as members of duced their potential usefulness to the court.
a multidisciplinary team, and the PAT placed a high priority on Several features of the pilot clinic (e.g., conducting intake on the
obtaining all background records, even if that entailed waiting day of referral, using a streamlined system for record gathering,
months to complete a report. The pilot clinic specifically hired, training and supervising clinicians in recommended forensic prac-
trained, and supervised clinicians to conduct parenting evaluations tices) were designed to facilitate more thorough and timely pilot
using recommended forensic practices, and their reports reflect clinic evaluations. The clinical coordination process, which ap-
close alliance with these practices. In addition, the pilot clinic plied to all requests for clinical information, potentially benefited
placed a premium on completing evaluations before the next court all provider sources. However, given the quasi-experimental na-
date, and its structure was designed to support clinicians in com- ture of the study, the impact of these variables awaits further
pleting reports promptly. Thus, any of several features of the research. Another limitation is that the reform model was imple-
provider groups may have contributed to the differing outcomes. mented in only one court system. Further research is needed to
determine whether the findings apply to other juvenile courts.
Implications In spite of these limitations, several important implications flow
from the current findings.
This research found that the pilot clinic was successful in
First, this research confirms that timely, clinically relevant eval-
meeting the objectives of providing timely, relevant clinical infor-
uations using recommended forensic guidelines can be achieved in
mation reflecting recommended forensic evaluation guidelines.
Overall, evaluations conducted by the pilot clinic demonstrate a a large, urban juvenile court system. Urban courts often are faced
high proportion of recommended features, including multiple ses- with overcrowded dockets that delay permanency decisions (Chil-
sions, settings, and sources; parent⫺child observation; articulation dren and Family Research Center, 2004). Despite the multifaceted
of specific referral issues; warning on limits of confidentiality; problems facing Cook County’s Juvenile Court prior to this
reference to reliability and validity; and description of findings project, the reform model was able to enact change in the pilot
regarding parenting strengths, weaknesses, and relationship to the courtrooms across the 3-year pilot study. This fact should provide
child. Further, the pilot clinic completed evaluations promptly and encouragement to other court systems facing similar problems.
consistently. Second, successful implementation of the reform model in the
The other provider groups were less successful in meeting one pilot project emboldened the Cook County court system to expand
or more of these objectives, although all groups displayed moder- the model. Indeed, in June, 2003, the pilot model was adopted
ate to high levels of some desired features (e.g., specific referral court-wide through the creation of a new Cook County Juvenile
questions, use of written records). FCS evaluations consistently Court Clinic (CCJCC), replacing the former FCS. Despite its much
reported describing the assessment purpose and limits on confi- increased scope, CCJCC’s structure is very similar to the pilot
dentiality to the parent, and they often included parent⫺child model. Monitoring CCJCC’s progress and performance over time
observation when referral questions related to parenting. DCFS will provide a more complete analysis of the reform model.
evaluations frequently included a statement about the reliability Third, parent evaluations reflecting desired forensic practices
and/or validity of findings, and their evaluations were second only need not be so time consuming that they are impractical for use in
to the pilot clinic in timeliness and consistency. PAT evaluations legal decision making, as evidenced by the pilot clinic’s timeliness
were particularly commendable in comprehensiveness of sessions and consistency. Rather than including each desired feature in all
and settings, use of parent⫺child observation, and description of assessments, evaluations should be tailored to referral questions
findings regarding parenting qualities. Despite the thoroughness of for individual cases, recognizing the pragmatic and resource lim-
PAT evaluations, this quality came at the expense of timeliness. itations facing clinicians.
 EVALUATING PARENTS IN CHILD PROTECTION DECISIONS 675

Finally, although the current project focused on parenting eval- minimal parenting competence. Journal of Clinical Child Psychology,
uations conducted within a court-based clinic, the lessons learned 25, 1–14.
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