The Role of Mental Health Professionals in the Prevention and Treatment of Child Abuse and Neglect

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You are in section: Table of Contents Preface Acknowledgments 1 - Introduction 2 - Working With Abused And… 3 - Responsibilities Of The Mental… 4 - How Child Abuse And Neglect… 5 - Mental Health Treatment… 6 - Treatment Modalities Notes Selected Bibliography Other Resources Glossary of Terms Appendix A - Crime Victim… Appendix B - List Of Other User…

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Working With Abused And Neglected Children And Their Families

Primary And Secondary Prevention

Mental health professionals may be involved in primary and secondary prevention depending on their interests and expertise. Primary prevention is directed toward preventing a problem from ever occurring. Broad-based public awareness, media campaigns, and school-based prevention programs are examples of effective means of educating the public about health and social concerns. Secondary prevention is targeted at a specific high-risk subpopulation or group. Examples include home visitor programs for mothers of newborns identified at the hospital as being "at risk."

Tertiary Intervention

The primary focus of mental health professionals' training is tertiary intervention through the provision of therapeutic services to clients with a psychological problem that impairs their day-to-day functioning and relationships with others. In the field of child abuse and neglect, this involves working with both child victims and parents who abuse or neglect their children. Therapeutic interventions with children are directed toward preventing the harmful effects of child maltreatment. Therapeutic interventions with abusive parents are directed toward preventing recidivism through education, developing problem-solving skills, providing cognitive and behaviorally oriented counseling to prevent maltreatment, helping parents identify when they are at risk of abusing or neglecting their children, and teaching parents how to obtain support and resources to prevent abuse and neglect. The following roles briefly describe the activities in which clinicians are involved as a result of providing tertiary intervention or therapeutic intervention with clients.

Evaluation And Treatment

The primary role of mental health professionals in cases of child abuse and neglect is evaluation and treatment of children, nonoffending parents, abusive or neglecting parents, and/or the family as a unit. Mental health professionals often specialize by working either with children, adolescents, or adults and by working with victims or offenders. Professionals with expertise in working with adults typically limit their practice to adults. Child and adolescent therapists, however, must also be knowledgeable about how to work with parents and families.

Treatment begins by developing a therapeutic relationship, evaluating the overall functioning of the client, and planning treatment goals and intervention strategies based on the initial and ongoing assessment of client needs. Services for children and their families may be limited to crisis intervention and referral, brief therapy (10 to 12 weeks), or long-term therapy. Treatment modalities vary and may include individual and group therapy for children and parents, family therapy, and marital therapy. Group therapy may include victims grouped by type of victimization, age, gender, or sibling group; or parents grouped by their role as offending or nonoffending adults.

The frequency and length of treatment are often determined by financial considerations such as health insurance, grant or contract funding for the treatment program, or whether the client is eligible for participation in the State's Victims of Crime Program. Every State has a Victims of Crime Program under which crime victims' expenses for medical and psychological services can be reimbursed by applying to the program and meeting eligibility criteria. (See Appendix A for a listing of State Victims of Crime programs.)

Evaluation and treatment are reviewed in this manual's sections entitled "Mental Health Evaluations" and "Mental Health Treatment Issues and Models." The traditional therapeutic role expands when working with child abuse and neglect cases to include that of an advocate, information and referral source, educator, consultant, and member of a multidisciplinary team.

Advocate

An advocate enables clients to become aware of their needs; receive competent intervention and decisionmaking by social services, criminal justice, and mental health personnel; and receive fair and equitable treatment. The number of cases, the many variables associated with child abuse and neglect cases, and the complexity of the system designed to serve children and families create the need for client advocacy. Individual client advocacy involves providing referrals, emotional support, assistance, and sometimes accompanying clients to other agencies to enable clients to obtain resources, services, and fair treatment.

Mental health professionals may also be involved in program advocacy or public awareness activities to promote improved or expanded services, increase funding for services, provide greater access for clients to services, develop new approaches to prevention and intervention, or prevent the elimination or reduction of services. Advocacy may also take the form of promoting new or revised laws, State regulations, or social policies. This type of change is most often accomplished through analysis of existing problems and/or research to establish a basis for proposing change. These proposals can be initiated by individuals but are most often brought about through coalitions and associations of professionals from single or multiple disciplines.

Source of Information And Referrals

Clients and their families may have needs that cannot be met through traditional therapy. These clients may need referrals to parenting classes, parent aide programs, homemaker services, alcohol and drug treatment programs, self-help groups, battered women shelters, rape crisis centers, medical and legal services, tutoring services, victim/witness programs, offender treatment programs, and services for children with special needs such as hearing or vision problems or learning or developmental disabilities. Some communities have service directories; otherwise, it is useful to develop a local referral list.

Educator

The role of educator is performed on several levels. Part of psychotherapy involves education of the client regarding family and interpersonal dynamics; abuse and neglect dynamics; psychological and behavioral signs of abuse and neglect; information regarding child abuse investigation procedures; and Juvenile, Family, or Criminal Court proceedings.

Mental health professionals are also involved in the education and training of professionals from their own as well as other disciplines such as medicine, law enforcement, prosecution, and the judiciary. Mental health professionals may also be involved in public education through the media, community meetings, and forums.

Preparing Clients To Testify In Court

Children and adults experience anxiety about testifying in court. Part of the victim-witness advocates' role is to prepare clients to testify in court. In communities without such services or in situations not handled by advocates, other professionals such as therapists, police officers, or CPS social workers may provide support. Anxiety and ambivalence about testifying can be reduced by familiarizing the client with court procedures; the courtroom setting; and the roles of the judge, prosecutor, defense attorney, bailiff, and court reporter.

Consultant To County Or State Departments Of Social Services

County and State Departments of Social Services make referrals to mental health professionals for assessments and treatment most often at one of three points during intervention in the child protection system. The first point is during the CPS investigation but prior to the adjudication or dispositional hearing. The purpose of this referral may be to obtain a psychological evaluation of the child to assess the mental health status of the child as a result of the abuse or neglect, or to obtain a psychological evaluation of the parent to assess the capability or nature and extent of the disabilities of the parent. These assessments are used to develop case plans and to support the agency recommendations regarding the disposition of the case.

The second point in time may occur after the adjudication or dispositional hearing when the family is ordered to participate in court-ordered protective supervision or the child is removed from his/her family and placed in foster care. The purpose of the referral may be to request an assessment of the child because of behavior that raises concern, provide psychological treatment for the child and/or parent, or evaluate the effects of multiple failed foster placements.

The third point in time may occur after the parent has failed to comply with family reunification efforts or is assessed to be incapable of parenting the child, and the decision is made to proceed with termination of parental rights. Children may be referred for psychological assessment and treatment for preadoptive therapy or conjoint therapy with adoptive parents.

Expert Witness

Mental health professionals may be called to render an opinion or testify as an expert witness in Juvenile, Family, or Criminal Court. The purpose of the Juvenile or Family Court adjudication hearing is to determine whether the child needs protection through court-ordered supervision of the family or whether the child must be removed from the home for a period of time to establish conditions for parental action for family reunification. The mental health professional may be asked to testify either to provide support for social service agency recommendations in the case or, if the professional has been working with the parent, support the parent's objectives. This is usually not a jury trial but a hearing conducted by a judge. Mental health professionals are also called to serve as expert witnesses in criminal trials for the prosecution or the defense, if felony offenses are charged.

Expert witnesses have the following responsibilities:

• to provide objective testimony whether one is testifying for the prosecution or the defense;
• to be a scholar in the field or related fields, and be familiar with or have contributed to the literature in that field;
• to be an active or recently active investigator in the field, if testifying on research matters, or be an active or recently active clinician in the field, if testifying on clinical matters;
• to consider the role of expert witness as a minimal part of professional activity and not as a profession (in other words, the main activities of an expert witness should be those of scholar, clinician, teacher, or investigator in the field of expertise);
• to be aware of the legal and ethical impact of the testimony, and the importance and potential consequences of the testimony to the people involved in the case;
• to be aware of the basic elements of the law and the legal procedures with which the expert will be involved;
• to understand that it is the expert's job to provide information and/or render an opinion, not to win or lose the case, and, therefore, avoid becoming consumed with the adversarial atmosphere of the legal process; and
• to obtain all the facts from the attorneys and clients(s) to avoid being surprised by damaging information later in the legal process.⁷

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You are in section: Table of Contents Preface Acknowledgments 1 - Introduction 2 - Working With Abused And… 3 - Responsibilities Of The Mental… 4 - How Child Abuse And Neglect… 5 - Mental Health Treatment… 6 - Treatment Modalities Notes Selected Bibliography Other Resources Glossary of Terms Appendix A - Crime Victim… Appendix B - List Of Other User…

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