Research into Risk Assessment of Children
Ludwig.F. Lowenstein Ph.D
Southern England Psychological Services
Expert witnesses and others have always been concerned with how
much risk can be taken, if any, in the concern for the safety of
children. Safety of children should ensure that they are in no danger
of physical, sexual or emotional abuse or neglect. The prediction
of danger to children, though vital, can be problematic.
It is vital for those who assess risk to use any type of assessment,
measurement, interview etc. likely to lead to the most accurate
prediction. There is a tendency for many who assess dangerousness
to over-estimate it, as it is better "to err on the side of
caution" then the reverse. This despite the fact that few individuals
are likely to be a danger compared to those who are not likely to
act as such (Menzies et al, 1994).
There has been an increase in the use of the actuarial method for
predicting that risk is minimal. Hence false positives may be prevented,
i.e. people who are predicted to do something wrong but do not do
so. False negatives are people who are not expected to do anything
dangerous but do so; they must also be identified (Gardner et al,
Ackerman, (1999) clearly indicates the factors likely to increase
the risk of dangerousness or violence. These include:
- History of violence (Steadman & Robbins, 1998; Wrightsman
et al, 1998)
- The use of substances such as alcohol and drugs (Steadman et
al, 1998; Steadman & Robbins, 1998)
- Psychotic illness including hallucinations and delusions such
as fear of being threatened (Melton et al, 1997).
- Being immature or under the age of 30 (Tardiff et al, 1997;
Melton et al, 1997).
- Anti-social personality disorder i.e. psychopathy (Tardiff
et al, 1997, a, b; Harris&Rice, 1997).
- Failure to take psychotropic medication (Monohan & Steadman,
The most recent research into risk assessment of children has been
divided into four parts:
- Risk factors associated with children's welfare.
- Problems associated with risk assessments.
- Assessment methods for ascertaining risk to children.
- Therapeutic approaches to reduce risk towards children
A. Risk Factors Associated with Children's Welfare
Risk factors for physical child abuse were studied by Christmas
et al (1996). The review of the current literature in relation to
this considers foremost a history of abuse in the past, the depression
of one or both parents, single parenting, the socio-economic status
of the family, social isolation, the maternal age with younger women
being more vulnerable and partaking in substance abuse.
Mentally ill mothers who have killed in the past were studied by
Jacobsen & Miller(1998), One proposal is to "fast-track"
cases involving parents with long-standing mental disorders by automatically
terminating parental rights. This approach assumes that a severe
and chronic mental disorder is incompatible with safe parenting.
Three cases were studied where children were killed. The conclusion
was evaluation of parenting competency of mentally ill parents is
important. An American study carried out in the state of Massachusetts
by Whitney & Davis (1999) considered the importance of an internal
domestic violence programme better to identify and serve families
where partners abuse and child abuse overlap.
Child custody disputes there are particular dangers to children
as well as to adults due to the acrimony which exists between the
former partners. Austin (2000,a) studied the relocation ui child
custody and its impact on children. Courts usually allow the child
to move away with the residential parent, unless there is potential
harm to the child. The forensic violence risk assessment literature
provides an analogous conceptual framework for understanding the
prediction of harm. Harm is likely to be exacerbated when comments
are made by the resident parent towards a child to develop a condition
commonly termed parental alienation syndrome (Lowenstein 1998a;
1998b; 1999 a,b,c; 2001; Gardner 1992; 1998; 2001).
Finally Gambrill & Shlonsky (2001) considered that risk assessment
studies in child welfare have largely focused on identifying individual
or family risk factors. This is often associated with future harm.
These risks include, lack of proper assessment of service needs,
inadequate linkage of available services to desired outcomes, and
an agency culture that is reactive rather man pro-active in pursuit
of risk reduction.
B. Major Problems Associated with Risk Assessment
There are major problems in carrying out risk assessments. To carry
out no risk assessment is obviously wrong, but to consider that
risk assessments are always reliable is equally fallacious. A review
of the literature up to 1996 by Lyons et al (1996) of risk assessments
included the examining of psychometric properties including reliability
and validity and outcomes of the implementation as a response to
the crisis of growing intakes of child protective services agencies.
Risk assessment models and their evaluation were search based on
two criteria: 1) the evaluation published or presented at a conference;
2) the evaluation conducted by an independent evaluator. The result
highlighted the need for development and research into risk assessment
Kelly & Milner (1996) suggested that case conference decisions
e.g. by social worker, were inherently more risky than those taken
by professionals with "individual responsibility" because
of the way in which cases are framed in terms of losses. A different
view was expressed by Milner et al (1998). They stressed that despite
the number of assessment techniques currently available, researchers
and practitioners had few methods of clearly identifying risk and
mitigating factors and that direct assessment techniques currently
offer the best assessment strategies. Unfortunately, a child care
worker was the poorest predictor of further risk.
Bell (1999) studied 22 Local Authorities in Great Britain and their
social workers undertaking child protection investigation. He noted
that while social workers were committed to being, and believed
their practice to be, participative, the duel tasks of making risk
assessments for conferences and working in partnership with problem
families created conflicts of interest and rights. The impact of
this on social workers engagement with family members, on their
assessment, and on the decision-making process was explored. It
was concluded that the difficulties identified, were endemic and
pointed the need for a more broadly-based child care service to
appropriately meet the welfare needs of the family. Also the contradictory
nature of the conference task needed to be addressed by clarifying
the legal base of the intervention and developing other models of
Drury-Hudson (1999) examined the process of decision making in
child protection, particularly as it related to the decision whether
or not to remove a child from home. A group of novice social workers
was compared with expert practitioners, with particular focus on
the types of knowledge that novices draw upon when making such decisions.
A three stage qualitative methodology was employed. All parts of
the study utilised a case vignette of a neglect scenario. Findings
were reported in respect of the use of theoretical, empirical and
procedural knowledge and suggested novices tended to kek a clear
understanding of the factors associated with child maltreatment.
While they have a superficial awareness of the concept of risk assessment,
they failed to weigh factors appropriately and apply them to their
practice. This supports the findings of the previous study.
An Australian study by Goddard et al (1999) considered the practice
of risk assessment in children via the protection services. It highlighted
the complexity of the concept of risk as the basis for a future
oriented assessment activity. The authors suggested that this change
of time frame (from what has happened to what might happen) was
likely to be detrimental to children. Through a critical review
of the literature, the authors questioned whether risk predictions
were possible and discussed limitations of risk assessment instruments
which omitted some risk factors and may have totally ignored the
perspective of the child. The authors therefore challenged the validity
of risk assessment instruments in statutory settings and suggested
that the protection of the organisation was likely to be the major
objective in their implementation. This might be considered a kind
of self-protection rather than risk assessment of children!
Houston & Griffiths (2000) argued that objectivist paradigms
failed to provide valid and reliable measures of risk. Risk should
be explored from an alternative subjectivist paradigm. They therefore
advocated the reinstatement of the individual to the family and
the relationship as the guiding rationale for social work intervention.
This view is likely to be highly criticised by many social services,
especially when there is a threat of child sex or physical abuse.
Risk reduction interventions in the case of child custody relocation
cases were considered by Austin (2000,b). When a custodial parent
chooses to relocate to a new community, the child of divorce faces
a life transition that was potentially even more traumatic than
the parental break-up. The courts generally allow the custodial
parent to move away with the child. Divorce affects research into
child risk assessments and a recent model of risk assessment for
relocation suggested factors that predicted potential harm or protection
for the child.. Family mediators and psychotherapists had important
roles to play in reducing the risk. (This will be discussed in the
last section dealing with the therapeutic approaches to reduce risks
for children.) It must be added that there are risks caused by the
involvement of social services as noted in one study by DePanfilis
& Zuravin (2001) which found that families with a previous substantiated
report of child abuse were 22% less likely to be open for services
than. families without prior substantiated reports. In cases substantiated
for neglect they were 20% less likely to be open for services than
physical abuse cases.
C. Assessment Methods for Ascertaining Risk to Children
Notwithstanding the problems associated with risk assessment risk
must still be assessed albeit using imperfect tools. Jagannathan
& Camasso used the Washington Risk Assessment Matrix and found
three distinct risk profiles which made risks more likely. These
- Children with behaviour problems were more likely to be at
risk; as were
- children from disadvantaged households; and,
- children with an unemployed parent.
Psychological tests were particularly useful in the assessment
of risk of children, who had been, and might yet again be, sexually
abused. Babiker & Herbert (1998) found these tools to be less
intrusive and therefore less damaging to children and their families.
This is in contrast to clinical interviews most often used by social
services. It was however suggested that risk assessment should ideally
use several procedures in a multi-dimensional approach to assessing
child sexual abuse. This method was also favoured by Lowenstein
Baird et al (1999) also found there were no 100% reliable methods
of risk assessment. It was only possible to reduce the risk in the
end by using a number of methods, and monitoring the situation carefully
and intensively (Lowenstein, 1998).
Assessing the credibility in allegations of marital violence in
the high conflict child custody type situation was studied by Austin
(2000,c). The author states that forensic psychology had not systematically
examined the problem of evaluating the credibility of allegations
of marital violence in the context of a child custody case. A risk
assessment approach to marital violence in the custody evaluation
context must be viewed as a serious matter involving the children.
The actuarial approach was considered to classify more accurately
cases of risk (Baird & Wagner, 2000). Again the Washington State
Risk Assessment Matrix was favoured by Camasso & Jagannathan
(2000). Fuller et al (2001) gave preference to the Illinois Child
Endangerment Risk Assessment. Here results indicated that the age
of the youngest child, single parent households and the number of
child problems as well as type of maltreatment could be more effectively
diagnosed as to risk.
D. Therapeutic and Other Approaches to Reducing the Risk Toward
Christmas et al (1996) considered the most effective therapeutic
method to be cognitive behaviour therapy especially when the parents
suffer from depression. When dealing with parents who cause risks
to their children also important were sex education, and instruction
skills in anger management. On the whole a multi-faceted approach
is to be preferred.
Fisher & Beech (1998) emphasised the use of a comprehensive
assessment of sex offenders using psychological methods and risk
factors for offending, families after sexual abuse has taken place.
The emphasis needs to be on reducing social inadequacies and dealing
with pro-offending attitudes in the case of sexual abuse and the
denial which frequently accompanies this and relapse prevention.
A question to be answered as far as Turnell & Edwards (1999)
were concerned was: "How can child protection professionals
build partnerships with parents where there is suspected or substantiated
child abuse or neglect. The authors felt there was a need for practical
hands-on strategies for building a partnership with parents, which
may, in the long run, prevent abuse and family dissolution. The
emphasis was on family reunification practices supposed to be carried
out following the identification of specific risks of re-entry of
family members (Terling,1999).
At present protection service agencies tend to be bureaucratic,
technocratic, regulatory mechanisms for detecting and managing abuse
and neglect. Krane & Davies (2000) suggested a "mothering
narrative", and thereby prevent risks to children emerging.
Initially however it is important to filter out "high risk"
cases from the rest. A view, currently growing, is that there is
limited empirical support for the wholesale adoption of managed
care of children and their families (Embry et al, 2000). The focus
it is felt, should be on the reduction of maltreatment risks between
case opening and closing. A large study by Lyle & Graham (2000)
consisting of 245 families with a total of 592 children resulted
in significant decreases in risk scores from intake to case closing.
Dealing with the whole family in the form of family therapy was
a necessary approach according Hohmann-Marriot (2001) rather than
just an individual or individuals without the whole family.
Much must be done to improve the accuracy of risk assessment of
children. Agencies and social services tend to err on the side of
extreme caution rather than truly weigh the risks. This is undoubtedly
due to the anxieties associated with the consequences, should tragic
mistakes occur. Hence children are often unnecessarily prevented
from being with their families. This could be considered an abuse
The best risk assessment techniques require a number of approaches
including psychological testing, especially personality assessments,
intensive monitoring of children at risk and interviewing members
of families. More accurate specific methods including psychological
tests are needed to assess and weigh risks more accurately.
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