- Email: [email protected]
Implementation of a family stress checklist
C/u/d Abure & Neglecr, Vol. 9. pp. 405-410. printed in the U.S.A. All nghts resavd.
1985 Copyright
IMPLEMENTATION
0145.2134185 $3.00 + .XJ ri 1985 Pergamon Press Ltd.
OF A FAMILY STRESS CHECKLIST
BONNIE ORKOW, M.S.W. Director,
Division
of Program
Operations, Bureau of Medical Services, State Department 1575 Sherman, Room 1010, Denver, CO 80203
of Social Services,
INTRODUCTION THIS ARTICLE is a supplement to the Murphy, Orkow, Nicola paper, Prenatal prediction of child abuse and neglect: A propective study, published in volume 9, number 2 of this journal [l]. It summarizes the method of developing and implementing the revised Carroll-Schmitt Parenting Checklist [2]. The questions used to complete the revised checklist and the new checklist are provided. This supplement describes how the Family Stress Checklist was incorporated into the prenatal clinics described in the earlier research paper [ 11.
METHOD
DEVELOPMENT
The original Carroll-Schmitt Parenting Checklist [2], later renamed the Family Stress Checklist (reprinted here for quick reference as Table l), was incorporated into prenatal clinic files only after clinic staff expanded the checklist by adding information about patients’ ages, marital status, living arrangements, and relationship with the father of the child the woman was carrying. These additional factors were felt to also be important indicators of possible risk for abuse and neglect. The staff decided to incorporate the Family Stress Checklist into each maternity patient’s chart. The checklist was filled out by nursing and social work staff as part of the necessary routine health information. The form was never shared with the patient because it had never been validated. The form also was never a part of the patient’s legal chart so was never copied or allowed out of the agency’s files. The families never saw this checklist although the areas of concern were always discussed with them. These ideas initially were well received by the total agency staff, but once the program began and staff found themselves interviewing each patient, many staff members became increasingly uneasy. Even skilled public health nurses eventually spoke up about their feelings of inadequacy in asking patients about sensitive areas of their personal lives. The nurses felt they did not have the time to delve into personal areas, nor did they feel they had the This paper is a sequel to the paper, “Prenatal prediction of child abuse and neglect: A prospective study,” published in the preceding issue of this joumal[ I]. The study was conducted when the author was employed as Director of Social Services, Tri-County District Health Department. Englewood. Colorado. Reprint requests to Bonnie Orkow. Director. Department of Social Services, 1575 Sherman
Division of Program Operations, Bureau St., Room 1010. Denver, CO 80203. 405
of Medical
Services,
State
406
Bonnie Orko\l, Table 1. No Risk. Score 0
Family Stress Checklist*
Risk. Score 5 M F
I. Parent beaten or deprived as child
Infrequent spank. ings. Consistent “parenting”
Frequent spankings. some bruises. Received intermittent “parenting”
2. Parent has criminal or mental illness record 3. Parent suspected of abuse in the past 4. Parent with low self-esteem, social isolation. or depression 5. Multiple crises, or stresses.
Not present
Present, but demonstrates rehabilitation
Not present
Official report of mild abuse: child not placed in foster care. Intermittent coping skills. No current lifelines or unreliable ones
6. Violent temper
outbursts 7. Rigid, unrealistic expectation of child’s behavior 8. Harsh punishment of child 9. Child difficult
and/or provocative or perceived to be by parents. IO. Child unwanted, or at risk for poor bonding.
Not present
High Rihk. Score 10 51 F
‘~1F Severe beatmgs. Repeated foster homes. No heloful parent model m ⅈhood. Current psychosis: chronic pattern of psychiatric problems Official report of serious abuse: children placed m foster care or died. Severelv deoressed. No hfelines in iast or present.
Not present
Moderate environmental and/or marital problems
Not present
Damages property
Chaotic life style. severe environmental and/or marital problems Attacks people
Not present
Afraid of spoiling child, unrealistic expectations
Intolerance of normal behavior. Very strict parent.
Not present
Current frequent spankings or use of belt, not in head area.
Not present
Child triggers abuse by intermittent provocative behavior
Not present
Risk factors present. but bonding adequate
Physical punishment of baby prior to crawling; sadistic and/or dangerous punishment. Child triggers abuse by constant provocative behavior (i.e.. seen as having no good points) Risk factors present. and bonding poor.
* Developed by B.D. Schmitt and C.A. Carroll[Z]-Child Protection Team at the University of Colorado Health Sciences Center. Abbreviations used are M. mother. F. father. Used with permission.
interviewing skills to adequately cover all areas outlined on the checklist. Nurses in the agency were accustomed to soliciting historical information about health care and illnesses. not about patient’s satisfaction with their early home life and their possible encounters with legal authorities. Even when nurses were able to obtain such sensitive material, they found themselves in a position of not knowing what to do with the information. The program was on the verge of being disbanded because of the high level of frustration. Further discussions among team members helped identify the office social worker as that person best trained and most comfortable in discussing these issues with the patients. Once it had been decided that the office social worker would complete the Family Stress Checklist with every pregnant woman and her partner (whenever that was possible), tensions diminished among all staff. Social workers then were faced with the job of deciding how to gather information for the checklist in such a way that the patients would not be frightened or become defensive. Social workers were already interviewing each maternity patient as a routine service of the clinic which made it possible to simply expand the content of those interviews (Table 2). An added responsibility for the social workers was how to assure that all staff social workers would. in fact, agree.on what answers put the patient at: (1) no risk for potentially abusing or neglecting her child; (2) moderate risk to inflict damage on her child; or (3) severe risk for potentially inflicting severe damage to her child (Table 3).
Implementation Table 2.
Ouestions
of a family stress checklist
Used bv Social Work
Staff to Comolete
407 Parenting
Checklist
(Questions are not asked in any order. nor are all questions necessarily asked of each client.) 1. Parent beaten or deprrved as a child. - How did your parents treat you when you were a child?
-
How did your parents get you to behave when you were growing up? Did both parents treat you the same? Was the treatment fair? Who are you living with now? When a child? Do you want to raise your child differently than you were raised? Were your brothers and sisters treated the same as you were? Did your parents treat you differently when you became a teenager?
2. Parent has crtminal or mental rllness histoy (categov stresses).
used for mental breakdown a.7 well as tratwent .srtuarronal
- Have you ever seen a counselor before?
- Did you have any problems in school? (Did you see a school counselor?) - Have you had any contact with other agencies. e.g.. mental health, welfare. legal? - Tell me about your partner-are you together? What type of work does he do? (Pay particular attention to issue of how he gets to work, driver’s license? police involvement? If wife/girlfriend describes her partner’s behavior as weird, ask if he has ever had any treatment for that.) - Was there anyone who took a particular interest in you when you were growing up? - Do you/your partner drink? Is that a problem? 3. Parent supected
ofabuse
rn the past.
- How do you discipline a child?
- Do you have any problems getting a child to cooperate? - Does your partner agree with you that “Johnnie” has/does not have a problem? - Have you ever seen a social worker/been to a social agency about the behavior problem (give examples: school social worker, mental health, welfare)? - How do you handle the situation when you get mad at a child? - Did you babysit when you were younger? How was that experience? - (If patient is a stepparent) How was it to become a “parent” overnight? 4. Parent with ion, self-esteem, social isolation, or depressron - If you were not talking to me about your concerns, who would you be talking to? (Observe general appearance:
Does client look sad or at a loss to talk.) - With whom do you spend most of your time? - What do you do for fun? - Do you like the way life is going for you? -What is a typical day like for you? - Do you think you/your partner will be a good mother/father? father/mother?
Do you think you/your partner is a good
5 Multiple crises or stresses - Who is in the home? Does everyone get along? How are things going for you? (Observe client’s interaction in
the clinic with child/other parents/professional staff.) - How does your partner feel about this pregnancy? - Does your living situation work for you? (Observe types of requests client makes of staff. e.g., emergency food order. housing emergencies, clinic walk-in with sick child.) - What is most stressful in your home? 6. Violent temper outbursts - When you/your partner get angry, what do you do?
-
What does your partner do when you get angry? What do you do when he gets angry? Do you have a bad temper? And your partner? Do you find you and your partner hitting each other when you get angry? What hanoens in vour home when vou/vour oartner drink too much?
408
Bonnie Orkow Table 2.
Questions Used bv Social Work
7. Rigid, unrealimc expectations
Staff to Complete
Parenting
Checklist
(Continued)
ofchild’s behavior.
- How is cooperation handled in your home? - If interviewing while children in playroom or office are screaming, ask client what the screaming of kids does to her. - Do you feel you know enough about how children grow and develop? - Would you like to know more about raising children? (It is difficult to imagine what it WIII be like caring for a newborn if one has never had the experience.) -Who has talked to you about raising children? - What would you do if a child you were caring for began to cry? 8. Harsh punishment of child. -
How do Do you Are you What is Do you
you discipline your child? or your partner use the same methods to get your child to cooperate? satisfied with the discipline methods you use? the most important thing in raising a child? want to raise your child differently than you were raised? What changes
have you made?
9. Child difficult/provocative or perceived to be by parents. - Is your child difficult to handle? (Observe mother’s interaction with the child.) - What does your child do that irritates you? Do you think he does that on purpose? - In what ways is your partner involved with your child (childien)? 10. Child unwanted or at risk for bonding. -
Was this pregnancy planned? Do you want to be a mother/father? How is life going to be different once this baby is born? Are you making Have you baby clothes? Thought of names? Do you own maternity clothes? When did your partner/family find out you were pregnant? If you were not pregnant now, what would you be doing? What had YOU been Dlannine. for yourself for next vear?
METHOD
plans for those changes?
IMPLEMENTATION
Social workers designed questions to elicit the historical information necessary for Table 2. Categories l-7 and 10; questions for filling out Table 2, Categories 8 and 9 were developed somewhat differently as those categories applied to women with previous children. As part of the social work assessment interview, social work staff felt it was important to include teaching materials so that patients would not feel interrogated. For example. when women expressed stress (see Category 5 of Table 2) due to financial/housing problems, resources for help were immediately supplied. When primigravidas expressed the belief that newborns should be spanked when they cried (see Category 7, Table 2). time was taken with the motherto-be to educate her about the physiological and emotional needs of infants. Only in that way were social work staff themselves comfortable with obtaining information that would possibly “label” a family at severe risk for dysfunctional parenting. Even after questions had been developed for each category, it became necessary to define the specific categories more clearly. Such careful defining of terms assured all staff that a family would be scored the same no matter which social worker did the interview (Table 3). During social work staff meetings, case histories were presented and all staff would give hypothetical scores before being told by the presenter what score actually was given the family. This, too. helped assure all staff that they were viewing the patients similarly.
Implementation Table 3. Category
Risking
Y1
NORMAL
Definition
MODERATE RISK SEVERE RISK
NORMAL MODERATE RISK
SEVERE RISK
x3 Parent suspected of abuse in the past
NORMAL MODERATE RISK SEVERE RISK
NORMAL t4 Parent with low selfMODERATE esteem social isolaRISK tion, or depression SEVERE RISK
*5 Multiple crisis or stresses
NORMAL MODERATE RISK SEVERE RISK
ft6 Violent temper outbursts
NORMAL MODERATE RISK SEVERE RISK
f7 NORMAL Rigid. unrealistic expectations of child’s MODERATE RISK behavior SEVERE RISK
* Modified from Carroll-Schmitt
409
Defined Stwific Categories on Parenting Checklist*
Parent beaten or deprived as child
$2 Parent has criminal or mental illness record
of a family stress checklist
Two-parent or one parent figures in the home (can be step. foster. or adoptive parents) with physicril punishment not primary means of discipline. Two-parent home or one-parent figure raising dependent children primarily alone with physical punishment primary means of discipline. Children in the home removed voluntarily or involuntarily due to physical violence, sexual abuse. psychological neglect or physical neglect. This should include teens who repeatedly run away from home and see themselves as not having parent figure on whom they can depend. History free of legal offenses or encounters with mental health professionals. Minor traffic violations or record of minor juvenile or adult crime (speeding, minor theft) or contact with mental health professionals for situational stress or for preventive illness; demonstrating no ongoing propensity for dysfunctional behavior. History of driving under the influence of alcohol, theft, burglary, larceny, violence, felonies or hospitalized for mental breakdown or evaluation of mental competence. Chronic pattern of emotional problems with or without any attempt made to change that behavior. Babysitting or step-parenting experience free of mistreatment to children under care. Babysitting, step-parenting, or parenting experience involves professional or lay referral to child welfare for suspected mistreatment; child not removed due to minor nature of complaint and parents’ willingness to engage in corrective treatment. Babysitting, step-parenting, or parenting experience where child welfare authorities felt child in question needed to be removed from home due to seriousness of abuse or neglect and parents’ unwillingness/or inability to cooperate for necessary change. Has sense of self (plus friends/family) which gives support for their success at daily functioning. Has some successes in their lives but this is intermingled with failures in daily living tasks. Friends/family/partner currently not supportive or helpful toward person. Not able to perform daily living tasks due to clinical signs of depression. Has never been happy. Has never perceived themselves as able to depend on anyone for emotional and physical support. Daily stresses of living evident but patient coping adequately. Problems evident in marital (partner) relationship, child-parent relationship, and other relationships which patient not handling. Patient experiences job losses, financial strains, housing location concerns. or legal problems. Signs of stress evident. Multiple run-ins with authority (evictions, collection agencies, fired from jobs); dysfunctional marriage (alcoholism. violence, infidelity); inability to relate or make use of environmental options for personal benefit. Has developed techniques for handling anger which do not harm other persons or property. When angered punches walls, throws dishes. or in any way strikes out at objects; or is not able to rationally handle anger. Fights by slapping. punching. kicking others, or instigates fights with others. Understands basic developmental needs of infants and children and attempts to meet those needs by nurturance and physical comfort. Minimal understanding of children’s needs coupled with fear of being unsuccessful parent. Feels that infants and children intentionally misbehave out of malice and must be physically or psychologically dominated at all times to insure “respect.”
Parenting Checklist (2).
Bonnie Orkow
410 Table 3. Cateeorv
Risk&
X8 Harsh punishment of chifd
NORMAL
Defined Specific Categories on Parenting Checklist* K’onfinued~
MODERATE RISK SEVERE RISK *9 Child difficult and/ or provocative or perceived to be by parents
NORMAL
if10 Child unwanted at risk for poor bonding
NORMAL
MODERATE RISK SEVERE RISK
or MODERATE RISK SEVERE RISK
Definition Physical punishment not used or used as tertiary strategy to withWhen child is punished physidrawal of privileges and “time-out.” caliy, no implements (spoon. paddle. stick) used. Physical punishment used as primary means of discipline. Implements used but not in the head or spinal column area. Physical punishment alone used even for infants. with no restraints as to implement used or duration or severity of blows. Child’s behavior not viewed as destructive or dysfunctional for family but as normal part of growth process. Child’s behavior seen as occasionally destructive and provoking anger in parents which results in physical punishment of child. Child’s behavior viewed as intentional to disrupt family life and happiness and seen as correctable only by physical discipline carried out routinely. Pregnancy planned and parenting desired; or pregnancy itself not planned but c~ldr~a~ng looked upon as positive life change. Pregnancy not desired and initially rejected but changes being made in lifestyle to accommodate new addition to family. Pregnancy not desired. Infant not desired and viewed as necessary burden on lifestyle. No positive statements made about pregnancy or childrearing No identification with fetus.
After each checklist was completed, it was placed in the non-active part of the patient’s medical record. Originally this was done because the validity of the checklist was not known. The checklist was reviewed at team conferences, and persons deemed to be at risk by the results of the checklist might be given special services, such as weekly home visits by a public health nurse. However, this was not routinely done because the staff was insufficient to meet all patients with needs. Parenting classes were also used by willing patients. Also available to some patients were lay therapists through the University Medical Center’s Parent Infant Project [3]. The checklist was seen as useful again after the baby was born, and the mother was attending regular agency pediatric clinics. Information from the hospital on the labor and delivery experience was added to the information obtained by a public health nurse during a perinatal home visit. Those pieces of information, plus information from the checklist. helped team members decide what interventive services would be most beneficial to each family.
REFERENCES 1. MURPHY, S., ORKOW, B. and NICOLA. R. M. Prenatal prediction of child abuse and neglect: A prospective study. Child Abuse & Neglect 9, Number 2 (1985). 2. SCHMIIT, B.D. (Ed.). The Child Profecr~on Handbook, Pp. 105-108. Garland STPM. New York and London ( 1978). 3. DAWSON, P. and VAN DOORNICK. W. Use of lay home visitors in high risk families, Unpublished data, University of Colorado Health Sciences Center, Denver (1979).
1985 Copyright
IMPLEMENTATION
0145.2134185 $3.00 + .XJ ri 1985 Pergamon Press Ltd.
OF A FAMILY STRESS CHECKLIST
BONNIE ORKOW, M.S.W. Director,
Division
of Program
Operations, Bureau of Medical Services, State Department 1575 Sherman, Room 1010, Denver, CO 80203
of Social Services,
INTRODUCTION THIS ARTICLE is a supplement to the Murphy, Orkow, Nicola paper, Prenatal prediction of child abuse and neglect: A propective study, published in volume 9, number 2 of this journal [l]. It summarizes the method of developing and implementing the revised Carroll-Schmitt Parenting Checklist [2]. The questions used to complete the revised checklist and the new checklist are provided. This supplement describes how the Family Stress Checklist was incorporated into the prenatal clinics described in the earlier research paper [ 11.
METHOD
DEVELOPMENT
The original Carroll-Schmitt Parenting Checklist [2], later renamed the Family Stress Checklist (reprinted here for quick reference as Table l), was incorporated into prenatal clinic files only after clinic staff expanded the checklist by adding information about patients’ ages, marital status, living arrangements, and relationship with the father of the child the woman was carrying. These additional factors were felt to also be important indicators of possible risk for abuse and neglect. The staff decided to incorporate the Family Stress Checklist into each maternity patient’s chart. The checklist was filled out by nursing and social work staff as part of the necessary routine health information. The form was never shared with the patient because it had never been validated. The form also was never a part of the patient’s legal chart so was never copied or allowed out of the agency’s files. The families never saw this checklist although the areas of concern were always discussed with them. These ideas initially were well received by the total agency staff, but once the program began and staff found themselves interviewing each patient, many staff members became increasingly uneasy. Even skilled public health nurses eventually spoke up about their feelings of inadequacy in asking patients about sensitive areas of their personal lives. The nurses felt they did not have the time to delve into personal areas, nor did they feel they had the This paper is a sequel to the paper, “Prenatal prediction of child abuse and neglect: A prospective study,” published in the preceding issue of this joumal[ I]. The study was conducted when the author was employed as Director of Social Services, Tri-County District Health Department. Englewood. Colorado. Reprint requests to Bonnie Orkow. Director. Department of Social Services, 1575 Sherman
Division of Program Operations, Bureau St., Room 1010. Denver, CO 80203. 405
of Medical
Services,
State
406
Bonnie Orko\l, Table 1. No Risk. Score 0
Family Stress Checklist*
Risk. Score 5 M F
I. Parent beaten or deprived as child
Infrequent spank. ings. Consistent “parenting”
Frequent spankings. some bruises. Received intermittent “parenting”
2. Parent has criminal or mental illness record 3. Parent suspected of abuse in the past 4. Parent with low self-esteem, social isolation. or depression 5. Multiple crises, or stresses.
Not present
Present, but demonstrates rehabilitation
Not present
Official report of mild abuse: child not placed in foster care. Intermittent coping skills. No current lifelines or unreliable ones
6. Violent temper
outbursts 7. Rigid, unrealistic expectation of child’s behavior 8. Harsh punishment of child 9. Child difficult
and/or provocative or perceived to be by parents. IO. Child unwanted, or at risk for poor bonding.
Not present
High Rihk. Score 10 51 F
‘~1F Severe beatmgs. Repeated foster homes. No heloful parent model m ⅈhood. Current psychosis: chronic pattern of psychiatric problems Official report of serious abuse: children placed m foster care or died. Severelv deoressed. No hfelines in iast or present.
Not present
Moderate environmental and/or marital problems
Not present
Damages property
Chaotic life style. severe environmental and/or marital problems Attacks people
Not present
Afraid of spoiling child, unrealistic expectations
Intolerance of normal behavior. Very strict parent.
Not present
Current frequent spankings or use of belt, not in head area.
Not present
Child triggers abuse by intermittent provocative behavior
Not present
Risk factors present. but bonding adequate
Physical punishment of baby prior to crawling; sadistic and/or dangerous punishment. Child triggers abuse by constant provocative behavior (i.e.. seen as having no good points) Risk factors present. and bonding poor.
* Developed by B.D. Schmitt and C.A. Carroll[Z]-Child Protection Team at the University of Colorado Health Sciences Center. Abbreviations used are M. mother. F. father. Used with permission.
interviewing skills to adequately cover all areas outlined on the checklist. Nurses in the agency were accustomed to soliciting historical information about health care and illnesses. not about patient’s satisfaction with their early home life and their possible encounters with legal authorities. Even when nurses were able to obtain such sensitive material, they found themselves in a position of not knowing what to do with the information. The program was on the verge of being disbanded because of the high level of frustration. Further discussions among team members helped identify the office social worker as that person best trained and most comfortable in discussing these issues with the patients. Once it had been decided that the office social worker would complete the Family Stress Checklist with every pregnant woman and her partner (whenever that was possible), tensions diminished among all staff. Social workers then were faced with the job of deciding how to gather information for the checklist in such a way that the patients would not be frightened or become defensive. Social workers were already interviewing each maternity patient as a routine service of the clinic which made it possible to simply expand the content of those interviews (Table 2). An added responsibility for the social workers was how to assure that all staff social workers would. in fact, agree.on what answers put the patient at: (1) no risk for potentially abusing or neglecting her child; (2) moderate risk to inflict damage on her child; or (3) severe risk for potentially inflicting severe damage to her child (Table 3).
Implementation Table 2.
Ouestions
of a family stress checklist
Used bv Social Work
Staff to Comolete
407 Parenting
Checklist
(Questions are not asked in any order. nor are all questions necessarily asked of each client.) 1. Parent beaten or deprrved as a child. - How did your parents treat you when you were a child?
-
How did your parents get you to behave when you were growing up? Did both parents treat you the same? Was the treatment fair? Who are you living with now? When a child? Do you want to raise your child differently than you were raised? Were your brothers and sisters treated the same as you were? Did your parents treat you differently when you became a teenager?
2. Parent has crtminal or mental rllness histoy (categov stresses).
used for mental breakdown a.7 well as tratwent .srtuarronal
- Have you ever seen a counselor before?
- Did you have any problems in school? (Did you see a school counselor?) - Have you had any contact with other agencies. e.g.. mental health, welfare. legal? - Tell me about your partner-are you together? What type of work does he do? (Pay particular attention to issue of how he gets to work, driver’s license? police involvement? If wife/girlfriend describes her partner’s behavior as weird, ask if he has ever had any treatment for that.) - Was there anyone who took a particular interest in you when you were growing up? - Do you/your partner drink? Is that a problem? 3. Parent supected
ofabuse
rn the past.
- How do you discipline a child?
- Do you have any problems getting a child to cooperate? - Does your partner agree with you that “Johnnie” has/does not have a problem? - Have you ever seen a social worker/been to a social agency about the behavior problem (give examples: school social worker, mental health, welfare)? - How do you handle the situation when you get mad at a child? - Did you babysit when you were younger? How was that experience? - (If patient is a stepparent) How was it to become a “parent” overnight? 4. Parent with ion, self-esteem, social isolation, or depressron - If you were not talking to me about your concerns, who would you be talking to? (Observe general appearance:
Does client look sad or at a loss to talk.) - With whom do you spend most of your time? - What do you do for fun? - Do you like the way life is going for you? -What is a typical day like for you? - Do you think you/your partner will be a good mother/father? father/mother?
Do you think you/your partner is a good
5 Multiple crises or stresses - Who is in the home? Does everyone get along? How are things going for you? (Observe client’s interaction in
the clinic with child/other parents/professional staff.) - How does your partner feel about this pregnancy? - Does your living situation work for you? (Observe types of requests client makes of staff. e.g., emergency food order. housing emergencies, clinic walk-in with sick child.) - What is most stressful in your home? 6. Violent temper outbursts - When you/your partner get angry, what do you do?
-
What does your partner do when you get angry? What do you do when he gets angry? Do you have a bad temper? And your partner? Do you find you and your partner hitting each other when you get angry? What hanoens in vour home when vou/vour oartner drink too much?
408
Bonnie Orkow Table 2.
Questions Used bv Social Work
7. Rigid, unrealimc expectations
Staff to Complete
Parenting
Checklist
(Continued)
ofchild’s behavior.
- How is cooperation handled in your home? - If interviewing while children in playroom or office are screaming, ask client what the screaming of kids does to her. - Do you feel you know enough about how children grow and develop? - Would you like to know more about raising children? (It is difficult to imagine what it WIII be like caring for a newborn if one has never had the experience.) -Who has talked to you about raising children? - What would you do if a child you were caring for began to cry? 8. Harsh punishment of child. -
How do Do you Are you What is Do you
you discipline your child? or your partner use the same methods to get your child to cooperate? satisfied with the discipline methods you use? the most important thing in raising a child? want to raise your child differently than you were raised? What changes
have you made?
9. Child difficult/provocative or perceived to be by parents. - Is your child difficult to handle? (Observe mother’s interaction with the child.) - What does your child do that irritates you? Do you think he does that on purpose? - In what ways is your partner involved with your child (childien)? 10. Child unwanted or at risk for bonding. -
Was this pregnancy planned? Do you want to be a mother/father? How is life going to be different once this baby is born? Are you making Have you baby clothes? Thought of names? Do you own maternity clothes? When did your partner/family find out you were pregnant? If you were not pregnant now, what would you be doing? What had YOU been Dlannine. for yourself for next vear?
METHOD
plans for those changes?
IMPLEMENTATION
Social workers designed questions to elicit the historical information necessary for Table 2. Categories l-7 and 10; questions for filling out Table 2, Categories 8 and 9 were developed somewhat differently as those categories applied to women with previous children. As part of the social work assessment interview, social work staff felt it was important to include teaching materials so that patients would not feel interrogated. For example. when women expressed stress (see Category 5 of Table 2) due to financial/housing problems, resources for help were immediately supplied. When primigravidas expressed the belief that newborns should be spanked when they cried (see Category 7, Table 2). time was taken with the motherto-be to educate her about the physiological and emotional needs of infants. Only in that way were social work staff themselves comfortable with obtaining information that would possibly “label” a family at severe risk for dysfunctional parenting. Even after questions had been developed for each category, it became necessary to define the specific categories more clearly. Such careful defining of terms assured all staff that a family would be scored the same no matter which social worker did the interview (Table 3). During social work staff meetings, case histories were presented and all staff would give hypothetical scores before being told by the presenter what score actually was given the family. This, too. helped assure all staff that they were viewing the patients similarly.
Implementation Table 3. Category
Risking
Y1
NORMAL
Definition
MODERATE RISK SEVERE RISK
NORMAL MODERATE RISK
SEVERE RISK
x3 Parent suspected of abuse in the past
NORMAL MODERATE RISK SEVERE RISK
NORMAL t4 Parent with low selfMODERATE esteem social isolaRISK tion, or depression SEVERE RISK
*5 Multiple crisis or stresses
NORMAL MODERATE RISK SEVERE RISK
ft6 Violent temper outbursts
NORMAL MODERATE RISK SEVERE RISK
f7 NORMAL Rigid. unrealistic expectations of child’s MODERATE RISK behavior SEVERE RISK
* Modified from Carroll-Schmitt
409
Defined Stwific Categories on Parenting Checklist*
Parent beaten or deprived as child
$2 Parent has criminal or mental illness record
of a family stress checklist
Two-parent or one parent figures in the home (can be step. foster. or adoptive parents) with physicril punishment not primary means of discipline. Two-parent home or one-parent figure raising dependent children primarily alone with physical punishment primary means of discipline. Children in the home removed voluntarily or involuntarily due to physical violence, sexual abuse. psychological neglect or physical neglect. This should include teens who repeatedly run away from home and see themselves as not having parent figure on whom they can depend. History free of legal offenses or encounters with mental health professionals. Minor traffic violations or record of minor juvenile or adult crime (speeding, minor theft) or contact with mental health professionals for situational stress or for preventive illness; demonstrating no ongoing propensity for dysfunctional behavior. History of driving under the influence of alcohol, theft, burglary, larceny, violence, felonies or hospitalized for mental breakdown or evaluation of mental competence. Chronic pattern of emotional problems with or without any attempt made to change that behavior. Babysitting or step-parenting experience free of mistreatment to children under care. Babysitting, step-parenting, or parenting experience involves professional or lay referral to child welfare for suspected mistreatment; child not removed due to minor nature of complaint and parents’ willingness to engage in corrective treatment. Babysitting, step-parenting, or parenting experience where child welfare authorities felt child in question needed to be removed from home due to seriousness of abuse or neglect and parents’ unwillingness/or inability to cooperate for necessary change. Has sense of self (plus friends/family) which gives support for their success at daily functioning. Has some successes in their lives but this is intermingled with failures in daily living tasks. Friends/family/partner currently not supportive or helpful toward person. Not able to perform daily living tasks due to clinical signs of depression. Has never been happy. Has never perceived themselves as able to depend on anyone for emotional and physical support. Daily stresses of living evident but patient coping adequately. Problems evident in marital (partner) relationship, child-parent relationship, and other relationships which patient not handling. Patient experiences job losses, financial strains, housing location concerns. or legal problems. Signs of stress evident. Multiple run-ins with authority (evictions, collection agencies, fired from jobs); dysfunctional marriage (alcoholism. violence, infidelity); inability to relate or make use of environmental options for personal benefit. Has developed techniques for handling anger which do not harm other persons or property. When angered punches walls, throws dishes. or in any way strikes out at objects; or is not able to rationally handle anger. Fights by slapping. punching. kicking others, or instigates fights with others. Understands basic developmental needs of infants and children and attempts to meet those needs by nurturance and physical comfort. Minimal understanding of children’s needs coupled with fear of being unsuccessful parent. Feels that infants and children intentionally misbehave out of malice and must be physically or psychologically dominated at all times to insure “respect.”
Parenting Checklist (2).
Bonnie Orkow
410 Table 3. Cateeorv
Risk&
X8 Harsh punishment of chifd
NORMAL
Defined Specific Categories on Parenting Checklist* K’onfinued~
MODERATE RISK SEVERE RISK *9 Child difficult and/ or provocative or perceived to be by parents
NORMAL
if10 Child unwanted at risk for poor bonding
NORMAL
MODERATE RISK SEVERE RISK
or MODERATE RISK SEVERE RISK
Definition Physical punishment not used or used as tertiary strategy to withWhen child is punished physidrawal of privileges and “time-out.” caliy, no implements (spoon. paddle. stick) used. Physical punishment used as primary means of discipline. Implements used but not in the head or spinal column area. Physical punishment alone used even for infants. with no restraints as to implement used or duration or severity of blows. Child’s behavior not viewed as destructive or dysfunctional for family but as normal part of growth process. Child’s behavior seen as occasionally destructive and provoking anger in parents which results in physical punishment of child. Child’s behavior viewed as intentional to disrupt family life and happiness and seen as correctable only by physical discipline carried out routinely. Pregnancy planned and parenting desired; or pregnancy itself not planned but c~ldr~a~ng looked upon as positive life change. Pregnancy not desired and initially rejected but changes being made in lifestyle to accommodate new addition to family. Pregnancy not desired. Infant not desired and viewed as necessary burden on lifestyle. No positive statements made about pregnancy or childrearing No identification with fetus.
After each checklist was completed, it was placed in the non-active part of the patient’s medical record. Originally this was done because the validity of the checklist was not known. The checklist was reviewed at team conferences, and persons deemed to be at risk by the results of the checklist might be given special services, such as weekly home visits by a public health nurse. However, this was not routinely done because the staff was insufficient to meet all patients with needs. Parenting classes were also used by willing patients. Also available to some patients were lay therapists through the University Medical Center’s Parent Infant Project [3]. The checklist was seen as useful again after the baby was born, and the mother was attending regular agency pediatric clinics. Information from the hospital on the labor and delivery experience was added to the information obtained by a public health nurse during a perinatal home visit. Those pieces of information, plus information from the checklist. helped team members decide what interventive services would be most beneficial to each family.
REFERENCES 1. MURPHY, S., ORKOW, B. and NICOLA. R. M. Prenatal prediction of child abuse and neglect: A prospective study. Child Abuse & Neglect 9, Number 2 (1985). 2. SCHMIIT, B.D. (Ed.). The Child Profecr~on Handbook, Pp. 105-108. Garland STPM. New York and London ( 1978). 3. DAWSON, P. and VAN DOORNICK. W. Use of lay home visitors in high risk families, Unpublished data, University of Colorado Health Sciences Center, Denver (1979).