PI Brief Update

Dr Mark Burgin BM BCh (oxon) MRCGP considers how the biopsychosocial model can assist the family court when assessing risk by providing a clear structure.

23/07/18. Dr Mark Burgin BM BCh (oxon) MRCGP considers how the biopsychosocial model can assist the family court when assessing risk by providing a clear structure.

Assessing risk is an important aspect in family law cases where there is a risk of harm to the children from the adults who care for them and needs a holistic approach to be successful.

The current system is likely to miss many cases as prevalence studies in adults indicate that the real incidence of abuse is much higher than the numbers which are detected.

The difficulty with assessing risk is that many parents with multiple risk factors do not abuse their children and many who do not have risk factors are abusive.

The NSPCC quotes evidence that there are 11 million children under 18 years old in England and 390,000 children received support from children’s services in England in 2017.

This is about 4% but even with the recent increase in numbers there were only 14599 referrals to the family court under public law in England in 2017 or about 0.1% of the English child population.

A test that only gets 10% of cases wrong (90% specific) would unnecessarily take 39000 children from their parents, which would be unacceptable.

The biopsychosocial model provides a simple and logical approach to risk assessment by considering evidence within its psychosocial context.

The Actuarial Risk

The most accurate way of determining on population level whether an adult will abuse is based upon actuarial tables which compile and analyse statistics to calculate risk.

Static-99 estimates risk of sexual abuse and VRAG estimates risk of violence and the work by Black (2001) estimates risk of physical and emotional abuse.

These risk assessments have a specificity of less than 50% for the potential for abuse of an individual and there are several factors which can make it even less accurate.

The ability of the other parent to prevent the potential risk and protect the children can be identified with BPSM problem solving questions.

BSPM also can detect when a parent will collude with an abusive parent and can increase the detected episodes of abuse by using BPSM preference questions which do not have right answers.

Expressing risk in the BSPM is ‘a person with these risk factors would kill a child every 150 years’ and protective or worsening features rather than high, medium or low risk.

The parent child relationship

Observing parents and children interacting is one approach to explore the relationship but some experts see the assessment of the parent as key evidence.

The parent’s behaviour with the assessor can give valuable information such as the level of emotional control and social skills but leaves important areas untouched.

Discussion of the parent’s attachments with their own parents and significant others allows exploration of the parent’s attitudes and can predict other behaviours.

The BPSM can identify causes of parental low self-confidence and lack of control such as childhood adversity or present social services involvement again increasing the areas covered.

Detecting a parent who has overwhelming emotional needs and will have less capacity to provide for their children’s needs at times of crisis can be difficult if they can manage day to day.

The BPSM has a role in predicting this type of intermittent loss of parenting ability with for instance worst-best questioning (what is the worst thing – best thing about being a parent).

The child’s needs

Interacting with children is an effective approach to determine the child’s needs but it can be difficult to determine how much is the child’s temperament rather than poor parenting.

The child on the spectrum undoubtably has a genetic contribution to their brain structure but whether that structure causes problems is due to environment.

Assessments of the parent can help define the parent contribution to the child’s behaviour by using BPSM to look at how the parent is helping and hindering.

Parental understanding of the child is the best predictor of long term success whatever the social class and intelligence level of the parent.

Parents have often identified what the child wants and the BPSM explores the apparently logical reasons they have for providing for the need or denying the child that need.

This reasoning is often based upon cultural norms and expressed as ‘a good smack bottom’ or ‘he deserves…’ explaining otherwise inexplicable behaviours.

Conclusions

The court is often faced with data and opinions but little clarity when assessing the risk that parents present to their children but the BPSM provides a holistic structure.

The BPSM recognises that risk is not an exact science and risk assessment alone cannot guide decisions without the psychosocial context explain that risk.

Identifying the reasons for the type of parent child relationship that is present allows the court to make sense of the risk using techniques which do not have right answers.

Many parents learn the right answers to pass the assessment but BPSM is like a game of chess where there are no perfect moves making deception more difficult.

Other advantages are that the BPSM reports easy to read and understand and the focus on understanding the parent’s point of view can be therapeutic to the family.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.
Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

Burgin 2016 How to Document a Biopsychosocial Assessment in Personal Injury www.pibriefupdate.com

Burgin 2017 Why is a Generalist an Expert? www.pibriefupdate.com

Burgin 2018 Short Notes on Psychological Injury www.pibriefupdate.com

NSPCC www.nspcc.org.uk

Static-99 www.static99.org

VRAG - Violence Risk Appraisal Guide www.vrag-r.org

Danielle A. Black (2001) Risk factors for child physical abuse

Danielle A. Black (2001) Risk factors for child sexual abuse

Danielle A. Black (2001) Risk factors for psychological abuse

Image ©iStockphoto.com/marvinh