Family and Community Issues Affecting Evaluations of the School-Age Child

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Many children presenting for evaluation will have experienced parental marital conflict, separation, and/or divorce. In separation or divorce cases, it is particularly critical that at the initial appointment the clinician discuss and establish plans and goals for completing the evaluation. Whether one or both parents accompany the child, it is critical to inquire about custody arrangements, including which parent has primary custody and health insurance responsibility and what are the guardianship visitation and custody-sharing arrangements. Requesting a copy of the custody agreement is advised. These discussions are critical for both establishing the fundamental collaborative relationship and clarifying the role of the clinician. It is important to address issues related to access to medical records, court involvement, and limitations related to roles. Custody evaluations are a highly specialized and contentious type of evaluation (see Chapter 43, "Legal and Ethical Issues"). Specialized training and procedures are standard practice for these evaluations (American Academy of Child and Adolescent Psychiatry 1997a). Clinicians need to be clear with parents about the limits upon our role if custody issues are involved and we are not providing a formal custody evaluation. Referrals to court mediators and custody evaluators are appropriate for these requests. However, even if the role of the clinician is not to conduct a custody evaluation, if custody disputes are ongoing, clinical records may be subpoenaed by the court. Although one parent may claim that the noncustodial parent has very little interest in or involvement with the child you are evaluating, it is good practice to attempt to include both parents in your information-gathering process. A direct request from a clinician regarding observations and concerns about the child may result in a very different response than was predicted by the other parent. In most cases, both parents do have some role with the child. Including both parents in the diagnostic process therefore underscores for the child and parents that both relationships are important and impact the child. In addition, it sets the stage for future therapeutic interventions that may necessitate coparenting despite the end of the marital relationship.

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