Divorce | Trauma and Loss | Exposure to Violence and Sexual Images From the Media
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.