Assessing parenting risk within the context of severe and persistent mental illness: Validating an observational measure for families with child protective service involvement

Women with severe and persistent mental illness (SMI) face formidable challenges as parents. While many raise their children to adulthood, others struggle considerably in the parenting role. In cases where there is child protective service involvement, an assessment may be requested to establish what risks an individual with SMI poses as a parent. Unfortunately, many current approaches to parenting assessments have serious methodological problems. One problem is a lack of valid and reliable measures to assess the parenting behavior of individuals with SMI who have child protective service involvement. In an effort to improve the quality of parenting assessments for this vulnerable group, this study drew on a sample of mothers with SMI who had lost custody of a child to examine the reliability and validity of the Child and Adult Relational Experimental Index (CARE-Index), an observational measure of parenting behavior. Independent and trained raters achieved a high level of reliability on the measure. Mothers' ratings on the measure also were associated with children's interactive behavior and with an estimation of risk based on a multifaceted, comprehensive assessment. The measure's relation to estimation of risk remained significant when two other predictors of risk, maternal caregiving attitudes and insight into mental illness, were considered. Taken together, the findings suggest that the measure can provide reliable, valid, and independent information on parenting behavior that could inform comprehensive, multifaceted assessments of parenting risk.