Psychiatric Evaluation

An evaluation to address issues of parenting capacity and the best interests of the child in light of allegations of exaggeration, fabrication, and/or inducement of illness in a child by a parent is a complex process and ideally should be performed in the context of a forensic evaluation. When courts are involved, such evaluation is strongly recommended to inform and expedite decision making. Evaluations that are limited and attempted without court sanction are often not only unhelpful but also harmful; integration of all of the material about the child,

Table 12-2. Munchausen by proxy protocol for hospitals and health care facilities

Obtain individual and group case consultation with relevant medical specialties and a consultant knowledgeable about Munchausen by proxy.

Notify and consult with hospital child protection and legal staff.

Outline conditions under which covert staff or electronic surveillance would be initiated as a routine element of the protocol, as well as specification of who has the authority to initiate covert staff or electronic surveillance.

Describe how the mandated reporting requirement will be accomplished, including designation of a specific person to make the mandated report, content of the report to be made to state child protection authorities, and coordination with child protection.

Implement child safety initiatives such as the following:

- Intensively monitor or temporarily suspend parent-child and family-child contact pending more definitive diagnosis and/or the involvement of child protection authorities.

- Have in place a procedure by which a preemptive court order bars removal of the child by parents, or initiate a protocol permitted under state law by which a physician might place a "hold" on discharge pending notification of the court. Indicate steps to be followed in the event a parent attempts to remove a child against medical advice, including the role to be played by hospital security.

Designate a single source of information to whom the family or others with an interest in the case can turn for reliable information regarding the situation and the condition of the child.

Source. Adapted from Kinscherff R, Ayoub C: "Legal Issues in Munchausen by Proxy," in The Treatment of Child Abuse. Edited by R. Reece. Baltimore, MD, Johns Hopkins University Press, 2000, pp. 242-267. Used with permission.

parent, and family is needed to reach the best-documented independent evaluation.

In carrying out a psychological assessment in a primary care setting, evaluators should be aware of the need for comprehensive integrated evaluation and acknowledge the limitations of evaluations performed during a child's relatively brief stay in the hospital. In a comprehensive integrated evaluation (Sanders and Bursch 2002; Schreier et al. 2009), the focus of the assessment is on the caregiver-child interactional patterns. The details of this evaluation are outlined in Table 12-3. For more details about forensic assessment, see Sanders and Bursch (2002).

Although such an evaluation is extensive, the complexity of the MBP situation usually requires comprehensiveness so that juvenile and family courts can proceed with findings and dispositional issues that focus on the child's best interests. Ideally, a court-ordered evaluation provides the evaluators with the neutrality and the court's authority to work with all parties and to request the court's support in gaining access to individuals and records.

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