What are Poor Prognosis Indicators for Families?

You've learned in CASA training that each family you work with has inherent strengths and weaknesses unique to the family and its circumstances. Most families have the ability to change and make improvements to their home life and parenting style, and ultimately, to be reunified with their children. And some seem to struggle.

But did you know that there is another tool you can use to assess the prognosis of the families you are working with? It's called the Poor Prognosis Indicators, a list of 20 factors developed by Linda Katz, Norma Spoonemore, and Chris Robinson in 1994, and published in Concurrent Planning: From Permanency Planning to Permanency Action in 1994. The list is used to identify families for whom reunification may be a difficult or possibly unachievable outcome.

In families where the prognosis is poor, a well-developed concurrent plan is absolutely essential from the beginning of the case. Also, families with poor prognosis may need help breaking down the individualized service plan into a short-term, prioritized, manageable set of to-do's with clear directions, such as phone numbers to call and the names of people with whom to speak. Progress on the ISP should be reviewed regularly as the case progresses, and a list of both items completed and items left incomplete should be shared with the judge in the CASA Report.

Some of the Poor Prognosis Factors bear an asterisk (*). According to Katz, Spoonemore, and Robinson, "Any condition with an asterisk is, in and of iteself, an indicator of poor prognosis. For other items, the more that are present in a family, the worse the prognosis. This worksheet is suitable in cases of young children who are already in foster care, who are entering care under the age of eight, and who have no relative or parent with whom they can immediately and safely live. It is not intended to be used to determine risk to children still living in their own homes, since it relates to risk of long-term foster care drift rather than risk of parental abuse or neglect."

Following are the 20 Poor Prognosis Indicators, by category:

CATASTROPHIC PRIOR ABUSE

1. Parent has killed or seriously harmed another child through abuse or neglect, and no significant change has occurred in the interim. *
2. Parent has repeatedly and with premeditation harmed or tortured this child. *
3. Child experienced physical or sexual abuse in infancy. (Treatment of abusing parent may be so difficult and lengthy that the child spends years in foster care).

DANGEROUS LIFESTYLE

4. Parent's only visible support system and only visible means of financial support is found in illegal drugs, prostitution, and street life. *
5. Parent is addicted to debilitating illegal drugs or to alcohol.
6. There is a pattern of documented domestic violence between the partners of one year or longer, and they refuse to separate.
7. Parent has a recent history of serious criminal activity and jail.
8. Mother abused drugs/alcohol during pregnancy, disregarding medical advice to the contrary.

SIGNIFICANT CHILD WELFARE HISTORY

9. Parental rights to another child have been terminated following a period of service delivery to the parent, and no significant change has occurred in the interim. *
10. There have been three or more DHS interventions for serious separate incidents, indicating a chronic pattern of abuse or severe neglect.
11. In addition to emotional trauma, the child has suffered more than one form of abuse or neglect.
12. Other children have been placed in foster care or with relatives for periods of time over six months' duration or have had repeated placements with DHS intervention.
13. This child has been abandoned with friends, with relatives, at a hospital, or in foster care; or once the child is placed in subsequent care, the parent does not visit of his or her own accord.
14. DHS preventative measures have failed to keep the child with the parent: home-based services, visiting public health nurse, Homebuilders, therapeutic daycare, and so forth.
15. Parent is under the age of 16 with no parenting support systems, and placement of the child and parent together has failed due to the parent's behavior.
16. Parent has asked to relinquish the child on more than one occasion following the initial intervention.

INHERENT DEFICITS

17. Parent has been diagnosed with severe mental illness (psychosis, schizophrenia, borderline personality disorder, sociopathy), which has not responded to previously delivered mental health services. Parent's symptoms continue, rendering the parent unable to protect and nurture the child. *
18. Parent has a diagnosis of chronic and debilitating mental illness (psychosis, schizophrenia, sociopathy) or other illness that responds slowly or not at all to current treatment modalities.
19. Parent is intellectually impaired, has shown significant self-care deficits, and has no stable support system able to share parenting.
20. Parent grew up in foster care or group care, or in a family of intergenerational abuse. (Unfamiliarity with normal family life can severely limit parents' ability to overcome other problems in their lives.)

The Poor Prognosis Indicators can be applied to each case by checkmarking those indicators that are of concern. Be sure to discuss this checklist with your Advocate Coordinator for next steps on the road to finding permanency for the children on your caseload.