Challenges in Family Forensic Psychology:
Families with Special-Needs Children II
By Neil S. Grossman and Barbara F. Okun
Approximately 30% of all children under the age of 18 have a chronic illness and, as discussed in our last column, special needs children's symptoms can be exacerbated during a divorce (Seligman & Darling, 2005). Family forensic psychologists can help families and members of the legal system consider some of the important issues necessary to work out the details of divorce, custody, visitation and child support when there is a special needs child in the family. To mention a few:
1) Do child support figures include medical bills, expense of therapy, medical equipment, medications, dietary and sensory needs?
2) Are costs for professional help for child and parent(s) and siblings included?
3) Do visitation plans include some respite for the primary caretaker?
4) Are costs of home modifications and special equipment included?
5) If one parent cannot work or must curtail his/her job, are 401K contributions from the working spouse included?
6) Does the parenting plan include agreements about lifelong care and a process for resolving parental differences?
7) Are the needs of the whole family system considered?
Family forensic psychologists have an advanced knowledge of family and individual dynamics and assessment (including families with special needs children), psycho-legal issues, and related interventions. They may provide expert information to the family, attorneys or the court and design interventions to correct for problems they identify, e.g., through parenting coordination, as a divorce coach, etc. In situations where they do not have expertise in a content area under consideration, they obtain expert consultation.
Whether divorced are not, families with special needs offspring struggle with lifelong dilemmas about care for someone who might never be able to live independently. Whether in the forefront of one's mind or not, it is a chronic concern. One important intervention role is to inform families about legal assistance the offspring is entitled to, e.g., empower families to advocate for state and federally mandated services. Many states must provide services through the age of 21. But parents are often not aware of this. Consider the following case:
Mark and Jill's son, who has moderate to severe autism, is completing high school and Mark and Jill were told that he would receive a diploma and not be eligible for further services from their school district.. Mark and Jill were considering options for Larry's adult life. They had reviewed a list of residential placements furnished by their school district and visited several, finding that most of the populations were more severely disabled than Larry. Their dream was for an affordable community where Larry would receive supervision, vocational training and a social environment. They shared nightmares about what would happen to Larry in the future and worries about Larry's younger siblings concerns about future responsibility for Larry. A family forensic psychologist together with a special needs attorney were consulted by this family They guided Mark and Jill through exploring options and researching limited resources. The family also had concerns about estate planning. The psychologist suggesting that they also talk to a lawyer versed in setting up special trusts for such families. Estate planning is complicated in that families have to create the types of special trusts that do not jeopardize their offspring's eligibility for government programs such as Medicaid. There were many concerns about who should be the trustees for Larry - a family member? A sibling? An outside expert? While these ongoing dilemmas persisted, the professionals determined that the school district was obliged to give Larry a "certificate" instead of a "diploma" and he was able to receive special services for several more years.
But in another family involved in a high conflict divorce, one parent wanted her son to be declared "independent" at the age of 18 so that she would no longer have management and financial responsibility for him. Her ex-spouse has suffered financial reverses and could not provide the care he had hoped to. In addition, he may have to relocate in order to maintain an income. Yet, this father was reluctant to "turn his son out to the wolves." The task of the psychologist was to help to the family explore options that would balance the needs of the son, the mother, the father and his new family and the son's siblings.
Each situation is unique and existing laws do not always apply. It is essential that psychologists working with these families are informed and work with family lawyers knowledgeable about special education law as well as sensitive to the special needs of these families. As more and more youngsters are diagnosed with special needs or chronic illness, longer range planning becomes crucial. Because it is uncharted territory, the available research is not very helpful. Much is based on distortions and wishful thinking (Bruch, 2006) and outdated theories based on traditional family structures. In contemporary society, particularly in an economic downturn, how are the parents supposed to be available to care for a needy child and still put food on the table? What about the realities of single parenthood? The needs of other children? The needs of the parents? When the child becomes an adult, how long can the parents provide daily care? Is isolation in the family in the best interests of the adult offspring and the other family members?
While it is true that early intervention and educational technology help children to reach their full potential, there are many cases where full potential is not enough for what this culture considers independent adult living.
Many of these people will outlive their parents, thanks to medical and psychological interventions. There are not enough supported living day or residential programs to meet this growing need. And for those that do exist, there are long waiting lists. So, in actuality, more people live with their families until their parents are unable to provide care. This can create a sudden crisis if an elderly parent dies or becomes ill. It is important for family forensic psychologists to help families create a flexible plan for lifelong caring earlier in the family life cycle.
Often our client will be a sibling or parent of the adult with disabilities. Viewing these concerns from a family systems perspective enables us to help the family understand these dilemmas as family system issues. Over the years, caretaking roles, family rules and resources necessarily need to be reassessed and reformulated. This is new territory that psychologists in conjunction with family lawyers must navigate.
References
Bruch, C.S. (2006). Sound research or wishful thinking in child custody cases? Lessons from relocation law. Family Law Quarterly, 40(2) 281-314.
Sligman, M. & Darling. R.B. (2005). Ordinary families, special children (3rd ed.), New York: Guilford.