Pergamon Child Abuse & Neglect, Vol. 19, No. I I, pp. 1349 1360, 1995

Copyright © 1995 Elsevier Science Ltd Printed in the USA. All rights reserved

0145-2134/95 $9.50 + .00

0145-2134(95)00101-8

PARENTAL LEVELS OF EMPATHY AS RELATED TO RISK ASSESSMENT IN CHII,D PROTECTIVE SERVICES

P A U L A R O S E N S T E I N

Corpus Christi, TX, USA

Abstract--Much attention has been paid to empathy as a concept necessary to the therapeutic relationship and successful outcomes with clients. Less attention has been paid to the importance of empathy in the parent-child relationship. Even less attention has been paid to empathy as it relates to the presence or absence of child abuse in the parent-child relationship. While early literature on child abuse eluded to the parents' ability or inability to empathize with the child, recent emphasis on risk assessment and studies of variables used as factors to predict risk of abuse do not include parental empathy. Research presented in this article suggests that a complete assessment of risk of child physical abuse must include a measure of parental empathy. The article also suggests that a measure of parental empathy be added to each of the risk assessment tools used by child protective service specialists.

Key Words--Empathy, Risk assessment, Research, Child protective services.

I N T R O D U C T I O N

M U C H A T T E N T I O N H A S b e e n p a i d to e m p a t h y as a c o n c e p t n e c e s s a r y to the t h e r a p e u t i c

r e l a t i o n s h i p and s u c c e s s f u l o u t c o m e s w i t h c l i en t s (G lads t e in , 1983; Ra ines , 1990; Roge r s ,

1957). L e s s a t t e n t i o n ha s b e e n p a i d to the i m p o r t a n c e o f e m p a t h y in the p a r e n t - c h i l d r e l a t i on -

ship . E v e n less a t t e n t i o n h a s b e e n pa id to e m p a t h y as it r e la tes to the p r e s e n c e or a b s e n c e o f

ch i ld a b u s e in the p a r e n t - c h i l d r e l a t i o n s h i p . In te res t in e m p a t h y w i t h i n the p a r e n t - c h i l d r e l a t ion -

sh ip d e v e l o p e d f r o m s tud ie s c o n d u c t e d o n the a n t e c e d e n t s o f m o r a l d e v e l o p m e n t in c h i l d r e n

( H o f f m a n , 1963) . A t a b o u t the s a m e t ime , C. H e n r y K e m p e de f ined the b a t t e r e d c h i l d s y n d r o m e

( K e m p e , S i l v e r m a n , S tee le , D r o e g m u e l l e r , & S i lver , 1962). A s ear ly as 1968, B r a n d t S t ee l e

l i n k e d c h i l d a b u s e and a p a r e n t ' s ab i l i ty to e m p a t h i z e w i t h the ch i ld as fo l lows :

The history of neglect and abuse in the early years of the life of the abusive caretaker has been stressed because we believe that therein lies the source of the caretaker's later inability to provide empathic care for infants and children. By empathy we mean a caretaker's sensitive awareness of a child's state and needs and the ability to instigate appropriate responses thereto. Abuse and neglect are the outward behavioral evidences of a caretaker's inadequate empathy for the child . . . . Excessive punitive discharge of aggression or neglectful disregard of a child's basic needs could not occur if normal, adequate empathy existed in the ca r e t ake r . . , we find that in times of stress or crisis, the caretaker gives priority to his or her own needs and ideas, while the child's needs are given only secondary consideration or are completely disregarded (Kempe & Heifer, 1980, p. 52-53).

H o w e v e r , w i t h f e w e x c e p t i o n s , the r e c e n t e m p h a s i s o n r i sk a s s e s s m e n t a n d s tud ie s o f f ac to r s

to p r ed i c t r i sk o f a b u s e do no t i n c l u d e p a r e n t a l e m p a t h y . R e s e a r c h p r e s e n t e d in th is a r t ic le

sugges t s tha t a c o m p l e t e a s s e s s m e n t o f the r i sk o f c h i l d p h y s i c a l a b u s e m u s t i n c l u d e a m e a s u r e

o f p a r e n t a l e m p a t h y .

Received for publication November 21, 1994; final ~vision ~ceivedMay 5, 1995; accepted May 10, 1995.

Repfintrequests should be add~ssed to Paula Rosenstein, L.M.S.W., 711N. Carancahua,#420, Corpus Christi, TX 78475.

1349

1350 P . Rosenstein

EMPATHY

A Review of Related Literature

Definitions of empathy. The literature identifies two types of empathy: (a) affective and (b) cognitive. Affective empathy is the ability of an individual to experience the emotions of another as the other acts out or describes those feelings. Cognitive empathy is the ability to understand the perspective of another, which is also called role-taking. Within the literature on attachment theory, the construct called maternal sensitivity is close to empathy. Sensitivity was defined by Crittenden and Bonvillian (1984) to include "responsiveness, positive affect, cooperation, and the use of infant-adapted communication" (p. 259).

Soon researchers suggested the possibility of an integrative definition of empathy. Deutsch and Madle wondered:

• . . whether an empathic response is a shared emotional experience, an understanding or affect, or both; whether an empathic response is a response to an object, another's affect, and/or circumstance; whether one process or several explain how one is empathic; and whether self-other differentiation is required by various definitions of empathy. (1975, p. 267)

Feshbach (1975) proposed an integrative model in which there are three components to empathy. Two are cognitive and one is affective. Feshbach studied the development of empathy in children. She suggested a socialization process in which the child first learns the cognitive ability to understand the feeling perspective of another. Later, the child learns to understand the role of the other. Still later, the child develops the affective ability to feel those feelings on behalf of the other. Some children do not complete development through all three phases, nor have all adults achieved the ability to empathize at all three levels.

Study findings. A literature search was conducted to locate studies that relate parental levels of empathy to patterns of discipline and/or child abuse. A further purpose of the literature search was to find studies using empathy as a risk factor to predict the presence or absence of child physical abuse. Studies such as those by Ayoub, Willett, and Robinson (1992) compared situational risk factors to personality risk factors. Only those that specifically include parental empathy are reported here.

Several studies were found that link parental patterns of discipline to the development of empathy in children. Four were reported by Hoffman, one with Saltzstein, between 1960 and 1975 and the fifth was a 1984 study by Jansen, Perry, and Gaynard. Others, for example the Zahn-Waxler, Radke-Yarrow, and King (1979) study, looked at parental discipline and the development of altruistic/reparative behavior in children. These studies did not measure parental levels of empathy. Instead, they linked the parental patterns of discipline to the development of empathy (or empathy-like behaviors) in children.

Melnick and Hurley (1969) reported on a series of personality inventories given to 20 mothers. Ten of the mothers were identified as abusive by child protective services (CPS). The other 10 were used as nonabusive control group. The mothers were matched by age, income, education, and number of children. All were low income and Black. Among the instruments given was the Pathogenic Index (PI) reported as a measure of the mothers' ability to empathize and/or to trust. The PI measure accounted for 22% of the variance to predict abuse. The abusive mothers showed significantly less empathy than the mothers in the control group. TAT cards were presented and the women told stories about the cards. The authors used the cards to get a measure of what they called a need to nurture. The TAT nurturance was 13% of the variance. The authors concluded that the abusive mothers " m a y have a deficient capacity for empathizing with and administering to their children's needs" (p. 748).

Risk assessment in child protective services 1351

Letourneau (1981) studied the relationship between parental empathy and the presence of child abuse. The study population was two groups of mothers. Thirty were mothers identified as abusive by CPS and 30 were identified as nonabusive by a day-care center. The mothers were all comparable in age, income, social class, education, number of children, and race. Each mother took the Hogan Empathy Scale (cognitive measure) and the Mehrabian and Epstein (affective measure). The mothers also participated in the Rothbart and Maccoby role- play inventory. Letourneau found that the abusive mothers' scores on the empathy scales and "in both their emotional responsiveness and their role-taking ability" (p. 385) were signifi- cantly lower than the nonabusive mother. In this study Letourueau controlled for stress. The mothers took a measure called the Schedule of Recent Life Experiences (SRE). Scores for the abusive and nonabusive mothers did not differ significantly on this measure. Since stress did not differentiate abusive from nonabusive mothers, Letourneau concluded:

The fact that many mothers apparently function adequately in the presence of high stress, or inadequately even when experiencing low levels of stress, suggests that empathy and stress somehow interact and that empathy serves a mediating function.., empathy appears to be the critical variable that influences the rate of abuse . . . . "' (pp. 285, 287)

A 1988 study reported by Kugler and Hansson looked at variables that contribute to the risk of child abuse. The authors assumed that "perceived loss of control" (p. 329), which they described as learned helplessness and depression, are both risk factors. Based on that assumption, they wanted to know whether situational stressors or personality variables are more predictive of depression and/or control. The subjects were 54 parents who were participating in a Parents Anonymous program, a peer group support program for abusive parents. Only two of the variables measuring situational stress, "availability of feedback regarding parenting" and "loneliness" (p. 330), were significant to predict either control or depression. The six personality variables were more predictive of risk. Included in the personality variables were two measures of empathy, one cognitive and one affective. Both measures of empathy were significant to predict the risk variables. Unfortunately, there was not a control group of nonabu- sive parents.

In 1989, Feshbach reported a study in which she measured empathy levels in 219 mothers. The subjects came from a control group; a group of child guidance clinic clients presumed nonabusive, and a physically abusive group. Only 26 mothers were in the abuse group. Feshbach used an instrument she developed called the Parent/Partner Empathy Scale. It measures four types of empathy: cognitive, affective, partner, and a type she calls empathetic distress, which reflects "shared reactions to distress and discomfort in others" (p. 365). The scores on the cognitive, affective and partner empathy were significantly different between the control group and the experimental groups. However, there was not a significant difference in the scores on these measures between the clinic group and the abusive mothers. There was a significant difference on the empathic distress scores between the control and abusive group, but not between the abusive and clinic groups.

Other studies on parental empathy and child physical abuse were done as part of the development and validation of the Adult-Adolescent Parent Inventory (Bavolek, 1984). This instrument was used in the present study and is described in detail below. Bavolek reports that 1,239 parents with no known history of abuse and 782 parents identified as abusive took the AAPI as part of several studies to develop normative tables for the instrument. The population sample was from four different states, the majority from an urban environment. The abusive and nonabusive groups included males and females, Black and White subjects. Abusive parents scored significantly lower on empathy than the nonabusive parents. The specific results are in Table 3.

1352 P. Rosenstein

Summary of Study Findings on Empathy

Very few studies exist linking parental levels of empathy to parental patterns of discipline and/or child physical abuse. Existing studies suggest that physically abusive parents are less able to empathize with their children than nonabusive parents. Feshbach writes:

Although empathy is acknowledged to be only one of a large number of variables that constitute the psychological and contextual antecedents of child abuse, empathy appears to have a special potential for regulation of physical violence toward children• (1989, p. 367)

RISK ASSESSMENT

History of Risk Assessment

Risk assessment is not new to the field of child protection. Risk was discussed as early as abusive parents were first described (Kempe & Heifer, 1968). In the 1960s and 1970s the phrase most often used to designate risk was potential to abuse (Kempe & Helfer, 1972) because the discussion centered around parental capabilities. The focus on risk was amplified with the passage of the Child Abuse Prevention and Treatment Act of 1974, which provided for research and encouraged the identification of risk factors (Stein, 1974). From the late 1960s through the 1980s a number of assessment instruments were developed (Children's Bureau, 1991; Garbarino, Guttman, & Seeley, 1987; Magura & Moses, 1987; Magura, Moses, & Jones, 1987; Milner & Gold, 1984).

With the passage of the Adoption Assistance and Child Welfare Act of 1980 and the greater public awareness of abuse, the number of referrals made to CPS and accepted for assessment increased rapidly. The amount of money available to hire staff was not increasing relative to the growing number of families to assess. In the "good old days" the purpose of child welfare intervention was to provide services to families. Now, with limited resources, legislatures defined abuse and neglect into the law and demanded that intervention also serve the purpose of preventing further abuse (Wald & Woolverton, 1990). The Adoption Assistance and Child Welfare Act mandates efforts to prevent as many child out of home placements as possible. States began to look to risk assessment as a way for CPS workers to make better and more efficient decisions for children.

The American Humane Association, the Child Welfare League of America, ACTION for Child Protection, and the Illinois Department of Children and Family Services were the first to assist state agencies to develop risk assessment models for their CPS programs. In 1987, the first of the National Roundtables on CPS Risk Assessment conferences was convened. In 1988 the CPS Risk Assessment Project of the American Public Welfare Association was established. At that time, 13 states had risk assessment systems. By 1991 approximately 40 states had implemented models (Tatara, 1991).

Risk and Risk Assessment Defined

Risk is the likelihood of maltreatment in the future. It is the likelihood of repetition of incidents which put the child at significant risk of harm or risk of injury. Rapport and Johnson say:

• . . One does not observe risk per se. Rather, one observes situations which, given other information, leads to a conclusion that there is a high level of risk. If risk is indeed largely unobservable, we are left with a dilemma. How

Risk assessment in child protective services 1353

do we infer that a high risk is present? This problem has been "solved" by utilizing a set of risk factors. These factors may be called "proxy measures." (1989, p. 211)

Risk assessment is the decision making process that decides the likelihood of risk. A risk assessment model is a framework used to make the risk assessment. Variables assumed to predict risk are chosen for the model and put into a format the worker uses to assist in the decision making process. To accomplish the objective of predicting likelihood of future harm, it follows that the risk factors selected in the model be predictive of risk. However, many of the models presently in use include risk factors that have not been empirically validated. Marks, McDonald, Bessey, and Palmer (1989) reviewed eight risk assessment models for the National Child Welfare Resource Center for Management and Administration, of the University of Southern Maine. The models included more than 100 variables, but only 29 were statistically significant to predict risk of abuse and/or neglect (McDonald, 1991).

PARENTAL LEVELS OF EMPATHY AND THE RISK OF CHILD PHYSICAL ABUSE

Hypothesis

The hypothesis of the present study is that a (negative) relationship exists between parental levels of empathy and risk of child physical abuse. A secondary hypothesis is that the presence of empathy in the parent/caretaker mediates the amount of stress the caretaker can handle without abusing the child.

Method

Subjects. The study population consists of cases presented to this author for a child protective services assessment of the presence and risk of child physical abuse from January 1, 1994 until May 25, 1994 and four additional CPS clients who took the AAPI as a pre-test for the Nurturing Program. During the study time period, this author was assigned 50 cases of alleged child physical abuse referred to the Texas Department of Protective and Regulatory Services in Bexar County, Texas, which includes San Antonio and the surrounding communities. Cases are brought to the CPS assessment units in Bexar County on a predetermined, rotation schedule. Cases are then assigned on rotation to the workers by the unit supervisors. From the original 50 possible subjects, the author eliminated six. One was eliminated because the alleged perpe- trator was a minor. Another was not included because the alleged perpetrator lived in another County. Two were eliminated because the individuals spoke only Spanish and the instruments were available only in English. One was eliminated because the alleged perpetrator was unable to read and the sixth was eliminated because the alleged perpetrator refused an interview. The remaining 44 alleged perpetrator/caretakers were asked to participate. Twenty-five persons completed both instruments. An additional four CPS clients completed only the AAPI.

All 29 of the caretakers who participated did so as parents of the children involved. Two were grandmothers. Another turned out to be a nonrelated caretaker who presented as a relative. Twenty of the caretakers (68.9%) were female; nine were male (31.1%). They ranged in age from 19 to 52. The mean age of the subjects was 30.25 years for females and 33 years for the males. Nearly half (45.8%) were married, but not necessarily to the biological parent of the children involved. Ten of the female subjects (50%) were Hispanic; two (10%) were Black; and eight (40%) were White. Six of the male subjects (66.6%) were Hispanic; two (2.2%) were Black; and one was White (11.1%). All children in the subject families ranged in age from newborn to 16. The same age range applies to the child(ren) who was the alleged victim

1354 P. Rosenstein

of physical abuse. The number of children in each family varied from one to five. One of the mothers had seven children, but only two were living with her. The mean age for all the alleged victims was 7.5 years.

All of the families had at least one referral for physical abuse to CPS. After assessment, the families fell into four categories: (1) First CPS referral/no abuse; (2) First CPS referral/ abuse validated; (3) More than one referral/no abuse; (4) More than one referral/abuse validated.

Procedure. The alleged perpetrator in each case was asked to complete the Adult-Adolescent Parent Inventory and the Parental Stress Inventory. The request was made just as this auChor completed a first interview with these clients. Each was told that the instruments were measures of their own opinions about themselves and their children. They were told that the UPS assessment would be concluded separate from the instruments and that the instruments would not be scored until after the CPS determination was made. Therefore, nothing on the instrument would influence the outcome of the CPS investigation. A brief explanation of how to complete the instruments was offered and the instruments were left with the client along with an envelope in which to return the instruments at no cost. Only two of the 44 declined to participate. The rest accepted the instruments. Twenty-five returned completed instruments. Four additional CPS clients completed only the AAPI. After the CPS interviews were done, the SMART Risk Assessment Model was completed by this author for each family.

The author made a decision to either validate or invalidate for child physical abuse before the instruments were scored and statistically evaluated. Validation of allegations were based on the definition of child physical abuse in the Texas Family Code (1993) as follows: physical injury that results in substantial harm to the child or the genuine threat of substantial harm from physical injury, to the child, including an injury that is at variance with the history or explanation given and excluding an accident or reasonable discipline by a parent, guardian, or possessory conservator that does not expose the child to a substantial risk of harm (Chapter 34, Section 34.012 (C)).

Measures

Parental stress inventory (PSI). The PSI was developed in 1976 by Richard Abidin (1990A) to measures parental stress. The original instrument included over 100 questions. In 1990 a short version was introduced (1990B). The shorter version was used in this study because it is similar in length to the AAPI. The instrument includes 36 items answered by the client on a 5-point Likert Scale from strongly agree to strongly disagree. It measures three constructs of parent stress. The first is personal parental stress. This scale measures such things as the degree of parental depression and the parent's perception of availability of social supports. The second construct is parent-child relationship stress. This scale measures such things as the degree to which the child is accepted by the parent. The third construct is a measure of how stressful the parent perceives the child's behaviors. Studies conducted on the long version of the PSI attest to the validity and reliability of the instrument (Abidin, 1990a). The short version was tested for reliability and validity against the items in the longer PSI. On those measures the PSI/SF is both valid and reliable. However, independent tests of the short version are still incomplete (Abidin, 1990b).

Adult-adolescent parent inventory (AAPI). The AAPI was developed by Stephen Bavolek starting in 1975. The instrument is designed to measure parental attitudes of both adolescent and adult parents. It is "an indication of the individual's abilities to parent children in a nonabusive manner. The most important use of the AAPI is assessment for treatment and education" (Bavolek, 1984, p. vii). The instrument consists of 32 items each scored on a five

Risk assessment in child protective services 1355

point, Likert Scale from strongly agree to strongly disagree. It measures four constructs: (a) parental expectations of the child; (b) parental empathy for the child; (c) the value the parent places on use of physical punishment; (d) parent-child role reversal. The reliability and validity of the instrument was tested many times by Bavolek and others and reported in the AAPI Manual (1984) and a separate report on the instrument (1990).

Structured model for assessment of risk in Texas (S.M.A.R.T.). By September, 1992, the Texas Department of Protective and Regulatory Services had instituted a new risk assessment model for all CPS workers. This model is called the Structured Model for Assessment of Risk in Texas, which was quickly designated "Smar t . " The SMART model was developed by the State of Texas for use statewide after several years pilot project in which one region of workers used the CARF model produced by ACTION for Child Protection. CARF is one of the models included in the research mentioned above. The CARF pilot project results were analyzed and combined with information from other models to develop the SMART Model. The SMART Model also reflects the Texas Family Code, which contains legal definitions for child abuse and neglect. SMART recognizes two types of risk of child abuse. The first is risk of harm, which is the risk that significant injury has and/or will occur. The second is the risk of abuse or neglect in the future, which may be present even if there is no present injury that meets the statutory definitions. The SMART Model assesses risk of all six statutory types of abuse and neglect. It also assesses risk at all levels of the CPS system from intake through family preservation services. However, to match the research reported in this paper, the SMART Model is considered only with reference to child physical abuse and only in the arena of the initial family assessment. The assessment portion of the SMART Model includes at least one risk factor for physical abuse from six of the seven domains of risk identified in the research. It includes a risk factor similar to personal parental stress and a risk factor for parental expectation of the child in the parent/child domain, but it does not include a measure of parental empathy. None of the factors are operationalized.

Results

Correlations were run to see how the measure of empathy on the AAPI was associated with the three other constructs the instrument measures. The association between empathy levels and parental expectations of the child(ren) were in the moderate range. For this population, on this instrument, there is an association between a parent's level of empathy and his/her understanding and acceptance of the child's limitations at .6319 (p = .0001). There was a high level of association between parental levels of empathy and whether the parent values or does not value the use of corporal punishment at .7542 (p = .0001). The highest level of association was between the parental levels of empathy and the presence or absence of role reversal in the parent-child relationship. The correlation among the total population on these two scores was .8072 (p = .0001).

The correlations between parental levels of empathy and the three types of stress measured in the PSI were all negatively associated in the low-moderate range. The total scores for perceived stress correlated at - .4816 (p = .015) with the empathy scores. The scores for stress in the parent-child relationship were the most closely, but negatively, associated with the empathy levels at - . 5179 (p = .008). The correlation between the parent-child relationship stress and the role-reversal scores are also associated in the low-moderate range, but lower than the empathy scores (- .4489, p = .024).

To test the hypothesis concerning the ability of empathy to predict child physical abuse, each construct was checked in a one-way analysis of the variance. The subjects were first divided into two groups of either abusers or nonabusers and the variances were checked. Next

1356 P. Rosenstein

Table 1. Analysis of Variance of Empathy By Abuse/Non-Abuse

Source df Sum of Squares Mean Squares F Ratio F Probability

Between Gr. 1 73.4025 73.4025 1.9471 .1743 Within Gr. 27 1017.8389 37.6977 Total 28 1091.2414

Group N Mean Standard Deviation Standard Error Min. Max.

Abusive 20 30.4500 6.9090 1.5449 19.00 40.00 Non-Abusive 9 33.8889 3.7231 1.2410 28.00 40.00 Total 29 31.5172 6.2428 I. 1593 19.00 40.00

the subjects were d ivided into two groups o f those referred to CPS only once and those referred for assessment more than once and the var iances were checked. Because the populat ions were small , none of the analyses were significant.

Table 1 shows the analysis of var iance between the abuse and the nonabuse groups as to their scores on the empathy measure in the AAPI . Al though it is not significant (.1743), it was the closest to s ignif icance in predict ing abuse of all the constructs measured in the AAPI , including the measure of role reyersal .

Table 2 shows the analysis o f var iance o f the construct in the PSI that measures the stress in the parent-chi ld relat ionship. Again, the results were not significant (. 1553), but o f the three stress constructs, it was the one that came closest to significance in predict ing which subjects were in the abuse or nonabuse groups. None o f the constructs in ei ther instrument were significant to predict which subjects had more than one referral to CPS.

Because the number of subjects in this s tudy is so small , a compar ison of means was done to see how typical this populat ion was o f a much larger populat ion of abusive and neglectful parents who took the A A P I in a group o f studies reported by Stephen Bavolek (1984). The

Bavolek studies included 2,021 subjects. The results of this means compar ison are shown in Table 3. The subjects of this study are typical o f the subjects in the larger study on the empathy and role reversal measures.

The secondary hypothesis suggests a relat ionship between parental empathy, stress and child physical abuse. The strongest correlat ion was the negative correlat ion between the empathy

measures and the measure o f stress in the parent-chi ld relat ionship. This author d iv ided these subjects along the mean scores into four groups, one each for high and low empathy and one each for high and low parent-chi ld re la t ionship stress. Because of the small number o f subjects, there is no signif icance to these figures. However , the fo l lowing correlat ions were discovered:

For 75% of the cases, when empathy was low and parent-child stress was high abuse was present.

Table 2. Analysis of Variance of Parent-Child Distress Index by Abuse/Non-Abuse

Source df Sum of Squares Mean Squares F Ratio F Probability

Between Gr. 1 211.7024 211.7025 2.1593 .1553 Within Gr. 23 2254.9375 98.0408 Total 24 2466.6400

Group N Mean Standard Deviation Standard Error Min: Max.

Abusive 16 26.0625 I 1.1980 2.7995 12.00 46.00 Non-abusive 9 20.0000 6.8374 2.2791 12.00 32.00 Total 25 23.8800 10.1379 2.0276 12.00 46.00

Risk assessment in child protective services

Table 3. Comparison of Abusive and Non-Abusive Subjects on Empathy and Role Reversal in the Bavolek Study and in this Study

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Abusive Non-Abusive Study Mean (SD) N Mean (SD) N

Empathy Bavolek 29.53 (5.58) 782 32.45 (4.67) 1,239 This study 30.45 (6.90) 20 33.88 (3.72) 9

Role Reversal Bavolek 27.35 (6.22) 782 28.73 (5.86) 1,239 This study 26.45 (6.70) 20 29.55 (8.18) 9

Case Example: Ms. M. is a 22-year-old mother who had given birth to six children. Five of the children she had voluntarily given to relatives. She is presently living with her mother and her 3-year-old daughter. Ms. M. was referred to CPS upon the birth of her seventh child because of her history of glue sniffing and her history of three prior involvements with CPS. Exposure of unborn children to mind altering substances is considered by CPS as physical abuse. Ms. M. indicated a history of childhood molestation and significant feelings of depression with several attempted suicides. Ms. M. was unable to individualize her 3-year-old saying that her mother provides most of the child care. Her SMART Assessment indicated a significant degree of risk for future abuse and neglect. Ms. M.'s mother agreed to care for this infant and this case was staffed and accepted for ongoing services. Ms. M's empathy score was 19, which was the lowest score of the abusive subjects. Her parent-child stress score was 44, which was very close to the highest score of 46.

For 100% of the cases, when empathy was low and parent-child stress was low abuse was present.

Case Example: Mrs. F. lives with her second husband, her own two sons, ages 7 and 10 and her stepdaughter, age 14. Mrs. F. put bruises on her 7-year-old son's back and lower left arm with a belt. She disciplined him with the belt when he "talked back" during a time when she was feeling ill. Both boys indicated that similar incidents occurred in the recent past. Mrs. F. indicated a history of abuse as a child and feelings of significant depression. Her SMART risk assessment indicated a risk for future abuse. Her case was staffed and accepted for ongoing services. Her empathy score of 31 is in the average range for abusive parents, but below average for nonabusive parents. Her parent-child relationship stress score of 14 is well below average for both abusive and nonabusive parents.

For 80% of the cases, when empathy was high and parent-child stress was low no abuse was present.

For 33.3% of the cases, when empathy was high and parent-child stress high no abuse was present.

Case Example: Mr. A. is the single father of three all living with him. The oldest son is 19, and the two younger children are a daughter, age 1 I and a son, age 7. The 7-year-old is blind. Mr. A. lost his wife to cancer several years ago. His second marriage ended in divorce. Mr. A. was referred to CPS because the 7-year-old had a bruise to his face that was suspected as the result of physical abuse since the child indicated that his father does hit him. The SMART Assessment ruled out both physical abuse and risk of future injuries. Mr. A.'s empathy score was 37, which is in the high range. His parent-child stress score was higher than average at 24.

Because the correlation is negative, the means are in the right direction to imply that abusers have less empathy and more parent-child relationship stress than nonabusers (Table 4).

Table 4. Comparison of the Mean Scores in the Empathy, Parent-Child Relationship Stress, Parental Distress, and Child Distress Constructs

Empathy P-CI Stress PD Stress DC Stress

Abusers 30.45 26.00 27.18 29.37 Non-Abusers 33.88 20.00 26.00 24.77

1358 P. Rosenstein

Discussion

The results of this study indicate, as hypothesized, that there is a relationship between parental levels of empathy and child physical abuse. Empathetic parents, as defined by the AAPI, (Bavolek, 1984) have the ability to perceive and act on the needs of their children. This is cognitive empathy. This result is consistent with other studies on empathy which indicate that parental cognitive empathy is related to reduction of child abuse. Cognitive empathy has also been defined as the ability to put oneself in the role of another. This study showed a strong correlation between high levels of cognitive empathy and the absence of role reversal in the parent-child relationship. Role reversal is not the same as parental inappropriate expectations. It is a more subtle construct in which the parent treats and/or describes the child in ways that sound like the parent and child roles are reversed. Sometimes this is behavioral and sometimes emotional. The parent expects that the child should be and can be sensitive to the parents needs instead of the reverse.

Study results also indicate a negative correlation between parental empathy and the presence of stress in the parental-child relationship as an predictor of child physical abuse. In the PSI parental-child relationship stress is described (Abidin, 1990) as a measure of parental satisfac- tion in the role of parent and also, in attachment theory language, describes the parent's ability or lack of ability to be sensitive to the needs of the child. Thus, the PSI parental-child relationship stress is similar itself to a measure of empathy and/or role reversal. Significance was not reached on the secondary hypothesis that empathy mediates stress. However, in 33.3% of the cases where parent-child stress was high there was no abuse. This suggests that more extensive studies are needed to explore this relationship.

The results of this study are consistent with those theories and studies that suggest that parental empathy is a necessary concept to the prediction of the risk of child physical abuse. There is a need for a similar study with a much larger study population and a closer look at the relationship between the empathy, role-reversal and parent-child relationship stress constructs.

Implications for Practice

With the passage of the Family Preservation and Family Support Act (P.L. 103-66) in August, 1993, states are once again called upon to expand programming to abusive and neglectful families. The legislation implies that states will channel resources to those families with the greatest need and then to provide more intensive services to those families. Risk assessment is a tool to assist states in accomplishing that goal. This means continuing the work in progress to see that risk assessment models truly do assess risk. To this end, this author recommends that a measure of parental levels of empathy be operationalized and added to the risk assessment models used in child protective services. Specifically, this author suggests the following questions be added to the parent/caretaker dimension:

a. Is the parent able to individualize each child? b. Is the parent able to describe the child in terms of the child's needs? c. Does the parent expect the child to satisfy parental needs?

These questions should be operationalized and designated as moderate, serious or severe in terms of risk of future abuse.

This author also suggests that the risk factor called parental expectation of the child be formulated in the models in terms of role-reversal and operationalized. Further research is needed to study the relationships between parental empathy, stress and role reversal.

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R6sum6----Le concept de l 'empathie en tant qu'616ment essentiel ~ la relation th6rapeutique et it des r6sultats positifs pour le client (Gladstein, 1983; Raines, 1990; Rogers, 1957), a fait l 'objet d 'une attention particuli~re. Par contre, on s 'est moins pench6 sur l 'empathie entre le parent et l 'enfant, et encore moins Iorsqu'il s 'agit de mauvais traitements dans la relation parent-enfant. L'int6r6t qu 'on y prfite nait des 6tudes sur les ant6c6dents du d~veloppement moral chez l 'enfant (Hoffman, 1963). A la m~me 6poque, C. Henry Kempe definit le syndr6me de I'enfant maltrait~ (1962). En 1968 d6jit, Brandt Steele fait le lien entre les mauvais traitements et la capacit6 du parent it 6prouver de l 'empathie envers son enfant : Nous avons mis l 'emphase sur l 'anamn~se o~ figurent la n6gligence et la maltraitance chez les personnes charg6esde la garde de tr~s jeunes enfants parce que nous croyons que c 'est la source de leur incapacit6 6ventuelle h 6prouver de l 'empathie pour les b6b6s et les jeunes enfants. Pour nous, l 'empathie signifie ~,tre sensible

I'enfant, son 6tat, ses besoins et pouvoir r6agir de faqon appropri~e. La maltraitance et la n~gligence sont des manifestations ext6rieures de la difficult6 de l'adulte A 6prouver de I'empathie envers I'enfant. Un comportement agressif excessif ou une incapacit6 de reconna~tre les besoins essentiels de I'enfant n'auraient pas lieu si une empathic normale et suffisante existait. Nous croyons que durant des p6riodes de stress ou de crise, l 'adulte responsable pour le bien-&re de l 'enfant fait passer ses besoins et ses id6es avant ceux de l'enfant, ou bien les ignorant compl~tement. (Kempe et Heifer, 1980, page 52-53) . Cependant, sauf certaines exceptions rares, I'int~r& qu 'on accorde ~ l'6valuation des risques et les 6tudes sur les facteurs pouvant pr6dire les risques de maltraitance excluent la question de I 'empathie du parent. Les recherches dont l'article fait 6tat semblent indiquer que pour compl6ter une 6valuation approfondie des risques de maltraitance, il faudrait inclure des mesures qui d6termineraient le niveau d'empathie.

R e s u m e n - - S e le ha concedido mucha atenci6n a la empatia como un concepto necesario para la relaci6n terap6utica y para obtener resultados exitosos con los clientes (Gladstein, 1983; Raines, 1990, Rogers, 1957). Menos atenci6n ha recibido la importancia que tiene la empatia para la relaci6n padre(madre). Todavia menos atenci6n se le ha concedido a la empatia en cuanto a su relaci6n con la presencia 6 ausencia de abuso a los nifios/as en la relaci6n padre(madre)- hijo/a. El inter(:s en la empatia dentro de la relaci6n padre(madre)-fiijo/a se desarroll6 de los estudios realizados sobre los antecendentes del desarroll6 moral de los nifios/as (Hoffman, 1963). Casi al mismo tiempo, C. Henry Kempe define el Sindrome del Nifio/a Maltratado (Kempe et al, 1962). En 1968, ya Bran& Steele habfa relacionado el abuso a los nifios/as con la habilidad del padre(madre) para tener empatia en la relaci6n con su hijo/a de la siguiente manera: Se ha destacado la historia de abuso en los primeros afios de la vida del encargado de los cuidados del nifio/a abusivo porque creemos que alli se encuentra la causa de la incapacidad que despugs muestra, para ofrecerle cuidados con empatia a los infantes y nifios/as. Por empatia queremos decir, la conciencia sensible del cuidador del estado y necesidades del nifio/a y su habilidad para provocar las respuestas adecuadas de ahi en adelante. El abuso y la negligencia son las evidencias conductuales extemas de la empatia inadecuada del cuidador y el nifio/a . . . . Descargas excesivamente punitivas de agresi6n o el descuido negligente de las necesidades b~isicas del nifio/a no podrian ocurrir si existiera una empatla normal y adecuada en el cuidador . . . encontramos q u e e n tiempos de tensi6n o crisis, el cuidador le da prioridad a sus propias ideas y necesidades, mientras que las necesidades del nifio/a reciben solo consideraci6n on segundo puesto o son completamente descartadas (Kempe & Heifer, 1980, p. 52-53) . Sin embargo, con raras excepciones, el 6nfasis reciente en evaluaciones de riesgo y estudios sobre los factores para predecir el riesgo de abuso, no incluyen empatia parental. La investigaci6n presentada en este artfculo sugiere que una evaluaci6n completa del riesgo de un nifio/a de ser victima de abuso fisico debe incluir una medida de empatfa parental.