Saturday, November 8, 2014

Police: 3-year-old hung up by feet, beaten, killed in Pa.

Police say a man and his girlfriend are charged with murdering the girlfriend's 3-year-old son in what a prosecutor described as an "unspeakable act of depravity.".

Chester County District Attorney Tom Hogan announced the arrests of Gary Fellenbaum and Jillian Tait Thursday morning. He says Fellenbaum, his wife, and girlfriend, Tait, all lived together in a mobile home in West Caln Township and worked at a local Walmart.

On Tuesday authorities were called to their residence for the report of an unresponsive child. Responding EMTs found 3-year-old Scott McMillan suffering from bruises, lacerations and puncture wounds all over his body.

Police say Fellenbaum, Tait, and Fellenbaum's wife, Amber, confessed that the little boy had been beaten with blunt and sharp objects, whipped, taped to a chair with electrical tape and beaten, hung up by his feet and beaten, leading to his death.

Authorities say they beat Scott to death using homemade weapons, like a whip, a curtain rod, a frying pan, and an aluminum strip.

Police say Tait explained that the fatal beating began when the boy wouldn't eat his breakfast.

Hogan said, "Little Scotty McMillan is dead. Over a three day period ... he was systematically tortured and beaten to death. He was punched in the face and in the stomach. He was scourged with a homemade whip. He was lashed with a metal rod. He was tied to a chair and beaten. He was tied upside down by his feet and beaten. His head was smashed through a wall."

Hogan said professionals with deep experience in these types of cases were brought to tears.

"Our ER nurses see a lot of terrible things. But when they saw his body, they wept," Hogan said.

The district attorney says Gary Fellanbaum and Tait went car shopping, bought pizza, took a nap and engaged in sexual activity - all while the child lay dying after weeks of relentless torture.

Tait allegedly told police that Fellenbaum beat her 6 and 3-year-old boys on a number of occasions. He would allegedly hit them with a closed fist in the head, face, chest and buttocks, and on one occasion she says he strung the boys up by their feet and beat them, while she and Fellenbaum laughed.

That 6-year-old boy is now in the care of relatives.

Fellenbaum and Tait are charged with murder and are currently being held without bail. Hogan says he will be seeking the death penalty.

One neighbor told us, "I don't know if they should [be sentenced to death]or not... because they would probably suffer more in jail all their lives."

The Fellenbaums and Tait only moved into the mobile home community last month. Authorities say there are no signs of drug use in the home.

Amber Fellenbaum, who lived in the home with their 11-month-old child, has been charged with child endangerment for not calling police. She is currently being held on $500,000 bail.

Law enforcement veterans tell Action News that they have never seen a child abuse murder case like this one.

Hogan said, "When you go to bed tonight, say a prayer for little Scotty McMillan. The brief nightmare that was his life... is over."

Wednesday, September 24, 2014

Termination of Parental Rights Law in Wisconsin -- Grounds for Termination By John DiMotto


In Wisconsin, termination of parental rights can result either voluntarily or involuntarily. The vast majority of cases filed seek involuntary termination. These cases are almost always brought by the State and the petition sets forth detailed information and facts to support the grounds alleged. There are instances, however, when a parent makes the decision to consent to termination of his/her rights because he/she believes that it is in the child's best interests. Many of these cases are filed by the parent himself/herself under 48.41 although in some instances they are brought by the State allege the parent's consent as the grounds. see 48.42.

In a voluntary consent scenario, the grounds consist of giving a free, knowing, intelligent consent. In these cases the Court must undertake a colloquy with the parent to be sure that termination is what the parent wants and be convinced that the parent fully understands the consequences of the decision. see 48.422(7). If the court accepts a voluntary consent after an in depth colloquy with a parent, it can proceed to disposition. A finding of unfitness is not a condition precedent to disposition.

In an involuntary TPR scenario, a parent disputes the allegations of the State and will demand either a jury trial or a court trial. The grounds alleged must be proven by the State by clear, convincing and satisfactory evidence. There are seventeen grounds that can be alleged:

1) Abandonment. Child left without provision for care or support and parents can not be found for 60 days. see 48.415(1)(a)1.

2) Abandonment. Child left without provision for care or support in a place where child is exposed to substantial risk or great bodily harm or death. see 48.415(1)(a)1m.

3) Abandonment. Child abandoned at less than one year of age. see 48.415(1)(a)1r.

4) Abandonment. Child out of parent home and parent does not visit or communicate with child for 3 months. see 48.415(1)(a)2.

5) Abandonment. Child away from parent, parent could visit or communicate but does not for 6 months. see 48.415(1)(a)3.

6) Relinquishment. This occurs when a parent gives up custody within the first 72 hours of the child's life. see 48.415(1m).

7) Child in Continuing Need of Protection or Services. This occurs where there is in place a dispositional order that governs a child in need of protection or services, reasonable efforts have been made to help the child and family reunite but the parent has failed to take advantage of the programming and services offered. see 48.415(2)(a).

8) Child in Continuing Need of Protection or Services - Three Strikes. see 48.415(2)(am).

9) Continuing Parental Disability. For two of the last five years the parent has been under disability, the condition is likely to go on indefinitely and the child is not being properly cared for. see 48.415(3).

10) Continuing Denial of Periods of Physical Placement or Visitation. This occurs when an order affecting a family has denied placement or visitation for at least one year. see 48.415(4).

11) Child Abuse. see 48.415(5).

12) Failure to Assume Parental Responsibility. This occurs where a parent does not have a significant parental relationship. see 48.415(6).

13) Incestuous Parenthood. This is utilized against the father. see 48.415(7).

14) Homicide or Solicitation to Commit Homicide against a parent by the other parent. see 48.415(8).

15) Parenthood as a result of a Sexual Assault. see 48.415(9).

16) Serious Felony against One of the Person's Children. see 48.415(9m).

17) Prior Involuntary TPR. see 48.415(10).

Of these 17 grounds, most oftentimes the State alleges three grounds: Abandonment - 3 or 6 months, Continuing Need for Protection or Services, and Failure to Assume Parental Responsibility. Regardless of what grounds are alleged, the allegations brought by the State provide the basis upon which the case will proceed.

In my next blog, I will look at the responsibilities of the Court at the Initial Appearance in the case.

Wisconsin Law on Moving With Child


Information Provided by: Max D. Harris, Esq.

If one parent is considered a custodial parent, i.e., has placement of the child more than the other parent, then the following applies:

If a custodial parent wishes to move with the child out of state or more than 150 miles from the other parent within the state, the custodial parent must give the noncustodial parent 60 days advance written notice by certified mail, with a copy to the court. The notice shall state the custodial parent's proposed move, including specifics on location and date of proposed move, and shall inform the noncustodial parent that he or she may object to the move by sending written notice of objection to the custodial parent and to the court within 15 days of receiving the 60 days written notice from the custodial parent.

If the custodial parent receives a written objection from the noncustodial parent within 20 days after sending the 60 days advance notice, the custodial parent is automatically prohibited from moving with the child pending resolution of the dispute unless that parent obtains a temporary order permitting the move on a temporary basis.

The parties will be referred to mediation to attempt to settle the dispute. A guardian ad litem may be appointed to represent the child either upon referral to mediation or, as is more likely, if mediation fails to resolve the dispute.

Unless the parties agree to extend the time period, failure to mediate a solution within 30 days after referral to mediation will be deemed an impasse and the matter will proceed to a hearing before the court, provided that the noncustodial parent files a motion or petition seeking either a change of placement or an order prohibiting the move. Failure to file such a motion or petition would constitute abandonment of the objection to the move.

If the objecting parent is seeking a change in placement, the court may modify the placement if the court finds that the move will result in a substantial change of circumstances and the modification is in the best interests of the child. There is a statutory rebuttable presumption that continuing the current physical placement with the custodial parent is in the best interests of the child, and to overcome this presumption the objecting parent must show that the proposed move is unreasonable and not in the best interest of the child. The burden of proof is on the parent objecting to the move.

If the objecting parent is seeking a prohibition of the move, the court may prohibit the move if the court finds that the prohibition is in the best interest of the child. The burden of proof is again on the parent objecting to the move.

Whether the objecting parent is seeking a change of placement or a prohibition of the move, the factors the court must considering in making its decision are defined by statute as the following:

  • Whether the purpose of the proposed move is reasonable.
  • The nature and extent of the child's relationship with the other parent and the disruption to that relationship which the proposed move may cause.
  • The availability of alternative arrangements to foster and continue the child's relationship with and access to the other parent.

If a custodial parent intends to remove the child for an extended time of more than 14 days duration from the child's primary residence, such as an extended vacation or staying with a relative, but this removal is not a permanent move, the custodial parent has an obligation to notify the other parent. However, the other parent does not have the same rights of objection as indicated above for proposed moves.

If parents have shared placement of the child, a move that disrupts the feasibility of shared placement must necessitate a modification of the placement order. Either parent may move the court to modify the placement order if mediation fails to resolve the dispute, and the court may modify the order if the court finds that the proposed move makes it impractical for the parties to continue to have shared placement and the modification is in the best interest of the child. The statute provides that the burden of proof is on the parent filing the motion (so the objecting parent should just wait and force the parent who wants to move to file the motion).

Wisconsin's child removal statute is 767.327.

Information Provided by: Max D. Harris, Esq.

Wednesday, September 17, 2014

A Note From The Author Jessica Lynn Hepner

I have come to the conclusion after some long  time  of consideration that I will no longer fill the role of a Parental Advocate anymore.   It has been a long 7-8 years work on this blog.  I dedicated my life to it, just to make sure other parents who find them selves where I was so many years ago, would have a place to turn where they could get all the information they were going to need for the fight of their lives.  I researched and I studied and I applied my own  personal experience.  And I have tried to help as many who asked for my help.  But, now it has come to a time when the toll it has taken  upon me and my life has become too much for me to bare.

  For all these years I thought that the one person, who had my back in this and who understood my desperation in getting all the information I could out there for other parents, was not fully backing me.  Well he was too my face but behind my back he was trashing me about it.  He would say things like, “All she cares about is that fucking blog!” or things like “She is working on that stupid fucking blog again!”  The whole time offering up nothing but praise and showing pride in the things that I was accomplishing, to my face.  What he failed to mention to  people when he talked shit about this blog, is what the blog actually was about.  He conveniently left that part out.  And when it was brought to my attention by a  quite a few people about what he was saying, they were floored when they found out which blog it was, and they were even shocked that he would say such a thing,

Well this is the final blow that I believe that I can take.  After 16 years of sucking the life out of me and everyone of the dreams I had, this is the straw the broke the camels back.  I sincerely apologize to everyone who this may affect.  I just do not feel like I have anything left to give, to anyone,  and not even myself. 

So I think the time has come for me to walk away from Parental Advocacy.  I will leave the blog in place for future reference for anyone who might need it but I will no longer be posting on it or updating any of the information on it.  Again I am very sorry.  I have done all that I can do.

And for any parent who is new to this fight for your life, hang in there do what your case plan tells you to do, and I mean all of it, when Child Protection says and how they say.  That is the only way you will get  your kids back.  And to those who lost their kids due to drug related allegation, I am telling you this and I cannot stress it enough, if you want your kids back you have to quit the drugs.  And do not even consider doing them again until your child is 18 years old because if you do you are opening the door for Child Protection Services to come right back into your life again.  You cannot beat the system.  So do not even bother to try because the only ones you will be hurting are your very own children.

Good luck to all and may God be with you.  And thanks to all who came to this blog to get the information I wanted so much to share with you, Goodbye.

Jessica Lynn Hepner

Parentification Resources

What Is Parentification?

Parents are the guardians and caretakers of children - they care for the emotional and physical needs of a child to ensure that the child's needs are met. However, for some, the traditional roles of parent and child are not followed. Parentification may be defined as a role-reversal between parent and child. A child's needs are sacrificed to take care of the needs of one or both of his or her parents. In very extreme cases, the parentified child may be used to fill the void of the parent's emotional life. Parentification is a form of child abuse.

During the process of parentification, a child may give up his or her needs of attention, comfort, and parental guidance to care for the needs and care of logistical and emotional needs of his or her parents.

The parent, in the case of parentification, does not do what he or she should do to take care of the child or children as a parent and instead, gives up parental responsibilities to one or more of his or her children. Thereby the children are "parentified." During parentification, the child becomes "the parental child."

What Happens During Parentification?

Parents who have certain personality disorders are more at risk for transferring the responsibility of parenthood - the physical and emotional needs of the rest of the family - in an active or passive fashion.

There is an expectation of parentified children to forgo playing, making friends, school work, and/or sleep to better meet the needs of the rest of the family members.

In a family with more than one child, the eldest or most mature child is usually the child prone to be parentified.

In certain cases, a child of the opposite sex is chosen to meet the emotional needs of the parent and become a "surrogate spouse." It may also lead to emotional incest.

Most children are anxious to make their parents happy, so a child undergoing parentification, often takes his or her new responsibilities seriously. It may even feel as though it's a huge honor to have such responsibility given to them.

In the long term, however, parentification means that the child's emotional needs are not met. This can lead to many, greater problems down the road.

How Do I Know If I Was Parentified As A Child?

If you're unsure if you were parentified as a child, ask yourself the following questions:

Were you made to feel responsible for your parents welfare, well-being, and feelings?

Was your parent indifferent or did he or she ignore your feelings most of the time?

Were you often blamed, criticized, devalued and demeaned by your parents?

When your parent was upset, were you often the target of those negative feelings?

Did you feel like you were always trying to please your parent - without ever succeeding?

Did you feel like your parent took all the credit for your successes?

If you answered yes to any of the above, you may have been the victim of parentification.

If those questions sounded familiar to you, ask yourself the following:

Did your parents ever say anything like...

  • "Don't you want me to feel good?"
  • "You make me feel like a failure when you..."
  • "You should care about me."
  • "If you cared about me, you'd do what I want you to."

What Type Of Parents "Parentify" Their Children?

While all parents may run the risk of parentifying his or her child, there are a few types of parents who run a higher risk of emotionally damaging their child through parentification. These include:

Parents who suffer personality disorders, including narcissistic personality disorder, antisocial personality disorder, histrionic personality disorder, borderline personality disorder, and dependent personality disorder. Click each name to learn more about the specific personality disorders.

Read more about personality disorders.

Parents who are alcoholics.

Read more about alcoholism.

Parents who have a serious, chronic illness.

Read more about chronic illness.

Parents who have other mental illnesses.

Read more about mental illness.

What Are The Types Of Parentification?

Two types of parentification exist that may or may not occur together. These types of parentification are "emotional" and "instrumental" parentification.

1) Physical or Instrumental Parentification: In this type of parentification, a child takes up the role of the parent to meet the physical needs of the family and relieves the anxiety of a non-functioning parent.

The child usually takes over the needs of the household, by cooking, cleaning, shopping for groceries, paying bills, managing the budget, getting his or her siblings ready for school, and caring for his or her siblings.

This differs from teaching a child to manage assigned chores and tasks, which is healthy for child development. The parent forces the child to become caretaker, dumping more and more responsibilities upon their child, whether or not the child is developmentally ready for such tasks. This leaves the physically parentified child without opportunity to behave as a child and engage in normal childhood behaviors. The child feels like a surrogate parent to his or her siblings as well as his or her parents.

2) Emotional Parentification: In this type of parentification, a child is forced to meet the emotional needs of his or her parents and siblings. Emotional parentification is the most destructive type of parentification as it robs the child of his or her ability to have a childhood. Emotional parentification also sets up the child for a series of dysfunctions that may incapacitate the child as he or she grows into an adult.

In the role the child is forced to try and meet the emotional and psychological needs of his or her parent. The child may become the parent's confidant. Every child feels the desire to please his or her parent, even if it means not having his or her emotional needs met. This comes at a high cost - the child cannot develop normally or learn what an emotionally healthy bond is, which can lead to many problems in intimate relationships down the road.

Emotional incest is a type of Emotional Parentification that may occur if a parent selects a child of the opposite sex to confide in, openly discuss the problems and issues facing the parent as the parent uses the child as a surrogate spouse or surrogate therapist. Children should never, ever be treated as adults and exposed to adult problems in such a way.

How Do Parentified Children Respond To Parentification?

There are two major responses that children who have been parentified exhibit. These responses are the compliant response and the siege response and are discussed in greater detail below:

Compliant Response to Being Parentified: this behavior is a continuation of how you behaved as a child caring for his or her parents.

  • Spend much time caring for others.
  • Very conforming
  • Hyper-vigilant about acting to in a manner that pleases others.
  • Feel responsible for care, welfare and feelings of others.
  • May be self-deprecating.
  • Seldom get their own needs met.
  • Rushes to maintain peace and soothe hurt feelings of others.

Siege Response to Being Parentified: a continuation of the behavior as a child who was parentified and rebelled by attempting to fight to be separate and independent.

  • Work hard at preventing others from manipulating you.
  • Withdrawn and seemingly insensitive to others.
  • Work to avoid being involved by the demands of others.
  • Assume responsibility for the welfare of others and feel diminished when you don't meet their expectations.

What Are The Future Problems For Victims Of Parentification?

Growing up parenting your parent, having your childhood taken away, never getting the opportunity to be a child, can lead to a number of bigger problems down the road. The two main problem facing parentified children as adults include anger and difficulty with interpersonal relationships and attachments.

Extreme Anger - parentified children can grow to become extremely angry. They may have a love/hate relationship with their parent, but they may not understand why. Some adults who were parentified children may not understand the seemingly endless chasm of anger at others, including friends, partners and children. These people may explode with anger if the emotional wounds of their childhood are triggered.

Difficulty Forming Attachments With Other Adults: an adult parentified child may have a difficult time connecting with others. This difficulty can be closely tied to growing up without understanding healthy versus unhealthy attachments. This may lead to problems forming a healthy intimacy in relationships.

Other Problems Facing An Adult Who Was A Parentified Child:

There's not a question that becoming the parent of your own parent can lead to some pretty heavy burdens. Losing your childhood, your innocence, turning into "little adults" far too young leads to many problems later in life. These problems can include the following:

  • Low or poor self-esteem
  • Depression
  • Feeling of disconnect from their real self.
  • Shame
  • Fears that he or she may not properly meet his or her own demands and expectations.
  • Anxiety
  • Feeling incompetent 
  • Feelings of being unable to cope with adulthood
  • Underestimation of his or her own intelligence
  • Overestimation of the importance of others
  • Codependency in relationships
  • Becoming a caregiver
  • Becoming a workaholic

Related Resource Pages on Band Back Together:

Child Abuse

Emotional Abuse


Personality Disorders

Narcissistic Personality Disorder

Antisocial Personality Disorder

Histrionic Personality Disorder

Borderline Personality Disorder

Dependent Personality Disorder

Mental Illness

Adult Children of Addicts




How To Increase Self Esteem

Additional Parentification Resources:

Parentification Resources: University of Alabama's research into parentification, including links to parentification articles as well as research findings.

Family Boundaries and the Parentified Child: Article that discusses the reason certain children are parentified as well as how it impacts normal childhood development.


Defining and Understanding Parentification:

Implications for All Counselors
Lisa M. Hooper
The University of Alabama
This article advances a balanced
discussion of the extent to which varied
outcomes are evidenced in adulthood
after one has been parentified in
childhood. Recommendations are
provided that may help counselors avoid
the potential overpathologizing of clients
with a history of parentification.
Suggestions for clinical practice are put
forth for all counselors.
Parentification is a ubiquitous
phenomenon that most school,
community, and family counselors as
well as other human helpers face (Byng-
Hall, 2002). That is, most counselors are
likely to encounter both children and
adults who have a history of
parentification—a potential form of
neglect (Boszormenyi-Nagy & Spark,
1973; Chase, 1999). What is
parentification, and given its relationship
with negative outcomes and behaviors,
what can counselors do to avoid
overpathologizing the client’s signs,
symptoms, and behaviors associated
with parentification? This paper offers a
review of what clinical practitioners and
researchers have described in the
literature. Subsequent to a brief review
of the literature, suggestions regarding
practice efforts directed toward clients
who have experienced parentification are
put forward.
Defining Parentification
Parentification is the distortion or lack
of boundaries between and among
family subsystems, such that children
take on roles and responsibilities usually
reserved for adults (Boszormenyi-Nagy
& Spark, 1973). That is, either explicitly
or implicitly, parents create an
environment that fosters caretaking
behaviors in their children that help
maintain homeostasis (i.e., balance) for
the family in general and the parent in
particular. Above and beyond
maintaining homeostasis for the family,
the responsibilities that are carried out
by the parentified child are traditionally
behaviors that provide the parent with
the specific emotional and instrumental
support that the parent likely did not
receive while he or she was growing up
(Boszormenyi-Nagy & Spark,1973;
Minuchin, Montalvo, Guerney, Rosman,
& Schumer, 1967). Thus, the child must
be emotionally available for the parent,
even though the parent is often
emotionally unavailable for the child,
which may engender a chronic state of
anxiety and distress in some emotionally
parentified children (Bowen, 1978;
Briere, 1992; Cicchetti, 2004). The
clinical literature has also reported that
the breakdown in the generational
hierarchy may rob the child of activities
that are developmentally appropriate; the
child instead participates in either
instrumental or emotional caregiving
behaviors directed toward parents,
siblings, or both that may go unrewarded
and unrecognized (Boszormenyi-Nagy
Defining and Understanding Parentification
& Spark,1973; Jurkovic, 1997; Kerig,
2005; Minuchin et al.,1967). Some
research and practitioners contend that to
fully understand the aftereffects of
parentification, the type of
parentification (i.e., emotional and
instrumental) experienced in the family
must be assessed (Jurkovic, 1997).
Emotional parentification is the
participation in the “socioemotional
needs of family members and the family
as a whole” (Jurkovic, Morrell, &
Thirkield, 1999, p. 94). Behaviors
described by Jurkovic and colleagues
include, “serving as a confidant,
companion, or mate-like figure,
mediating family conflict, and providing
nurturance and support” (p. 94).
Instrumental parentification is the
participation in the “physical
maintenance and sustenance of the
family” (Jurkovic et al., 1999, p. 94).
Behaviors described by Jurkovic and
colleagues include, grocery shopping,
cooking, housecleaning, and
performance of daily duties that involve
caring for parents and siblings” (p. 94).
Of significance to counselors and other
mental health practitioners, not all
children who are parentified will
experience negative aftereffects (Byng-
Hall, 2002; DiCaccavo, 2006; Earley &
Cushway, 2002; Tompkins, 2007). In
fact, approximately only one-fourth of
all children who experience neglect will
go on to experience negative aftereffects
(Alexander, 1992; Cicchetti & Toth,
1995; Golden, 1999; Toth & Cicchetti,
1996; West & Keller, 1991). The next
section takes a less myopic view of the
potential aftereffects of parentification
often reported in the literature. The
following section includes a brief review
of the research base of both negative and
positive outcomes associated with
Understanding Parentification: The
Negative and Positive Effects of
Established Negative Effects. Studies in
the last 30 years have established a
relationship between parentification and
later maladjustment. Researchers have
found linkages from early childhood
stress/trauma to child and parent factors
such as divorce (Wallerstein, 1985),
parental alcohol and drug use (Bekir,
McLellan, Childress, & Gariti, 1993),
disruption in attachment (Zeanah &
Zeanah, 1989), family discord, low
socioeconomic status (Boszormenyi-
Nagy & Spark, 1973; Minuchin et al.,
1967), depression, and attachment and
relational difficulties (Jones & Wells,
The effects of childhood parentification
can be long-lasting, multigenerational,
and deleterious, presenting over the
course of a lifetime (Chase, 1999;
Karpel, 1976; West & Keller, 1991). For
young adults, parentification can impede
“normal” development related to
relationship building, personality
formation, and other developmentally
critical processes (Burt, 1992; Goglia,
Jurkovic, Burt, & Burge-Callaway,
1992; Sessions & Jurkovic, 1986;
Wolkin, 1984). Valleau, Bergner, and
Horton (1995) found that children who
are parentified have significantly more
“caretaker characteristics” in adulthood
than do those children who are not
parentified. Similarly, Jones and Wells
(1996) found an association between
personality characteristics such as
“people pleasing” and adults who had
been parentified. Further, their study,
comprising 208 undergraduate students
The Alabama Counseling Association Journal, Volume 34, Number1, Spring 2008
35 Defining and Understanding Parentification
Defining and Understanding Parentification
from a large Midwestern university,
found that participants who were
destructively parentified as children
often relate to others in problematic,
overfunctioning, caretaking ways.
Domains like separating from the family
of origin, participating in ageappropriate
behaviors (Olson & Gariti,
1993), engaging in academic pursuits,
and developing self-esteem can also be
affected (Bekir et al., 1993; Chase,
Demming, & Wells, 1998). Other
aftereffects may include mental illness in
general, and depression, anxiety,
substance abuse, and dependence
disorders in particular. For example,
Chase et al. (1998) found relationships
between high levels of parentification
and academic achievement and parental
use of alcohol. These findings are
consistent with multiple studies that
have established a relationship between
parentification and alcohol use by at
least one parent or guardian (Bekir et
al.,1993; Goglia et al., 1992). Bekir et al.
concluded that adults who abuse alcohol
or drugs are often unable to perform
their parental duties and that, therefore,
the parentified child is often left to care
for self, siblings, and parents. Bekir et al.
also found that the parentified child is
often inclined to repeat the same
behaviors as an adult with his or her own
children. Borderline personality and
dissociative disorders, although rare, can
be evidenced in extreme cases of this
phenomenon (Cicchetti, 2004; Liotti,
1992; Wells & Jones, 2000; Widom,
As previously mentioned, neglect
such as parentification can be and often
is traumatic for a child as well as for the
adult he or she becomes (Aldridge,
2006; Alexander, 1992; Chase, 1999;
Jurkovic, 1998). Trauma is often
experienced when a situation or
environment is perceived as being
overwhelming, threatening, and too
much for the individual (Briere, 1992;
Lazarus & Folkman, 1984), or when a
chronically stressful situation becomes
unrelenting and the individual is unable
to adapt and cope with the experience in
a healthy functional way (Brewin,
Andrews, & Gotlib, 1993; Werner,
Parentification can therefore be
characterized as a traumatic event and an
adverse process, in accord with the
definitions and criteria put forward in the
family and trauma literature, that have
long-lasting effects experienced in
adulthood (Belsky, 1990; Briere, 1992;
Chase, 1999; Cicchetti, 2004). Further,
extant literature on parentification has
shown that the process is in fact adverse
for most children and that it can later be
linked to poor adult functioning. The
process of childhood parentification can,
in the adults those children become,
produce a fear of having children and/or
lead to the transmission of
parentification across many generations
(Boszormenyi-Nagy & Spark, 1973;
Bowen, 1978; Chase et al., 1998).
Potential Positive Effects
Because of the trauma often related to
the parentification process (e.g.,
significant distress, adversity,
dissociation, and even suicide [Jurkovic,
1997; Markowitz, 1994), research has
tended to focus on psychopathology and
other negative outcomes (Barnett &
Parker, 1998; Walker & Lee, 1998).
There is a dearth of research discussing
positive outcomes after childhood
parentification. One of the few studies to
do so, conducted by Jurkovic and Casey
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Defining and Understanding Parentification 36
Defining and Understanding Parentification
(2000), reported on the linkage between
emotional parentification and
interpersonal competence among Latino
adolescents. That study’s findings
suggested that higher levels of emotional
parentification are predictive of higher
levels of interpersonal competence. On
the other hand, adolescents who
experience low levels of emotional
parentification—in a family system in
which they perceive the parentification
process (i.e., the assignment of and the
responsibility to carry out parent like
duties) to be unfair—also experience
low levels of competence. Jurkovic and
Casey concluded that parentification has
the potential to promote competence.
Additionally, they suggested that
potentially critical to positive outcomes
after parentification is the degree to
which the child perceived the process to
be fair. In the context of a family system
where children have reported that the
parentification process was “fair” also
reported that their parent-like behaviors
and responsibilities did not go unnoticed
and they carried out those
responsibilities for brief periods of time.
Of significance, a family system absent
of parentification may prevent some
children of the skills and abilities they
could use across domains and
throughout their lives—although more
research is needed to clarify and support
this assertion. Towards this end, in
Thirkield’s (2002) study examining the
relationship between instrumental
parentification in childhood and
interpersonal competence in adulthood, a
significant positive linear relationship
was obtained. Thirkield also found a
positive relationship between age,
positive outcomes (operationalized as
interpersonal competence), and
instrumental parentification. Findings
from these studies (Jurkovic &
Casey,2000; Thirkield,2002) provide
preliminary support showing that (a)
benefits may be engendered by the
parentification process, and (b) benefits
may last over time.
In a more recent study conducted by
Walsh, Zvulun, Bar-On, & Tsur (2006)
they examined the extent to which the
parentification process may be
associated with positive factors among
adolescent immigrants. In their study
they found parentification was related to
positive outcomes such as high levels of
individuation and differentiation from
the family system. They also found
when adolescent immigrants and nonimmigrants
perceived their roles and
responsibilities as fair and age
appropriate the outcome was positive:
sense of mastery and competence. Thus
they concluded the provision of parentlike
roles and responsibilities among the
study sample engendered individual
autonomy, self-mastery, and family
cohesion. McMahon and Luthar (2007)
also found a relationship between
psychosocial adjustment and
parentification. Of significance, and in
support of divergent findings related to
childhood parentification and adult
outcomes, McMahon and Luthar
contend this process and its associated
outcomes are multidetermined and
multifactorial, even in the context of
severe, long-standing levels of
parentification. For example, among
their study sample of children living in
poverty, the researchers failed to find a
significant, stable relationship between
parentification and poor outcomes.
Given the overwhelming findings
regarding negative outcomes, counselors
The Alabama Counseling Association Journal, Volume 34, Number1, Spring 2008
37 Defining and Understanding Parentification
Defining and Understanding Parentification
may be inclined to delimit their
therapeutic encounters to investigations
that look for the negative outcomes often
seen among this population (DiCaccavo,
2006; Earley & Cushway, 2002; Kerig,
2005). This potential overpathologizing
among counselors (Barnett & Parker,
1998; Hooper, 2007) could result in
missed opportunities to uncover
exceptions, that is, when positive skills
and coping strategies are experienced.
Consistent with a wellness, strengthbased
counseling framework, counselors
should assess for clients’ strengths—if
any—derived from the parentification
process and infuse them into the
counseling and treatment planning
process. Therefore, the advantage of the
application of the counseling wellness
framework—as compared to a deficit or
medical model framework—is that it
allows for the explication of differential
outcomes—both negative and positive—
associated with parentification
(DiCaccavo,2006; Hooper,2007;
Jurkovic, 1997; Mayseless , et al.,
In the case of potential neglect, such as
parentification, many factors, as
previously described, may contribute to
the same event or process leading to
divergent outcomes. For example,
parentification can be perceived as
traumatic, as stressful but not traumatic,
or as a regular, even an anticipated
cultural event in the course of daily
living (Walsh, et al., 2006). To this end,
a large body of trauma literature has
suggested that the number of stressors
has more to do with the outcome or
aftereffects than does a particular
stressor itself (Waller, 2001). Thus, in
the case of parentification, the number of
stressors may influence the outcome
exhibited in both childhood and
Also, as asserted in the parentification
literature (Chase, 1999; Jurkovic, 1997,
1998; Minuchin et al., 1967), how long
the stressor was related to providing
caregiving to the parent and sibling is
also a contributing factor for those
children who carry out the parentified
role in their family of origin. Those who
perform this role for short periods of
time may perceive the role as less
overwhelming, stressful, or traumatic
than will others (Byng-Hall, 2002;
Saakvitne & Tennen, 1998; Tedeschi &
Calhoun, 1995). Finally, from a
developmental perspective, older
children are likely to feel more equipped
to take on the caregiving role than
younger children, thereby influencing
growth or distress outcomes associated
to the parentification process.
All counselors should consider the
following points when working with
clients who have a history of
1. First, consider that not all clients who
are parentified experience negative
sequlae that are often reported in the
clinical and research literature (Barnett
& Parker, 1998; Byng-Hall, 2002;
Jurkovic, 1997; Jurkovic & Casey, 2000;
McMahon & Luthar, 2007; Thirkield,
2002; Tompkins, 2007).
2.Consider how long the parentification
process has been going on. The resultant
aftereffects may be different for clients
for whom the process is brief and
temporary as compared to long and
chronic (DiCaccavo, 2006; Tompkins,
2007). Shorter brief episodes of
parentification may foster competency
and self-efficacy in the client rather than
The Alabama Counseling Association Journal, Volume 34, Number 1, Spring 2008
Defining and Understanding Parentification 38
Defining and Understanding Parentification
pathological, poor outcomes (McMahon
& Luthar, 2007).
3.Consider the age of the client. The
aftereffects are likely to be different for
a younger child who is parentified as
compared to an older adolescent
(Kaplow & Widon, 2007; Walsh et al.,
4.Determine if the parentification
process is delimited to instrumental,
emotional, or both. The research
suggests emotional parentification may
be more deleterious than instrumental
parentification (Hooper, 2007;
McMahon & Luthar, 2007; Tompkins,
5.Consider the cultural and familial
context in which the client is embedded.
For example, how do the family and
people who adopt the client’s culture
perceive the parentification process
(Jurkovic, et al., 2001; Walsh, et al.,
2006)? Is the parentification process
culturally expected and valued?
6.Consider using a questionnaire to
capture the level, type, and perceived
fairness of parentification (e.g., Jurkovic
& Thirkield, 1998, for child and adult
7.Examine to what extent the client feels
the parentification process is “fair.”
Again, research suggests if the process is
perceived to be “fair” then it is often
associated with fewer negative outcomes
(Jurkovic, et al., 1999).
8.There may be strengths engendered by
the parentification process (Hooper,
2007; Tompkins, 2007). Thus it may be
helpful to explore both positive and
negative aspects of the parentification
9.Involve the family if possible.
Education may be all the family needs to
help the client and family restore or
reestablish the appropriate boundaries
where the child (if working with a child
or adolescent) has a safe, appropriate
context to grow, learn, differentiate, and
thrive (Walsh et al., 2006).
10.Consider a referral. Depending on the
context in which a counselor works, and
the extent and level of adversity
associated with the parentification
process, specific trauma-based
counseling (Calhoun & Tedeschi, 1999)
may be indicated.
Counselors and researchers have long
demonstrated a clear awareness of the
deleterious effects of parentification in
general (Chase, 1999; Jurkovic, 1997;
Mayseless, Bartholomew, Henderson, &
Trinke, 2004). On the other hand, and at
the same time, Barnett and Parker
(1998) concurred with Boszormenyi-
Nagy and Spark (1973) that it may in
fact be maladaptive to avoid or miss out
on any parental roles in the family of
origin—in that many lessons for
adulthood and parenthood are derived
from family-related roles and
responsibilities (i.e., parentification)
during childhood. Recently, Barnett and
Parker (1998) have questioned whether
parentification leads to early competence
or childhood deprivation. Similarly, one
of the “founding fathers” (Boszormenyi-
Nagy) of the construct of parentification
reminded counselors, theorists,
researchers, and the like that “the term
describes a ubiquitous and important
aspect of most human relationships. It is
suggested that parentification should not
be unconditionally ascribed to the realm
of ‘pathology’ or relational dysfunction.
The Alabama Counseling Association Journal, Volume 34, Number1, Spring 2008
39 Defining and Understanding Parentification
Defining and Understanding Parentification
It [parentification] is a component of the
regressive core of even balanced,
sufficiently reciprocal relationships”
(Boszormenyi-Nagy & Spark, 1973, p.
Correspondence regarding the
manuscript should be directed to: Lisa
M. Hooper, Ph.D., Department of
Educational Studies in Psychology,
Research Methodology, and Counseling,
The University of Alabama, Box
870231, Tuscaloosa, Alabama 35487-
0231. Email:
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43 Defining and Understanding Parentification



From Wikipedia, the free encyclopedia

Parentification is the process of role reversal whereby a child is obliged to act as parent to their own parent. In extreme cases, the child is used to fill the void of the alienating parent's emotional life.[1]

Two distinct modes of parentification have been identified technically: instrumental parentification and emotional parentification. Instrumental parentification involves the child completing physical tasks for the family, such as looking after a sick relative, paying bills, or providing assistance to younger siblings that would normally be provided by a parent. Emotional parentification occurs when a child or adolescent must take on the role of a confidant or mediator for (or between) parents and/or family members.[2]


Melitta Schmideberg noted in 1948 how emotional deprivation could lead parents to treat their children (unconsciously) as substitute parent figures.[3] "Spousification" and "parental child" (Minuchin) offered alternative concepts exploring the same phenomenon; while the theme of intergenerational continuity in such violations of personal boundaries was further examined.[4] Eric Berne touched on the dangers of parents and children having a symmetrical, rather than asymmetrical relationship, as when an absent spouse is replaced by the eldest child;[5] and Virginia Satir wrote of "the role-function discrepancy...where the son gets into a head-of-the-family role, commonly that of the father".[6]

Object relations theory highlighted how the child's False Self is called into being when it is forced prematurely to take excessive care of the parental object;[7] and John Bowlby looked at what he called "compulsive caregiving" among the anxiously attached, as a result of a parent inverting the normal relationship and pressuring the child to be an attachment figure for them.[8]

All such aspects of disturbed and inverted parenting patterns have been drawn under the umbrella of the wider phenomenon of parentification - with the result (critics suggest) that on occasion "ironically the concept of parentification has...been as over-burdened as the child it often describes".[9]

Choice of child

For practical reasons, elder children are generally chosen for the familial "parental" role - very often the first-born children who were put in the anomalous role.[10] However, gender considerations mean that sometimes the eldest boy or eldest girl was selected, even if they are not the oldest child overall, for such reasons as the preference to match the sex of the missing parent.

Thus where there is a disabled child in the family to be cared for, "older siblings, especially girls, are at the greatest risk of parentification";[11] where a father-figure is missing, it may be the eldest son who is forced to take on his father's responsibilities, without ever obtaining the autonomy that normally accompanies such adult roles.[12]

Alternatively a widower may put a daughter into the social and emotional role of his dead wife - "spousification"; or a mother can oblige her daughter to play the caring role, in a betrayal of the child's normal expectation of love and care.[13]

Narcissistic parentification

Narcissistic parentification occurs when a child is forced to take on the parent's idealised projection, something which encourages a compulsive perfectionism in the child at the expense of their natural development.[14] In a kind of pseudo-identification, the child is induced by any and all means to take on the characteristics of the parental ego ideal[15] - a pattern that has been detected in western culture since Homer's description of the character of Achilles.[16]


The almost inevitable byproduct of parentification is losing one's own childhood.[17] In destructive parentification, the child in question takes on excessive responsibility in the family, without their caretaking being acknowledged and supported by others:[18] by adopting the role of parental care-giver, the child loses his real place in the family unit and is left lonely and unsure.[19] In extreme instances, there may be what has been called a kind of disembodiment, a narcissistic wound that threatens one's basic self-identity.[20]

In later life, parentified children may be left struggling with unacknowledged anger and resentment, may have difficulty trusting their peers, and may end up struggling to form and maintain romantic relationships.[21]

However, not all results of parentification may be negative. Some studies have hypothesized that when a child is the subject of parentification, it might sometimes result in them, later in life, having greater psychological resilience, more individuation, a clearer sense of self, and more secure attachment styles during adulthood. These characteristics may be because the person had to adapt to changes and take on responsibilities.[22] Crosscultural studies also point to the widespread nature of the practice of parentification, and indicate that normal as well as pathological aspects of parentification need to be taken into account.[23]

Case studies

  • Carl Jung in his late autobiography reports that his mother always spoke to him as an adult, confiding in him what she could not share with her husband.[24] Laurens van der Post commented on the grown-up atmosphere surrounding the young Jung, and considered that "this activation of the pattern of the "old man" within himself...was all a consequence of the extent to which his father and mother failed each other".[25]
  • Patrick Casement reports on a patient - Mr T – whose mother was distressed at any and all his feelings, and who therefore protected her from them – mothering her himself.[26]

Literary examples

In The Tale of Genji, we are told that for "Kaoru's mother...her son's visits were her chief pleasure. Sometimes he almost seemed more like a father than a son - a fact which he was aware of and thought rather sad".[27]

Charles Dickens' "Angel in the house" characters, particularly Agnes Wickfield in David Copperfield, are in fact parentified children.[28] Agnes is forced to be the parent of her alcoholic father and seems to strive for perfection as a means of reaching the "ego ideal" of her deceased mother (who died upon child-birth). Agnes marries late, has relationship and intimacy problems (she has a hard time expressing her love for David until he reveals his own love for her), and has some self-defeating attitudes; in one scene she blames her own father's misfortunes on herself. However, she proves to be resilient, resourceful, responsible and even potentially career-driven (she forms her own school). She also manages to marry the protagonist David and the two live happily together for 10 years with children by the end of the novel.

The theme of parentification has also been explored in the Twilight series,[29] with particular (but not exclusive) reference to the character of Bella Swan.[30]

See also


  1. R. A. Gardner et al., The International Handbook of Parental Alienation Syndrome (2006) p. 200
  2. Gregory J. Jurkovic, 'Destructive Parentification in Families' in Luciano L'Abate ed., Family Psychopathology (New York 1998) pp. 237-255
  3. Jurkovic, p. 240
  4. Jurkovic, in L'Abate ed., p. 240
  5. Eric Berne, Sex in Human Loving (Penguin 1970) p. 249-53
  6. Virginia Satir, Peoplemaking (1983) p. 167
  7. Adam Phillips, On Kissing, Tickling and Being Bored (1994) p. 31
  8. John Bowlby, The Making and Breaking of Affectional Bonds (London 1979) p. 137-8
  9. Karpel, quoted by Jurkovic, in L'Abate ed., p. 238
  10. Satir, p. 167
  11. Bryna Siegal, What about Me (2002) p. 131
  12. Harold Bloom, Tennessee Williams's The Glass Menagerie (2007) p. 142
  13. Diana Brandt, Wild Mother Dancing (1993) p. 54
  14. Jurkovic, in L'Abate, ed., p. 246-7
  15. Otto Fenichel, The Psychoanalytic Theory of the Neuroses (London 1946) p. 510-11
  16. R. K. Holway, Becoming Achilles (2011) Chapter Five 'Fathers and Sons'; and notes p. 218-9
  17. Siegal, p. 114
  18. Jurkovic, p. 237
  19. Satir, p. 167
  20. Paula M. Reeves, in Nancy D. Chase, Burdened Children (1999) p. 171
  21. "Parentification & Parentified Children"
  22. Hooper, L. M., Marotta, S. A., & Lanthier, R. P. (2008). Predictors of growth and distress following childhood parentification: A retrospective exploratory study. Journal of Child and Family Studies, 17(5), 693-705. doi:10.1007/s10826-007-9184-8
  23. Nancy D. Shape, Burdened Children (1999) p. 26
  24. C. G. Jung, Memories, Dreams, Reflections (London 1983) p. 69
  25. Laurens van der Post, Jung and the Story of Our Times (Penguin 1978) p. 77
  26. Patrick Casement, Further Learning from the Patient (1990) p. 174
  27. Murasaki Shikiki, The Tale of Genji (London 1992) p. 790
  28. Nina S. "Unwilling Angels: Charles Dickens, Agnes Wickfield, and the Effects of Parentification." Dickens Blog.
  29. E. D. Klonsky/A. Blas, The Psychology of Twilight (2011)
  30. Nancy R. Reagin ed., Twilight and History (2010) p. 184-5 and p. 258-9


Tuesday, September 16, 2014

Another Note From The Author

To the cocksuckers that like to keep reporting my posts to Google for what ever fucking reason,  why don’t you take the posts you reported and shove them up your ass.  I have had it with you sorry ass pieces of shit..  Report away all you want.  What needed to be accomplished has been accomplished and you cant stop it. 

Friday, August 29, 2014

The Governor’s Action Plan on Child Protective Services Reform Substance-Exposed Newborn Committee GUIDELINES FOR IDENTIFYING SUBSTANCE-EXPOSED NEWBORNS

A Publication Of:
The Governor’s Action Plan on Child Protective Services Reform
Substance-Exposed Newborn Committee
January 2005
TO: Chairman, Obstetrics Department
Chairman, Pediatric Department
Chairman, Neonatology Departments
RE: Statewide Initiative to Identify Substance-Exposed Newborns
There is growing concern for the care and safety of substance-exposed newborns in Arizona
and nationwide. The care and safety of this vulnerable population has a profound effect on the
medical community and the child welfare system.
Under the direction of Governor Janet Napolitano, Arizona physicians with expertise in prenatal
substance abuse, Child Protective Services (CPS), Arizona Department of Health Services
(ADHS), Indian Health Services (IHS), and hospital social services have come together to
develop a consistent approach to identifying substance-exposed newborns.
Based on extensive medical literature review, review of other state guidelines, and input from
Arizona hospital newborn programs, this committee drafted Guidelines for Identifying
Substance-Exposed Newborns.
As a health care provider, you have an important role in identifying substance-exposed
newborns. These Guidelines have been developed to assist health care professionals:
· To improve your ability to effectively identify substance-exposed newborns;
· To standardize guidelines for maternal and neonatal screening in Arizona; and
· To improve the health and well-being for women and their at-risk newborns.
These Guidelines support the state law requirement that a health care professional, who
reasonably believes that a newborn infant may be affected by the presence of alcohol or
a drug, to immediately report this information, or cause a report to be made, to Child
Protective Services. For reporting purposes, "newborn infant" means a newborn infant who is
under thirty days of age (A.R.S. § 13-3620).
These Guidelines have been reviewed and commented upon by the following organizations:
American Academy of Pediatrics-Arizona Chapter (AzAAP), Arizona Medical Association
(ArMA) – Maternal Child Health Committee, Arizona Perinatal Trust, and the American College
of Obstetricians and Gynecologists – Arizona Chapter.
Including these Guidelines in your policies and procedures for nursing staff, social services, and
medical staff will provide a consistent approach and avoid potential bias in the identification of
these newborns.
The attached documents will be maintained and updated on the Arizona Department of Health
Services website:
Any questions related to these Guidelines may be directed to Susan M. Stephens-Groff, MD,
Medical Director, Comprehensive Medical & Dental Program, via email address:
Linda Johnson, MSW, LCSW
Manager, Policy and Program Development
Division of Children, Youth, and Families
Substance-Exposed Newborns Committee Chair
Michelle Bez, MD
Phoenix Children’s Hospital, Neonatologist
Joanne Butler, MSW, LMSW
Navajo Nation Division of Social Services
Carla Conradt, MSW
ADES Division of Children Youth and
Families / Child Protective Services Hotline,
Program Manager
Nelda Dugi-Huskie, MSW, LMSW
Navajo Nation Division of Social Services
Juan Espitia, MSW, LCSW
Yuma Regional Hospital, Care Coordination/
Social Worker
Mary Ferrero, RN
ADES Division of Children, Youth and
Families / Children’s Medical and Dental
Program, Medical Services Manager
Carlos Flores, MD
Arizona Perinatal Trust, Neonatologist
Patty Graham, MD
Maricopa Medical Center, OB/GYN Specialist
in Perinatal Substance Abuse
Nancy Hansen,
ADES Division of Children Youth and
Families, Arizona Families F.I.R.S.T.,
Program Specialist
Linda Johnson, MSW, LCSW
ADES Division of Children, Youth, and
Families, Manager, Policy and Program
Patti Mooers, MSW, ACSW, LCSW
Arizona Perinatal Social Workers
Association; Maricopa Medical Center,
NICU Social Worker
Carol Renslow,
ADES Division of Children, Youth and
Families / Children’s Medical and Dental
Program, Provider Services Manager
Marilyn Riebel, MSW, LCSW
Sierra Vista Regional Health Center, Social
Kelli Sieczkowski, MSW, LCSW
Flagstaff Medical Center, Social Work
Peggy Stemmler, MD
American Academy of Pediatrics, Arizona
Chapter President
Susan Stephens-Groff, MD
ADES Division of Children Youth and
Families / Children’s Medical and Dental
Program, Medical Director
Kathy Stribrny, RN
Arizona Health Care Cost Containment
System, EPSDT Coordinator
Christine Tien, MPH
Arizona Department of Health Services /
Office of Women and Children’s Health, High
Risk Perinatal Program Unit Manager
Alan Tupponce, MD
Phoenix Indian Medical Center
Glen Waterkotte, MD
Banner Desert Samaritan Hospital,
Mary Wodecki, MSW
ADES Division of Children, Youth and
Families, Child Protective Services Specialist
III, Investigator – District 2
Prenatal substance abuse of drugs or alcohol is a complex public health problem often resulting
in multiple consequences for a woman and her newborn. Drug use during pregnancy may result
in adverse effects on the health and well-being of the newborn in addition to the woman’s
health. Early intervention services for the newborn and mother are critical in minimizing the
acute and long-term effects of prenatal substance exposure. Thus, even if the newborn exhibits
no clinically significant difficulties in the neonatal period, identification of the substance-exposed
newborn may improve the infant’s long-term outcome.
In addition to the direct toxic effects of the drugs to the newborn, continued substance abuse by
the mother increases the risk for child abuse and neglect. Indeed, reports of child abuse and
neglect have increased dramatically over the past decade and are correlated with an increase
in drug use among primary caregivers.
Prenatal substance abuse is a condition that crosses all social, racial and ethnic groups. The
National Pregnancy and Health Survey estimated in 1995 that 5 percent of four million women
who gave birth in 1992 used illicit drugs during their pregnancies. According to the Arizona
Department of Health Services, in 2002, there were 87,379 births in Arizona. When national
statistics regarding the prevalence of prenatal substance abuse are applied, more than 4,500
Arizona newborns are affected by prenatal drug exposure annually.
A recent Centers for Disease Control and Prevention (CDC) survey found that 500,000
pregnant women reported alcohol use, with approximately 80,000 reporting binge drinking.
Every year in the United States, approximately 40,000 newborns will experience some degree
of learning or behavioral dysfunction or physical effect as a result of in-utero exposure to
alcohol. Approximately 5,000 newborns will be identified with Fetal Alcohol Syndrome.
In addition to individual negative outcomes, societal impact related to prenatal substance abuse
profoundly affects many facets of our communities. Successful identification and intervention
may result in substantial cost savings in health care, foster care, special education and
As a health care provider, you have an important role in identifying substance-exposed
newborns. These guidelines have been developed to assist health care professionals:
· To improve your ability to effectively identify substance-exposed newborns;
· To standardize guidelines for maternal and neonatal screening in Arizona; and
· To improve the health and well-being for women and their at-risk newborns.
Arizona Revised Statutes § 13-3620 requires a health care professional, who reasonably
believes that a newborn infant may be affected by the presence of alcohol or a drug, to
immediately report this information, or cause a report to be made, to Child Protective
Services. For reporting purposes, "newborn infant" means a newborn infant who is
under thirty days of age.
Maternal Screening Criteria
Prenatal screening begins initially with the maternal interview. The following screening criteria
may identify substance use/abuse, which can impact the health of the mother and the newborn.
· History of previous or current substance use by mother and/or significant others living in
the home, or history of a previous delivery of a substance-exposed newborn.
· Non-compliance with prenatal care (late entry to care, multiple missed appointments, or
no prenatal care).
· Evidence of unexplained poor weight gain during the pregnancy.
· Medical non-compliance.
· Medical symptoms of withdrawal in the mother.
· Signs of substance use/abuse.
· Maternal medical history of Hepatitis B or C, HIV infection, or 2 or more sexually
transmitted diseases.
· Previous or current history of placental abruption or unexplained vaginal bleeding.
· Cardiovascular accident of the mother.
· Pre-term labor may be seen in association with substance use or abuse as reported in
the literature. It may be considered prudent to screen, if any of the above factors exist in
association with pre-term labor.
If positive for one or more of the above screening criteria, recommend:
· Testing of the mother*; and
· A referral for further assessment, including possible treatment services.
*Toxicology Consideration
Maternal urine toxicology will generally identify only common drugs of abuse (eg. cocaine,
marijuana, opiates, barbiturates, benzodiazopines, amphetamines, and PCP) that have been
used within the last 24 to 48 hours and will be negative if drugs were used earlier in the
pregnancy. Alcohol use is best identified by blood or saliva testing and some drugs such as
volatile inhalants can only be identified by special testing. You may wish to consult with a
toxicologist to determine the best way to screen for drugs that are not included in routine urine
drug screening.
Neonatal Screening Criteria
Identification of substance-exposed newborns is determined primarily by clinical indicators in
the prenatal period including maternal and newborn presentation, history of substance use/
abuse, medical history, and/or toxicology results. Newborn toxicology screening should be
performed if the results will influence management of medical care for the mother and newborn,
including treatment options, and/or to confirm the maternal pattern of drug use.
Newborn toxicology screening:
· Confirms presence of substance of use and abuse.
· Determines use of multiple substances, which were not identified during the maternal
· Identifies the newborn that is at risk for withdrawal.
· Identifies substances or drugs that may be contraindicated in breastfeeding.
· Identifies newborns that may need protective services, and/or developmental follow-up.
· Identifies the mother who may need treatment services.
The recommended screening criteria for the newborn includes:
· Signs of neonatal abstinence syndrome which may include marked irritability, highpitched
cry, feeding disorders, excessive sucking, vomiting, diarrhea, rhinorrhea, or
· Unexplained apnea in the newborn.
· Microcephaly (when accompanied by additional symptoms).
· Birth weight <5th percentile for gestational age (unexplained intrauterine growth
restriction, or newborns who are small for gestational age).
· Cerebral vascular accident in the newborn (not otherwise considered at-risk).
· Other vascular accident in the newborn.
· Necrotizing enterocolitis (NEC) in the full-term newborn (or newborn not otherwise
considered at-risk for NEC).
· Positive maternal drug screen.
If positive for one or more of the above screening criteria, recommend:
· Testing of the newborn* and a social service referral to identify potential
accompanying diagnoses; and
· Consider testing of the mother.
*Toxicology Consideration
Newborn urine toxicology: The first urine contains the highest concentration of drug or
metabolites. If this urine sample is missed, a confirmatory test is less likely, even in the
presence of intrauterine drug exposure. A negative urine toxicology result is common even in
the presence of substance use or abuse.
Limitations of newborn urine testing include:
· The first urine sample may be easy to miss.
· Bag urine collections for newborns are difficult to collect.
· Positive drug threshold values have not been scientifically determined.
· The threshold values for the newborn have been arbitrary set at the adult reference range.
· False negative urine toxicology may be the result of using a higher adult reference range in
the newborn population.
Meconium Testing: Meconium testing is the most reliable and comprehensive toxicology
screen in the newborn. Meconium formation starts between 16 to 20 weeks gestation, and
continues until birth. Newborn meconium testing will identify most substance used by the
mother after 20 weeks, such as: cocaine, marijuana, opiates, barbiturates, benzodiazopines,
amphetamines, and PCP. Best results are obtained by collecting multiple meconium
specimens. In addition, meconium is easier to collect.
Fatty acid ethyl esters (FAEEs) have been identified as an important biomarker of alcohol
consumption. They are formed by esterification of ethanol with free fatty acids. High levels of
FAEEs in meconium are a “direct biomarker reflective of true fetal exposure to ethanol in-utero”.
Supplemental meconium testing can identify FAEEs, by gas chromatography/mass
spectrometry (GC/MS) analysis and provides a 99% level of sensitivity in identifying FAEEs. If
the level is in the 3rd or 4th quartile, this is indicative of heavy alcohol exposure, which would
identify the infant at higher risk for effects from alcohol exposure.
Further recommendations if above screening criteria are positive:
· Consider maternal and newborn testing for identification of related infections (Syphilis,
Hepatitis B or C, HIV).
· If maternal or newborn toxicology is positive for opiates, watch for onset of abstinence
syndrome in the newborn.
· Counsel mother that breastfeeding is contraindicated in the presence of a positive
history of cocaine, heroin, methamphetamine, PCP, or marijuana use.
· If the medical provider reasonably believes that a newborn infant may be affected by the
presence of alcohol or a drug, (per A.R.S. § 13-3620) immediately report this
information, or cause a report to be made, to Child Protective Services (CPS) at 1-888-
767-2445 (1-888-SOS-CHILD).
· Consider consultation with CPS prior to the newborn’s discharge.
· Consider Home Health nursing visit(s).
· The Primary Care Provider should notify CPS if there is poor follow-up with
recommended medical care, or if the newborn’s medical needs are being neglected.
Ethical Considerations
The subject of testing for drugs of abuse, particularly testing for those that are illegal, presents
ethical dilemmas for health professionals. On the one hand, the screening for the detection of
substances of abuse holds the promise of benefit to the mother with addiction problems that
may be remedied by treatment. On the other, the detection of illegal substances may lead to the
discovery of information that may require reporting to authorities. Reporting of detected illegal
substances in the mother may lead to criminal prosecution and incarceration as a form of
punishment. Similarly, detection in the infant may lead to mandated reporting to child protection
service agencies and lead to custodial litigation, prosecution, or other disruptions to the mother
and infant relationship.
Punitive approaches and incarceration have not been demonstrated to be beneficial in
improving health for mothers and infants. Foster placement of children and mandated entry to
complex child welfare systems with limited resources and capabilities may also lead to suboptimal
outcomes for both mother and infant. This may be especially true in our own State of
Arizona, where many of our child protective organizations and agencies are undergoing
dynamic change and development to improve the delivery of services for children. Hence, as is
the case with all decisions in medicine, practitioners are often faced with dichotomous choices,
each carrying broad implications that must be carefully weighed before potentially causing harm
to mothers and infants under their care.
Health professionals, when entering into a relationship with a patient, are bound by duty to act
in their best interest. Hence, the decision to obtain information through the use of body fluids or
tissues should be carefully weighed with an anticipated expectation of benefit for infant and
mother. As with any other medical intervention, drug, or treatment, the provider should weigh
the anticipated benefits carefully against the potential risks. For a health professional to do
otherwise is unethical.
Another dilemma involves the patient’s right to privacy. Recent Supreme Court actions suggest
that collection of health information without the express consent of the patient, such as that
obtained during urine drug screening for other than directly medical indications, represents
unreasonable search and seizure. Thus, health professions organizations, including the
American Academy of Pediatrics, the American College of Obstetricians and Gynecologists,
and the Department of Health and Human Services generally recommend that drug screening
for substances of abuse be obtained on mother and infant only with the consent of the mother,
unless the medical situation demands otherwise.
These considerations demand care and thoughtfulness in the decision by health professionals
or institutions to implement procedures that involve the use of drug screening.
In an effort to maintain the interests of the pregnant woman and the newborn foremost in the
delivery of their care, the following guiding principles are suggested:
· Health professionals should be knowledgeable about state and local laws regarding
mandatory reporting of illegal drug detection in pregnant women and infants.
· Health professionals should be knowledgeable regarding the resources and facilities
available for treatment and management of substance abuse in their communities.
· Health providers should remain cognizant of the duty they assume when engaged in
the delivery of care to their patients. This duty requires their actions to be performed
in the best interest of the patient.
· Medical decision-making requires an assessment of risk and benefit to mother and
newborn. The potential risk and adverse consequences of screening and
identification of substance–exposed newborns should be weighed against the
potential benefits in a manner no different than as applied to other medical
· Health providers should be aware of the legal implications of their actions in the
context of recent court decisions that uphold the rights of mothers against unlawful
search and seizure.
· In keeping with recommendations by health professions organizations, health
providers should obtain informed consent from patients (or the mother of an infant)
before chemical drug screening procedures except where this is not possible for
medical reasons.
These guidelines are not an exclusive course of management. Variations that incorporate
individual circumstances or institutional preferences may be appropriate.
Regional Behavioral Health Authorities
Maricopa County
Four Gateway Plaza
444 N. 44th Street, Suite 400
Phoenix, Arizona 85008
Customer Service Number: 1-800-564-5465
Pima, Graham, Greenlee, Santa Cruz & Cochise counties
Community Partnership of Southern Arizona (CPSA)
4575 East Broadway Blvd.
Tucson, Arizona 85711
Customer Service Number: 1-800-771-9889
Mohave, Coconino, Apache, Navajo & Yavapai counties
Northern Arizona Regional Behavioral Health Authority (NARBHA)
1300 S Yale Street
Flagstaff, Arizona 86001
Customer Service Number: 1-800-640-2123
Pinal & Gila counties
Pinal Gila Behavioral Health Association, Inc. (PGBHA)
2066 West Apache Trail, Suite 116
Apache Junction, Arizona 85220
Customer Service Number: 1-800-982-1317
Yuma & La Paz counties
The Excel Group
2573 Arizona Ave. Ste. #1
Yuma, AZ 85364
Customer Service Number: 1- 800- 880-8901
Community Information and Referral
Yuma, La Paz, Cochise, Maricopa, Mohave, Coconino, Apache, Navajo, Yavapai, Pinal and
Gila counties
1-800-352-3792 or (602) 263-8856
Information and Referral
Pima, Graham, Greenlee, Cochise & Santa Cruz counties
1-800-362-3474 or (520)-881-1794
Specialty Programs for Mothers and
Maricopa County
Native American Connections
609 N 2nd Avenue, #120
Phoenix AZ
(602) 424-2060
Elba House (owned and operated by Ebony
6222 S. 13th Street
Phoenix AZ
(602) 276-4288
New Arizona Family, Inc.
3301 E. Pinchot
Phoenix AZ
(602) 553-7300
Casa de Amigas (no children)
1648 W Colter #8
Phoenix AZ
(602) 265-9987
Center for Hope (owned and operated by
Community Bridges)
554 S. Bellview
Mesa, AZ 85204
(480) 831-7566
Pima, Graham, Greenlee, Santa Cruz &
Cochise counties
Community Partnership of Southern
Arizona (CPSA)
CODAC Behavioral Health Services
333 W Ft. Lowell #219
Tucson, AZ 85705
(520) 327-4505
Fax: (520) 792-0033
Las Amigas
502 Silverbell Road
Tucson, AZ 85745
(520) 882-5898
The Haven
1107 E. Adelaide
Tucson, AZ 85719
(520) 623-4590)
Amity Foundation
Robin Rettmer
Director of Family Services
(520) 749-5980
Fax: (520) 749-5569
American Academy of Pediatrics
American College of Nurse Midwives (ACNM)
American College of Obstetrics and Gynecologists (ACOG)
American Society of Addiction Medicine
Arizona Department of Economic Security
Arizona Department of Health Services
Association of Women’s Health Obstetric and Neonatal Nurses (AWHONN)
National Clearinghouse for Alcohol and Drug Information
National Institute for Drug Abuse
National Organization on Fetal Alcohol Syndrome (NOFAS)
Pacific Southwest Technology Transfer Center
Physician Leadership on National Drug Policy
Substance Abuse Mental Health Services Administration (SAMHSA)
Chasnoff IJ, Prenatal substance exposure: Maternal screening and neonatal identification
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Graham K, Koren G, Klein J, Scheiderman J, Greenwald M. Determination of gestational
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Gillogley KM, Evans AT, Hansen RL, Samuels SJ, Batra KK, The perinatal impact of
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Arizona Department of Economic Security
Administration for Children, Youth and Families
1789 West Jefferson, Third Floor SE
Phoenix, Arizona 85007
(602) 542-3598
Every child, adult and family in Arizona will be safe and economically secure.