Dr Renée P Marks began undertaking specialist assessments in 2002, in her capacity as a therapist. The assessments focused on adopted children and children with very complex needs, initially commissioned by a single local authority and then commissioned nationally from 2006 onwards; this included expert witness assessments for care proceedings in court.
The Clinical Child Assessment Model (CCA), developed by Dr. Marks has been the primary model for assessments at Integrate Families since 2006. The assessment can be used on children between the ages of 1 and 19 years of age. The structure is play-based and consists of various techniques, enabling the therapist to see the world through the eyes of the child. The main aim of the assessment is to determine how the child views their world, internally and externally, and whether there are early signs of, or existing mental health problems, so that these may be addressed in order to promote the child’s wellbeing.
The CCA, is an uninformed assessment, in that the therapist only has the name and age of the child prior to the onset of the assessment process. This provides the most objective perspective, as it is through the child’s eyes, that insight is gained into the child’s and family’s functioning. Background information is only obtained after completing the assessment process in order to provide the most objective perspective of the child’s internal world.
This type of assessment differs from other assessments, where the assessor compiles information, from parents, social workers, reports etc. before assessing the child. The CCA is suitable for children 18-months to young adults of 19 years and between 1 – 2.5 hours, during which there may be multiple breaks, for refreshments or to do fun activities etc. The assessment is adapted according to the age and needs of the individual child.
The CCA’s focus, is to obtain the child’s internal experience of:
- school,
- friends,
- attachments to parents,
- relationship with siblings or extended family,
- perception of self,
- potential mental health difficulties,
- behavioural, social and emotional functioning.
The child’s view may fit with the parent’s and school’s experience or it may differ. Depending on this, recommendations on how and where to start with the therapeutic process, will vary. For example, a child whose perception is that they have no problems, while the family and / or school report significant problems, require a different approach, to children who have a more realistic perspective about themselves and their need for help.
The assessment includes activities which provides information on gross, fine motor and perceptual development, eye movements, balance and coordination. This does not comprise an in-depth physical assessment but provides sufficient information to inform the NMT assessment and report, which provides information regarding educational gaps and a home programme of physical activities, promoting postural security and emotional regulation.
The assessment comprises of a semi-structured interview, projective techniques, including drawings, story completions, sentence completions, projective play, pictures and age appropriate forms which the child completes. Afterwards the child receives age appropriate feedback.
While the child is undergoing the assessment, the parents complete forms which provide information about the child, including attachments, sensory integration, sibling relationships, behaviours, emotional and social functioning, trauma and dissociation. Additionally, there are forms to assess the levels of secondary trauma and stress that the parents may be experiencing. After the assessment an interview is conducted with parents, which, includes preliminary assessment feedback and exploration of parent’s major concerns.
In addition to information from the child and parent, feedback is obtained from the nursery, school or college via a questionnaire. This information enriches the assessment in terms of providing the best overall view of the child’s academic performance, peer relationships and any significant problems outside the family home.
Assessment information is compiled in a Clinical Child Assessment Report, which is sent to the social worker and parents. The report includes comprehensive, bespoke recommendations which will specifically address the problems of the individual child, in both the home and school environments. This is done in line with our general policy not to provide a ‘one size fits all’ approach, but rather identify and prioritise crucial areas to address with specified therapies.
A second NMT (Neurosequential Model of Therapeutics) assessment, is undertaken, by therapists trained in and adhering to guidelines created by Dr Bruce Perry, child and adolescent psychiatrist in the USA, based on extensive research on children with complex problems.
During this assessment, an extensive interview is completed with parents, who provide background information and details of the child’s present functioning in specific areas. This information together with information from the CCA report, are utilised to provide a metric report containing a visual image of the child’s brain development, denoting which areas need to be addressed during the therapeutic process.
This metric map, highlights both the strengths and problem areas for the child. It also provides detailed information in terms of a ‘measure’, of the child’s emotional regulation, sensory integration, attachments and cognitive functioning, in comparison with children of similar age. This comprehensive overview, provides the most effective guidance in terms of appropriate interventions, which target the relevant brain levels.
All this information is comprehensively discussed, including the metric map in an NMT report which is sent to the social worker as well as the parents. Discussions after the release of this report is welcomed. All these reports are finalised by Dr Marks.