On March 11, 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a global pandemic. In the year that followed, 2.5 million persons of the more than 116 million confirmed cases around the world and 500,000 persons of the almost 29 million confirmed cases in the United States alone died from virus-related illnesses. Even now, each day adds tens of thousands to the number of confirmed cases around the world and, despite three approved vaccines, thousands to the number of deaths. It is a sad reality that, because of the difficulties tracking cases and deaths, these numbers are considered conservative estimates. https://coronavirus.jhu.edu/map.html. The COVID-19 pandemic has impacted everyone on the planet and every aspect of our personal and professional lives. Everyone has had to adapt to an unavoidable new reality.
In March 2020, we began researching the viability of conducting child custody evaluations (CCEs) by video conferencing (VC) out of necessity. Our project resulted in a paper, Making the Case for Videoconferencing and Remote Child Custody Evaluations (RCCEs): The Empirical, Ethical, and Evidentiary Arguments for Accepting New Technology, that was first available online in August 2020 (Dale & Smith, 2020). Michael Lamb, editor of Psychology, Public Policy & the Law, ushered our paper and other pandemic articles through the peer-review process as a way of helping practitioners make informed decisions as quickly as possible.
As the title of our paper suggests, we understood there would be numerous and different kinds of arguments for and against RCCEs. We wrote that arguments supporting use of VC in CCEs can be made on empirical, ethical, and evidentiary grounds. Our review of the literature revealed that the growth of telemedicine and telemental health was mostly “a story of successful applications across people of different ages, different clinical and forensic populations, and different clinical and forensic tasks” (Dale & Smith, 2021, p. 41). We noted the presence on numerous documents outlining “best practices,” frequently with checklists for using VC in clinical and forensic practice, as well as how to inform clients and patients about what they could expect. The evolving data set supporting VC as equivalent to face-to-face work was most robust in studies of clinical or therapy settings, but it was not limited to clinical tasks.
So now, just a little more than a year later, we write again informed by the staggering case and death statistics, the presence of three vaccines hailed as possessing life-saving benefits but of unknown duration, and educated by a year where everything associated with the COVID-19 pandemic became a fight between science and politics.
We write again, this time with new additions to our personal and professional vocabularies. We now know more about how the Coronavirus is spread from person to person and that we must “socially distance” (i.e., stay six feet from others) as a protective measure to protect both ourselves and those with whom we have contact. We can unknowingly infect our loved ones and our clients, but those who have received the vaccines can feel safer, both personally as well as for those around them. We now know what “personal protective equipment (PPE)” is, how to use it, and how important it is to our ongoing health and safety. We now know that frequent hand washing with proper sanitizing agents is another necessary protective practice. Round-the-clock news coverage and daily instantaneous round-the-world news cycles have taught us the meaning of “surges” due to “spreader events,” the increased contagiousness of “variant mutations” of the virus, and the difficult calculus about federal, state, and individual decisions to “lock down” or “open up”.
In the United States, our national political leaders have now purchased and promised vaccines will be available by the beginning of the 2021 summer. Unfortunately, it appears that some will not take them. Epidemiologists have emphasized the protections of “herd immunity,” which may be achieved when 70, or 75, or 80 percent of the population is vaccinated. No one really knows what percentage of the population must be vaccinated for the “herd” to become immune and commentators emphasizing social policy make few comments, if any, about the persistent risks to individuals in the herd. A form of habituation has set in as we seem to be becoming more accustomed to numbers that were once intolerable. We know there will be “free riders,” those who refuse to take the vaccine for any of a host of personal reasons, who will rely on the herd to starve the virus into an acceptable or tolerable prevalence. What the post-pandemic “new normal” will be is anything but certain.
A year after we began to research the literature for our first article, we wish we could share that new research can inform our decisions; that is, we wish we could say that we now know what can reliably be done or not done with VC in CCEs. But we cannot. Operation Warp Speed’s (OWS) resounding successes in developing COVID-19 vaccines demonstrate the kinds of results science and scientists can generate by unlimited budgets and funding. The financial support provided by OWS will forever be the envy of researchers everywhere. Still, despite the efforts by many professional and scientific journals to get information to practitioners, the research infrastructure in the social sciences lacks the funding to keep pace. Until it is safe, research comparing VC to face-to-face processes within CCEs will have to wait.
Competently and ethically using VC in CCEs requires using the principles and skills from other areas in the child custody context. This kind of cross-training has always happened, but this historical fact is also sometimes forgotten by those wishing the child custody field was more highly developed as its own unique specialty. In Making the Case, we proposed viewing the available research as demonstrating it was possible to develop a working alliance and to develop adequate empathy accuracy to competently complete a CCE. This is because we view the differences between clinical and forensic work as predominantly existing in the mind of the interviewer, not in the space between the interviewer and the interviewee, regardless of whether the interaction is occurring face-to-face or by VC connection.
While the research base about use of VC in CCEs has not grown much in the past year, our experience has grown exponentially. Some evaluators completely suspended their work. Other evaluators continued face-to-face meetings and counted on PPE and social distancing within their offices to be safe enough. But the vast majority of evaluators have chosen some kind of middle ground and continued incomplete evaluations or begun new ones using a variety of approaches. Some have continued face-to-face contacts, but have conducted these contacts in new ways such as in open settings – even outdoors. Others have developed hybrid methodologies within which certain procedures – for example, psychological testing, interviewing children, or conducting parent-child interactions – are done face-to-face while other procedures (interviewing adults) are done by VC. Others have completed CCEs using VC for all of their procedures. Even child advocacy centers have developed “teleforensic” interviews to interview alleged victims of child sexual abuse. The experiences in the field are shared between and among evaluators by emails, listservs, telephone calls, and webinars. Dialoguing, dining, and hugging with AFCC friends is another activity that will have to wait.
Ultimately, we believe the “VC CCE horse has exited the barn” and that there is little chance it will be corralled back in. We believe individual child custody evaluators will find a practice style that incorporates VC procedures they are comfortable using, while reverting to familiar face-to-face methods for elements that they view as risky or unreliable. We believe the best practice guidelines for use of VC apply to CCEs, add to the reliability of the processes, and offer advantages and benefits when properly used. Use of VC brings an additional set of ethical considerations into play. To use VC, evaluators should make these best practices documents and the procedures they prescribe a part of their processes.
Today, one year from the declaration of a global pandemic, the COVID-19 map changes almost every day. “Mask mandates” have lessened, curtailed by the politization of this part of the safety protocols into a debate over “civil liberties.” We are often left to wonder how changes in safety protocols are consistent with continued warnings about additional surges or waves. We still see the maps, the news clips from countries on other continents, and the disparate predictions. If wearing a mask has become a statement about personal determination, how much should we trust individual decision-making regarding a dangerous and contagious disease? With respect to using VC in CCEs, each case has become an individualized determination outlined by the evaluator, negotiated with those being evaluated and their counsel, and, when it happens, approved by the court. The need for evaluations has never dissipated. Doing what is in the best interests of children cannot wait.
Bibliography of Videoconferencing Best Practice Documents
American Academy of Child & Adolescent Psychiatry. (2008). Practice parameter for telepsychiatry with children and adolescents. Journal of American Academy of Child & Adolescent Psychiatry, 47(12), 1468-1483. https://doi.org/10.1097/CHI.0b013e31818b4e13
American Psychological Association, (2013). Guidelines for the practice of telepsychology. American Psychologist, 68(9), 791-800. https://doi.10.1037/a0035001
Myers, K., Nelson, E.L., Rabinowitz, T., Hilty, D., Baker, D., Barnwell, S.S., Boyce, G., Bufka, L.F., Cain, S., Chui, L., Comer, J.S., Cradock, C., Goldstein, F., Johnston, B., Krupinski, E., Lo, K., Luxton, D.D., McSwain, S.D., McWilliams, J., North, S., Ostrowski, J., Pignatiello, A., Roth, D., Shore, J., Turvey, C., Varrell, J.R., Wright, S., & Bernard, J. (2017). American Telemedicine Association practice guidelines for telemental health with children and adolescents. Telemedicine & e-Health, 23(10), 779-804. https://doi.org/10.1089/tmj.2017.0177
Shore, J.H., Yellowlees, P., Caudill, R., Johnston, B., Turvey, C., Mishkind, M., Krupinski, E., Myers, K., Shore, P., Kaftarian, E., & Hilty, D. (2018). Best practices in videoconferencing-based telemental health, 24(11) Telemedicine & e-Health, 827-832. https://doi.10.1089/tmj.2018.0237
Turvey, C., Coleman, M., Dennison, O., Drude, K., Goldenson, M., Hirsch, P., Jueneman, B., Kramer, G.M., Luxton, D.D., Maheu, M.M., Malik, T.S., Mishkind, M.C., Rabinowitz, T., Roberts, L.J., Sheeran, T., Shore, J.H., Shore, P., van Heeswyk, F., Wregglesworth, B., Yellowlees, P., Zucker, M.L. (2013). ATA practice guidelines for video-based online mental health services. Telemedicine and e-Health, 19, 722-730. https://dx.doi.org/10.1089/tmj.2013.9989
By agreement, the above article will be simultaneously published by the Colorado and New York AFCC state chapters in their respective newsletters.
 Milfred D. Dale & Desiree Smith, Making the Case for Videoconferencing and Remote Child Custody Evaluations (RCCEs): The Empirical, Ethical, and Evidentiary Arguments for Accepting New Technology, 27(1) Psychol., Pub. Pol’y & Law 30 (2021). A copy of this paper is available through the Senior Author’s website: www.buddale.com/knowledge-center