Difference between multidisciplinary diagnostic treatmant and process of expertise

In our daily work, we encounter a myriad of questions, concerns, and fears that you address during your visit to our Center in a situation where you may be lost between multiple systems and a wealth of information received by experts from other institutions, lawyers, friends, neighbors, acquaintances … Most often parents’ concerns, questions, and dilemmas arise during the divorce proceedings, sometimes because of the parents’ unrealistic expectations that expert will write exactly what they expect and how they view the situation. Sometimes parents and the Center’s role are seen as “distorted” by perceiving our Center more as a judicial rather than a healthcare institution that primarily makes multidisciplinary diagnostic, treats and protects children, and experts in finding write data relevant to mental health and protection of the child, which also indicates the name of our institution.

Possible dilemmas for parents on arrival at the Zagreb Child and Youth Protection Center

Some of the parents’ dilemmas are: Is multidisciplinary treatment at the same time an expert evaluation? Does the Center make recommendations and decisions regarding parental care? Is the Center obliged to invite both parents? Who can refer us to the Center? Is the Center a private healthcare facility? Whether the treatment is paid? In this text, we will try to address as many of these parenting concerns as possible, as well as explain the difference between multidisciplinary treatment and the expertise process.

Zagreb Child and Youth Protection Center is a public health institution that deals with the diagnosis and treatment of psychotraumatized children, ie the care for the mental health of children, and is provided through a referral from a child doctor, regardless of which institution recommends examination and treatment. Children are provided with a specialized team approach, and the multidisciplinary Centers’ team consists of: psychologists, psychiatrists, social pedagogues, social workers, neuro-pediatrician, speech therapists, nurses and a lawyer.

After the team processing, which involves the personal treatment of each expert/specialist with the collection of anamnestic data from the child, a final finding and opinion is written by combining all the individual findings of the experts involved in the treatment and further recommendations are made for possible treatment work with the child. The issued findings and opinion, as well as other medical documentation, are appropriate for the moment of implementation and the emotional state of the child, and recommendations on the necessary treatment or necessary procedures for the protection of the child, which may be changed in the case of new and changed circumstances or needs of the children, are accordingly given.

If in the course of multidisciplinary treatment or later during treatment work with a child, information is obtained that raises the suspicion that the child has been subjected to some form of violence/abuse or harmful treatment, every expert in our and all health institutions is in accordance to the current legislation of the Republic of Croatia and international conventions, they are obliged to inform the competent institutions: the police and the social welfare center according to the place of residence of the child, and sometimes the State Attorney’s Office is also informed.

 

What is mutidisciplinary treatment and where is it done in Croatia?

Diagnostic and treatment work is carried out through multidisciplinarity precisely because this approach of each individual expert contributes to quality diagnostics and determination and provision of treatments according to the individual need of each child. Considering that occasional misinformation appears in the public “that all processing of children in the case of divorce must be done in our Center and that the courts recognize only the findings of our Center”, we emphasize that with a valid child doctor’s referral, parents can take the child to other health care facilities for multidisciplinary treatment institutions with multidisciplinary treatment capability, such as:

 

  • IN ZAGREB:

– Child Diseases Hospital Zagreb,

– Suvag Hearing and Speech Rehabilitation Clinic,

– Psychiatric Hospital for Children and Adolescents, and

– Psychological Medicine Clinic.

 

  • IN RIJEKA:

– Tić Counseling Center

 

  • IN DUBROVNIK:

– Children and Youth Protection Clinic at Dubrovnik General Hospital

 

Given that multidisciplinary processing is carried out on the basis of a doctor’s referral, parents can independently decide which institution to turn to for help and carry out the processing of their child. Therefore, our Center is not the only institution that can multidisciplinaryly process a child, nor is it the only institution whose findings are respected by social welfare centers, state prosecutor’s offices, courts …

 

The procedure for the expert evaluation and who will be the expert witness is determined by the court

Unlike diagnostic multidisciplinary processing, the procedure of expert evaluation, as well as expert witnesses, is determined by court order, and experts are responsible for their findings and opinions to the court. Expert witnessing is a more extensive procedure, that is, as the statutory determinated, an expert’s finding and opinion is one of the evidentiary actions determined by the body which conducting the proceedings when need to find or evaluate an important fact, it is necessary to obtain a finding and opinion from a person with the necessary expertise or skill. Experts employed by the our Center are mostly expert witnesses in civil proceedings during divorce proceedings regarding the granting of care and in criminal proceedings where the criminal offense of abuse was committed against the child, as well as in cases where juveniles are the perpetrators of criminal offenses.

When a crime has been committed against a child, the expert witnesses do not assess whether the victim / child’s testimony is credible, but whether the child has the moral and cognitive competence to testify credibly in court.

 

Assessing parental competencies

What is important to say is that in psychological-psychiatric expert evaluation, expert witnesses establish medical and psychological preconditions for the court to make a decision. Therefore, an expert witness should not assume the role of a court or a public prosecutor, since they are the ones who consider the expert witness’s findings and opinion as a piece of evidence in the proceedings. Specifically, in civil proceedings, the expert does not determine which parent will be awarded parental care or with which parent the child will live, but assesses the individual’s parental personality structure, the existence of possible psychological disorders that would affect the parent’s competencies, assess the child’s condition, parent-child relationships, and assesses and determines the parental competences of both parents on the basis of their expert knowledge, ie assesses which parents have more preserved parental competences. Based on this and other evidence collected, the judge decides which parent the child will live with and how and to what extent he or she interacts with the other parent.

 

Difference between expertise and multidisciplinary processing

During the expert witness procedure, unlike multidisciplinary processing, court experts have access to the complete court file, reviewing and processing not only the child but both parents. In addition to seeing the complete court file, the expert witnesses have to search for other relevant documentation as well as to refer the subject to various tests (for example, liver tests).

Finally, it is important to note that during multidisciplinary processing, only a child is treated multidisciplinary in the Zagreb Child and Youth Protection Center on the basis of valid instructions from a competent family medicine doctor or pediatrician. Data is taken from the parents but is not processed or reviewed by any expert. Therefore, the professionals involved in the processing do not provide estimates of parenting capacity or make decisions about which parent the child will live with. Assessment of parental competences can only be given by authorized court experts, while multidisciplinary processing refers to the assessment of the child’s condition and indications for treatment. However, in both cases, if they become aware of the actions of parents or other adults against the child, court experts and professionals involved in the multidisciplinary processing of the child are obliged to inform the competent institutions, according to the legislation of the Republic of Croatia and ratified international conventions.

Experts of the Zagreb Children and Youth Protection Clinic conduct multidisciplinary processing on a daily basis so that there are about 1500 of them each year.

 

By: Nikolina Škrlec, Social work MA

 

Disclaimer: This is unofficial translation provided for information purposes. Zagreb Child and Youth Protection Center can not be held legally responsible for any translation inaccuracy.   

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