PSY 626. Alberta Quintero Molina

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FORENSIC INTERVIEW: {CASE NO: 45914-0935}
ASSESSMENT CENTER FOR CHILDREN OF LAYTON,
MICHIGAN
ALBERTA QUINTERO MOLINA
Tylaer G. Davis, M.S., NCAC

FORENSICINTERVIEWREPORT:ChildProtective Services{Case No#45914-0935}
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CONTRACT FOR FORENSIC INTERVIEWING SERVICES
QUALIFICATIONS
The professional qualifications of the forensic interviewer, Tylaer G. Davis, M.S. NCAC,
summoned to interview minor child Alberta Quintero Rivera {Case NO: 45914-0935}, who
resides in the care and custody of Calumet Catholic Charities of Michigan. The qualifications of
the professional are considered to be appropriate according to FRE 702. The forensic interviewer
has a Bachelor’s Degree from Grand Valley State University in General Psychology. The
professional also has a Master’s Degree in Forensic Psychology from Southern New Hampshire
University. The professional is nationally certified in forensic interviewing of children by the
National Child Advocacy Center. The professional is also state certified by the MNCA or the
Michigan National Children’s Alliance. The interviewer has been conducted forensic interviews
with the Assessment Center for Children of Layton, Michigan for 10 years. It has been
concluded that this professional is qualified as an expert by knowledge, skill, experience and
training obtained over years of psychological education and experience within child welfare
organizations and programs.
ROLES AND RESPONSIBILITIES
The forensic interviewer will have the role of collecting data and gathering information
on the minor child’s history. The interviewer will provide informed consent with the guardian of
the minor child, and the child. The child will be informed that their information will be shared
with the child’s case manager and lawyer. The child will be informed that the interviewer may
need to testify on behalf of information disclosed if subpoenaed. The interviewer will have a
video and audio recording of the entire interview. The interviewer will conduct the interview,

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facilitate all selected evaluations and assessments in no more than 1 hour and 30-minute session.
The interview will be reviewed by the supervisor of the forensic interviewer employed by the
Assessment Center for Children of Layton, Michigan to ensure the techniques employed in the
interview were appropriate, and adhere to the ethical and technical psychological standards.
CODE OF ETHICS
Ethical behavior is represented by our commitment and we set clear standards of
behavior within our organization. The code of ethics dictates that the Assessment Center for
Children of Layton, Michigan and its professional employees will operate responsibly and in
accordance with all laws and regulations.
Specifically, our organization will:
 Promote ethical practices, and abide by all ethical regulations and safeguards
 Ensure a safe environment, free from discrimination or bias.
 Policies that clearly outline treatment practices, options and limits.
 Provide a safe and healthy environment to process trauma and provide trauma
focused therapy.
 Informed Consent and clear client contracts.
 Provide professional and timely services to all clients.
 Promote children, families and uphold the practices and adhere to standards of child
welfare agencies in which we collaborate.
 Uphold the word of God and adhere to a Christ centered mission.
The practices align with the principals of integrity, trust, and our Christ centered
promotion of children and families. Our mission is to assist children and support the message of

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therapy, treatment and ethical practice. If there are any questions about the content of this
document, please contact Judy Dudley, 616.345.7767 or send all emails to
Jdudley@ACCLayton.org
ETHICS
All parties within the treatment team for the child are required to submit reports to the
Calumet Catholic Charities Organization upon formal request of documentation. The foster
parents are ethically mandated to report all significant incidents that occur while the foster child
is within the agencies care to the legal guardians of the child. The clinician is ethically mandated
to share all disclosed information that can cause harm to the child to their supervisor so action
may be taken within the organization to protect the child. The caseworker is mandated to report
harm and disclose concerns to their supervisor involving the welfare and endangerment of
children. This reporter is also mandated by law to disclose any possible harm and danger that
may occur or has occurred to a child, to the referring social services agency upon formal request
of documentation from the organization.
Adhering to the Specialty Guidelines within the case, all transcripts and videos of the
assessment have been collected and attend to the relevant laws and rules within the state of
Michigan. The interviewer will maintain all records, organization will maintain all records in
database (10.08 Recordkeeping, APA 2013, p. 16). The client is a child and has been adjudicated
as a Temporary Ward of Kent County court, as a result the client is presumed by law to be
unable to provide informed consent. The interviewer obtained appropriate permission for the
legal guardian of the child who is Calumet Catholic Charities of Michigan (6.03.03 Persons’
Lacking Capacity to Provide Informed Consent, APA 2013, p.13)

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An affidavit of guardianship complete with the date of placement, signed by the
organization’s caseworker and program supervisor was provided to the interviewer, prior to the
initial risk assessment of the client. The professional has informed the Calumet Catholic
Charities of Michigan that a signed release of information from the agency must be completed by
the caseworker, or supervisor prior to the forensic assessment release or information release of
any kind to the legal guardian for continuity of care, and case management (8.01 Release of
Information, APA 2013, p. 14). The Calumet Catholic Charities of Michigan organization has
stated that they need all documents regarding the client’s file in preparation for their yearly audit
of case files. Forensic interviewer and supervisor have requested a written formal release of
information, as the policy within the assessment center is in conflict with the caseworker’s direct
request for all documentation on her client (7.02 Conflicts with Organizational Demands, APA
2013, p. 8). Once the formal written release of information is requested and can be placed in the
client’s file with the assessment center, then information can be submitted to the legal guardian
of Alberta, Calumet Catholic Charities of Michigan.
FEES
INTERVIEWING FEES
Interviewers of The Assessment Center for Children of Layton, Michigan are
compensating at an hourly rate of 110.00$ for interviews, all interviews include a complete
written report summarizing the findings of the assessments and interviews conducted. Transcript
or video of the interview is unavailable unless requested by a specific official court order. All
interviews are confidential, and property of The Assessment Center for Children of Layton,
Michigan unless violating the patient-professional code.

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RECORD REVIEWS
A record review of a previous professional’s documentation or a record review of the
agencies documentation may require additional fees. If a case requires consultation with another
professional or agency additional fees may occur, per required compensation of the third-party.
AGREEMENTS AND PAYMENTS
Prior to all assessments and interviews all agreements and payment forms must be completed by
a legal guardian or responsible party. Signatures on the forms indicate (1) all policies have been
reviewed, read and understood. (2) All rights are waived to interview information and The
Assessment Center for Children of Layton, Michigan organization file records without official
court order. (3) A signature authorizes the release of interview records, assessments and
documentation to the court, attorneys and other parties the interviewer is mandated to release for
official purposes.
COURT PROCEEDINGS
Expert testimony or dispositional reviews will cost 75$, if court time is longer than an
interview session. Or the jurisdiction of the court is at least an hour or more from the assessment
location. The charges will apply every 2 hours over the scheduled appointment time. The final
written reports will be submitted to legal guardians, agencies with appropriate releases of
records, attorneys or guardians’ ad litem or upon official court order.
CANCELLATIONS

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Cancellations must be made at least 24 hours prior to the scheduled appointment time, if
the appointment time is missed or cancelled less than 24 hours the client will be charged a 75$
cancellation fee.
Assessment for Risk
Name: Alberta Quintero Molina Gender: F
DOB: 04/24/2003 Age: 10 LOC: 3yrs 90 days
Program: Calumet Catholic Charities of Michigan Admit Date: 04/06/2010
Assessment Date: 09/13/2013
Complete every 90 days per LOC (length of care)*
1. Do you feel safe within your foster home?
2. Do you feel safe with your foster parents?
3. Do you feel comfortable talking to your foster parents while living in the foster home?
4. Do you feel comfortable with your foster siblings?
5. Describe the foster home.
6. What are things you like to do with your foster family?
7. Do you spend time with your foster parents?
8. Do you spend time with your foster siblings?
9. Are you ever home alone? If so, how long?
10. Describe a typical day at your foster home.
The risk assessment was conducted by the Calumet Catholic Charities of Michigan, it
was selected as a foster home review, and supported by a contemporary humanistic

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psychological theory pertaining to specifically child welfare programs. Children are
constantly growing and changing, children within child welfare programs are receiving
treatment and counseling to assist them in processing past trauma and developing their
personal growth. The child welfare programs assist children in striving toward their full
potential (Hogg, 2006). Children must be reassessed frequently while in any treatment or
child welfare programs so that the treatment team has a clear awareness and understanding of
the child’s current development and level of risk. All children are reassessed every 90 days
during their stay in care.
Psychological Assessment Report
Client’s Name: Alberta Quintero Molina
DOB: 04/24/2003
Case No # 45914-0935
Client Address: 4507 Lablie Dr. SW Allegan, MI 45688
Telephone No: (231) 435-9961
Referred by: Grace L. Hawkins, LLMSW
Psychologist/Examiner: Tylaer Davis, MS
Report Generated: 09/20/2013
INFORMED CONSENT
Informed Consent cannot be gathered directly by the client. The child is 10 years of age
and is an adjudicated Temporary Ward of Kent County Court within the care of Calumet
Catholic Charities of Michigan. The child’s case worker, program supervisor and adjudicating
judge have given consent as legal guardians for the client. An affidavit of guardianship signed by
all parties was received prior to the initial day of services. Prior to the interview, the subject was
informed of the purpose of the evaluation. Specifically, the child was informed that a report of
the outcome of the evaluation will be issued to their case manager and attorney. The child was
also informed that the forensic examiner may be required to testify about the report, and things
related to the examination or diagnosis. Minor child stated that she understood the nature of the

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examination and the purpose. The limits of confidentiality were explained thoroughly to the child
and her case manager. The child stated that she understood the limits of confidentiality. The
child participated voluntarily in the examination process. The report will be sent to Calumet
Catholic Charities of Michigan upon official release of information request from the
organization. Initial ground rules of the interview were explained to the client, and the client is
encouraged to ask any questions she may have.
REFERRAL
Referral follows a young 10-year-old girl, placed into the care and custody of
Calumet Catholic Charities of Michigan on 04/06/2010, who reports chronic victimization of
physical abuse as emotional abuse as the reasons for being placed within foster care. Client was
referred by her treatment team at Calumet Catholic Charities of Michigan, and formal officiant
recommendation for evaluation from Kent County Court at child’s last dispositional review.
Alberta has stated that she believes she was referred due to “problems in my head” client stated
“it doesn’t work right.” Requested was a psychological evaluation for an updated assessment of
the emotional strengths, weaknesses and behavior or personality traits of the minor.
ASSESSMENTS
-Parental Clinical Interview
Mrs. Kalisa Brady- Interviewed – 09/15/2013
Mr. Jon Brady- Interviewed -09/16/2013
- Clinical Observation
Observation at Calumet Catholic Charities of Michigan –After school program-
09/16/2013 – 3:30 pm – 6pm
Observation at Loblayne Elementary School -09/15/2013- 1:00pm- 3:30pm
-School Interviews
Mrs. Judy Turlan – 09/13/2013-2:30pm – 3:00pm
Mrs. Kathryn Oakes -09/13/2013 – 12:00pm-12:30pm
-Parental Statements
- Collateral School Reports (2014-2016)
- Trauma Scales Checklist for Young Children (TSCYC)

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Alberta Quintero Molina evaluated – at Assessment Center for Children of Layton-
09/14/2013(4:00pm- 5:15pm)
BACKGROUND
Identification: Alberta Quintero Molina is a single 10-year-old female minor, currently residing
within a foster home licensed through Calumet Catholic Charities of Michigan, in Allegan,
Michigan.
Psychological History: Alberta has no history of significant psychological issues or treatment.
Records state the child was removed from her biological parents at 4 years of age, due to
emotional and physical abuse. Alberta was allegedly involved in a car accident in July 2012.
Medical History: No serious hospitalizations, surgeries or injuries for the client.
Legal History: No legal history for the minor client
Family History: No biological family medical history provided by foster care agency.
Information on biological family consists of physical abuse and emotional abuse by caregivers,
resulting in the removal of the minor child in 2010. Alberta currently resides with licensed foster
family Mr. John and Mrs. Kalisa Brady in Allegan, Michigan. The family has 3 female children,
ages 9, 12 and 16.
ASSESSMENT VALIDITY
The assessment data for this case study has been derived using reliable methods. The
assessment data was generated from the Trauma Scales Checklist for Young Children (TSCYC).
The TSCYC is the first standardized trauma measure for young children. The measure can
evaluate children from ages 3 to 12 years old (Briere, 2001). It is a widely accepted measure
within the psychological community. Data suggests that the measure accurately evaluates acute

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and chronic posttraumatic symptomatology within the young children for the forensic
interviewer to understand the level of symptomatology the child may be experiencing (Briere,
2001, p. 1006). The assessment (TSCYC) would be considered appropriate by the Daubert
standard, as it is a standardized forensic protocol. “The individual clinical scales of the TSCYC
appear to have good to excellent reliability, as presented in Table 1. Alpha internal consistency
for the clinical scales ranged from .81 for Sexual Concerns to .93 for PTSD-Total, with an
average scale alpha of .87” (Briere et. al, 2001, p.1007). A typical center for child protection
procedure was used within the assessment of Alberta Quintero Molina. A parental clinical
interview/observation, parental statements, the assessment, preschool interviews and collateral
school reports were collected between the years of 2011-2013 (Case Scenario 4, SNHU, 2016).
Regarding the preschool teachers and the director’s results on the TSCYC scale the data
shows that the anxiety score for the teacher was (ANX=72) which is high, and the anxiety score
for the director was (ANX=80). The anger score for the teacher was (ANG=66) while the anger
score for the director was (ANG= 70) The post-traumatic stress arousal for both parties was also
high, with the teacher (PTS-AR=75) and the director (PTS-AR = 72). The measure of the post-
traumatic stress avoidance response seemed to be the only category where the teacher scored
higher in distress than the director. The information demonstrates from this assessment that both
parties have high anxiety, which may result in elevated irritability, or minimized patience. In
regards to the foster parents, Mr. Brady had a higher score in the abuse category, and was
slightly more rigid than his wife, but comparatively all of the scores were similar for both Mr.
Brady and Mrs. Brady. The foster parents generally scored within points of each other suggesting
they shared many similarities (Case Scenario 4, SNHU, 2016). The foster parents recalled

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information from memory regarding their typical reactions to Alberta’s behavior, and their
methods of discipline with their own children.
As for the information presented on the case of Alberta Quintero Molina. It should be
noted that the foster father, Mr. Jon Brady was arrested for domestic violence in 2000. The
information states that Alberta was an independent learner of normal functioning in 2011, within
the preschool reports. In 2012 after her placement with the Brady’s the child began to interact
and learn differently. Maladaptive social behaviors, problems concentrating, needing
reassurance. The child expressed to staff that they “pray for her head”, but no documents exist of
a brain injury or neurological issues for Alberta. No documented history of trauma or abuse
prior, no history of psychological care for the child.
BEHAVIORS
The behaviors of Alberta include anxiousness, bizarre inappropriate sexual behavior
towards other children, and noncompliance in school activities. The foster parents have admitted
to using corporal punishment on the child for tantrums or speaking back to them. The foster
parents have stated the child has had exposure to inappropriate television programs while under
the supervision of their hire for child care. The foster parents have reported a change in
caregivers as they were not able to afford the hired childcare anymore. The foster parents are
participating in a service plan. The agency states that there is possible the child will be removed
from the home (Case Scenario 4, SNHU, 2016).
RECOMMENDATIONS
First recommendation would be for the foster care agency to launch a special
investigation with the licensor of the foster home, and the foster parents. Alberta should be

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removed from the home and placed in a respite foster care placement until the special
investigation is complete. The ethics guidelines and regulations for child welfare state that an
investigation must be launched into each allegation of abuse brought to the agency attention. All
licensed foster parents are aware of the behavior management plan they sign with the agency
regarding various approved methods to use to manage behaviors of the foster child (time out,
removal of privileges, ignoring/extinction etc.) Corporal punishment is not prohibited for
licensed foster parents to use with foster children. As a result, the case manager must report the
allegation to CPS, the specific foster child is removed from the home as the agency licensor and
CPS complete an investigation to assess the safety of the foster home for the specific foster child
(Bethany Christian Services Long-Term Foster Care Foster Parent Manual, 2014).
It is recommended that the case manager of Alberta Quintero Molina complete the
appropriate referrals for the child to attend counseling and meet with a behavioral specialist. The
child would benefit from an initial session with the counselor while living in the Brady home,
once the child is removed for the CPS investigation. The counselor should note any changes in
the child’s behavior or functioning after a set adjustment period in the respite foster home. The
clinician should continue with risk assessments of the child as per program policy, every 90 days
until the child is discharged from care. The clinician should engage in appropriate recordkeeping
of the risk assessments for Alberta adhering to all laws and rules, the clinician should maintain
the records until all appeals and investigations into the matter have been completed (APA, 2016,
Standard 10.08 Recordkeeping).
It is concluded that the Brady foster parents are of Alpha typology, they are not
considered a danger to themselves or others and are very structured. They participate in church,
stable jobs and home life. The parent’s scores suggest they experience anxiety or tension in the

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home, and this can influence the anxiety and concentration of Alberta. According to the
contemporary psychological theory of social- cognition, the foster parents may be currently
demonstrating heightened anxiety and rigid behaviors due to coping with the social pressures of
their financial strains, and supporting a foster child that has experienced significant physical and
emotional abuse (Hogg, 2006). The foster parents would benefit from additional trauma support
and training from the Calumet Catholic Charities of Michigan Child Welfare agency.
TREATMENT RECOMMENDATIONS
Recommendations for the respite home, the home should not have other children, so the
treating clinician can note the behaviors Alberta demonstrates, without having to disregard
learned behaviors in the home from older children. The clinician will continue individual therapy
with Alberta, reporting in the child in quarterly reports and completing risk assessments every 90
days while the child is in care. If trauma is disclosed from the child during therapy, the clinician
will report the significant incident to other Calumet Catholic Charities agency workers and begin
DBT or TF-CBT for the youth. Regarding the sexually inappropriate behaviors, Alberta should
have a non-intrusive examination at the Helen DeVos Center for Child Protection. It will be a
formal medical exam, where they will interview the parents, observe the child and look at her
private areas without further intrusive medical procedures. If no injuries are present, it should be
considered the child is demonstrating the behaviors based on the lack of supervision from the
caretakers and exposure to inappropriate sexual content. Unless further concerns are noted. The
concerns should be reviewed by a professional and any release of information should adhere to
professional ethical guidelines, requiring the consent of a relevant party authorized by law or
court order to release information (APA, 2016, Standard 8.03).

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Alberta will receive a referral to the Calumet Catholic Charities behavioral specialist
Tanya Barnes, LLPC to meet weekly regarding her anxious and non-compliant behaviors.
Meetings with the agency behavioral specialist will be in addition to the individual counseling
provided by the agency clinician. The behavioral specialist will meet with the child once weekly
within the foster home environment, and observe, provide support with adjustment to the respite
placement, Brady foster home and potentially provide support if the child will need to
permanently move placements. The behavioral specialist will employ treatments based in the
contemporary behaviorism perspective. This approach will focus on the importance of
environment (Poole, 2016). The specialist will determine if the environmental forces within the
Brady foster home are shaping the behaviors of Alberta. The foster parents will continue to
participate in the service plan with Alberta, but a safety plan should be created for the foster
parents and the child. The safety plan should be reviewed every 90 days during a report period
with the foster parents and the child. The plan should also be signed and reviewed by all
members of the treatment team.
The foster parents should have participation in attending family therapy with Alberta,
even during sessions that occur while the child is residing within her respite placement. The
safety plan created for the family, should include proper supervision of the child, age appropriate
communication to the child (“pray for her head”), and appropriate behavior management
techniques. The licensor and the agency should enter into a safety/accountability plan for the
foster parents (if their license is not closed) regarding using corporal punishment with their foster
children within the home. The family will remain on a probationary period for at least 6 months
with the agency, and may have their placement license temporarily restricted.
THEORY AND TREATMENT STRATEGIES

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The professional theory of the case of Alberta and the overall diagnosis that was provided by the
forensic interviewer were a combination of the reliable and valid assessments used, the collection
of direct observations of the child’s behavior and a thorough review of the DSM IV and clinical
childhood anxiety disorder symptoms. The recommendations provided to Calumet Catholic
Charities of Michigan were created based on a thorough review of Child welfare practices in
foster care, the regulations of the licensing department, and the organization. As Calumet
Catholic Charities of Michigan is the legal guardian for Alberta.
According to the organizations policies and procedures adhering to the guidelines and
regulations for child welfare. The child will need to be removed from the foster home until a
thorough investigation of the home has been completed by the agency. “Article 4.56 Special
Investigations- All allegations of abuse or suspected abuse within the foster homes will result in
removal of all placements within the home. The licensing team of Calumet Catholic Charities of
Michigan will contact the foster parents to arrange a preliminary investigative interview into the
home. All placements will remain in respite foster homes until the conclusion of the
investigation. Upon successful conclusion of the investigation the licensing team will assess the
appropriateness of the child’s replacement into the foster home” (Calumet Catholic Charities of
Michigan, foster parent handbook, 2013, p.35).
It is mandated that all allegations of abuse within foster care are investigated. This is
required by the U.S. Department of Health and Human Services, the administration for children
and families and the children’s bureau. “When a report of possible child abuse or neglect is
received, the initial response often involves an investigation. Investigations may be conducted by
child protective services staff, the police, or a multidisciplinary team. The purpose of the
investigation is to determine if a child has been harmed or is at risk of harm (a disposition),

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reduce the risk and increase the safety of the child, and determine the need for services to support
the family” (Child Welfare Information Gateway, 2013). Any non-investigated allegations of
abuse within a foster home can result in disciplinary action for the organization or specific
mandated reporters involved in the child’s case.
The treatment recommendations for the child were concluded from specialized
knowledge provided by a college certified in Applied Behavioral Analysis for children. The
recommended treatment for the child was the use of DBT skills or TFCBT skills within her
individualized therapy at the social services agency, provided by her clinician or behavioral
specialist. DBT is Dialectical Behavioral Therapy which promotes mindfulness and assists with
the modification of behaviors in which the child engages. Examples of these methods are direct
skills training which can assist with teaching children how to self-soothe, manage stress and
regulate their emotional reactiveness to situations (Jennings & Apsche, 2014).
All scientific evidence presented within this document has been supported with research
facilitated by this reporter, all evidence and testimony are supported with reliable and valid
scales used during forensic assessments with children at Assessment Center for Children of
Layton, Michigan.
TESTIMONY ANALYSIS
The testimony of evidence was submitted to the court in the form of a Psychological Assessment
Report on the minor child. The professional was also asked to speak before the court on behalf of
the psychological assessment report that was written, dated 09/20/2013. The testimony is the
product of reliable methods of gathering background information on the child from caregivers
and direct observation. Alberta was assessed within her initial forensic interview using the

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Trauma Scales Checklist for Young Children. The TSCYC assessment is a 90 item caretaker
reporting instrument which has been specifically developed for young children, ages 3 to 12. The
scale is composed of two reporter validity scales and eight clinical scales.
The domains assessed within the scale are traumatic stress and internalization of
symptoms such as stress and anxiety for small children (Briere, 2005). The format of the scales
checklist is a questionnaire that is typically administered through gathering information from
parents and caregivers. In the case of Alberta, the information was collected directly from the
child’s current foster parents and school staff, her primary caregivers during interviews. The
information that is provided from the Trauma Scales Checklist for Young Children is valuable.
The scales can report information on the areas of concern/risk for the minor, the need for
continuous assessment through additional professionals. The assessment can also assist in laying
the groundwork and framework for another clinician to understand the background and possible
underlying emotional or traumatic issues with the child (Briere, 2005). The testimony for the
case is a product of the reliable and valid assessment scale used to measure the trauma of the
young child.

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State of Michigan
Kent County Court
17th district Family Court
Juvenile Division
In the Matter of Alberta Quintero Molina CASE NO # 103490-NA-5683
RESPONDENT Honorable Judge
Kathleen H. Laky
Affidavit of Tylaer G. Davis, M.S., NCAC
I, Tylaer G. Davis having been duly sworn, do hereby state the following information:
Qualifications
1. I am a certified forensic interviewer employed by the Assessment Center for Children of
Layton, Michigan. I conduct forensic interviews for social services agencies, legal
professionals and mental health professionals within the community. I am nationally
certified by the National Children’s Advocacy Center (NCAC) and state certified for the
state of Michigan within the Michigan Chapter of the national Children’s Alliance
(MCNCA) which provides services and training alongside the Prosecuting Attorney’s
Association of Michigan (PAAM).
2. I have a Master of Science degree in Forensic Psychology from The University of
Southern New Hampshire. I have been affiliated with ACC of Layton Michigan since
April 2014. I was employed with Aquinata Christian Services beginning in May 2010 and
have been working in a trauma-focused environment with refugee children of all ages. I
have extensive experience working with trauma survivors, torture survivors, and
survivors including domestic violence, sexual abuse, trauma from war, survivors of gang
violence and chronic illnesses.
Background Information
Alberta Quintero Molina was referred to me by Calumet Christian Services and Child
Protective Services of Michigan to assess her current psychological functioning on 09/14/2013.
Alberta and I met on the following dates: (9/14/2013, 09/15/2013 and 09/16/2013) totaling
approximately (5 ½ hours). Observation of Alberta occurred at Calumet Social Services agency,
within classes at Loblayne Elementary School. A thorough forensic interview was conducted at

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the Assessment Center for Children of Layton, Michigan. The assessment included a clinical
observation, parental clinical interview, parental statements, school interviews, collateral school
reports for the child from 2011-2013 (8 to 10 years of age). The administration of the following
standardized questionnaires: Trauma Scales Checklist for Young Children (TSCYC) was
completed for Alberta.
I have reviewed the declaration of the Calumet Christian Services agency worker, and
clinician on behalf of the minor child and I find it to be consistent with the events described to
me by the minor child and adult caregivers interviewed.
3. It is my professional opinion that Alberta’s symptoms developed after placement with the
Brady family, and are a result of the environment within the Brady foster home. As a
result of the stressors and environment within the foster home including but not limited
to:
 Separation from birth family at young age/ placement into foster care.
 Trauma- related behaviors arising after a car accident in Fall 2012.
 Development of maladaptive behaviors, change in child’s learning style.
 Corporal punishment facilitated by foster parents.
 Inappropriate sexual behaviors, expressed towards other children.
 Child repeats phrases spoken to them regarding their mental capabilities.
 Lack of childcare resources, lack of supervision during nighttime hours.
 Financial struggles of the foster family.
Diagnosis
4. Alberta’s symptom presentation and known history would be consistent with a diagnosis
of Post-Traumatic Stress Disorder (PTSD) and has many traits of a Generalized Anxiety
as a result of the trauma regarding the separation from her birth family, the trauma of a
severe car accident and the environment of her foster home. The disorder as listed within
the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental
Disorders (DSM- IV), which includes:
The development of characteristics following exposure to one or more traumatic events.
These events include threatened or actual physical assault, threatened or actual sexual assault,
natural or man-made disasters and severe motor vehicle accidents. In regards to children,
sexual violent events can include inappropriate sexual experiences without physical violence
or injury. Also witnessing others experience violent or accidental traumatic events.
5. The features of PTSD in Alberta are: (1) Directly experiencing a traumatic event; (2)
Repetitive play with themes and aspects of the traumatic event; (3) Persistent and
exaggerated negative beliefs or expectations about oneself, others or the world; (4)
Problems with concentration; (5) Sleep disturbances; (6) Hypervigilance. Alberta
presents with the need for reassurance and support from others, which is a central
characteristic of generalized anxiety.

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6. The criterion for the Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition was used to determine the child’s diagnosis. Attached is a copy of the criteria to
this affidavit as exhibit A, also I have attached a copy of the Global Assessment of
Functioning Scale (Axis V) as exhibit B.
Axis I: 309.81 Post-Traumatic Stress Disorder
300.02 Generalized Anxiety, Recurrent
Mild
Axis II: No Diagnosis
Axis III: No Diagnosis
Axis IV: Severe stressors: Abuse, Forced Separation, Car
accident, developmentally inappropriate
sexual exposure.
Axis V: GAF= 70 (current), Mild
Assessment
7. Alberta presented herself as an affable, personable and polite child. Alberta extended her
hand politely to great the examiner. Alberta was composed and behaved developmentally
appropriately for her age of 10 years old. Alberta was able to recall experiences she
remembers from her birth family. During the interview Alberta described witnessed
physical abuse within her home and emotional abuse. Alberta described the forced
separation from her mother and siblings and her placement within the Brady foster home.
8. Characteristics of PTSD are dissociative reactions and marked psychological reactions to
internal and external cues of traumatic events. During the interview, Alberta would look
at a wall behind the interviewer and recall in a flat affect as if reading the memories of
experiences with her birth parents. Possible flashback behaviors when recounting
memories of the trauma. Child would stop fidgeting, breathing would become shallow, at
times the child’s eyes would dart back and forth, possible dissociation.
9. Alberta reported re-experiencing her trauma through nightmares with traumatic content.
Alberta described having nightmares at least 4 times a week, and being too afraid to go
back to sleep. Alberta states that she sleeps about 2 hours per night when she has
nightmares. Alberta is often awakened 2 hours after falling asleep, by images of her
mother and sisters being beaten or the angry verbal abuse of her father. The nightmares of
her parents’ house did not begin until after the severe car accident experienced in Fall
2012. Consequently, the inability to sleep has begun to influence the child’s functioning
throughout the day. Alberta admitted to watching adult TV programs at night in the foster
parents home, Alberta stated “it’s all that’s on” when she is awake at night.
10. Alberta reported anxiousness, feeling as though she is culpable for her birth family’s
separation, the car accident and the stress that the Brady foster family is experiencing

22
financially. Alberta has described that she was the reason the family was traveling on the
day of the accident. Alberta also feels as though the family would financially be able to
afford more, if she was not a burden in the home. Self-blame is common in children that
have experienced abuse, as a method to understand traumatic experiences that have
occurred to them.
11. Caregivers of Alberta have reported a range of symptoms of increased arousal and
hypervigilance, inappropriate sexual behaviors towards other children, decreased
concentration and sleep disturbances. Alberta described only sleeping 2 hours per night
about 4 times per week when experiencing nightmares. Alberta described how
uninterested she is in school and that her mind wanders frequently while completing
work. Alberta described always feeling exhausted at the end of the day, but not being
able to sleep.
12. As a result of the trauma from family separation, the severe accident and the current
financial uncertainty and placement uncertainty for the child. Alberta has experienced
symptoms of anxiety and excessive worrying. The child will frequently blame herself for
small infractions that are outside of her control. And worries that her behavior at school
has led to more problems for the Brady family financially and additionally, with Calumet
Christian Services. Alberta repeated that there is “something wrong with my head.”
13. During the interview the physical symptoms including shallow breathing, loss of
orientation to time and place, excessive worrying, restlessness, increased heart rate, and
dissociation were present. The child would speak in a flat affect and choppy as if reading
the information. The child would not move, freeze completely and lower her voice when
recounting the memory.
14. I find, based on the evidence of traumatic events, descriptions from caregivers of the
child’s behavior and Alberta’s description of details regarding the forced separation,
flashbacks and anxiety symptoms. All symptoms are characteristic of children who have
suffered trauma.
Summary and Recommendations
15. In conclusion, Alberts is consistent with the diagnosis of Post-Traumatic Stress Disorder.
The emotional and cognitive experiences reported has resulted in a mild impairment for
the child. This impairment had interfered with her ability to concentrate in school, sleep
during the night and gain a positive self-image.
16. Treatment Recommendations are as follows:

23
 Referral to the Calumet Christian Services Behavioral Specialist, to meet with the
child weekly and assist in alleviating symptoms of anxiety and promote DBT
skills to assist in behavior modification.
 Continued Individual Therapy with agency clinician of Calumet Christian
Services, for continued trauma-focused Cognitive Behavioral therapy and support
processing trauma. Continued risk assessments every 90 days while the child
remains in care. Additional therapy regarding family separation. (Group or
individualized therapy)
 Continue to develop a relationship with case manager, as a possible in home
counselor during monthly home visits to assess the need for additional referrals
and services for the child.
 Referral to Dr. Malin Gupta at Helen DeVos Center for Child Protection for a
physical examination for signs of sexual abuse. If evidence is present, a forensic
interview with the onsite sexual abuse interviewer to assess the child for possible
exposure to abuse.
All information written has been reported to the best of the affiant’s knowledge.
__Tylaer G.Davis____ ___SisaP.Chon___
Tylaer G. Davis, M.S., NCAC Notary Public
Michigan License #908432 Submitted and sworn before me on this 13th day of October

24
References
American Psychological Association (2013). Specialty Guide for Forensic Psychology.
Retrieved from:http://www.apa.org/practice/guidelines/forensic-psychology.aspx
Briere, J., Johnson, K., Bissada, A., Damon, L., Crouch, J., Gil, E.,.. & Ernst, V. (2001). The
Trauma Symptom Checklist for Young Children (TSCYC): Reliability and association
with abuse exposure in a multi-site study. Child abuse & neglect, 25(8), 1001-1014.
Child Welfare Information Gateway, Department of Health and Human Services, Administration
for Children and Families (2013) Retrieved September, 24, 2016
Hogg, M. A. (2006). Social identity theory. Contemporary social psychological
theories, 13, 111-1369.
https://snhumedia.snhu.edu/files/course_repository/graduate/psy/psy622/therapeutic_risk_typolo
gies.pdf
https://snhu-media.snhu.edu/files/course_repository/graduate/psy/psy622/case_scenario_four.pdf
Jennings, J. L., & Apsche, J. A. (2014). The evolution of a fundamentally mindfulness-based
treatment methodology: From DBT and ACT to MDT and beyond. International Journal
Of Behavioral Consultation And Therapy, 9(2), 1-3. doi:10.1037/h0100990
Poole, D. A. (2016). Interviewing Children: The Science of Conversation in Forensic
Contexts (pp. 90-98). Washington, DC: American Psychological Association.
Rule 702. Testimony by Expert Witness. (2011). In Cornell University Law School.

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