Court Appointed Special Advocate (CASA) / Guardian Ad Litem (GAL)

Representing a child as a CASA or GAL in a Munchausen by Proxy case presents very specific challenges due to the highly manipulative nature of these perpetrators. It’s extremely common for offenders to attempt to befriend those working on their case or, alternately, to attempt to turn others against those who try to hold them accountable.

Family court judges are often extremely biased towards mothers and can be susceptible to these offenders because they typically present as competent and loving parents who’ve done everything for their children. Family court judges may not be at all familiar with Medical Child Abuse and FDIA. These cases require GALs and CASAs to have especially thick skin as perpetrators are drawn to distractions and drama; anyone who questions them often comes receives intense pushback from the suspected offender and their supporters.

Important Points for CASAs and GALs

  • The process will begin with separately interviewing each parent. Multiple interviews are recommended. Download a sample intake form (link) and questionnaire (link).
  • These cases are work-intensive. They frequently involve reviewing hundreds of pages of medical records, writing an extensive, and thorough reporting.
  • The first step will be establishing a referral question. For example: What, if any, role does Factitious Disorder Imposed on Another play in the suspected abuse?
  • It’s important to start clean and make no assumptions about what may be happening.
  • It’s crucial to get releases to speak to every professional who has ever been involved in treating the child. If parents refuse to grant releases, they can be obtained by a court order.
  • Transparency is crucial, particularly when suspicions of abuse are being investigated as part of a high-conflict custody case.
  • Deception is a huge part of MBP cases, so be on the lookout for inconsistencies between the parent’s story of the child’s health and the documentation.
  • Polarization amongst healthcare providers is extremely common.
  • Safeguards around a parenting plan are crucial. Suspected victims should never be placed with family members who disbelieve the allegations or are sympathetic to the offender. Temporary placement with foster parents allows for a neutral third party to document the victim’s symptoms during separation from the offender.
  • Only a thorough review of the evidence can determine whether Medical Child Abuse has occurred. However, psychological testing can be helpful to establish the presence of other factors such as distorted reality, exaggeration, depression, and personality disorders, which are extremely common in perpetrators
  • It is not the job of the GAL/CASA to diagnose the perpetrator, but to formulate a hypothesis and make a call based on the evidence.