Young Children in Out of Home Care: How Foster Parents Can Help : Young Children in Out of Home Care: How Foster Parents Can Help Indiana Association for Infant and Toddler Mental Health
Stacey Ryan, LCSW & Angela Tomlin, Ph.D.
2007
Young Children in Foster Care : Young Children in Foster Care Carol and Terry
Young Children in Foster Care : Young Children in Foster Care There are over 540,00 children in foster care in the US
25% of children in foster care are under 5 years old
13% of those entering care are under 1 year
Infants are the faster growing population in foster care
Young Children in Foster Care : Young Children in Foster Care Reasons for placement:
Neglect (30 to 59%)
Parental incarceration (30 to 75%)
Physical abuse (9 to 25%)
Abandonment (9 to 23%)
Sexual abuse (2 to 6%)
Factors Leading to Placement in Foster Care : Factors Leading to Placement in Foster Care Parent issues
Child characteristics
Environmental stressors to the family
As a result…. : As a result…. Most children in foster care have:
Medical
Mental health and
Developmental problems
Young Children in Foster Care : Young Children in Foster Care Once in foster care, babies stay longer than other children
They are more likely to be abused while in foster care or when returned to parents
Reunification of babies placed under 3 months is low
More than 25% are returned to care after reunification
Young Children in Foster Care : Young Children in Foster Care Of all the children who died from abuse and neglect, 77% were under 4 years old.
How to Help? : How to Help? Start with relationships…..
Promoting positive mental health in young children : Promoting positive mental health in young children A good relationship with a caring adult is the foundation
What can happen when young kids enter foster care?
What Adults do with Young Children Really Matters! : What Adults do with Young Children Really Matters! Experience, especially social experiences, change the way the brain is shaped and functions
When you do everyday good caregiving actions, babies and young children benefit
For a child in foster care, you may be providing the only positive relationship
On the Other Side… : On the Other Side… Exposure to poor caregiving, abuse, or domestic violence can lead to developmental and mental health problems in young children
Babies, toddlers, and preschoolers can demonstrate depression, PTSD, and disruptive behaviors
Bottom Line : Bottom Line Babies and toddlers can experience:
Emotional distress
Problems with early relationships
Behavior difficulties
Atypical development
How Foster Care Helps : How Foster Care Helps One of the most important things a foster parent can do is to help young children have positive relationships
Doing this will help with development and behavior
To do it right, you have to pay attention to attachment
Attachment : Attachment Attachment is a special relationship between a baby or child and a special adult
To grow and develop infants and children have to be able to form attachments with adults
It is ok for babies and children to have more than one attachment
Attachments to Foster Parents : Attachments to Foster Parents Foster parents may have been told not to get too close to children in their care
In past, it was believed that it was confusing for children to feel close to foster parents
Attachments to Foster Parents : Attachments to Foster Parents Now we believe that attachments to foster parents should be encouraged
It can be hard for children to have separations from parents
But the long term effects of no attachments at all are more damaging
What Helps : What Helps The most effective mental health intervention for young children in foster care is prevention of multiple changes in caregivers.
Multiple disruptions in placement have been associated with the most problematic outcomes.
The relationship between the child and the foster parent is a primary piece of the plan.
Secure attachment : Secure attachment Parent comforts and nurtures the baby when she is upset
The baby begins to expect that she will be able to get help when needed
Secure relationships lead to many positive long term effects
Adult actions that promote attachments : Adult actions that promote attachments Reduce upset feelings
Provide positive social experiences
Claiming behaviors
Arousal-Relaxation Cycle : Arousal-Relaxation Cycle Child experiences a need
Child feels upset Adult satisfies need Child feels content
Are there children with no attachments? : Are there children with no attachments? There are children with no attachments
It is more likely that a child have an attachment problem rather than no attachment at all
The child will develop an attachment with the adult that is available
Why do children form attachments to abusive parents? : Why do children form attachments to abusive parents?
Children’s need for survival and safety results in attachment to any available adult, even those who abuse or threaten them
Children prefer the familiar, even when what is familiar is frightening
Insecure Attachments : Insecure Attachments Avoidant patterns (turning away from the caregiver when distressed) develop when caregivers reject baby’s request for nurturance.
Resistant patterns (fussy, resistant behavior) develops when caregivers inconsistently respond to the baby
Insecure Attachments : Insecure Attachments Infants show disorganized pattern when adults demonstrate frightening or frightened behavior with them
Infant is afraid of the person they look to for reassurance and nurturance
Infant behavior is unorganized and bizarre
These patterns are common when children are abused or they witness domestic violence
Long term Effects of Disorganized Attachments : Long term Effects of Disorganized Attachments Aggression with peers
Dissociative behaviors
Role of Foster Parent in Attachment : Role of Foster Parent in Attachment Help the child develop a healthy attachment
Help child extend attachment to you and improved behaviors to birth family, new foster family, or adoptive family
Abused Children : Abused Children Kathy and James
Types of Trauma : Types of Trauma Witnessing violence (domestic and other)
Natural disaster
Terrorism
Accidents
Neglect
Abuse
Loss of caregiver
Do Young Children Experience Trauma? : Do Young Children Experience Trauma?
Children under 12 months account for 44% of deaths from child abuse and neglect
Persistent crying is an important risk factor in abuse of very young children, related to shaken infant syndrome
Young children and sexual abuse : Young children and sexual abuse Infants and toddlers may account for as many as 10% of substantiated sexual abuse
Appearance of sexualized behavior is more likely than physical findings
The younger the child when abused, the more likely sexualized behavior appears
Young children and domestic violence : Young children and domestic violence
Child sees attachment figure injured
Attachment figure cannot protect self; child is unsure if she can protect him
Attachment figure may in turn injure the child
Assessing severity of trauma : Assessing severity of trauma Closeness of people involved to the child
What the child saw
Child’s developmental level
Reactions of important adults
How Young Children Understand Traumatic Events and Experiences : How Young Children Understand Traumatic Events and Experiences Cognitive and emotional capacity determines how child experiences trauma
Level of understanding can also affect memory
2-3 year olds do not understand the finality of death
Young children may believe they caused a traumatic event
Effects of Trauma : Effects of Trauma Can appear immediately or after days, weeks
May remind young child of previous traumas, making reaction more severe
Effects of Trauma : Effects of Trauma Physical & Self-Regulation Effects
Traumatic Reminders
Development
Play
Behavior
Relationship
Physical and Self-Regulation Effects : Physical and Self-Regulation Effects Self-regulation is important task of infancy
In babies and young children, problems with self-regulation look like:
Sleep problems
Eating problems
Exaggerated startle
Hypervigilance
Physical and Self-Regulation Effects : Physical and Self-Regulation Effects Exposure to traumatic events seems to change the way the infant reacts to future stressors
Animal and human studies shows changes in hormones and brain chemicals after trauma
These brain changes can be long lasting, leading the child to feel numb or anxious
Traumatic reminders : Traumatic reminders Can be difficult to identify in nonverbal child
Sensory (siren, smell)
Dreams
Re-experiencing the event
Irrational fear of benign objects
Developmental Effects of Trauma : Developmental Effects of Trauma Developmental delays are expected—developmental assessment is advised
Problems may occur in development of attachments and other social emotional skills
Regression is possible
Effects on Play Skills : Effects on Play Skills Repetitive actions
Driven quality
Constricted quality
Preoccupation with separation, loss, and reunion
Effects on Behavior—infants and toddlers : Effects on Behavior—infants and toddlers Increased irritability/inability to soothe
Sleep disturbance
Emotional distress; sadness
Fears of being alone; clinging; refusal to separate
Motor agitation
Temper tantrums
Effects on Behavior—toddlers and preschoolers : Effects on Behavior—toddlers and preschoolers Being too clingy with adults
Not able to be comforted when upset
Problems with exploration: either reckless or too inhibited
Aggression toward caregivers, peers, animals
Angry noncompliance
Effects on Relationship : Effects on Relationship Difficulty forming positive relationships
Poor sense of self
Lowered self esteem
Expectation of being treated poorly
Loss of secure base
Loss of sense of trust
Long Term Effects of Trauma : Long Term Effects of Trauma Persistent grief reactions (Bowlby)
Protest: efforts to find the parent through crying, calling, and searching
Despair: lethargy, sadness, emotional withdrawal, loss of interest in activities
Detachment: apparent indifference to reminders; selective forgetting*
Long Term Effects of Trauma : Long Term Effects of Trauma Increased risk for academic problems
Substance use and abuse
Early pregnancy
Criminal involvement
Psychiatric symptoms and disorders
Experiencing abuse as a child is linked to abusing one’s own child
Abused children as parents : Abused children as parents Harsh discipline
Failure to respond to child’s needs
Inconsistent limit setting
Inability to express affection
Inability to enjoy interactions with child
Minimize or deny child’s painful experiences
Neglected Children : Neglected Children John and Marissa
Why Neglect Occurs : Why Neglect Occurs Parent is overwhelmed
Parent does not know how to take care of child
Parent does not know how to ask for help
Parent is afraid to ask for help
Young children and neglect : Young children and neglect Failure to provide for child’s physical and emotional needs
Leaving child alone for long periods
Leaving child for long periods with varied and unreliable caregivers
Effects of neglect can be as devastating as physical or sexual abuse
Effects of neglect : Effects of neglect Lack of play and other developmental skills
May hoard food
Unfamiliar with things we take for granted
Expects to take care of self or siblings
Challenges adult authority
Lacks trust in adults
Avoids adults when upset; hard to soothe
Expected difficult reactions to placement in foster care : Expected difficult reactions to placement in foster care Previous relationship failures lead the child to behave in ways that alienate foster parents
Caregivers misread behaviors and respond in ways that increase problems
Child responds to loss of attachment figure with behavioral, emotional, and physiological dysregulation
Expected difficult behaviors of children in care : Expected difficult behaviors of children in care Acting like they do not need caregivers, even under threatening conditions
Acting angry when adult makes efforts to soothe
Turning away when hurt
Behaving aggressively toward caregivers
Behaving aggressively toward peers
Problem behavior after visits
Why Do They Do That? : Why Do They Do That? You wake up in a strange bed, in a strange house, surrounded by furniture you're not familiar with, people you don't know, and perhaps even a language you don't understand. It's not the script of a B-rated suspense film; this is the real-world drama for children in foster care--a drama that Francine Cournos, director of the Washington Heights Community Service in New York City, knows all too well.
"Foster children are removed from everything they are familiar with and placed in a home that is probably out of their neighborhood, has different inhabitants, and is generally as strange as a foreign country," Cournos says. A former foster child herself, and author of a memoir entitled City of One, she remembers well the stress and trauma of adjusting to a different life--away from everyone she had known.
Why do we see behavior problems after visits with family? : Why do we see behavior problems after visits with family? Visits with parents are traumatic reminders of events that led to the separation or of the separation itself
Both the child and parent may feel anxious and angry
Supervised visits increasing parents feelings of incompetence
Child feels safer expressing angry feelings toward foster parent/family
Birth & Foster Parents : Birth & Foster Parents Michael & his two families
How Foster Parents Can Help : How Foster Parents Can Help Work with the parents
Avoid judgments about the biological parents
Provide transitional objects to child
Provide family pictures
Have a plan for the first visit
How Foster Parents Can Help : How Foster Parents Can Help Responding to parent anger
Listen
Be non-reactive
Acknowledge how difficult it is to be away from child
How Foster Parents Can Help : How Foster Parents Can Help Recognize that the child needs you, even when they do not show it
Understand rejecting behaviors as old coping methods
Listen
Put words to behaviors
Attend to your own reactions
Encourage touch, but do not force it
How Foster Parents Can Help at Home : How Foster Parents Can Help at Home Safety
Routine that shows an adult is “in control”
Soothing sensory activities
Stop activities that result in re-enactment (including television)
Advocate to reduce moves to provide continuity
Another Way to Help : Another Way to Help Speak for the babies..
Question and Answer : Question and Answer
Want to learn more? : Want to learn more? Indiana Association for Infant and Toddler Mental Health (mentalhealthassociation.com)
317/638-3501 EXT 221
Zero to Three (zerotothree.org)
The Center for Social and Emotional Foundations for Early Learning (csefel.uiuc.edu)
Young Children in Out of Home Care: How Foster Parents Can Help : Young Children in Out of Home Care: How Foster Parents Can Help Indiana Association for Infant and Toddler Mental Health
Stacey Ryan, LCSW & Angela Tomlin, Ph.D.
2007