Young Children in Out of Home Care: How Foster Parents Can Help

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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

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Young Children in Foster Care

• Carol and Terry

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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

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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)

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Factors Leading to Placement in Foster Care

• Parent issues
• Child characteristics
• Environmental stressors to the family

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As a result.

• Most children in foster care have
• Medical
• Mental health and
• Developmental problems

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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

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Young Children in Foster Care

• Of all the children who died from abuse and
  neglect,77 were under 4 years old.

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How to Help?

• Start with relationships..

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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?

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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

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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

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Bottom Line

• Babies and toddlers can experience
• Emotional distress
• Problems with early relationships
• Behavior difficulties
• Atypical development

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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

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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

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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 thatit was confusing
  for children to feel close to foster parents

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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

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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.

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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

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Adult actions that promote attachments

• Reduce upset feelings
• Provide positive social experiences
• Claiming behaviors

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Arousal-Relaxation Cycle
Child experiences a need
Child feels content

• Child feels upset

Adult satisfies need
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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

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Why do children form attachments to abusive
parents?

• Childrens 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

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Insecure Attachments

• Avoidant patterns (turning away from the
  caregiver when distressed) develop when
  caregivers reject babys request for nurturance.
  
• Resistant patterns (fussy, resistant behavior)
  develops when caregivers inconsistently respond
  to the baby

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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

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Long term Effects of Disorganized Attachments

• Aggression with peers
• Dissociative behaviors

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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
  fosterfamily, or adoptive family

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Abused Children

• Kathy and James

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Types of Trauma

• Witnessing violence (domestic and other)
• Natural disaster
• Terrorism
• Accidents
• Neglect
• Abuse
• Loss of caregiver

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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

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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

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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

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Assessing severity of trauma

• Closeness of people involved to the child
• What the child saw
• Childs developmental level
• Reactions of important adults

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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

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Effects of Trauma

• Can appear immediately or after days, weeks
• May remind young child of previous traumas,
  making reaction more severe

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Effects of Trauma

• Physical Self-Regulation Effects
• Traumatic Reminders
• Development
• Play
• Behavior
• Relationship

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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

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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

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Traumatic reminders

• Can be difficult to identify in nonverbal child
• Sensory (siren, smell)
• Dreams
• Re-experiencing the event
• Irrational fear of benign objects

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Developmental Effects of Trauma

• Developmental delays are expecteddevelopmental
  assessment is advised
• Problems may occur in development of attachments
  and other social emotional skills
• Regression is possible

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Effects on Play Skills

• Repetitive actions
• Driven quality
• Constricted quality
• Preoccupation with separation, loss, and reunion

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Effects on Behaviorinfants and toddlers

• Increased irritability/inability to soothe
• Sleep disturbance
• Emotional distress sadness
• Fears of being alone clinging refusal to
  separate
• Motor agitation
• Temper tantrums

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Effects on Behaviortoddlers 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

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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

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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

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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 ones own child

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Abused children as parents

• Harsh discipline
• Failure to respond to childs needs
• Inconsistent limit setting
• Inability to express affection
• Inability to enjoy interactions with child
• Minimize or deny childs painful experiences

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Neglected Children

• John and Marissa

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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

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Young children and neglect

• Failure to provide for childs 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

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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

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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

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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

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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.

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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

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Birth Foster Parents

• Michael his two families

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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

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How Foster Parents Can Help

• Responding to parent anger
• Listen
• Be non-reactive
• Acknowledge how difficult it is to be away from
  child

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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

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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

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Another Way to Help

• Speak for the babies..

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Question and Answer
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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)

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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