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

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1. 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

2. Young Children in Foster Care Carol and Terry Carol, an experienced foster parent, agrees to take 30 month old Terry after another foster family finds they cannot handle her behavior. Terry is a beautiful girl with dark eyes and hair. She has a great smile and is starting to use words to make her wants known. Carol soon finds that the reason Terry is so hard to manage is that she can quickly become angry and aggressive when restricted in any way. Because she is so impulsive, climbing and running off from Carol in public places she often gets hurt. At these times she screams loudly and resists Carol’s efforts to comfort her.Carol, an experienced foster parent, agrees to take 30 month old Terry after another foster family finds they cannot handle her behavior. Terry is a beautiful girl with dark eyes and hair. She has a great smile and is starting to use words to make her wants known. Carol soon finds that the reason Terry is so hard to manage is that she can quickly become angry and aggressive when restricted in any way. Because she is so impulsive, climbing and running off from Carol in public places she often gets hurt. At these times she screams loudly and resists Carol’s efforts to comfort her.

3. 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 First stat from VIg and is from 2003 numbers All others from Oser & Cohen 2003First stat from VIg and is from 2003 numbers All others from Oser & Cohen 2003

4. 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%) Data from four different samples combined by Vig (2005)Data from four different samples combined by Vig (2005)

5. Factors Leading to Placement in Foster Care Parent issues Child characteristics Environmental stressors to the family Group discussion of each: Parent Issues: Parental neglext or incapacity for other reasons top source of removal. Examples: mental health, substance abuse, intellectual limitations, domestic violence, their own history of foster care placement Child characteristics: difficult temperament, self regulation problems, developmental delays Family stressors: finances, poverty, unemployment, lack of social supports, dangerous living situationsGroup discussion of each: Parent Issues: Parental neglext or incapacity for other reasons top source of removal. Examples: mental health, substance abuse, intellectual limitations, domestic violence, their own history of foster care placement Child characteristics: difficult temperament, self regulation problems, developmental delays Family stressors: finances, poverty, unemployment, lack of social supports, dangerous living situations

6. As a result…. Most children in foster care have: Medical Mental health and Developmental problems 3 to 7 times as many acute and chronic health problems, emotional adjustment problems, and developmental delays as other children 80% of kids in foster care were exposed to maternal drug use (in Vig, 2005) About 40% born premature Under mental health: think attachment, regulation, and PTSD all of which can lead to behavior concerns Development: we can see concerns in all areas, including cognitive, communication, and motor skills Interactions of factors: child is exposed to alcohol prenatally and now has developmental and behavior problems. 3 to 7 times as many acute and chronic health problems, emotional adjustment problems, and developmental delays as other children 80% of kids in foster care were exposed to maternal drug use (in Vig, 2005) About 40% born premature Under mental health: think attachment, regulation, and PTSD all of which can lead to behavior concerns Development: we can see concerns in all areas, including cognitive, communication, and motor skills Interactions of factors: child is exposed to alcohol prenatally and now has developmental and behavior problems.

7. 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 # 4 from vig (2005) # 4 from vig (2005)

8. Young Children in Foster Care Of all the children who died from abuse and neglect, 77% were under 4 years old.

9. How to Help? Start with relationships…..

10. 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? Elicit some discussion about the how kids in foster care may miss the opportunity to get in a caring relationship with an adult. Points that should be included: Lack of connection in birth home Removal/separation from birth parent Frequent moves within foster care systemElicit some discussion about the how kids in foster care may miss the opportunity to get in a caring relationship with an adult. Points that should be included: Lack of connection in birth home Removal/separation from birth parent Frequent moves within foster care system

11. 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 We need to understand that science backs up this emphasis on relationships. Researchers have shown that social experiences actually change the way the baby’s brain is shaped and functions. Everyday caregiving actions, holding, smiling, cuddling, feeding, diapering, playing, build social skils, capacity for appropriate behaviors, AND this happens at the brain levels of structure and function. For some children in out of home care, a good foster care situation may provide their first positive social experience.We need to understand that science backs up this emphasis on relationships. Researchers have shown that social experiences actually change the way the baby’s brain is shaped and functions. Everyday caregiving actions, holding, smiling, cuddling, feeding, diapering, playing, build social skils, capacity for appropriate behaviors, AND this happens at the brain levels of structure and function. For some children in out of home care, a good foster care situation may provide their first positive social experience.

12. 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 On the other side, babies and toddlers who have been exposed to poor caregiving, abuse, neglect, and violence….can have developmental, behavioral, and mental health problemsOn the other side, babies and toddlers who have been exposed to poor caregiving, abuse, neglect, and violence….can have developmental, behavioral, and mental health problems

13. Bottom Line Babies and toddlers can experience: Emotional distress Problems with early relationships Behavior difficulties Atypical development Bottom Line: babies and toddlers can have difficult emotional experiences. Although it is hard for many to accept, families with babies and toddlers do need MH help at times. Babies and toddlers can experience negative emotions that lead to problems getting along with others, behavior issues and developmental issues.Bottom Line: babies and toddlers can have difficult emotional experiences. Although it is hard for many to accept, families with babies and toddlers do need MH help at times. Babies and toddlers can experience negative emotions that lead to problems getting along with others, behavior issues and developmental issues.

14. 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

15. 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 One of the most important things to understand about when you foster very young children is attachment. Developing a relationship with a caring adult is the most important emotional skill that a baby learns in the first year of life. To be emotionally healthy and to develop all kinds of other important skills, a baby and a young child needs a healthy attachmentOne of the most important things to understand about when you foster very young children is attachment. Developing a relationship with a caring adult is the most important emotional skill that a baby learns in the first year of life. To be emotionally healthy and to develop all kinds of other important skills, a baby and a young child needs a healthy attachment

16. 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 Facilitate discussion around these statements. See if foster parents have been told these things and elicit their viewsFacilitate discussion around these statements. See if foster parents have been told these things and elicit their views

17. 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

18. 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. From Vig, 2005From Vig, 2005

19. 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 When infants and children form a positive relationship, we usually call this a secure attachment. Examples of positive long term effects of secure attachment in infancy: Good problem-solving in toddlers Independent relationships with teachers in preschool More effective peer relationshipsWhen infants and children form a positive relationship, we usually call this a secure attachment. Examples of positive long term effects of secure attachment in infancy: Good problem-solving in toddlers Independent relationships with teachers in preschool More effective peer relationships

20. Adult actions that promote attachments Reduce upset feelings Provide positive social experiences Claiming behaviors Reduce upset feelings by doing actions that help the child regain calm/content feelings This can be hard when babies are especially fussy, due to drug exposure, for example. Discuss actions such as swaddling, rocking, using low background noise, etc to promote calmness. Provide positive social experiences through routine interactions. Discuss typical baby games, especially those the include coming and going (peek a boo), singing to babies. The baby or child will begin to have more positive behaviors and this will start a cycle of positive behaviors between parent and child Use claiming behaviors or ways to show a baby or child that they belong to you (at least right now). Reduce upset feelings by doing actions that help the child regain calm/content feelings This can be hard when babies are especially fussy, due to drug exposure, for example. Discuss actions such as swaddling, rocking, using low background noise, etc to promote calmness. Provide positive social experiences through routine interactions. Discuss typical baby games, especially those the include coming and going (peek a boo), singing to babies. The baby or child will begin to have more positive behaviors and this will start a cycle of positive behaviors between parent and child Use claiming behaviors or ways to show a baby or child that they belong to you (at least right now).

21. Arousal-Relaxation Cycle Child feels upset From Fahlberg, 1990 When children are upset or experience displeasure, they need to know that adults will do things to make them feel feel better. The parent’s role is to help the child move into a feeling of contentment by providing the relief that comes when a need is satisfied. With repeated successful completions of this cycle, the child come to feel trust, security, and an attachment to the helpful caring adult. We can help children who did not get to experience this cycle with their birth parents to get this experience in foster care.From Fahlberg, 1990 When children are upset or experience displeasure, they need to know that adults will do things to make them feel feel better. The parent’s role is to help the child move into a feeling of contentment by providing the relief that comes when a need is satisfied. With repeated successful completions of this cycle, the child come to feel trust, security, and an attachment to the helpful caring adult. We can help children who did not get to experience this cycle with their birth parents to get this experience in foster care.

22. 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 Fahlberg says that only a small percentage of children with attachment troubles are unattached. It is more likely that the child has established an unhealthy attachment. This is because infants are wired (programmed, genetically programmed) to form an attachment to whatever adult is available and who provides any kind of interaction.Fahlberg says that only a small percentage of children with attachment troubles are unattached. It is more likely that the child has established an unhealthy attachment. This is because infants are wired (programmed, genetically programmed) to form an attachment to whatever adult is available and who provides any kind of interaction.

23. 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 The fact that young children are wired to form attachments helps us to understand why they will form attachments even when the parent is abusive. Instead of no attachment, the child develops and insecure or unhealthy attachment. The child will may try to stick with that less positive attachment, because it is familiar, than to get close to new people. This can be frustrating for foster parents who are trying hard to connect to a child. This is from Vig, et al. 2005The fact that young children are wired to form attachments helps us to understand why they will form attachments even when the parent is abusive. Instead of no attachment, the child develops and insecure or unhealthy attachment. The child will may try to stick with that less positive attachment, because it is familiar, than to get close to new people. This can be frustrating for foster parents who are trying hard to connect to a child. This is from Vig, et al. 2005

24. 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 When the parent has not provided positive caregiving, we say that the attachment that forms is insecure. There are 3 kinds of insecure patterns. Two can occur with parents who are insensitive. When the parent does not recognize or respond to the baby’s requests for help to reduce their upset feelings, an avoidant patterns can develop. The baby starts turning away from the parent, probably because he has learned that the parent will not help. When the parent helps sometimes and ignores the baby other times, the baby can form a resistant pattern. The baby is fussy, wants the parent and doesn’t want the parent. This mirrors the parent behavior.When the parent has not provided positive caregiving, we say that the attachment that forms is insecure. There are 3 kinds of insecure patterns. Two can occur with parents who are insensitive. When the parent does not recognize or respond to the baby’s requests for help to reduce their upset feelings, an avoidant patterns can develop. The baby starts turning away from the parent, probably because he has learned that the parent will not help. When the parent helps sometimes and ignores the baby other times, the baby can form a resistant pattern. The baby is fussy, wants the parent and doesn’t want the parent. This mirrors the parent behavior.

25. 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 Another insecure pattern, disorganized attachment, is a more concerning pattern. This pattern most often occurs when the parent behaviors in frightening way. At other times the parent acts frightened or unable to cope. The baby, who needs to rely to the parent for support to feel safe and calm, feels afraid of the parent.Another insecure pattern, disorganized attachment, is a more concerning pattern. This pattern most often occurs when the parent behaviors in frightening way. At other times the parent acts frightened or unable to cope. The baby, who needs to rely to the parent for support to feel safe and calm, feels afraid of the parent.

26. Long term Effects of Disorganized Attachments Aggression with peers Dissociative behaviors Children with insecure attachments do not have the positive results we discussed with secure attachments. In addition, they can be aggressive and act unconnected to others.Children with insecure attachments do not have the positive results we discussed with secure attachments. In addition, they can be aggressive and act unconnected to others.

27. 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 As we have seen, some children have not learned appropriate ways to be in a relationship with others. In foster care, they can learn positive ways to be in relationships with others. A foster parent can help the child use these new ways of being in relationship with others, including the birth family, or other carers. Letting a child get close to you, and getting close to the child is important. It teaches the child how to behave in close relationships The child can use this new pattern of interaction that you have taught them to have healthier relationships in the future. You may also see improvements in development and behavior.As we have seen, some children have not learned appropriate ways to be in a relationship with others. In foster care, they can learn positive ways to be in relationships with others. A foster parent can help the child use these new ways of being in relationship with others, including the birth family, or other carers. Letting a child get close to you, and getting close to the child is important. It teaches the child how to behave in close relationships The child can use this new pattern of interaction that you have taught them to have healthier relationships in the future. You may also see improvements in development and behavior.

28. Abused Children Kathy and James Foster parent Kathy is a single woman who is already caring for 2 children when James comes to live in her home. She notices that James has many sleep problems. He has trouble falling asleep and wakes often apparently after a nightmare. Because Kathy works part time, James and the other boys attend child care a few days per week. The child care worker calls with a concern that James “fell apart” when he saw an extension cord the worker was using for a TV. When Kathy told this story to the caseworker, she was told that James had been beaten with an electric cord. You may see children who have experienced violence, either directly through abuse, witnessing violence or in other ways. Now will will discuss the effects of violence on young children, including expected difficult behaviors.Foster parent Kathy is a single woman who is already caring for 2 children when James comes to live in her home. She notices that James has many sleep problems. He has trouble falling asleep and wakes often apparently after a nightmare. Because Kathy works part time, James and the other boys attend child care a few days per week. The child care worker calls with a concern that James “fell apart” when he saw an extension cord the worker was using for a TV. When Kathy told this story to the caseworker, she was told that James had been beaten with an electric cord. You may see children who have experienced violence, either directly through abuse, witnessing violence or in other ways. Now will will discuss the effects of violence on young children, including expected difficult behaviors.

29. Types of Trauma Witnessing violence (domestic and other) Natural disaster Terrorism Accidents Neglect Abuse Loss of caregiver Trauma is defined broadly in child welfare. All of these events can be experienced as traumatic by a child.Trauma is defined broadly in child welfare. All of these events can be experienced as traumatic by a child.

30. 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 Nationally, Children under 12 months comprise 44% of deaths from child abuse and neglect. This is a disproportionate number and reflects just how vulnerable a baby or toddler can be. Persistent crying is a big risk factor for abuse in very young children. Oser & Cohen, 2003 America’s Babies The Zero to Three Policy center Data BookNationally, Children under 12 months comprise 44% of deaths from child abuse and neglect. This is a disproportionate number and reflects just how vulnerable a baby or toddler can be. Persistent crying is a big risk factor for abuse in very young children. Oser & Cohen, 2003 America’s Babies The Zero to Three Policy center Data Book

31. 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 Although it is uncomfortable for us to think about, young children can also experience sexual abuse. Oser & Cohen, 2003 America’s Babies The Zero to Three Policy center Data Book Although it is uncomfortable for us to think about, young children can also experience sexual abuse. Oser & Cohen, 2003 America’s Babies The Zero to Three Policy center Data Book

32. 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 Some children may come into your care not because they have been abused, but because of domestic violence at home. Seeing an attachment figure hurt is damaging to the young child. The child may wonder if that parent will be able to keep the child safe, since she cannot help herself. In addition, the attachment figure may in turn injure the child; perhaps because upset, stressed, or angry or maybe even to keep the child quiet Some children may come into your care not because they have been abused, but because of domestic violence at home. Seeing an attachment figure hurt is damaging to the young child. The child may wonder if that parent will be able to keep the child safe, since she cannot help herself. In addition, the attachment figure may in turn injure the child; perhaps because upset, stressed, or angry or maybe even to keep the child quiet

33. Assessing severity of trauma Closeness of people involved to the child What the child saw Child’s developmental level Reactions of important adults Most severe: child witnesses parent’s violent death at a developmental stage of complete dependence on parentMost severe: child witnesses parent’s violent death at a developmental stage of complete dependence on parent

34. 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 Young children can remember traumatic events, but their memory is different from the way that older children or adults will remember. It will be remembered in line with their current developmental level. Distortions and omissions are common; young children may misunderstand an event or action. For example, the child could understand a medical procedure as an angry attack and instead of remembering that he got a shot, just understand and recall the person in the white coat hurt him on purpose. Another common memory mistake is forgetting some parts of the traumatic experience that the child could not make sense of. But don’t make the mistake of thinking that young children will always forget difficult material. That is not true. Young children often cannot grasp that death is forever. They may keep looking for a parent who has died. If you remember back when you took a psychology class, you may remember learning that young children sometimes believe that the world revolves around them. They often have magical thinking, believing that they can make things happen with their wishes. An unfortunate consequence of this belief can happen when a young child comes to believe that a bad thing happened when the wished it, or because they did something wrong.Young children can remember traumatic events, but their memory is different from the way that older children or adults will remember. It will be remembered in line with their current developmental level. Distortions and omissions are common; young children may misunderstand an event or action. For example, the child could understand a medical procedure as an angry attack and instead of remembering that he got a shot, just understand and recall the person in the white coat hurt him on purpose. Another common memory mistake is forgetting some parts of the traumatic experience that the child could not make sense of. But don’t make the mistake of thinking that young children will always forget difficult material. That is not true. Young children often cannot grasp that death is forever. They may keep looking for a parent who has died. If you remember back when you took a psychology class, you may remember learning that young children sometimes believe that the world revolves around them. They often have magical thinking, believing that they can make things happen with their wishes. An unfortunate consequence of this belief can happen when a young child comes to believe that a bad thing happened when the wished it, or because they did something wrong.

35. Effects of Trauma Can appear immediately or after days, weeks May remind young child of previous traumas, making reaction more severe Responses or reactions to trauma may not show up right away. When placed with you, the child may seem fine, then start to show regression or behavior features days or even weeks later. For children who experience chronic trauma or neglect, repeated exposures can worsen the reactions.Responses or reactions to trauma may not show up right away. When placed with you, the child may seem fine, then start to show regression or behavior features days or even weeks later. For children who experience chronic trauma or neglect, repeated exposures can worsen the reactions.

36. Effects of Trauma Physical & Self-Regulation Effects Traumatic Reminders Development Play Behavior Relationship Trauma can affect a child in many different ways, across all areas of development and activities.Trauma can affect a child in many different ways, across all areas of development and activities.

37. 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

38. 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

39. Traumatic reminders Can be difficult to identify in nonverbal child Sensory (siren, smell) Dreams Re-experiencing the event Irrational fear of benign objects It can be hard to figure out what the traumatic reminder is. Is it a person, object, or situation? This is a bigger problem when the child is not yet verbal, because it is hard for the child to help us to understand. Consider sensory experiences, including sounds and smell. A traumatic reminder can happen in dream time. If the child would like to tell, listen and stay close. The chidl may have the feeling that the upsetting even tis happening again. It can help to label that feeling (“I think you are remembering the time when blank happened.”) and then to add that that event is NOT happening now, and that you will try hard to make sure that it will not happen again. Irrational fear of benign objects: This is what happened with the boy in the exampleIt can be hard to figure out what the traumatic reminder is. Is it a person, object, or situation? This is a bigger problem when the child is not yet verbal, because it is hard for the child to help us to understand. Consider sensory experiences, including sounds and smell. A traumatic reminder can happen in dream time. If the child would like to tell, listen and stay close. The chidl may have the feeling that the upsetting even tis happening again. It can help to label that feeling (“I think you are remembering the time when blank happened.”) and then to add that that event is NOT happening now, and that you will try hard to make sure that it will not happen again. Irrational fear of benign objects: This is what happened with the boy in the example

40. 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 You may notice that children in your care who were abused or who experienced other forms of trauma act younger than their age. The child may be behind in all areas of may have a mixed profile: developing as expected in some ways but not others. Delays in social and emotional skills are especially likely. Some children may go backward in a skills for a time following a trauma. For example, a child who witnessed a serious accident may lose their toileting skills for a time. You may notice that children in your care who were abused or who experienced other forms of trauma act younger than their age. The child may be behind in all areas of may have a mixed profile: developing as expected in some ways but not others. Delays in social and emotional skills are especially likely. Some children may go backward in a skills for a time following a trauma. For example, a child who witnessed a serious accident may lose their toileting skills for a time.

41. Effects on Play Skills Repetitive actions Driven quality Constricted quality Preoccupation with separation, loss, and reunion When you watch children in your care play, you may notice that the play has a driven quality, as though the child HAS to do certain things. The play may be repeated, with certain actions done over and over. Little emotion may be shown during the child’s play and it may seem narrow and not free like the play of other children. Children in foster care or who have lost parents in other ways may play out their preoccupation with separation, loss, and reunion. For example, the story of the play may be of a child repeatedly being lost and then found in a store or the woods.When you watch children in your care play, you may notice that the play has a driven quality, as though the child HAS to do certain things. The play may be repeated, with certain actions done over and over. Little emotion may be shown during the child’s play and it may seem narrow and not free like the play of other children. Children in foster care or who have lost parents in other ways may play out their preoccupation with separation, loss, and reunion. For example, the story of the play may be of a child repeatedly being lost and then found in a store or the woods.

42. 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 A baby who has been abused or traumatized can be expected to show some difficult behaviors. These behaviors reflect the baby’s problems with self regulation and a need for adults to help the baby regain or develop the ability to regulate using the cycle discussed earlier. It is not unusual for these babies to seem irritable and hard to soothe. You may find that the baby sleeps poorly, seems sad, or can’t be alone. Other babies show their upset with uncontrolled physical movements or tantrums. A baby who has been abused or traumatized can be expected to show some difficult behaviors. These behaviors reflect the baby’s problems with self regulation and a need for adults to help the baby regain or develop the ability to regulate using the cycle discussed earlier. It is not unusual for these babies to seem irritable and hard to soothe. You may find that the baby sleeps poorly, seems sad, or can’t be alone. Other babies show their upset with uncontrolled physical movements or tantrums.

43. 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 It is also not unusual for toddler or preschool children to show the effects of abuse or trauma exposure through their behaviors. Behaviors that relate to attachment may be distorted. This shows up when the child does not have balance in his ability to be close with an adult and move away from an adult appropriately. Toddlers can be too clingy, not able to calm down with adult help, or too inhibited. Others go the opposite and run off, acting reckless when you would expect them to stay close. Aggression is also common and can occur toward adults, other children, or your pets. This can occur because the child has had learned that aggression is the way to handle feelings or because the child has not had the chance to have adult support to begin to learn self control. While many young children are noncompliant and these behaviors are part of healthy development of self, abused children show noncompliance in an angry way that is more concerning. Redirection may not be effective as it would with normal developmental noncompliance.It is also not unusual for toddler or preschool children to show the effects of abuse or trauma exposure through their behaviors. Behaviors that relate to attachment may be distorted. This shows up when the child does not have balance in his ability to be close with an adult and move away from an adult appropriately. Toddlers can be too clingy, not able to calm down with adult help, or too inhibited. Others go the opposite and run off, acting reckless when you would expect them to stay close. Aggression is also common and can occur toward adults, other children, or your pets. This can occur because the child has had learned that aggression is the way to handle feelings or because the child has not had the chance to have adult support to begin to learn self control. While many young children are noncompliant and these behaviors are part of healthy development of self, abused children show noncompliance in an angry way that is more concerning. Redirection may not be effective as it would with normal developmental noncompliance.

44. 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 As we discussed developing secure specific connections to special adults is an important task fo this age range. When adult’s violate that trust, children can have problems forming positive relationships. Because they did not get repeated positive interactions, the child may not have developed the needed sense of self as a separate, worthwhile person. They may learn that relationships involve pain and expect to be treated badly. In times of upset or when frightened, the child does not have the capacity to be comforted by an adult.As we discussed developing secure specific connections to special adults is an important task fo this age range. When adult’s violate that trust, children can have problems forming positive relationships. Because they did not get repeated positive interactions, the child may not have developed the needed sense of self as a separate, worthwhile person. They may learn that relationships involve pain and expect to be treated badly. In times of upset or when frightened, the child does not have the capacity to be comforted by an adult.

45. 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* It is normal for the child in care to grieve being apart from the parent, even when the parent has been abusive. Bowlby reported this set of stages that the child goes through when the grief reaction is more long lasting or persistent. This can occur with separation for any reason, including parent is in prison, passed away, or the child is removed from the home for abuse or neglect. If symptoms persist longer than 3 to 6 months, seek professional help With verbal children, they may deny the birth parents ever existed and say that the foster parents are their real parents. This is a protective behavior because it is too difficult to think about the loss. Some children become extremely emotional instead of detaching. It is normal for the child in care to grieve being apart from the parent, even when the parent has been abusive. Bowlby reported this set of stages that the child goes through when the grief reaction is more long lasting or persistent. This can occur with separation for any reason, including parent is in prison, passed away, or the child is removed from the home for abuse or neglect. If symptoms persist longer than 3 to 6 months, seek professional help With verbal children, they may deny the birth parents ever existed and say that the foster parents are their real parents. This is a protective behavior because it is too difficult to think about the loss. Some children become extremely emotional instead of detaching.

46. 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 These are some common long term outcomes in children who experienced different typesof trauma. As many as 75% of abusers were abused as a child…..These are some common long term outcomes in children who experienced different typesof trauma. As many as 75% of abusers were abused as a child…..

47. 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 Children who were abused learned inappropriate parenting methods and are at risk to repeat these interactions with their own children. Children who were abused learned inappropriate parenting methods and are at risk to repeat these interactions with their own children.

48. Neglected Children John and Marissa Marissa is almost three years old. She and her newborn brother came into the care of John and his wife because the parents had an addiction problem. John usually takes care of the children in the morning because his wife has to be at work very early. John found out quickly that Marissa sees herself as her brother’s caregiver. He frequently finds her trying to feed or change the baby. Marissa often give John instructions about the baby, such as telling him to give the baby a pacifier or medicine. John knows that Marissa’s mother often left her and the baby alone a lot, but he can’t understand why she doesn’t stop trying to take care of the baby now that she is in a good home with competent adults.Marissa is almost three years old. She and her newborn brother came into the care of John and his wife because the parents had an addiction problem. John usually takes care of the children in the morning because his wife has to be at work very early. John found out quickly that Marissa sees herself as her brother’s caregiver. He frequently finds her trying to feed or change the baby. Marissa often give John instructions about the baby, such as telling him to give the baby a pacifier or medicine. John knows that Marissa’s mother often left her and the baby alone a lot, but he can’t understand why she doesn’t stop trying to take care of the baby now that she is in a good home with competent adults.

49. 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

50. 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

51. 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

52. 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 From Dozier et al. 2002 The situations that lead children to be removed from their homes also lead to relationship problems, as previously discussed. We may expect that young children in care may have behaviors that upset or confuse foster parents. The foster parent may ot understand the meaning of the behavior, leading to reactions that are not helpful and that may lead to more problems. In addition, the child may also have behaviors that come from grieving the loss of the birht parent, or attachment relationship. Child has behaviors associated with insecure attachment patterns Caregivers do not have skills to provide supports at child’s level of need. Child needs adult support for emotional regulation and to develop own capacity for emotional regulation. Child does not have caregiver to buffer from stressors. Physiological changes in neural and endocrine systems are present.From Dozier et al. 2002 The situations that lead children to be removed from their homes also lead to relationship problems, as previously discussed. We may expect that young children in care may have behaviors that upset or confuse foster parents. The foster parent may ot understand the meaning of the behavior, leading to reactions that are not helpful and that may lead to more problems. In addition, the child may also have behaviors that come from grieving the loss of the birht parent, or attachment relationship. Child has behaviors associated with insecure attachment patterns Caregivers do not have skills to provide supports at child’s level of need. Child needs adult support for emotional regulation and to develop own capacity for emotional regulation. Child does not have caregiver to buffer from stressors. Physiological changes in neural and endocrine systems are present.

53. 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 Due to inadequate care history or because of disruption of care, many children will show these difficult behaviors. These behaviors are confusing to foster parents; the response does not make sense from the foster parents perspective. These behaviors are learned and they do make sense in the world the child knows. These behaviors are a reasonable response to an unreasonable situation.Due to inadequate care history or because of disruption of care, many children will show these difficult behaviors. These behaviors are confusing to foster parents; the response does not make sense from the foster parents perspective. These behaviors are learned and they do make sense in the world the child knows. These behaviors are a reasonable response to an unreasonable situation.

54. 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. http://www.fkce.net/id99.htmhttp://www.fkce.net/id99.htm

55. 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 Supervised visits may lead parents to feel incompetent: child may affiliate with supervisor if afraid or angry with parent; parent may then feel even more badly; note taking by supervisor often interpreted as critical by now hypersensitive parent. Supervised visits may lead parents to feel incompetent: child may affiliate with supervisor if afraid or angry with parent; parent may then feel even more badly; note taking by supervisor often interpreted as critical by now hypersensitive parent.

56. Birth & Foster Parents Michael & his two families Michael is a 4 year old boy with many developmental delays. His parents, who have developmental and psychiatric problems, had trouble handling his behavior and asked to have him placed in foster care. While in care, the time came for him to go to a developmental evaluation at a child development center. His biological parents and foster mother both attended. At the end of the day, the adults met to discuss the results of the evaluation. As the psychologist talked Michael’s behavior, his father suddenly said, “I noticed today he is a lot better with the foster mother than he is with us.” the psychologist said, “That’s interesting. What do you think that’s all about?” The father said, “I don’t know. I guess we have a lot to do to get better.” It can be easy for foster parents and birth parents to feel conflicted, pitted against each other, and so on. For the child’s sake, working together is critical. Michael is a 4 year old boy with many developmental delays. His parents, who have developmental and psychiatric problems, had trouble handling his behavior and asked to have him placed in foster care. While in care, the time came for him to go to a developmental evaluation at a child development center. His biological parents and foster mother both attended. At the end of the day, the adults met to discuss the results of the evaluation. As the psychologist talked Michael’s behavior, his father suddenly said, “I noticed today he is a lot better with the foster mother than he is with us.” the psychologist said, “That’s interesting. What do you think that’s all about?” The father said, “I don’t know. I guess we have a lot to do to get better.” It can be easy for foster parents and birth parents to feel conflicted, pitted against each other, and so on. For the child’s sake, working together is critical.

57. 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 Whether the child will go home with parents or not, it is helpful if foster parents try coordinate with biological parents. Biological and foster parents can have different backgrounds, values, and ways of being with children. If you can, avoid making judgments about each other. Giving the child a familiar object from home can help their transition into care. Common objects are blankets, stuffed animals, etc. If the child does not bring such an object, the foster parent can help the child develop an object attachment. Whenever possible, have some photos of the birth family toe as separation. Ask the parents for them or if you can take some snapshots of the child and parent together. If appropriate, have a plan for the first visit. Even if you are not sure how much a child understands, talk to the child about what they will do and say and how it will feel. Remind them that they will see their parents again and that it is not their fault that they are living apart right now. Whether the child will go home with parents or not, it is helpful if foster parents try coordinate with biological parents. Biological and foster parents can have different backgrounds, values, and ways of being with children. If you can, avoid making judgments about each other. Giving the child a familiar object from home can help their transition into care. Common objects are blankets, stuffed animals, etc. If the child does not bring such an object, the foster parent can help the child develop an object attachment. Whenever possible, have some photos of the birth family toe as separation. Ask the parents for them or if you can take some snapshots of the child and parent together. If appropriate, have a plan for the first visit. Even if you are not sure how much a child understands, talk to the child about what they will do and say and how it will feel. Remind them that they will see their parents again and that it is not their fault that they are living apart right now.

58. How Foster Parents Can Help Responding to parent anger Listen Be non-reactive Acknowledge how difficult it is to be away from child Sometimes biological parents will take out their anger on the foster parents. The best way for you to be in this situation is to: Listen Don’t react or retaliate And Acknowledge that is is very hard to be away from one’s children. Don’t try to reason with the parent or point out why the separation occurred.Sometimes biological parents will take out their anger on the foster parents. The best way for you to be in this situation is to: Listen Don’t react or retaliate And Acknowledge that is is very hard to be away from one’s children. Don’t try to reason with the parent or point out why the separation occurred.

59. 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 Foster parents can help children in several ways: Always keep in mind that the child really does need you, no matter how little they show it. Look at rejecting or pushing away behaviors as old coping strategies. This is just what the child learned to do in other relationships. He does not know other ways to act yet. Say, I think you might be feeling angry about/afraid about/…. Say, I think you might be remembering that scary time when X happened. That is not happening now. What your own response to these behaviors. Try NOT to pull away, pull back, or lash out. Encourage, but do not force touch. (NOT the same as holding therapy) Help the child feel that they can make things happenFoster parents can help children in several ways: Always keep in mind that the child really does need you, no matter how little they show it. Look at rejecting or pushing away behaviors as old coping strategies. This is just what the child learned to do in other relationships. He does not know other ways to act yet. Say, I think you might be feeling angry about/afraid about/…. Say, I think you might be remembering that scary time when X happened. That is not happening now. What your own response to these behaviors. Try NOT to pull away, pull back, or lash out. Encourage, but do not force touch. (NOT the same as holding therapy) Help the child feel that they can make things happen

60. 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 Help the child feel safe and talk about how you are doing that Provide a routine that help show that you, the adult, are taking care of the child. You care the one who can be counted on to make decisions. Sensory activities can help children with regulation problems—discuss what to do with babies here (rocking, swaddling, etc) Watch for signs of re-enactment in play or with traumatic responses and stop the activities. Don’t forget TV, always have someone with the child at least at first. Be very careful with the news with young children. Also watch with video games your older children or adults in the home may play that might have scary content. If you have a chance, be a voice for the baby or toddler and help reduce moves from home to home.Help the child feel safe and talk about how you are doing that Provide a routine that help show that you, the adult, are taking care of the child. You care the one who can be counted on to make decisions. Sensory activities can help children with regulation problems—discuss what to do with babies here (rocking, swaddling, etc) Watch for signs of re-enactment in play or with traumatic responses and stop the activities. Don’t forget TV, always have someone with the child at least at first. Be very careful with the news with young children. Also watch with video games your older children or adults in the home may play that might have scary content. If you have a chance, be a voice for the baby or toddler and help reduce moves from home to home.

61. Another Way to Help Speak for the babies..

62. Question and Answer

63. 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)

64. Thank YOU for making a difference in a child’s life!Thank YOU for making a difference in a child’s life!

65. 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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