Enhancing Child Welfare: Reducing Disrupted Relationships

1. Channeling King Solomon: Reducing DisruptedRelationships & Improving Permanency Judith Silver, Ph.D.,Co-Director Safe Place: Center for Children’s Safety & Health

2. Questions to Ponder How does removing children from their family impact them emotionally? How can we shape practice early in a child’s encounters with the courts & child welfare system to reduce adversity?

4. Focus of Today’s Discussion • Impact of disrupted relationships • Promoting stability through: • Placement decisions • Visitation practices • Permanency planning

5. Placement Instability & Disrupted Relationships • Instability: • the quality of being unstable. Especially lack of emotional stability • Unstable: • Not firm or fixed, characterized by the inability to control the emotions • Disrupt: • To break apart, to throw into disorder, to cause to break down • Webster’s New Collegiate Dictionary

6. Northwest Foster Care Alumni Study (N = 1500) Compared to the general population, Foster Care alumni more likely to experience rates of mental illness: • Post Traumatic Stress: 6 times • Substance Abuse: 4 times • Anxiety Disorder: 2.5 times • Depression: 2 times

7. 54 % 43 % 25 % 22 % 20 % 16 % 12 % 10 % 4% 3 %

8. Casey National Alumni Study Alumni who succeeded-What works? • Delayed first placement due to family support efforts • Fewer placement disruptions • Largest + effect on High School Completion • Promoting a positive relationship between child and foster parent • Twice as likely to complete High School

9. Casey National Alumni Study Alumni with a higher number of placements were more likely to experience: • Decreased likelihood of reunification • Greater severity of behavior problems • More time in residential care

10. Theories on why placements disrupt • Is it due to the System? • Is it due to the kids?

11. Theories Why Placements Disrupt Behavior Problems Placement Change

12. Research Study What is the impact of placement stability on children’s behavior problems after entering foster care? N = 729 children 15 years old & younger Behavior evaluated @ entry to FC Placement Stabilityeval’d after 12 months FC Behaviorevaluated after 18 months Rubin, D., et al (2007) Pediatrics, 119, 336-344.

13. Placement Stability • Early Stability 52% • Late Stability 19% • Unstable 28%

14. Probability of Behavioral Problems at 18 Months, by Child's Placement Stability & Baseline Risk for Problems

15. 36% 25% 22%

16. Conclusions • Placement Stability Strongly Associated with Behavioral Outcomes • Children in FC experience placement instability unrelated to their baseline problems • Placement instability has significant impact on their behavioral wellbeing • It’s critical to improve placement stability as a means to improve children’s outcomes • Rubin, D. , et al (2007). Pediatrics, 119, 336-344

17. Changing Placements = Disrupting Relationships When we move a child in care from one home to another home…or one placement to another placement… We are moving a child from one relationship to another relationship Dorothy Henderson, LCSW, Through the Eyes of an Infant: Why Early Relationships are Important, Jewish Board of Family & Children’s Services, NYC

18. Why do Relationships Matter?

19. Early Relationships • Relationships: the building blocks of healthy development • What children learn • How they react to people & events • What they expect from themselves & others • Deeply based on relationships with parents National Research Council & Institute of Medicine (2000) Neurons to Neighborhods

20. Emergence of Early Relationships Newborn babies are completely vulnerable & depend on caregivers for: • Temperature regulation • Neuroendocrine regulation • Protection from infection • Food • Protection from danger • Comfort Dozier, M. [ccc]

21. Emergence of Early Relationships • Infant is hard-wired to recognize patterns • Infants begin to recognize patterns through repetitions of daily caregiving routines • Feeding, play, diaper changes, bedtime

22. Baby Cries => Mother Arrives => Soothes Baby => Baby Learns through all 5 Senses • Sound • Sight • Scent • Touch • Taste

23. Parent-Infant Interactions • Baby learns from these episodes of engagement: • What it’s like to be with mother & others • What can I expect to happen? • What usually happens • What is “normal”? • Babies use internal models to evaluate current situations Stern, Daniel (2002). The First Relationship. Harvard U Press

24. Video clip: Infants’ Expectations of Mother Still-Face Paradigm Edward Tronick, Ph.D. Harvard University Children’s Hospital, Boston www.youtube.com/watch?v=7AGJFg6twjg www.youtube.com/watch?v=HD3_nHXFkmw

25. Implications for Child Welfare & Courts • Even tiny infants will have a profound response when moved from: • Placement to placement • When we move a baby in care from one home to another home…or one placement to another placement… what we are really doing is….moving a baby from one relationship to another relationship.”Dorothy Henderson, LCSW, Jewish Board of Child & Family Services, NYC

26. Attachment Formation • Children internalize how to • Calm down, feel soothed • Protect self • Ideas about Trust • The Right to be Cared for • The Right to be Safe

27. Grieving Disrupted Relationships • Adults don’t recognize when very young children grieve • Children’s behaviors are misinterpreted: • Withdraws or Avoids Contact • Appears not to need comfort when hurt • OR • Indiscriminant in showing affection • M. Dozier, 2002

28. Promoting Attachmentfor Young Children in FC • Very young foster children need frequent & consistent contact with their parents • Frequent visits have been found to: • Reduce pain of separation • Promote attachment • Increase parent’s motivation to change • Help parents practice skills • Increase likelihood of timely permanency • Smariga, 2007; Potter & Rothschild, (2002)

29. Unique to babies involved with child welfare system Extraordinary Stressors: • Prolonged Neglect for most • Physical Abuse for some • Separation from Family Impact: • Infants’ biological stress responses • Their coping strategies can threaten their well-being

30. “David” Enters Foster Care • 7 month old boy with several fractures. Placed in foster care wearing a body cast • No eye contact, flat emotions or piercing high pitched cry

31. 8 Weeks Later • Happy & engaged with foster family • Hysterical if someone approaches his legs • Terrified of loud noises

32. Developmental Considerations in Placement Decisions • Children’s reactions to separation from parents differ by developmental stage • Children between 6 months & 3 years old are most vulnerable to separation • Older children, though vulnerable, have the language skills to better understand loss and cope with change • Young children need frequent contact with their parents • Smariga, 2004

33. Channeling King Solomon Decisions must ensure • Safety & wellbeing • Permanency How can we minimize instability for children? • ASFA & Fostering Connections Legislation

34. Promoting Commitment & Stability • Concurrent planning: • Support child’s attachments to family AND to consistent foster caregiver • Keep relationships stable whenever possible: • Don’t move child when not necessary • Engaging & Finding Family • Biological relationship does not trump stability & commitment

35. Judicial & Child Welfare Decision-Makers Can Ensure • At onset placement decisions promote long-term stability • Placement decisions promote healthy child-caregiver attachments • Ties are maintained with birth parents & siblings with frequent quality visits • Permanency decisions respect bonds children have forged in out of home care • NCJFCJ, ABA, Zero to Three (2009). Healthy Beginnings, Healthy Futures: A Judge’s Guide

36. Family Interaction to Promote Permanency Placement location supports: • Frequent, meaningful visitation • Parents’ involvement in healthcare appointments Ensure visits are in the child’s best interests: • Family’s willingness to get help • Child’s reaction to visits • Therapeutic needs of child • -Ginther & Ginther

37. Family InteractionVisitation Plan Develop Family Interaction Plan: • Individualized • Developmentally appropriate • Promotes Permanency Guided by ongoing assessment of parents’ ability to: • safely care for children • Interact positively with children

38. The Caregiver Capacity Checklist • What are the specific challenges faced by the caregiver in caring for this child? • What are the learning requirements for caregivers to meet the child’s needs? • What are the specific illustrations of this caregiver’s ability to meet the child’s needs? Dicker & Gordon, 2004

39. “Devon” • 26 months old with Failure to Thrive • Weekly visits focus on mother-child feeding behaviors • Referred for pediatric evaluation

40. Learning Requirements forDevon’s Parents • Make appointments with several medical specialists • Attend Appointments with Devon • Follow Through with Surgery • Follow Up with Medical Recommendations • Follow Medication Regimens

41. Family InteractionVisitation Plan Meaningful activities of daily living Adequate level of supervision Sensitive to parents’ & children’s emotions • It’s natural for children to become dysregulated and does not mean the parent erred during visit • Monitor child’s reactions over time E. Leonard, 3003; M. Smariga (2007).

42. Visitation: Relationship-Based & Competency-Based INITIAL Phase: • Maintain ties between parent & children • Assess parent’s capacity to care for child • Develop goals If progress is minimal: • Reconsider reunification as proper goal Rose Wentz, Best Practices in Visits. www.hunter.cuny.edu/socwork/nrcfcpp/

43. Caregiver CapacityRed Flags! For parents with addictions: • Noncompliance with substance abuse treatment • Random drug testing critical For parents with psychiatric disturbance: • Noncompliance with treatment /medication • Dicker & Gordon, 2004

44. Caregiver CapacityRed Flags! Noncompliance with child’s health appointments & medication or therapeutic regimens • This impacts Safety, as well as Wellbeing A child’s poor growth • Need to have Growth Curve plotted by healthcare provider • Dicker & Gordon, 2004

45. MIDDLE Phase: Activities to help parent learn & practice new skills & behaviors Now visits are: • More frequent • Longer • In a Variety of settings Gradual reduction in supervision

46. TRANSITION PhaseSmoothing Transition to Reunification Maximize contact Least Restrictive Setting Evaluate Remaining stressors Ensure services to help parent meet child’s needs Ginther, N. & Ginther, J.

47. Reunification Aftercare • Monitoring & Services • Arrange visits with foster parent to maintain relationships

48. Overcoming Barriers • Prioritize Cases • Involve Foster Parents • Collaborate with Community Stakeholders

49. The Judge’s Role • Develop clear, enforceable, written visitation orders for each case • Develop local rules that address visitation • Facilitate collaborative community efforts to improve visitation practices • Encourage Cross-System Training for all participants in dependency court re: • child development • Strategies to improve quality of visitation • L. Edwards (2003)

50. The End