Essential social capital: Supporting foster parents

1. Essential social capital: Supporting foster parents Bernice Gabriel, Registered Psychologist School of Psychology, Massey University Child, Adolescent & Family Service, Hawke’s Bay DHB bernice.gabriel@hawkesbaydhb.govt.nz Joint Conference of the NZCCP and NZPsS April 2012

2. Dec 2009, 5,582 children in CYF care in NZ, ranging in age from 0 to 17 years (Atwool, 2010). New Zealand Maori continue to be significantly over-represented. The majority of children in care (c.i.c.) are placed with CYF caregivers or are in family/whānau placements. Older the child, less likely to achieve permanent placement; higher the number of placements the more behavioural/emotional problems and vice versa; and the more severe the maltreatment, the more dire are the outcomes for child. Introduction

3. Low levels of emotional support from parents and exposure to trauma, stress, loss, and emotional deprivation affect development of secure attachments (Tarren-Sweeney, 2008). High levels of impairment across emotional, behavioural, developmental and physical domains: attachment problems, relationship insecurity, inappropriate sexual behaviour, trauma-related anxiety, oppositional and defiant behaviour, inattention and/or hyperactivity, etc Poorer physical health, higher prevalence of learning and language difficulties, and poorer educational outcomes than other children. Mental Health Needs of Children in Care

4. 65% of c.i.c. in NZ have emotional or behavioural problems, 40% have a mental health disorder, including depression, anxiety disorder, conduct disorder and attention deficit hyperactivity disorder (Rankin, 2010). 7% of these children are engaged with a mental health service (poor recognition of behavioural and mental health problems by parents, caregivers and social workers, responsiveness of the mental health service, and caregiver capacity and level of engagement with mental health service. Externalising problems twice as common as internalising problems. Adolescents in care scored higher on depression scale than in general community, and also had higher rates of suicide attempts with many of them not having received professional help. Mental Health Needs of Children in Care

5. While some c.i.c. achieve placement stability, many have multiple placements and the risk of this increases the longer they are in care. As at 31 December 2009, 52.4% of children in care had between 1 and 3 caregivers, 25.5% had 4-6 caregivers, and 22.1% had >6 caregivers Of particular concern are figures for 0 to 4 age group - c.i.c. for more than two years have an average of just below 3 placements with a range between 1 and 9 (Atwool, 2010). Placement Breakdowns

6. Placement Breakdowns Complex MH and behavioural problems jeopardise placement stability resulting in unplanned moves Increasing likelihood that future placements will be disrupted Placement breakdowns increase MH and behavioural problems Rubin et al, 2004

7. Challenges of parenting go beyond typical parenting experiences - c.i.c. often have complex needs that may undermine effectiveness of evidence-based parent training programmes developed for securely attached children in generally intact families High parenting stress, lack of acknowledgement of burden of care, respectful engagement, involvement in decision-making, sharing of information, having opinions sought and valued, and substantive unmet needs for support and training on managing and responding to children’s difficulties Difficult to develop an attachment to a child who is detached, avoidant or indiscriminately affectionate Interventions should be directed to caregivers to maximise therapeutic potential of the placement Placement Breakdowns

8. Current literature fraught with methodological limitations Social learning theory is cornerstone of effective parent training but a quarter to a third of families do not benefit. Need to include attachment, attribution, family systems theories, and motivational interviewing approaches (Scott & Dadds (2009) Mixed evidence for the effectiveness of foster parent training and impact on child’s behaviour (Everson-Hock et al, 2011, Rork & McNeil, 2011). Some promising behaviourally based programmes, but need to include attachment-based interventions too. Effects of training decrease over time. Behaviour changes in children may emerge over a longer period of time Foster Parent Training Programmes

9. Recognition in therapeutic work of a need for caregiver support, education and training Cost effective to educate and share information in a group setting Initial meetings with CAFS and CYF managers early 2009 to discuss programme and fit with CYF national caregiver training structure. Training programme developed by CAFS psychologist and intern psychologist, and workshopped with CYF staff in HB for discussion and input Development of the Fostering Security Training Programme

10. CAFS and/or CYF clients so that keyworkers available for follow-up interventions First training programme, many issues arising related to CYF policies and practice, therefore CYF staff invited to co-facilitate. 5 programmes to date, 4 jointly with CYF Sept 2010, won Inaugural Werry Centre Innovative Workforce Development and Service Award in the category of innovation in service development Oct 2010 Christchurch CYF and CAFS staff trained. Other regions interested too… Development of the Fostering Security Training Programme

11. provide caregivers with education around child development, brain development, attachment theory, diagnostic issues, and the psychological and physiological effects of early trauma, abuse and neglect address factors affecting long-term foster care, facilitate self-reflection on parenting practices and qualities develop parenting skills to better understand and manage child’s behaviours, and understand and manage own responses to behaviour facilitate integrated approach to caregiver support between CAFS and CYFS establish support group for caregivers Long-term aim is prevention of placement breakdown Objectives

12. Fostering Security Programme More accurate attributions about child’s mood and behaviour Improved caregiver mind-mindedness, sensitivity, empathy Improved caregiver self-reflection Improved caregiver self-regulation, more appropriate responses to child’s mood and behaviour Placement stability Improved child behaviour, decreased caregiver stress levels and increased parenting confidence

13. Draws on attachment theory, child development theories, social learning theory, and attribution theory. Tone of FS group is non-judgemental, empathic, supportive, unconditional positive regard. Caregivers are nurtured, valued, supported, burden of care acknowledged. Many benefits from CAFS/CYF service integration, within and outside group. Field of interventions for c.i.c. tends to be characterised by distrust between agencies, lack of willingness to cooperate, inadequate communication and blame shifting – need a ‘whole of government approach’ (Conway, 2009) Fostering Security Programme

14. Three modules: 1. Psycho-educational module attachment theory infant brain development diagnostic issues the psychological, physiological and developmental impact of trauma, abuse, neglect and loss resilience factors factors contributing to successful long-term reparative care. Fostering Security Programme

15. 2. Caregiver self-reflection module self-care self-reflection on own attachment history and own internal working models self-regulation attributions for and responses to the child’s behaviour development of caregiver’s ability to reflect on their parenting and effect of this on the child caregiver’s interpretation of their child’s behaviour in terms of the child’s mental states (mind-mindedness) empathy, sensitivity, and responsiveness to the child, decreasing caregiver stress levels acknowledgement of high burden of care, validation, encouragement and support. Fostering Security Programme

16. 3. Behaviour management and skills training module developing a sense of safety and belonging for the child developing the child’s self-reflective and emotional regulation skills parenting to the child’s emotional level using consequences and rewards communicating with the child understanding and managing specific trauma- and attachment-related behaviours Fostering Security Programme

17. Caregiver evaluation forms High level of satisfaction with the programme Sense of relief at being listened to, understood and not being alone Wish that the training had been available earlier when child was placed Disclosure of own early difficulties and past mistakes with own children Preliminary Effectiveness Findings

18. Preliminary Effectiveness FindingsQualitative research – 6 main themes 1. Education and Information • Professionals to share the same information about the physiological and psychological effects of trauma, abuse, loss and neglect • Caregiver training to occur sooner • Caregivers to have information about child • Access/Visitation Issues • In best interests of child first • Not one size fits all • Need for team decisions around access/visitation

19. Preliminary Effectiveness FindingsQualitative research – 6 main themes • Grandparents Raising Grandkids • Lifestyle changes and isolation from peer group • Different parenting generation • Guilt issues – “Did I do something wrong when I raised my children?” • Historical Issues Re-surfacing • How they parented their children • How they were parented • Negative experiences with professionals • Own past trauma, abuse and/or neglect

20. Preliminary Effectiveness FindingsQualitative research – 6 main themes • “I’m Not Alone” • “I’m not a bad parent, I’m not doing the wrong thing” • “Others experiences give me hope for change, it’s not always going to be this way” • Useful Fostering Security Programme Strategies • E.g. Time in vs time out • Shark music: self-reflection and self-awareness • Steel box with velvet lining – firm but fair • Deliberate family belonging strategies

21. Quantitative research Initial pre-and post-group measures showed opposite of what had been expected – significant positive changes in child’s behaviour and not significant positive changes in parent stress levels. Current measures include parent and teacher questionnaires pre-mid- and post-programme. Evaluate caregiver’s ability to think about and effectively manage child’s mood and behaviour, and evaluate difference in child’s behaviour at home and at school/early childhood centre. Modular analysis of programme being undertaken to determine relative effect of the three modules on caregiver’s parenting and child’s behaviour. Preliminary Effectiveness Findings

22. References • Atwool, N. (2010). Children in Care. A report into the quality of services provided to children in care. Wellington: Office of the Children’s Commissioner. • Conway, P. (2009). Falling between minds: The effects of unbearable experiences on multi-agency communication in the care system. Adoption & Fostering, 33(1), 18-28. • Everson-Hock, E.S., Jones, R., Guillaume, L., Clapton, J., Goyder, E., Chilcott, Payne, N., Duenas, A., Sheppard, L.M., & Swann, C. (2011). The effectiveness of training and support for carers and other professionals on the physical and emotional health and well-being of looked-after children and young people: A systematic review. Child: care, health and development, 38(2), 162-174. • Rankin, D. (2010) Mental health of children in care. Child, Youth & Family. Presentation at the Werry Centre CAMHS Sector Day. • Rork, K.E. & McNeil, C.B. (2011). Evaluation of foster parent training programs: A critical review. Child & Family Behavior Therapy, 33, 139-170. • Rubin, D.M., Alessandrini, E.E., Feudtner, C., Mandell, D.S., Localio, A.R., & Hadley, T. (2004). Placement stability and mental health costs for children in foster care. Pediatrics, 113, 1336-1341. • Scott, S. & Dadds, M.R. (2009). Practitioner review: When parent training doesn’t work: theory-driven clinical strategies. Child Psychology and Psychiatry, 50(12), 1441-1450. • Tarren-Sweeney, M. (2008). The mental health of children in out-of-home care. Current Opinion in Psychiatry, 21, 345-349.