Birth to Six Initiative

1. Birth to Six Initiative Topic Three: Young Children in Foster Care

2. Learning Objectives • Learn how foster care is different for young children • Understand the role of the foster parent in the young child’s life • Understand how visitation with young children and birth parents should occur • Be able to create a visitation plan that meets the needs of young children • Value the need for a foster care system tailored for young children

3. What is foster care? • It is an intervention designed to protect and remediate children who have been maltreated.

4. Promote Infant Well Being • Physical Safety – child proofed homes • Provide developmentally appropriate levels of stimuli • Develop positive, nurturing relationships

5. Foster Care for Young Children:Premise #1 • Foster parent must become the primary caregiver and the primary attachment figure for the child.

6. Premise #2 • Safety, stability and emotional availability of the giving adult are paramount.

7. Premise #3 • Foster parents must psychologically invest in the child in order to become the attachment figure.

8. Premise #4 • Adults, but not young children, are capable of sustaining attachment relationships across time and space.

9. Question: • Based on these four premises, how is foster care different for young children?

10. Foster care is different for young children • Cannot sustain attachment relationships over time and space • Require substantial and regular physical emotional availability • No ability to appreciate the big picture of the child welfare system

11. How can foster parents help? • Be sensitive and responsive • Know and value the child as an individual • Place the needs of the child ahead of their own needs

12. Inherent Contradictions of Foster Parenting • Psychological Ownership • Love the child as their own • Advocate for the child • Become the child’s “go to” person in times of uncertainty • Uncertainty • Child can be removed at any time • Progress of biological parents

13. Isolation/lack of support • Repeated attachments and separation from children in their care • Insufficient or inadequate training • Caring for children who have experienced attachment difficulties • Behavioral or emotional difficulties

14. Institutional care for young children? • Children raised in institutions are at dramatically increased risk of • Disturbances of social relatedness and attachment • Externalizing behavioral problems • Inattention/hyperactivity • Developmental problems

15. Loss for Young Children • What do young children lose when they enter foster care?

16. Loss and Separation • Removal from birth family • Multiple placements • Ambiguous loss

17. Ambiguous Loss “with ambiguous loss, there is no closure; the challenge is to learn how to live with the ambiguity.” Pauline Boss, Ph.D. Ambiguous loss is a relationship disorder and not individual pathology.

18. Two types of Ambiguous loss situations • Type One: Occurs when there is physical absence and psychological presence. • Loss of parent due to divorce or giving up a child for adoption • Type Two: Occurs when there is physical presence but psychological loss • Person you care about is psychologically absent such as autism, depression, traumatic brain injury, dementia

19. How can the foster care system be different?Two Examples • Attachment and Bio behavioral Catch Up (ABC Intervention) • 10 session, manualized intervention delivered by trained clinicians in the home of the foster parent and young child together • Multi Disciplinary Treatment Foster Care (MTFC) • Intense training to foster parents, 24 hour on call staff, daily progress reports • Therapeutic play group, skills training, preschool, family therapy

20. Small Group Activity • Design a foster care system for young children in your county. • What would it look like? • What interventions would be in place? • What outcomes would you hope to see?

21. Facilitating Positive Transitions • Movement of infants should be prevented if possible. • Focus on the infant’s individual developmental needs • Timing is important • Before age 6 months, may be less traumatic than between 6-24 months when attachment is occurring. • Select a caregiver who is willing and able to care for the needs of an infant, i.e. crying, exploration when mobile, “terrible two’s”, etc.

22. Sensitive Transitions • Retain some semblance of continuity • Caregivers should share information about an infant’s needs and preferences • Caregivers should maintain an emotional connection based on their mutual desire for the infant’s well being • Maintain relationship with previous caregivers • Maintain child care settings whenever possible.

23. Retain some semblance of continuity(continued) • Maintain infant routines, including food, formula, sleep schedules • Maintain continuity in diapering, i.e. are they sensitive to temperature when being changed? • Use transitional objects, i.e. special toys, stuffed animals, blankets, music

24. Visitation • Effective visitation creates and optimal opportunity for children and parents to experience being together again. • A high quality visit has a therapeutic goal, incorporates well planned activities to support that goal and is conducted in a developmentally appropriate, interactive manner.

25. Visitation • Why is it important? • Who has the right to visit? • What should happen during visits?

26. The Role of Visitation • Is it harmful? • Stress vs. harm • Includes harm to child’s attachment to foster parent • Is it helpful to the child’s attachment to the biological parent? • What is the goal? • Is it helpful to the biological parents’ attachment to the child?

27. Principles of Visitation • Child’s well being is the primary concern • Must have an attachment figure present if visit more than 6 months old • Better to have an attachment figure present even if less than 6 months old • Child can sustain a relationship with parent without the parent being an attachment figure

28. As parents progress towards reunification, frequency and length of visits should increase • Relationships with foster parents should continue after reunification whenever possible

29. Things to Remember • Visitation is a child’s right, not a parent’s privilege. • Visitation should never be used as a reward or punishment. • Visitation should be planned and purposeful. • Visitation activities should match the child’s developmental level. • Visitation should occur in as natural a setting as possible.

30. Considerations of collaborative visitation • Visiting without attachment figure (foster parent) causes undue stress on child by second half of first year • Presence of the foster parent can improve quality of visit for biological parent

31. Promising Practices • Ice Breaker Meetings • Provide a structured, first informal meeting early in placement for both foster and birth families to create an atmosphere of “working together”. • This first meeting or “ice breaker” is a facilitated, child focused meeting held shortly after a child is placed (or replaced) in out-of-home care and lasting not more than thirty minutes.

32. Promising Practice: Visit Coaching • Visit coaching and support directly address the issues that brought the child into care, building on family strengths and guiding improved parenting. • Visit coaching begins with an agreement with the family that identifies the child-specific needs to be addressed and an understanding of how those needs relate to the risks that brought the child into care.

33. Visit Coaching (continued) • Before each visit, families work with the visit coach to address fears, barriers, and parenting issues. • During the visit, the coach actively acknowledges the family’s strengths in responding to their child(ren) and guides them in improving their skills. • After the visit, the family and coach evaluate how the next visit could be improved.

34. Small Group Activity • Develop a visitation plan for a child and mother. The mother is making good progress on her case plan and the plan is for reunification in 3 months. Currently visits occur one time a week for one hour.

35. Returning Home • Parents should develop a psychologically and physically safe home • The house should safety proofed • Place “transitional” objects in view of infants to create a “safe” environment • Sing a familiar song, read a familiar book, place former caregiver pictures around the home • Maintain current schedule • Refrain from “overnights” away from the home until adjusted

36. Looking at your County system • What is working well for young children? • What needs improvement? • Prioritize improvements

37. Discussion

38. Post-Test

39. Wrap Up & Next Steps