The BOOST Program: Meeting the needs of infants and toddlers in foster care

The BOOST Program: Meeting the needs of infants and toddlers in foster care Chelsea Siler, m.s, m.ed; A Step ahead in pierce County Melissa Russell, M.ed., ESA, IMH-E (III); Puget Sound ESD

Plan for today • What exactly is BOOST? • How does the Infant Mental Health model guide our work? • What do our services look like? • Strategies for supporting transitions for infants and toddlers in foster care • Questions/discussion

Background • How do we support infants and toddlers in foster/relative care who don’t qualify for Early Intervention (Part C) services but are considered “at-risk” (as a result of trauma history, attachment concerns, drug/alcohol exposure)?

What is the BOOST Program? • Home visiting services available to any infant/toddler living in Pierce County who is in foster or relative care through DCYF • Services continue up until a child turns 3, or until permanency is established (return to biological parents, or adoption is finalized) • Services focus on supporting the relationship between a caregiver and child

BOOST History • Established at A Step Ahead in Pierce County (ASAPC)14 years ago • Staff all have training/experience in infant mental health principles • Grant funded from a number of community partners, currently including the Pierce County Violence Prevention, United Way, several family foundations, and other fundraising/private donations • We serve about 80 children in foster care each year

Program Goals • Support the caregiver/child relationship so that each child can establish a healthy, secure attachment with an adult • Monitor children’s development and refer to other agencies/services as needed • Support transitions in a child’s life (i.e. placement changes, supervised visits, etc) • Address behavior and emotional regulation challenges, sleep or feeding concerns, etc. • Minimize the number of moves/placements a child experiences

Intake Process • Referrals received usually from social workers, CHET screeners, and area EI agencies • Staff obtains a Release of Information (ROI) from the child’s social worker, and contacts the family • 1-2 session intake process with the family to gather information about a child’s history, complete developmental screeners (ASQ, ASQ-SE) and write goals

Measuring Progress • Pre/Post parent surveys • Pre/Post ASQ-SE scores • Ongoing progress monitoring via the Hawaii Early Learning Profile (HELP) • Tracking moves

Infant Mental Health “Infant Mental Health” is defined as the healthy social and emotional development of a child from birth to three years; and a growing field of research and practice devoted to: -Promotion of healthy social and emotional development -Prevention of mental health problems -Treatment of the mental health problems of very young children in the context of their family Zero to Three, National Center for Infants, Toddlers and Families

IMH Principles in Practice • The relationship between an infant/toddler and his or her caregiver is paramount! • Goal: help caregivers and children experience safety and security in their relationship • We use play as a therapeutic tool to support the relationship by helping the caregiver understand the child’s abilities and needs. • We engage foster parents and caregivers to reflect on their own parenting practices and strengthen their capacity to understand their children’s emotional worlds.

Why is this important? • Stress early in life can have a physical impact on a baby’s health and development. Responsive parenting can reduce stress and promote resiliency in young children. • Experiencing sensitive and attentive caregiving helps children learn to express and regulate their emotions appropriately, and supports their ability to develop other healthy relationships into the future

Home Visiting • What does this look like in home visits? • Video clip

Transitions Change is hard on all but especially on the youngest of us……

Definition A transition is a bridge between the past, the present and the future. NerLittner said in 1975, “Until he can establish roots in his present relationships we need to protect his roots to the past, no matter how deformed they may be; without roots the child will die of emotional starvation. We build these bridges so that children can establish roots in their new relationships

Social and Emotional needs of the infant and toddler Infants and toddlers have a need for a primary attachment to one consistent adult. How are infants and toddlers in foster care impacted by this need? How do multiple childcare providers, transporters, foster parents, etc. impact healthy attachment?

Common Transitions/Moves for infants and toddlers in foster care • Move from birth family to foster care • Start of new childcare • Introduction of transporter(s) • Move from foster home to another foster home • Move from foster care to a birth parent • Move from foster care to a relative placement • Move from foster care to an adoptive home

Transition Tool Kit for infants and toddlers KEY COMPONENTS OF A TRANSITION: • For infants and toddlers in out-of-home placement, extra time and care must be employed by the team of adults who work with them to facilitate moves that keep the child’s best interest in mind. • Any move between primary caregivers, including a reunification with parents, a new foster or relative/kinship caregiver, or placement with an adoptive family, should be done with attention to the child’s experience. The main components of a transition plan are presented in this Tool Kit. • Listen to parents and caregivers – they are the experts on the child. • Transition plans are not an all or nothing endeavor. If parts of these best practice guidelines are not possible given the specific case situation, identify the aspects you can control and take action.

Before • Center relationships and contacts around shared goals of helping child well-being. • Develop a written transition plan document developed at Shared Planning Meetings (e.g. FTDMs) where all team members are invited to formulate this plan. • Ensure that roles, timeframes, services, and plans for follow-up are clear and agreed upon. • Consider referral to Infant Mental Health services for assessment and strategy support.

During • Multiple contacts between current and receiving caregivers prior to the move to a new placement (a minimum of 7-10 contacts). • Over the course of a minimum of 2 weeks. • 1-2 overnight stays with the receiving caregiver prior to the move. • A direct hand-off from the current caregiver to the receiving caregiver at time of the move.

After • Planned contacts between the current/previous and receiving caregivers following the move (minimum of 2-3 in person and/or virtual—such as Skype or FaceTime). No “waiting period” after the move for this contact. • Pictures and books of the previous family available to the child. • Follow routines and patterns from previous home for 2-3 weeks to offer familiarity of caregiving routines.

Transition Strategies for infants and toddlers FROM A CHILD’S EYES: • Infants and toddlers do not have the capacity developmentally to put the changes they are experiencing in their daily routine in perspective like an older child or adult. Therefore, it is important to create strategies that meet them at their developmental level, in the table below you will find different ways to support a move between primary caregivers. When using the below strategies use the following 4 phase framework to guide your placement transition:

1) Receiving caregiver enters the child’s world (current caregiver present). 2) Child and current caregiver enter the receiving caregiver’s world (current caregiver present). 3) Child enters receiving caregiver’s world and then returns to current caregiver. 4) Move occurs between caregivers and soon after previous caregiver visits the child (with receiving caregiver present). This Photo by Unknown Author is licensed under CC BY-NC-ND

STRATEGIES FOR SUPPORTING A HEALTHY TRANSITION • BUILD RELATIONSHIPS -Build and maintain positive relationships between all caregivers from the beginning to the greatest extent possible. • REFER -Foster children have increased risk for developmental delays, particularly in the area of social-emotional development. Refer children to Birth-to-Three services for assessment and recommendations. • COMMUNICATION -Create a communication plan for both parties (e.g., email, visit journal, phone/video calls). • REPLICATE DAILY EXPERIENCES - Maintain the same routines, experiences, and comfort items for the child in both living environments (e.g., use the same toys, foods/drinks, music, lullabies, soothing techniques, fabric softeners, etc.) – utilize the “All About Me” and “Child Information Form” on the website: www.cherish-kindering.org. • CREATE VISUALS -Create a transition book (with photos and cultural connections) to use with the child before, during, and after the transition process. Use photos of all caregivers and the child to support the transition process. • PREPARE THE CHILD -Identify when the child will be told about the move, who will tell him/her, and what will be said. Encourage sending caregiver to have a hopeful and reassuring approach with child.

Emotion coaching • A major focus in helping children who are moving is to help them identify and express their emotions. A second strategy is to include them as active participants in the moving process. – Vera Fahlberg

Before the Transition: • Schedule an FTDM to create the written transition plan and timeline. • Encourage positive contacts between caregivers. • Develop a collaborative transition plan. • Ask current caregivers to share child’s medical needs, services, likes and dislikes, soothing strategies and routines with receiving caregivers. • Ask all caregivers to look at transition books and photos with the child to assist with preparing for transition. • Consider cultural connections and needs of child. Embed these components throughout the transition plan. • Consider the experience of all caregivers and discuss appropriate additional supports.

During the Transition: • Introduce the child slowly to receiving caregivers with current caregivers present whenever possible. • Send a soothing object (e.g., blanket, toy) and photo of current caregivers with the child to all visit with receiving caregivers. • Schedule the first meetings in the child’s home environment or “home turf” (e.g., familiar playground, library or playgroup, etc.). Current caregivers should be present for the entire visit, but they are not there to supervise. Help build the child’s trust of receiving caregivers by encouraging all caregivers to interact with one another during subsequent visits. • Encourage current caregivers (and entire family, when possible) to be involved in literally handing off the child to receiving caregivers when it is time for the child to officially move. Make sure that a concrete “good-bye” takes place between the child and current caregivers. • Encourage new caregivers to use the transition book with photos with the child often to assist with coping with the transition.

After the Transition: • Facilitate the scheduling of a minimum of 2 in-person, phone, and/or virtual post-placement contacts between previous caregivers and receiving caregivers for after the transition takes place. The first visit is recommended to occur within the first 3-5 days of the move. The visit can occur in the receiving caregiver’s home or out in the community. The visit should not occur in the previous caregiver’s home, as this is confusing for the child. These visits help decrease stress and will result in a better relationship with the receiving caregiver. Children process their grief better when allowed contact with previous caregivers. • Instruct caregivers to continue using transition books, items, and photos often to support the child through this transition process. Encourage receiving caregivers to reach out to previous caregivers with questions about the child’s care, and for possible respite care after the first months following the transition.

Transition Toolkit • Created by Infant Mental Health staff from Northwest Center, Kindering, and A Step Ahead Pierce County • Informed by the writings of Vera Fahlberg, M.D. and Deborah Gray, MSW, MPA, LICSW.

Questions? Chelsea Siler BOOST Program Coordinator 253-363-0570 chelseas@asapc.org

The BOOST Program: Meeting the needs of infants and toddlers in foster care