Meeting the needs of foster children within the EI System

1. Meeting the needs of foster children within the EI System IECC Conference Tacoma, WA—5/03/12 Julie Fisher, MSW, LICSW Jill Reece, MSW, LSWAIC Marnie Klaasen, Foster Parent Kindering—Bellevue, WA

2. Questions guiding our discussion • Why foster children and EI? • How to qualify foster children for EI services? • When to assess foster children for services? • Who is involved when you are working with foster children? • What is Infant Mental Health? Where does it happen?

3. “Children who are removed from their homes and placed into foster care due to abuse, neglect or abandonment, almost by definition have special needs.”State Early Childhood Policy Technical Assistance Network June 2003

4. Risk Factors • Neglect • Pre or Post-natal Substance Abuse • Early losses/Multiple Caregivers • Domestic Violence Exposure • Physical or Sexual abuse • Prenatal Rejection • Child Hospitalization • Chronic Illness • Caregiver’s Mental Illness • Family Members Incarcerated

5. Developmental ConsiderationsIDEA & CAPTA • Part C (ages 0-3) of the Individuals with Disabilities Education Act (IDEA) was established by the federal government in 1986. • The Child Abuse & Prevention Treatment Act (CAPTA) of 2003 requires that infants and toddlers involved in substantiated cases of maltreatment be referred to EI services. • Foster children under age three experience developmental days at TEN times the rate found in the general population (NCCP, Sept. 2010)

6. Medical considerations & Perinatal Insults • Almost 80% of young foster children have prenatal exposure to substance abuse • More than 40% are born prematurely or at low birth weight, two additional risk factors • Over 50% suffer from physical health problems --Columbia University’s National Center for Children in Poverty

7. WA State Maltreatment Statistics (from 2007) • 10,000 children in foster care • 1/3 of these children placed with relatives (in formal kinship arrangements) • 42,300 referred to CPS

8. How to Qualify Kids? • Breakdown by domains • Speech • Receptive—particularly with infants, social communication lacking • Expressive—lack of opportunity/speech not encouraged • Adaptive—feeding, sleeping, sensory issues, medical issues • Motor—hypertonic with drug exposure; delayed due to too much confinement • Social/Emotional—Behaviors; use of DECA-I/T & DECA-C as well as ICO

9. Importance of timing • Schedule as soon as possible after child comes into foster care—we have evaluation spots dedicated to foster children, as well as a dedicated FRC • Relationships with CHET screeners—CHET has to be out to the foster home within 30 days of the foster child coming into care

10. Who are the players? • Foster Parent or Relative Caregiver • Birth Parent • Children’s Administration Social Worker • Birth Siblings--may be in a different foster home • Visit Supervisor • CASA/VGAL

11. Tips for Early Intervention staff regarding the Foster Care System What to call the foster child? What to call the foster parents? Who has legal rights? Myths about foster parents Differences between foster parents and kinship caregivers

12. What is CHERISH? • CHildren Encouraged by Relationships In Secure Homes • CHERISH provides reparative and preventative interventions for foster children and caregivers that address their traumatic experiences and developmental impacts. • Foster Children ages 0-3 living in King County, WA in out-of-home care are eligible for the CHERISH program

13. CHERISH Services for Kids • Comprehensive developmental evaluation • Psychosocial assessment in the home • Early history (risk factors) • Historical and current symptoms • Direct observation of relationship patterns • Developmental therapies if there is a delay • Stepping Stones toddler preschool classes • Dyadic developmental psychotherapy (home visiting model) • Adjustment issues (i.e. infant temperament/caregiver fit, grief & loss, transitions) • Bonding (forming an attachment) • Attunement (accurately reading and responding to the social-emotional cues of another) • Trauma • Psychoeducation

14. CHERISH Support Services“If we value our children, we must cherish their parents.” - John Bowlby, MD • Brief therapy for foster & relative caregivers • Systems consultation for staff and caregivers • Mamas & Papas kinship support group for relative caregivers (collaboration with Youth Eastside Services) • Topical trainings around parenting and children with special needs

15. Foster Parent Support • According to researchers at the Oregon Social Learning Center, supporting foster parents and helping them manage their stress are the biggest keys to placement preservation… (Healey presentation, 3/5/11) • “The interventions that have provided the most robust evidence of effectiveness…have typically focused on providing services to support the caregiver-child relationship (Dozier, et al., 2002; Fisher et al, 2006).”

16. CHERISH Program Outcomes • Child & Caregiver well-being: • PIR-GAS Scores (part of DC: 0-3R) • DECA-I/T Scores • Parent satisfaction surveys • Placement preservation: • In their first 12 months of care, 98.3% of our clients had 1-2 placements • The federal practice standard is 86.7%; King County stat is 66.6%

17. What is Infant Mental Health? • Infant Mental Health (age 0-3) is the capacity of the child to experience, regulate, and express emotions; form close and secure interpersonal relationships; and explore the environment and learn. • IMH is synonymous with healthy social and emotional development. - Zero to Three

18. What is Attachment? • The basic concept is that every infant needs at least one close, dependable relationship providing nurturance, security, responsive interaction and encouragement of exploration to develop to their fullest potential. • Attachment is a biologically-based process. • “Relationships with intimate caregivers promote physical, emotional, and behavioral regulation in infants through repeated interactions that are predictable, responsive, and nurturing.” Zero to Three, July 2005

19. Attachment Patterns • SECURE • INSECURE • Avoidant: characterized by high degrees of dissociation and withdrawal • Ambivalent: characterized by a persistent highly aroused, vigilant state • Disorganized: characterized by role-reversal with caregiver Juvenile & Family Court Journal, 2004

20. When a Secure Attachment is formed… Studies of resiliency have consistently found that the most basic and important protective factor is the history of caregiver-child attachment.Secure attachments are a primary defense against the development of severe psychopathology associated with adversity and trauma. In children who have been exposed to early loss and stress, the quality of parent-child attachment is the most important determinant of long-term damage. Even when securely attached children deteriorate in the school years due to extreme adversity, they are more likely to rebound later.” Levy & Orlans, 1998

21. Neurobiology of Trauma • Fight, flight, freeze alarm reactions to acute stress or danger is instinctive and normal • HOWEVER, traumatic experiences in infancy & early childhood can trigger prolonged alarm reactions which alter the neurobiology of the brain and the central nervous system • “Your brain will become the kind of brain you need.” --Stirling, MD 3/27/07

22. Symptoms of Maltreatment • Developmental delays/skill regression • Eating patterns—food refusal, stuffing mouth, hoarding, no knowledge of “full” • Sleep issues (separation problems, falling asleep/waking up, night terrors) • Self-soothing behaviors • Emotional functioning—incessant crying or not crying when should; refusal to make eye contact; dislike of touch; serious affect; clingy behaviors • Aggression/Irritability • Hypervigilance & Panic • Decreased exploration/play

23. Parenting Interventions—it all starts with building a secure attachment… • Consistency, predictability, reliability • Parenting based on emotional age; expect regression & ENCOURAGE it • Understand reasons behind behaviors • Modeling, narration • Patience—repetition is the name of the game • Repairs & Re-do’s • Self-care—caregiver HAS to attend to own self-regulation

24. Reflective Practice

25. “Kiss me when I’m bad, that’s when I need it the most.” --Maura Stuard, age 9

26. Books for Foster & Adopted Children • Kids Need to Be Safe by J. Nelson • The Way I Feel by J. Cain • Maybe Days by J. Wilgocki & M. Wright • Hug by JezAlborough • Families Change: A Book for Children Experiencing Termination of Parental Rights by J. Nelson • My Many Colored Days by Dr. Seuss • Calm-Down Time by Elizabeth Verdick

27. Website Resources • www.talaris.org • www.adoptmed.org • www.abcintervention.com • www.nccp.org • www.circleofsecurity.org • www.zerotothree.org • www.childtrauma.org • www.cpeip.fsu.edu

28. Selected References • Gray, Deborah. 2007. Nurturing Adoptions: Creating Resilience After Neglect and Trauma. Perspectives Press. • Hopkins-Best, Mary. 1997. Toddler Adoption: The Weaver’s Craft. Perspectives Press. • Jones-Harden, Brenda. 2007. Infants in the Child Welfare System: A Developmental Framework for Policy & Practice. Zero to Three Press. • Levine, P.A. & Kline, M. 2007. Trauma Through A Child’s Eyes. North Atlantic Books. • Levy, T. & Orlans, M. 1998. Attachment, Trauma, & Healing. CWLA Press. • Siegel, D. & Hartzell, M. 2003. Parenting From the Inside Out. Tarcher/Penguin.