Young Children in Out of Home Care: How Foster Parents Can HelpIndiana Association for Infant and Toddler

Mental Health

Stacey Ryan, LCSW & Angela Tomlin, Ph.D.

2007

Young Children in Foster Care Carol and Terry

Young Children in Foster Care There are over 540,00 children in foster care

in the US 25% of children in foster care are under 5

years old 13% of those entering care are under 1 year Infants are the faster growing population in

foster care

Young Children in Foster CareReasons for placement:

Neglect (30 to 59%) Parental incarceration (30 to 75%) Physical abuse (9 to 25%) Abandonment (9 to 23%) Sexual abuse (2 to 6%)

Factors Leading to Placement in Foster Care Parent issues

Child characteristics

Environmental stressors to the family

As a result….

Most children in foster care have:

Medical Mental health and Developmental problems

Young Children in Foster Care Once in foster care, babies stay longer than

other children They are more likely to be abused while in

foster care or when returned to parents Reunification of babies placed under 3

months is low More than 25% are returned to care after

reunification

Young Children in Foster Care

Of all the children who died from abuse and neglect,77% were under 4 years old.

How to Help?

Start with relationships…..

Promoting positive mental health in young children A good relationship with a caring adult is the

foundation

What can happen when young kids enter foster care?

What Adults do with Young Children Really Matters! Experience, especially social experiences,

change the way the brain is shaped and functions

When you do everyday good caregiving actions, babies and young children benefit

For a child in foster care, you may be providing the only positive relationship

On the Other Side…

Exposure to poor caregiving, abuse, or domestic violence can lead to developmental and mental health problems in young children

Babies, toddlers, and preschoolers can demonstrate depression, PTSD, and disruptive behaviors

Bottom Line

Babies and toddlers can experience:

Emotional distress Problems with early relationships Behavior difficulties Atypical development

How Foster Care Helps

One of the most important things a foster parent can do is to help young children have positive relationships

Doing this will help with development and behavior

To do it right, you have to pay attention to attachment

Attachment

Attachment is a special relationship between a baby or child and a special adult

To grow and develop infants and children have to be able to form attachments with adults

It is ok for babies and children to have more than one attachment

Attachments to Foster Parents Foster parents may have been told not to get

too close to children in their care

In past, it was believed thatit was confusing for children to feel close to foster parents

Attachments to Foster Parents Now we believe that attachments to foster

parents should be encouraged

It can be hard for children to have separations from parents

But the long term effects of no attachments at all are more damaging

What Helps

The most effective mental health intervention for young children in foster care is prevention of multiple changes in caregivers.

Multiple disruptions in placement have been associated with the most problematic outcomes.

The relationship between the child and the foster parent is a primary piece of the plan.

Secure attachment

Parent comforts and nurtures the baby when she is upset

The baby begins to expect that she will be able to get help when needed

Secure relationships lead to many positive long term effects

Adult actions that promote attachments Reduce upset feelings

Provide positive social experiences

Claiming behaviors

Arousal-Relaxation Cycle

Child experiences a need

Child feels upset

Adult satisfies need

Child feels content

Are there children with no attachments? There are children with no attachments

It is more likely that a child have an attachment problem rather than no attachment at all

The child will develop an attachment with the adult that is available

Why do children form attachments to abusive parents?

Children’s need for survival and safety results in attachment to any available adult, even those who abuse or threaten them

Children prefer the familiar, even when what is familiar is frightening

Insecure Attachments

Avoidant patterns (turning away from the caregiver when distressed) develop when caregivers reject baby’s request for nurturance.

Resistant patterns (fussy, resistant behavior) develops when caregivers inconsistently respond to the baby

Insecure Attachments

Infants show disorganized pattern when adults demonstrate frightening or frightened behavior with them

Infant is afraid of the person they look to for reassurance and nurturance

Infant behavior is unorganized and bizarre These patterns are common when children

are abused or they witness domestic violence

Long term Effects of Disorganized Attachments Aggression with peers Dissociative behaviors

Role of Foster Parent in Attachment Help the child develop a healthy attachment

Help child extend attachment to you and improved behaviors to birth family, new fosterfamily, or adoptive family

Abused Children

Kathy and James

Types of Trauma

Witnessing violence (domestic and other) Natural disaster Terrorism Accidents Neglect Abuse Loss of caregiver

Do Young Children Experience Trauma?

Children under 12 months account for 44% of deaths from child abuse and neglect

Persistent crying is an important risk factor in abuse of very young children, related to shaken infant syndrome

Young children and sexual abuse Infants and toddlers may account for as many

as 10% of substantiated sexual abuse

Appearance of sexualized behavior is more likely than physical findings

The younger the child when abused, the more likely sexualized behavior appears

Young children and domestic violence

Child sees attachment figure injured

Attachment figure cannot protect self; child is unsure if she can protect him

Attachment figure may in turn injure the child

Assessing severity of trauma

Closeness of people involved to the child

What the child saw

Child’s developmental level

Reactions of important adults

How Young Children Understand Traumatic Events and Experiences Cognitive and emotional capacity determines

how child experiences trauma Level of understanding can also affect

memory 2-3 year olds do not understand the finality of

death Young children may believe they caused a

traumatic event

Effects of Trauma

Can appear immediately or after days, weeks

May remind young child of previous traumas, making reaction more severe

Effects of Trauma

Physical & Self-Regulation Effects Traumatic Reminders Development Play Behavior Relationship

Physical and Self-Regulation Effects Self-regulation is important task of infancy In babies and young children, problems with

self-regulation look like:

Sleep problems

Eating problems

Exaggerated startle

Hypervigilance

Physical and Self-Regulation Effects Exposure to traumatic events seems to

change the way the infant reacts to future stressors

Animal and human studies shows changes in hormones and brain chemicals after trauma

These brain changes can be long lasting, leading the child to feel numb or anxious

Traumatic reminders

Can be difficult to identify in nonverbal child

Sensory (siren, smell)

Dreams

Re-experiencing the event

Irrational fear of benign objects

Developmental Effects of Trauma Developmental delays are expected—

developmental assessment is advised

Problems may occur in development of attachments and other social emotional skills

Regression is possible

Effects on Play Skills

Repetitive actions

Driven quality

Constricted quality

Preoccupation with separation, loss, and reunion

Effects on Behavior—infants and toddlers Increased irritability/inability to soothe Sleep disturbance Emotional distress; sadness Fears of being alone; clinging; refusal to

separate Motor agitation Temper tantrums

Effects on Behavior—toddlers and preschoolers Being too clingy with adults

Not able to be comforted when upset

Problems with exploration: either reckless or too inhibited

Aggression toward caregivers, peers, animals

Angry noncompliance

Effects on Relationship

Difficulty forming positive relationships Poor sense of self Lowered self esteem Expectation of being treated poorly Loss of secure base Loss of sense of trust

Long Term Effects of Trauma

Persistent grief reactions (Bowlby)

Protest: efforts to find the parent through crying, calling, and searching

Despair: lethargy, sadness, emotional withdrawal, loss of interest in activities

Detachment: apparent indifference to reminders; selective forgetting*

Long Term Effects of Trauma

Increased risk for academic problems Substance use and abuse Early pregnancy Criminal involvement Psychiatric symptoms and disorders Experiencing abuse as a child is linked to

abusing one’s own child

Abused children as parents

Harsh discipline Failure to respond to child’s needs Inconsistent limit setting Inability to express affection Inability to enjoy interactions with child Minimize or deny child’s painful experiences

Neglected Children

John and Marissa

Why Neglect Occurs

Parent is overwhelmed Parent does not know how to take care of

child Parent does not know how to ask for help Parent is afraid to ask for help

Young children and neglect

Failure to provide for child’s physical and emotional needs

Leaving child alone for long periods Leaving child for long periods with varied and

unreliable caregivers Effects of neglect can be as devastating as

physical or sexual abuse

Effects of neglect Lack of play and other developmental skills May hoard food Unfamiliar with things we take for granted Expects to take care of self or siblings Challenges adult authority Lacks trust in adults Avoids adults when upset; hard to soothe

Expected difficult reactions to placement in foster care Previous relationship failures lead the child to

behave in ways that alienate foster parents Caregivers misread behaviors and respond in

ways that increase problems Child responds to loss of attachment figure

with behavioral, emotional, and physiological dysregulation

Expected difficult behaviors of children in care Acting like they do not need caregivers, even

under threatening conditions Acting angry when adult makes efforts to

soothe Turning away when hurt Behaving aggressively toward caregivers Behaving aggressively toward peers Problem behavior after visits

Why Do They Do That?

You wake up in a strange bed, in a strange house, surrounded by furniture you're not familiar with, people you don't know, and perhaps even a language you don't understand. It's not the script of a B-rated suspense film; this is the real-world drama for children in foster care--a drama that Francine Cournos, director of the Washington Heights Community Service in New York City, knows all too well.

"Foster children are removed from everything they are familiar with and placed in a home that is probably out of their neighborhood, has different inhabitants, and is generally as strange as a foreign country," Cournos says. A former foster child herself, and author of a memoir entitled City of One, she remembers well the stress and trauma of adjusting to a different life--away from everyone she had known.

Why do we see behavior problems after visits with family? Visits with parents are traumatic reminders of

events that led to the separation or of the separation itself

Both the child and parent may feel anxious and angry

Supervised visits increasing parents feelings of incompetence

Child feels safer expressing angry feelings toward foster parent/family

Birth & Foster Parents

Michael & his two families

How Foster Parents Can Help Work with the parents Avoid judgments about the biological parents Provide transitional objects to child Provide family pictures Have a plan for the first visit

How Foster Parents Can HelpResponding to parent anger Listen Be non-reactive Acknowledge how

difficult it is to be away from child

How Foster Parents Can Help Recognize that the child needs you, even

when they do not show it Understand rejecting behaviors as old coping

methods Listen Put words to behaviors Attend to your own reactions Encourage touch, but do not force it

How Foster Parents Can Help at Home Safety Routine that shows an adult is “in control” Soothing sensory activities Stop activities that result in re-enactment

(including television) Advocate to reduce moves to provide

continuity

Another Way to Help

Speak for the babies..

Question and Answer

Want to learn more?

Indiana Association for Infant and Toddler Mental Health (mentalhealthassociation.com)

317/638-3501 EXT 221 Zero to Three (zerotothree.org) The Center for Social and Emotional

Foundations for Early Learning (csefel.uiuc.edu)

Young Children in Out of Home Care: How Foster Parents Can HelpIndiana Association for Infant and Toddler

Mental Health

Stacey Ryan, LCSW & Angela Tomlin, Ph.D.

2007