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Fostering Hope by Bridging the Gap
- 1. Fostering Hope by Bridging the Gap How to Meet the Unique Developmental and Emotional Needs of Foster Children
- 26. Understanding Abuse as Seen in Drawings Figure 1 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
- 27. Understanding Abuse as Seen in Drawings Figure 2 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
- 28. Understanding Abuse as Seen in Drawings Figure 3 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
- 29. Understanding Abuse as Seen in Drawings Figure 4 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
- 30. Understanding Abuse as Seen in Drawings Figure 5 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
- 31. Understanding Abuse as Seen in Drawings Figure 6 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
- 32. Understanding Abuse as Seen in Drawings Figure 7 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
- 33. Understanding Abuse as Seen in Drawings Figure 8 & 9 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
- 34. Understanding Abuse as Seen in Drawings Figure 10 & 11 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
- 35. Understanding Abuse as Seen in Drawings Figure 12 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
- 48. How the Unusual Needs & Difficult Behaviors Impact the Family
- 57. An Underestimated Challenge Create a therapeutic environment, be a healthy role model, offering a predictable, safe, and nurturing family experience, to children who have no inner locus of control
- 60. Pushing Buttons Foster children “pull” for repeating the trauma
- 63. Understanding the Difficult Behaviors & Recognizing Emotional & Developmental Needs
- 93. Discipline & Behavior Plans
- 105. Among infants placed in foster care at less than a year of age, the nature of the infant-foster mother relationship is a reflection of the foster mother’s attachment style. Conversely , with toddler placements (and older children), the child-foster mother relationship reflects the child’s previous attachment experiences (Stovall & Dozier, 1998).
Notas del editor
- When, for example, the young child hears about one boy who broke 15 cups trying to help his mother and another boy who broke only one cup trying to steal cookies, the young child thinks that the first boy did worse. The child primarily considers the amount of damage--the consequences--whereas the older child is more likely to judge wrongness in terms of the motives underlying the act (Piaget, 1932, p. 137)
- Ages 10, 13. and 16, Later added younger children, delinquents, and boys and girls from other US cities and from other countries Heinz Steals the Drug In Europe, a woman was near death from a special kind of cancer. There was one drug that the doctors thought might save her. It was a form of radium that a druggist in the same town had recently discovered. The drug was expensive to make, but the druggist was charging ten times what the drug cost him to make. He paid $200 for the radium and charged $2,000 for a small dose of the drug. The sick woman's husband, Heinz, went to everyone he knew to borrow the money, but he could only get together about $ 1,000 which is half of what it cost. He told the druggist that his wife was dying and asked him to sell it cheaper or let him pay later. But the druggist said: "No, I discovered the drug and I'm going to make money from it." So Heinz got desperate and broke into the man's store to steal the drug-for his wife. Should the husband have done that? (Kohlberg, 1963, p. 19)
- Stage 5 never becomes very prevalent If Kohlberg is right about the hierarchic nature of his stages, we would expect that people would still be able to understand earlier stages but consider them inferior, In fact, when Rest (Rest et al., 1969; Rest, 1973) presented adolescents with arguments from different stages, this is what he found. They understood lower-stage reasoning, but they disliked it. What they preferred was the highest stage they heard, whether they fully understood it or not. This finding suggests, perhaps, that they had some intuitive sense of the greater adequacy of the higher stages.
- While someone with these minimal qualifications can of course be a good foster parent, they do not ascertain that a person is ready for a child with trauma A traumatized child is very difficult to deal with, particularly when expectations go beyond providing basic needs for the child
- Elicit expectations from audience: Maybe: A hurt, uncared for, deprived, and vulnerable child would walk into your house and realize that you were someone good, someone safe, and that your house was a peaceful place, where s/he could finally be happy, and build long-lasting relationships That this child would be grateful for what you have provided And maybe even love you some day
- Audience, what they really experience 80% of children from high risk families (suffering from poverty, maltreatment, substance abuse, violence) develop severely compromised attachments 75% of foster children have a family history of mental illness or substance abuse. Over 80% of foster children have serious emotional and behavioral problems. 50% of foster children have cognitive and learning disabilities The youngest age group (0-3 yrs) are victimized most frequently. Interestingly: Substance abuse and the drug culture account for the majority of young children placed in foster care (Simms, 1991). Many children in foster care have experienced sexual abuse at some point in their lives.
- Audience, what they really experience 80% of children from high risk families (suffering from poverty, maltreatment, substance abuse, violence) develop severely compromised attachments 75% of foster children have a family history of mental illness or substance abuse. Over 80% of foster children have serious emotional and behavioral problems. 50% of foster children have cognitive and learning disabilities The youngest age group (0-3 yrs) are victimized most frequently. Interestingly: Substance abuse and the drug culture account for the majority of young children placed in foster care (Simms, 1991). Many children in foster care have experienced sexual abuse at some point in their lives.
- Hypervigilance Sleep Disturbance Inattention Hyperactivity Eating habits Self-Injurious Behaviors Impulsivity
- Particularly difficult to deal with Aggressive behavior Lack of concern for others Playing with, eating, smearing feces Inability to seek assistance from others
- So, with children who are aggressive, have little regard for other, cannot pay attention, and smear feces, you are supposed to : Create a therapeutic environment, be a healthy role model, not loose your cool, be predictable and nurturing, not get flustered or surprised in the process
- Most surprising feelings: Resentment Disgust Helpless Relief when the child left Foster parents often berate themselves for having normal reactions to strange behaviors
- Child Abuse trauma leads to feelings of powerlessness, shame and guilt, distrust, and often leads to a reenacting of abusive patterns in current relationships. The abuse is the one thing the child can count on. S/he knows what it takes to elicit it. But kindness was often followed by abuse. The state between unpleasure and pain. Karen: Abused, sexually, physically Very seductive, telling people she wanted to have sex, have a baby Feared rejection Did everything the foster family said they had difficulty tolerating Bio family very sadistic, her behavior never doing homework never studying engaging in sexual behavior in problematic places This all pulled for sarcasm, anger, frustration, low tolerance and patience
- recognize the limits of their emotional attachment to the child Understand the mixed feelings toward child understand mixed feelings toward the child's birth parents deal with the complex needs (emotional, physical, etc.) of children in their care Work with sponsoring social agencies dealing with the child's emotions and behavior following visits with birth parents Wanting to be loved and not getting it
- Foster children are typically very high needs They get everyone’s attention one way or another Aggression Sexual Other children want attention but there is little time for them because they are well-behaved If you do not give the foster child what s/he wants, s/he will up the ante, increasing severity of behavior until you do (or after you have set consistent, firm limits for a while) B/c some children are healthier, stronger, more capable, more is expected of them than those with lesser abilities You would not expect someone with less intelligence to make honor roll You would not expect someone disabled to run a marathon Thus they get privileges sooner which may feel “unfair”, confusing, and make you feel like a bad parent
- There are many different approaches, but what we have found most helpful is a comprehensive approach , which provides information which is as useful to the consumer as it is to the provider. Thus, having a clear and accurate picture of what is actually happening, why, and how you can address it from a variety of angles is important. I will address the difficulties with having inaccurate or unclear information later, as well as the importance of a team approach and support.
- You may only need some addressed, but usually there is an interaction effect. That is, a person is more than just one component. Thus, his emotional life will impact his academic life and access to cognitive potential, and vice versa.
- Those working with foster children/traumatized children benefit from not only knowing what the problem behaviors are, but why they are happening and what to do about it. The problem with difficult behavior due to a form of trauma is that people are likely to respond in the very way the perpetrator did Angry Frustration Being overly strict or permissive Feeling guilty The same behaviors can occur for different reasons, thus, knowing the reason helps to find the solution. There is a difference in being permissive b/c a child is conduct disordered and wants others to give up trying to limit him vs someone who gets others to give up and be permissive b/c he is masochistic and depressed
- Self-report measures are just that, a self-report. That means: biased if the person thinks s/he is depressed or has trouble with attention they can respond as such and look ADHD While this is useful in terms of understanding his/her subjective experience, it does not necessarily indicate the underlying cause example of self-report making everyone think Monique is ADHD and medicating her as such Objective : Questions that are answered Yes/No but the test is able to tell: when a person is truthful or not When a person is exaggerating and for what purpose Thus the results are able to accurately assist with diagnosis Projective : These are the most difficult for people to Fake b/c there is no right answer understand
- History: often not known of foster children due to moves, not everything is reported or accessible, and often bio parents were not the type to keep track of developmental milestones or have reasonable expectations of what is “normal” Family standards: often very surprising to see foster children and how they learned to behave Losses and Traumas ( unexpected events that occur as the child develops) and when they occurred in a person’s life are important to know about. A child who is 3 and loses a parent is very different from someone who first loses a parent at 15 or 25.
- Interactions : The child’s interaction with their parents and family members begins to frame their expectations for others around them Hostile home life leads to expecting the same The foster parent being different does not immediately change expectations Birth order : Oldest tends to be more responsible, caretaker Youngest tends to take on “baby” role, most permissive Social Interactions : Conflict : Learn how to deal with conflict from others
- Psychosocial – Deficits or disorders in the psychological or family development Trauma, Abuse, Neglect Lack of developmental milestones due to various areas of difficulty that the entire family faced together Psychological problems that would occur even in the “perfect” family environment due to temperament
- The child’s expression of their own temperament and ways of interacting with the world The child’s repetitive patterns of behavior and why the do the same patterns The child’s capabilities of expressing their needs, or lack thereof, depending on their current level of sophistication The child’s neurology, genetics, and biochemistry and the interplay with the real world Behavioral disorders/disabilities Behavioral treatment plan needs
- The child’s development and areas of struggle We all struggle to develop, and it wasn’t easy for any of us – no one gave us a choice in the matter The child’s individual temperamental preferences for various phases The child’s internal biochemistry and how it affects their interactions with others and how they respond to their own pain or pleasure The awareness of how many of these skills do not occur “as planned” even in the best of circumstances – otherwise known as “decalage.” When that occurs, even if a child is “advanced” in some area, they have a hard time with areas that fall behind Emotional disorders/disabilities
- Memory, Speed of processing, Capacity for different kinds of thoughts, Attention, Learning, Verbal and Nonverbal Abilities Executive Functioning How the brain works together to integrate various parts and execute responses that are good and adaptive How a person approaches a decision Areas of strength and weakness for intelligence and compensation/skill building How the deficits interplay with reality-based situations What parents can reasonably expect from their child and what are realistic goals What teachers can expect in performance Cognitive disorders/disabilities
- If all of that was done, you should have an accurate diagnosis Diagnosis: Can change over time due to resolving conflict or conflict becoming more ingrained Retesting: After a year or two of therapy and treatment Or, after the 3 rd grade Medication complications: Same issue of attentional difficult might mean different things Most common misdiagnosis right now is ADHD
- Stimulants: Can also help with depression Even helps those w/o ADHD Problematic for those with bipolar in family history Antidepressants: Problematic for those with a family history of Bipolar or those with agitated mood states Antipsychotics: Used for sleep and thinking or mood issues Mood stabilizers: Also used for seizure control and certain types of depression, particularly if the child has an anxious depression Difficulties: Social stigma When the bio family fights services: meds & therapy, foster parents are often in a difficult position Team disagreements on use of med and types of med
- The recommendations from a testing might involve: Emotional: therapy (Jessica will talk about this) and medication Cognitive: school accommodations such as a para, 1 on 1, individual classroom, how assignments or tests ought to be completed Behavioral: How to effectively discipline a child with trauma, how to talk to the child to avoid triggering oppositionality
- All children need rules and expectations to help them learn appropriate behavior. Children do not always do what parents want. Foster children rarely do what their foster parents want. This can be a difficult scenario in either instance, but particularly difficult when you are dealing with someone who is essentially someone else’s child, someone who has had a troubled/difficult past, someone you might feel sorry for, if you dislike feeling like you are punishing someone, if you fear anger, hatred, aggression...things foster parents inevitably experience with foster children
- Most foster children do not come from such a background
- Team Approach: It’s important that everyone who works with the child be consistent and supports the approach. Example of splitting b/t parents. Prioritize: Foster children and young children can only deal with so much at a time before becoming so overwhelmed nothing is learned. Pick a limited number of behaviors, (3-5), and focus on those Explanation: Explain your plans to the child and that everyone is going to do the same thing Child’s Investment : Important to know what the child hates to lose and wants to earn Praise : for wanted bx so the child knows what you like and what you don’t Logical Consequences : making it about the difference b/t who you are and what you do and comparable to real life, ex: phys agg, no play time with friends Follow-through and Commitment: Demonstrate that you pay attention all the time, apologize for letting them get away with something and that you will try not to do it again
- Immediate
- 6 yo highly verbal male: Physical Aggression (including but not limited to hitting, slapping, biting, scratching, kicking, jumping on people, throwing objects at people, using objects as a weapon) Physical aggression is problematic behavior, which could significantly interfere with Nicholas’s schooling and get him into serious trouble as he gets older, such as going to jail. In order to work with him on using other means to express himself, notice when Nicholas is becoming upset and ask him if he wants to “take a break ” and “go to his safe spot.” A place where he can cool down ought to be provided in all environments. Others ought to be stopped from interfering with Nicholas getting to his safe spot. When Nicholas becomes physically aggressive tell him: “ Nicholas, it is never ok to hurt people. You just lost an hour of TV time. What would Dr. Karla tell you?” If Nicholas says something to the effect of “Put it into words,” praise him and ask him to try his best to do this. If he does not know, indicate that she would say “Put it into words,” and ask him to give it his best try. For the first act of physical aggression Nicholas loses 1 hour of TV time, the same day. If he continues to be physically aggression after you have intervened, he loses another hour of TV time. 4 yo male with autism: Physical Aggression with Self and Others: A major problem area for Fred is his tendency to become physically aggressive both with himself and with other people. The above interventions are designed to decrease his stimulation so he is less likely to reach the point of physical aggression. The following interventions are for the times when Fred does engage in physical aggression towards people. “ No,” has become a stimulus for Fred’s aggressive behavior so this word should be avoided. So instead of saying “No Fred, that’s not your toy.” You should say, “Fred that is John’s car. You and teddy bear can play with this car or read this book.” Or instead of saying “No Fred, take that toy out of your mouth.” You should say, ”Fred are you and teddy bear hungry? We can get some food if you are hungry. We play with toys with our hands.” Whenever possible give Fred choices while redirecting him. When Fred does hit himself or others he should be reminded of the need for safety and taken to his quiet area. “ Fred, we don’t hit. Hitting hurts. We stay safe here. Let’s take teddy bear to the quiet spot for a break so we can stay safe.” Safety of Fred and others should be the top priority. If caregivers have difficulty redirecting Fred, and he continues to be aggressive, he will likely need to be physically brought to his quiet area. It is still important to prepare Fred for the physical touch. “ Fred, I need to help you stay safe. I won’t hurt you. I am going to pick you up and bring you to the quiet spot. I won’t hurt you. We stay safe here.”
- 13 yo female: Verbal Aggression (yelling, cursing, back-talking) Viola may say anything in her therapy sessions without getting in trouble Viola may say anything to her mother, provided she speaks with her in a calm voice If Viola is engaging in verbal aggression (defined above), adults ought to say: “ Viola, I’m glad you’re using your words. Make sure to let Dr. Karla know how you’re feelings. Is there a better way you can let me know what’s going on?” If Viola is able to speak about her concerns or chooses to take a time-out, praise her for being mature and making a good choice. If she continues engaging in verbal aggression, provide her with a total of 3 warnings. If she continues after the 3rd warning, let her know that she just lost her outing with her mother. If Viola is able to stop engaging in verbal aggression by the end of 3 warnings for a week, she earns an outing alone with her mother. 13 yo male: Verbal Aggression (defined as cursing, raising his voice to the point of yelling, asking “why” more than 3 times) At times Jeremiah resorts to verbal aggression. In order to work with him on finding more adaptive behavior, give him the following warning: “ Jeremiah, you’re being verbally aggressive. Think about the message you are sending. This is strike ______ (one, two).” If Jeremiah continues to be verbally aggressive after 2 warnings, he loses the option for any activities for 24 hours. If he is verbally aggressive two times in one week he must attend three therapy sessions. 7 yo male: Cursing When Eric curses ( limited to words involving ‘shit,’ ‘fuck,’ ‘ass,’ and ‘damn.’), tell him: “ Think about the way you are coming across. It’s not ok to do it here. Save it for Dr. Karla.” If Eric discontinues cursing, praise him for “turning it around”. If he continues cursing, provide him with a second warning (see above). If Eric discontinues curing, praise him again. If Eric curses a third time, tell him “ Eric, you know the consequence for cursing. Now you lose the chance to use your Black Pearl for the next 24 hours.”
- Oppositionality/Argumentative Behavior Oppositionality is defined as when David does not follow through with an activity he has been assigned by a person in authority or attempts to argue with a person in authority. When David is oppositional/argumentative, tell him : David ,you have a choice. You can ______ when I ask you or you can lose computer time. If David continues to be oppositional, give him a second warning, reminding him that if he continues, he will lose computer time. Consequence : For each act of oppositionality that has required 2 warnings, David loses 15 minutes of computer time.
- This means with a young child, the effort you put in gets clear, direct results. With older children it is much more difficult. How do you convince a child you are different from his or her birth mother/father.
- We designed a Foster Parent Group to address these issues.
- We designed a Foster Parent Group to address these issues.
- SKIP this page if short on time
- Can address these issues in group: dual process What the child feels the parent feels “ My chaos is your chaos” Some of these feelings are emotional reactions, feeling what the child is feeling: unprepared, underserved, unclear on what is expected, never included in case planning, information kept from them Sounds a lot like the concerns of a foster child