1. USING A TRAUMA LENS
FOR CHILDREN IN CARE
The reparative parenting group
programme for foster and kinship
carers

2. Why are we talking about this?
• Children in care present with high rates of “the
D‟s” -Oppositional defiant Disorder
-Conduct Disorder
-Attention deficit Hyperactivity Disorder
-Post traumatic stress disorder
-Reactive Attachment Disorder
-Mood disorder
-Bipolar Disorder
-Sleep/arousal/regulatory disorders

3. Why are we talking……
• Children in care have high levels of
presentations to hospital and emergency
departments
• Children in care have high levels of medication
use
• Emotional and behavioural problems are the
most common cause of placement disruptions.
• Poor educational, occupational and relational
outcomes.
• “Hard to treat”

4. High and complex needs
• Children in OOHC commonly have high and
complex needs which bring them to the attention
of support services.
• This population has significantly higher rates of
mental, developmental and physical health
problems than their non-fostered peers.
• These children are more likely to access public
sector services such as specialist health,
therapeutic and education programmes.

5. Low service uptake
• While present in relatively greater numbers,
children in OOHC have a very low rate of service
uptake.
• The majority of foster children identified as
needing support do not access services.
• Where looked after children do access support,
service providers often struggle to conceptualise
complex and fragmented trauma histories or
engage with children with limited connection to
care figures.

6. Using a trauma lens….
• Most/all children in care have suffered physical,
emotional and /or sexual abuse in their early
development, and at the hands of parental
figures.
• Most/all have suffered neglect.
• Most/all have suffered from losses and
dislocations from attachment figures.
• For most/all there has been a failure of
appropriate developmental experiences leading
to impaired developmental trajectories.

7. Using a trauma lens…..
• These developmental assaults have left sequelae- most
commonly-
-affect dysregulation
-chronic high arousal and hypervigilance, with consequent poor
concentration and learning
-a complex array of attachment strategies, including a need to
control, lack of trust in adults, a dismissive style and reluctance to
show feeling and need, exaggerated affects and needs, a poor
capacity to protect themselves.
-high levels of aggression
-an impoverished sense of themselves and other people
-a poor capacity for imagination and play
-verbal skills often poorer than non-verbal.
- poor sleep
- a range of specific trauma-related symptoms.

8. Using a trauma lens….
• These difficulties impact on the relationship the child can develop
with their carers- both foster and kinship carers.
• Yet the recovery from these traumas involves the experience of safe
predictable sensitive secure attachments, which allow the child to
grow and develop.
• The child‟s behaviours and fears work directly against this type of
relationship, often making it hard for the carer to accept, understand
and provide a corrective experience of care.
• The carer often becomes puzzled, disappointed and alienated from
the child, and in this context may search for mental health diagnoses
in an attempt to understand what is wrong with the child.
• This may be reinforced by the school, when the child has trouble
concentrating, can have violent outbursts and fails to keep pace with
peers.
• This is a current common pathway for help provision- and largely
ineffective.

9. Trauma informed practice
• Trauma informed practice seeks to
understand foster children‟s presenting
difficulties from a developmental
perspective (e.g., aversive experiences of
care, separation from attachment figures,
adjustment to new care environments) as
well as in the context of their current care
environment (e.g., caregiver needs,
expectations, perceptions).

10. OOHC in context

11. Correlates of childhood trauma
• Early and persistent experiences of trauma have
a fundamental impact on brain development,
organisation and functioning.
• Repeated experiences of aversive or inadequate
care confound children‟s capacity to connect
with others and contribute to enduring
attachment anxiety.
• These neurodevelopmental and attachment
correlates are complex in presentation,
entrenched and persist long after a child is
removed from their aversive care environment.

12. Disconnection
• The decision to remove a child from their family-of-origin
(FOO) is based on aversive experiences of care.
• However – the child‟s history of aversive care reduces
their capacity to adapt to being removed and placed in
an unfamiliar care environment.
• Children‟s resources are further strained by experiences
of care following removal such as subsequent changes
in carer, contact with FOO and changes within foster
family systems (e.g., entry/extrusion of foster siblings).
• Entry into OOHC represents a dislocation not only from
FOO but pre-existing school, peer and community
connections.

13. The care system
• The number of children in OOHC is growing and the demand for
placements commonly exceeds caregiver capacity.
• Pressure on existing carers is increasing in terms of the number of
children placed with a family and competition for existing support
resources.
• Foster carers often have limited connection to support services due
in part to scarce resources and foster children‟s high and complex
needs.
• Where present the efficacy of support is often reduced by common
misperceptions – particularly under-estimation of foster children‟s
needs, over-estimation of providers‟ capacity to effect change and
limited understanding or time frames required for progress.
• These misperceptions are based in part by the siloing of support
services and disconnection between child, carer and family
supports.

14. Fostering children
• Foster carers bring an array of pre-conceptions,
expectations, attributions, narratives and experiences to
their care role.
• These factors fundamentally shape the way carers
understand and interact with children in their care.
• Carers may have significant trauma histories
themselves, be unable to have biological children or are
isolated from extended families because of their decision
to foster.
• Kinship carers must maintain dual roles in caring for the
traumatised child while remaining connected with the
traumatising FOO.

15. Foster narratives
• Foster carers and children exist within dominant
and often competing narratives regarding
children in OOHC (e.g., „children should be OK
after being removed from abusive parents‟).
• These narratives stem from personal, family,
community and professional sources and shape
carers‟ perceptions of children‟s needs and how
these are best met.
• Two of the most common narratives from carers
is dissonance between expectations and reality
of care role and isolation associated with being a
foster carer.

16. Therapeutic foster care training

17. Genesis
• The Alternate Care Clinic (ACC) developed a therapeutic
foster care group training programme to address:
– Foster children‟s high and complex needs
– Low service uptake
– The reality that the carer relationship is core to the child‟s
recovery.
– The need for an intervention which was acceptable to carers.
– The need for an intervention which could be available to a range
of people working therapeutically with carers and children in
OOHC.
• These groups were developed from a trauma informed
perspective that incorporated neurodevelopmental,
attachment and systemic approaches.

18. Group process
• Training is provided in a group format using
psychodynamic principles – arousing content
and processes are mediated by group facilitators
and connection to shared experience of fellow
group members.
• Increased arousal in a supported environment
allows group members to access, reflect and
process a greater spectrum of care experiences
and facilitates connection to psycho-educational
components of training.

19. Format
• Group composition includes foster and kinship carers.
• Groups are currently composed of a range of carer types,
experience and make-up (e.g., child age, single carer homes,
Indigenous children).
• 9 content sessions and 1 follow up session.
• Sessions are 2.5 hours in length and run fortnightly at Redbank
House.
• Each group contains 2 facilitators who share responsibility for
content and process.
• Facilitators contact group members individually by phone on
alternate weeks to check in, monitor family progress and connect to
additional supports if requested.
• Childcare is provided on request.
• Psychometrics are administered pre- and post-training to monitor
progress and session feedback forms are provided throughout the
training.

20. Training structure
• Metaphor of House of Reparative Care.
• Foundation of reparative care is relationship
between child and carer.
• From this foundation cornerstones may be laid
by understanding impact of trauma on children‟s
neurodevelopmental trajectory and attachment
relationships.
• Effective parenting strategies emphasise the
importance of connection between children and
carers and the neurodevelopmental and
attachment needs of children in OOHC.

21. REPARATIVE PARENTING
• WHAT IS IT?
• A way of focusing on the parenting skills needed
by carers parenting children who have
experienced abuse and neglect within
attachment relationships, at vulnerable times in
their development.
• With children who have experienced multiple
losses before coming into their care.
• Who they may not know much about,
• Who will be very different from their own
children.

22. What is reparative parenting
• Foster children who are nurtured within a safe relational
environment are more likely to develop trust in the capacity
of others to care for them and less likely to maintain
maladaptive attachment strategies
• Foster children‟s early attachment relationships are often
damaged by recurrent experiences of abuse and neglect
• Reparative parenting encourages the development of safe
relational environments, within which traumatised children
are able to develop secure attachment relationships
• Secure attachment relationships contribute to children‟s
neurobiological development and can have a reparative
effect on key psychological processes (e.g., emotion
regulation, executive functioning, reflective capacity)

23. REPARATIVE PARENTING
• Is it different from other parent training?
• Is it different from other psychoeducation?
• Focus on the personal- the interactions between
that carer and that child, and the feelings elicited
in each.
• Finding ways for the foster parent to be the chief
agent for recovery of the child.
• Finding ways for carers to look after themselves.

24. REPARATIVE PARENTING
• Incorporates-
• Assistance with behaviour management
• PLUS identifying attachment anxieties and their
expression, and responses which help.
• PLUS identifying trauma issues from the child‟s
story and understanding the way “aggressive
outbursts”, “manipulative behaviour”, “being the
boss” etc might be understood.
• PLUS managing the feelings and automatic
responses these evoke.

25. How does reparative parenting
differ from „normal‟ parenting
• Shifts emphasis from seeking control over child
behaviour to helping children heal
• Reflects on current behaviour and emotions within a
historical context
• Some methods of behaviour management which are
effective with non-traumatised children escalate
traumatised children‟s behaviour (e.g., time out
strategies)
• Emphasises the importance of caregiver resources,
availability and reflective capacity
• Requires a greater investment of time, energy and
commitment

26. Reparative Parenting training
model – framework
1. Improve 2. Improve 3. Improve
Safety Reflection and Functioning
Coherence.
Child or
Young
Person
Carers
Wider
System

27. Reparative Parenting training
model – The House
I can trust adults to II csafely.
be in charge
My feelings are OK I am a “good kid”
I have a good relationship with my carer

28. Reparative Parenting training
model – components
• Manualised training program completed over a period of ten group
sessions by two Psychologist/Social Worker presenters
• Provide model to help explain arousal and the need to increase child‟s
feeling of safety, based on trauma model
• Provide model to help understand attachment and the concept of a
„secure base‟, based on circle of security model
• Teach child-directed play strategies to promote a secure relationship,
based on Parent Child Interaction Therapy model
• Teach strategies for setting limits while managing strong emotions,
based on social learning and emotion coaching theories
• Enable reflection on meaning of behaviour and caregiver responses
from an attachment perspective, based on circle of security and cycle
of repair theories
• Caregivers are encouraged to attend individual follow up sessions with
clinicians following conclusion of group sessions

29. Circle of Security
• Cooper, Hoffman, Marvin & Powell (1998)
• Caregivers attending to children‟s needs
• Provide a secure base for children to explore
from
• Provide a haven to which children are able to
return to
• Try to be bigger, stronger, wiser and kinder
• Whenever possible follow the child‟s lead
• Whenever necessary take charge

30. Cycle of Repair
• Maintaining trust and respect in the child-caregiver relationship
• Stress:
– Am I calm?
– What triggers my alarm system?
– What helps me to feel calm?
• I am calm:
– Is my child calm?
– What triggers my child‟s alarm?
– What helps to calm my child?
• Our repair routine:
– When I am calm and my child is calm what can we do together that feels good
to help repair our trust and respect?
– Be positive and avoid blame

31. Why is teaching reparative
parenting difficult
• Effective reparative parenting is fundamentally different
from „traditional‟ parenting
• Caregivers often assume parent training will be only
behaviourally oriented and focus on controlling problem
behaviour
• Caregivers may be challenged by :
– The commitment required (e.g., time, patience, self-care)
– Understanding children‟s needs within an attachment framework
(e.g., neurobiological factors, pace and scope of changes)
– Integrating reparative parenting information with other sources of
support (e.g., school, counselling, wider family group)

32. Challenges of teaching reparative
teaching in a group format
• Differing experiences of foster carers within group depending on:
– Kinship or non-kinship caregivers
– Age range and number of children in care
– Presence of non-fostered siblings
– Length of time spent as foster carer
– Level of external support foster carer is receiving
• Vicarious trauma associated with caring for children who have
experienced abuse and neglect
• Differing capacity for empathy and tolerating behaviour, including
rejection.
• Differing expectations and vulnerabilities, and commitment levels
• Caregivers own trauma histories may be activated
• Differing levels of individual, family, community and professional
resources

33. REPARATIVE PARENTING
• Foster Carers are very positive
• See it as different from other training and
helps them.
• Enables a group to use it, and gain from
each others knowledge.
• Enables a focus on the particular
relationships likely to be the most
reparative without stigmatising the carers,
or making them anxious about being
involved with “therapy”.