1. Young Children in Out of Home Care: How Foster Parents Can Help Indiana Association for Infant and Toddler Mental Health Stacey Ryan, LCSW & Angela Tomlin, Ph.D. 2007

2. Young Children in Foster Care Carol and Terry

3. 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

4. Young Children in Foster Care Reasons 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%)

5. Factors Leading to Placement in Foster Care Parent issues Child characteristics Environmental stressors to the family

6. As a result…. Most children in foster care have: Medical Mental health and Developmental problems

7. 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

8. Young Children in Foster Care Of all the children who died from abuse and neglect, 77% were under 4 years old.

9. How to Help? Start with relationships…..

10. 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?

11. 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

12. 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

13. Bottom Line Babies and toddlers can experience: Emotional distress Problems with early relationships Behavior difficulties Atypical development

14. 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

15. 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

16. 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 that it was confusing for children to feel close to foster parents

17. 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

18. 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.

19. 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

20. Adult actions that promote attachments Reduce upset feelings Provide positive social experiences Claiming behaviors

21. Arousal-Relaxation Cycle Child experiences a need Child feels upset Adult satisfies need Child feels content

22. 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

23. 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

24. 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

25. 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

26. Long term Effects of Disorganized Attachments Aggression with peers Dissociative behaviors

27. 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 foster family, or adoptive family

28. Abused Children Kathy and James

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

30. 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

31. 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

32. 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

33. Assessing severity of trauma Closeness of people involved to the child What the child saw Child’s developmental level Reactions of important adults

34. 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

35. Effects of Trauma Can appear immediately or after days, weeks May remind young child of previous traumas, making reaction more severe

36. Effects of Trauma Physical & Self-Regulation Effects Traumatic Reminders Development Play Behavior Relationship

37. 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

38. 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

39. Traumatic reminders Can be difficult to identify in nonverbal child Sensory (siren, smell) Dreams Re-experiencing the event Irrational fear of benign objects

40. 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

41. Effects on Play Skills Repetitive actions Driven quality Constricted quality Preoccupation with separation, loss, and reunion

42. 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

43. 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

44. 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

45. 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*

46. 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

47. 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

48. Neglected Children John and Marissa

49. 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

50. 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

51. 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

52. 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

53. 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

54. 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.

55. 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

56. Birth & Foster Parents Michael & his two families

57. 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

58. How Foster Parents Can Help Responding to parent anger Listen Be non-reactive Acknowledge how difficult it is to be away from child

59. 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

60. 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

61. Another Way to Help Speak for the babies..

62. Question and Answer

63. 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)

65. Young Children in Out of Home Care: How Foster Parents Can Help Indiana Association for Infant and Toddler Mental Health Stacey Ryan, LCSW & Angela Tomlin, Ph.D. 2007