Channeling King Solomon: Reducing DisruptedRelationships

& Improving Permanency

Judith Silver, Ph.D., Co-DirectorSafe Place: Center for Children’s Safety & Health

Questions to Ponder

How does removing children from their family impact them emotionally?

How can we shape practice early in a child’s encounters with the courts & child welfare system to reduce adversity?

Focus of Today’s Discussion

• Impact of disrupted relationships• Promoting stability through:

– Placement decisions– Visitation practices– Permanency planning

Placement Instability & Disrupted Relationships

• Instability: – the quality of being unstable. Especially lack of

emotional stability

• Unstable: – Not firm or fixed, characterized by the inability to

control the emotions

• Disrupt: – To break apart, to throw into disorder, to cause to

break down» Webster’s New Collegiate Dictionary

Northwest Foster Care Alumni Study (N = 1500)

Compared to the general population, Foster Care alumni more likely to experiencerates of mental illness:

–Post Traumatic Stress: 6 times –Substance Abuse: 4 times–Anxiety Disorder: 2.5 times–Depression: 2 times

54 %

22 %

43 %

16 %25 %

4%

20 %

10 % 12 %

3 %

Casey National Alumni Study

Alumni who succeeded-What works?• Delayed first placement due to family

support efforts• Fewer placement disruptions

– Largest + effect on High School Completion

• Promoting a positive relationship between child and foster parent– Twice as likely to complete High School

Casey National Alumni Study

Alumni with a higher number of placements were more likely to experience:–Decreased likelihood of reunification–Greater severity of behavior problems–More time in residential care

Theories on why placements disrupt

1. Is it due to the System?

2. Is it due to the kids?

Theories Why Placements Disrupt

Behavior

Problems

Placement Change

Research Study

What is the impact of placement stability on children’s behavior problems

after entering foster care?N = 729 children 15 years old & youngerBehavior evaluated @ entry to FCPlacement Stability eval’d after 12 months FCBehavior evaluated after 18 months

Rubin, D., et al (2007) Pediatrics, 119, 336-344.

Placement Stability

• Early Stability 52%• Late Stability 19%• Unstable 28%

Probability of Behavioral Problems at 18 Months, by Child's Placement Stability & Baseline Risk for Problems

22%

29%

47%

25%

32%

51%

36%

45%

64%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Low Med High

Pro

bab

ilti

y o

f B

ehav

iora

l P

rob

lem

s

Child's Baseline Risk for Placement Instability

Early

Late

Unstable

*

*

*

* p < 0.05

22% 25%

36%

Conclusions• Placement Stability Strongly Associated with

Behavioral Outcomes• Children in FC experience placement

instability unrelated to their baseline problems

• Placement instability has significant impact on their behavioral wellbeing

• It’s critical to improve placement stability as a means to improve children’s outcomes

• Rubin, D. , et al (2007). Pediatrics, 119, 336-344

Changing Placements = Disrupting Relationships

When we move a child in care from one home to another home…or one placement to another placement…

We are moving a child from one relationship to another relationshipDorothy Henderson, LCSW, Through the Eyes of an Infant: Why Early Relationships are Important, Jewish Board of Family & Children’s Services, NYC

Why do Relationships Matter?

Early Relationships

• Relationships: the building blocks of healthy development– What children learn– How they react to people & events– What they expect from themselves & others

• Deeply based on relationships with parents National Research Council & Institute of Medicine (2000)

Neurons to Neighborhods

Emergence of Early Relationships

Newborn babies are completely vulnerable & depend on caregivers for:

• Temperature regulation• Neuroendocrine regulation• Protection from infection• Food• Protection from danger• Comfort

Dozier, M. [ccc]

Emergence of Early Relationships

• Infant is hard-wired to recognize patterns

• Infants begin to recognize patterns through repetitions of daily caregiving routines– Feeding, play, diaper changes, bedtime

Baby Cries => Mother Arrives => Soothes Baby

=> Baby Learns through all 5 Senses• Sound• Sight• Scent• Touch• Taste

Parent-Infant Interactions

• Baby learns from these episodes of engagement:– What it’s like to be with mother & others– What can I expect to happen?– What usually happens– What is “normal”?

• Babies use internal models to evaluate current situations

Stern, Daniel (2002). The First Relationship. Harvard U Press

Video clip: Infants’ Expectations of Mother

Still-Face ParadigmEdward Tronick, Ph.D.

Harvard UniversityChildren’s Hospital, Boston

www.youtube.com/watch?v=7AGJFg6twjgwww.youtube.com/watch?v=HD3_nHXFkmw

Implications for Child Welfare & Courts

• Even tiny infants will have a profound response when moved from: – Placement to placement

• When we move a baby in care from one home to another home…or one placement to another placement… what we are really doing is….moving a baby from one relationship to another relationship.” Dorothy

Henderson, LCSW, Jewish Board of Child & Family Services, NYC

Attachment Formation

• Children internalize how to–Calm down, feel soothed–Protect self

• Ideas about Trust–The Right to be Cared for–The Right to be Safe

Grieving Disrupted Relationships

• Adults don’t recognize when very young children grieve

• Children’s behaviors are misinterpreted:– Withdraws or Avoids Contact– Appears not to need comfort when hurt– OR– Indiscriminant in showing affection

• M. Dozier, 2002

Promoting Attachmentfor Young Children in FC

• Very young foster children need frequent & consistent contact with their parents

• Frequent visits have been found to:– Reduce pain of separation– Promote attachment– Increase parent’s motivation to change– Help parents practice skills– Increase likelihood of timely permanency

• Smariga, 2007; Potter & Rothschild, (2002)

Unique to babies involved with child welfare system

Extraordinary Stressors:• Prolonged Neglect for most• Physical Abuse for some• Separation from FamilyImpact:

– Infants’ biological stress responses– Their coping strategies can threaten their

well-being

“David” Enters Foster Care

• 7 month old boy with several fractures. Placed in foster care wearing a body cast

• No eye contact, flat emotions or piercing high pitched cry

8 Weeks Later

• Happy & engaged with foster family

• Hysterical if someone approaches his legs

• Terrified of loud noises

Developmental Considerations in Placement Decisions• Children’s reactions to separation from

parents differ by developmental stage• Children between 6 months & 3 years old are

most vulnerable to separation• Older children, though vulnerable, have the

language skills to better understand loss and cope with change

• Young children need frequent contact with their parents

• Smariga, 2004

Channeling King Solomon

Decisions must ensure• Safety & wellbeing• PermanencyHow can we minimize

instability for children?

• ASFA & Fostering Connections Legislation

Promoting Commitment & Stability

• Concurrent planning:– Support child’s attachments to family AND

to consistent foster caregiver• Keep relationships stable whenever possible:

– Don’t move child when not necessary– Engaging & Finding Family– Biological relationship does not trump stability &

commitment

Judicial & Child Welfare Decision-Makers Can Ensure

• At onset placement decisions promote long-term stability

• Placement decisions promote healthy child-caregiver attachments

• Ties are maintained with birth parents & siblings with frequent quality visits

• Permanency decisions respect bonds children have forged in out of home care– NCJFCJ, ABA, Zero to Three (2009). Healthy

Beginnings, Healthy Futures: A Judge’s Guide

Family Interaction to Promote Permanency

Placement location supports: • Frequent, meaningful visitation • Parents’ involvement in healthcare

appointmentsEnsure visits are in the child’s best interests:• Family’s willingness to get help• Child’s reaction to visits• Therapeutic needs of child• -Ginther & Ginther

Family InteractionVisitation Plan

Develop Family Interaction Plan:– Individualized– Developmentally appropriate– Promotes Permanency

Guided by ongoing assessment of parents’ ability to:

• safely care for children• Interact positively with children

The Caregiver Capacity Checklist

What are the specific challenges faced by the caregiver in caring for this child?

What are the learning requirements for caregivers to meet the child’s needs?

What are the specific illustrations of this caregiver’s ability to meet the child’s needs?

Dicker & Gordon, 2004

“Devon”

• 26 months old with Failure to Thrive

• Weekly visits focus on mother-child feeding behaviors

• Referred for pediatric evaluation

Learning Requirements forDevon’s Parents

• Make appointments with several medical specialists

• Attend Appointments with Devon• Follow Through with Surgery• Follow Up with Medical Recommendations• Follow Medication Regimens

Family InteractionVisitation Plan

Meaningful activities of daily livingAdequate level of supervisionSensitive to parents’ & children’s emotions

– It’s natural for children to become dysregulated and does not mean the parent erred during visit

– Monitor child’s reactions over timeE. Leonard, 3003; M. Smariga (2007).

Visitation: Relationship-Based & Competency-BasedINITIAL Phase:• Maintain ties between parent & children• Assess parent’s capacity to care for child• Develop goalsIf progress is minimal:• Reconsider reunification as proper goal

Rose Wentz, Best Practices in Visits. www.hunter.cuny.edu/socwork/nrcfcpp/

Caregiver CapacityRed Flags!

For parents with addictions:– Noncompliance with substance abuse

treatment– Random drug testing critical

For parents with psychiatric disturbance:– Noncompliance with treatment /medication

– Dicker & Gordon, 2004

Caregiver CapacityRed Flags!

Noncompliance with child’s health appointments & medication or therapeutic regimens– This impacts Safety, as well as Wellbeing

A child’s poor growth– Need to have Growth Curve plotted by

healthcare provider – Dicker & Gordon, 2004

MIDDLE Phase:

Activities to help parent learn & practice new skills & behaviors

Now visits are:–More frequent–Longer–In a Variety of settings

Gradual reduction in supervision

TRANSITION PhaseSmoothing Transition to Reunification

Maximize contactLeast Restrictive SettingEvaluate Remaining stressorsEnsure services to help parent meet

child’s needsGinther, N. & Ginther, J.

Reunification

Aftercare – Monitoring & Services– Arrange visits with foster parent to

maintain relationships

Overcoming Barriers

• Prioritize Cases• Involve Foster Parents• Collaborate with Community

Stakeholders

The Judge’s Role• Develop clear, enforceable, written visitation

orders for each case• Develop local rules that address visitation• Facilitate collaborative community efforts to

improve visitation practices• Encourage Cross-System Training for all

participants in dependency court re: – child development – Strategies to improve quality of visitation

• L. Edwards (2003)

The End

References & Resources

• Dicker, S. & Gordon, E. Ensuring the Healthy Development of Infants in Foster Care: A Guide for Judges, Advocates, & Child Welfare Professionals. Zero to Three Policy Center. 2004 www.zerotothree.org.

• Dozier, M. et al. Intervening with Foster Infants’ Caregivers: Targeting Three Critical Needs. Infant Mental Health Journal, 23, 541-554. 2002

• Edwards, L. Judicial Oversight of Parental Visitation in Family Reunification Cases. Juvenile and Family Court Journal, 54, 1-24. 2003

References & Resources

• Ginther, D. & Ginther, N. Family Interaction: The Expressway to Permanency-Visitation. The Institute for Human Services. www.dhs.state.ia.us/docs/10.09_Family_Interaction_Practice_Bulletin.pdf

• Healthy Beginnings, Healthy Futures: A Judges Guide. National Council on Juvenile & Family Court Judges, ABA Center on Children & the Law, Zero to Three. 2009.

• National Resource Center for Permanency & Family Connections. www.hunter.cuny.edu/socwork/nrcfcpp/

• Rubin, D. et al. The Impact of Placement Stability on Behavioral Well-being for Children in Foster Care. Pediatrics, 119, 336-344. 2007

References & Resources

• Smariga, M. Visitation with Infants and Toddlers in Foster Care: What Judges and Attorneys Need to Know. ABA Center on Children & the Law. 2007