Channeling King Solomon: Reducing DisruptedRelationships & Improving Permanency
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Transcript of Channeling King Solomon: Reducing DisruptedRelationships & Improving Permanency
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Channeling King Solomon: Reducing DisruptedRelationships
& Improving Permanency
Judith Silver, Ph.D., Co-DirectorSafe Place: Center for Children’s Safety & Health
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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?
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Focus of Today’s Discussion
• Impact of disrupted relationships• Promoting stability through:
– Placement decisions– Visitation practices– Permanency planning
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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
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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
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54 %
22 %
43 %
16 %25 %
4%
20 %
10 % 12 %
3 %
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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
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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
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Theories on why placements disrupt
1. Is it due to the System?
2. Is it due to the kids?
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Theories Why Placements Disrupt
Behavior
Problems
Placement Change
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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.
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Placement Stability
• Early Stability 52%• Late Stability 19%• Unstable 28%
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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
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22% 25%
36%
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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
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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
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Why do Relationships Matter?
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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
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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]
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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
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Baby Cries => Mother Arrives => Soothes Baby
=> Baby Learns through all 5 Senses• Sound• Sight• Scent• Touch• Taste
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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
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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
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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
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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
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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
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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)
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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
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“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
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8 Weeks Later
• Happy & engaged with foster family
• Hysterical if someone approaches his legs
• Terrified of loud noises
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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
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Channeling King Solomon
Decisions must ensure• Safety & wellbeing• PermanencyHow can we minimize
instability for children?
• ASFA & Fostering Connections Legislation
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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
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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
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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
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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
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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
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“Devon”
• 26 months old with Failure to Thrive
• Weekly visits focus on mother-child feeding behaviors
• Referred for pediatric evaluation
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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
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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).
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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/
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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
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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
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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
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TRANSITION PhaseSmoothing Transition to Reunification
Maximize contactLeast Restrictive SettingEvaluate Remaining stressorsEnsure services to help parent meet
child’s needsGinther, N. & Ginther, J.
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Reunification
Aftercare – Monitoring & Services– Arrange visits with foster parent to
maintain relationships
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Overcoming Barriers
• Prioritize Cases• Involve Foster Parents• Collaborate with Community
Stakeholders
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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)
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The End
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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
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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
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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