Too often we hear bad news from the research on foster youth. In striking contrast, the latest research from the Foster Care Research Group, based at the University of San Francisco that evaluates the programs of A Home Within, demonstrates that the emotional well-being of foster youth seen by our therapists improves substantially over the time they are in therapy.
In particular, recent analyses of symptom reduction over the course of long-term treatment demonstrates clinically and statistically significant declines in depression, anxiety, dissociative symptoms, suicidal thoughts, sleep difficulties, learning problems, and self-injurious behavior. The quality of life improves as these symptoms lessen because they interfere with social interactions, learning, and the overall capacity to manage the ups and downs of everyday life. In short, long-term therapy is improving the chances for these foster youth to lead productive and personally satisfying lives.
Not surprisingly, establishing and maintaining relationships is hard for youth who have experienced multiple unexpected and inexplicable losses. With good reason, they do not trust easily. It typically takes several months for foster youth to feel safe enough to begin to share their feelings with a therapist. The fact that this data comes from interviews with therapists who, on average, have worked with their clients for over three years is a testament to the needs and hopes of the youth and the skill and hopes of our therapists.
The work of the Foster Care Research Group, headed by Dr. June Madsen Clausen in the Department of Psychology at USF, is an invaluable resource for A Home Within.
Under her guidance, for the last eight years, undergraduate research assistants have conducted telephone interviews with therapists at the beginning of treatment and annually thereafter until an “exit interview” when the therapist reports that the treatment has come to a close. Over that time, they have been gradually expanding the number of chapters included in this first phase of the research, and this fall will include all chapters. We are especially excited to learn that the research group will now be moving into the long-planned second phase of the research, which will involve collecting data from the caseworkers that are responsible for the foster youth referred to A Home Within. This will supply additional data points, helping us to better understand what we do well and what we can do better.
The data supports what we all know — relationships DO make a difference!
By Toni Heineman
A policy mandating that children coming into foster care may not be held in offices for more than eight hours certainly seems reasonable. These children are scared, confused, and reeling from the process of being removed from their caregivers. We want them to get settled into a comfortable home quickly—someplace where there are adults to feed, bathe, and comfort them.
We do not want them sitting in an office waiting room or shuffled from one office to the next. We don’t want them to visit the nearest McDonalds for a Happy Meal after seven hours and fifty-nine minutes only to start the clock running again when they return thirty minutes later.
However, according to a recent article in the Los Angeles Times, this is what caseworkers have resorted to when they have been unable to locate foster homes for children — particularly for infants and older teenagers, who are among the most difficult to place. The Department of Children and Family Services contends that only a small number of children have spent extended time in their offices awaiting more stable placement.
If the alleged events have happened to even one child, there’s a problem. In these situations, there is a tendency to try to affix blame, which only detracts from finding solutions. Caseworkers who have to meet a deadline for removing children from holding areas may feel as if they have no choice but to find clever ways of meeting the letter of the law when they have no chance of meeting the spirit of the law. What are they to do with children who have no place to go when they have no place to send them?
An abundance, or at least a reasonable supply, of foster homes, could solve the problem. But increasing the number of foster homes requires time and money, both of which are in short supply in the child welfare system, even in the best of times. As the country’s economic woes are increasingly felt at the state level, we are likely to see more and more imaginative approaches to insoluble problems.
It is difficult to legislate truly creative solutions. Laws and rules rarely include the feedback loops necessary to address unintended consequences. Innovative and imaginative solutions arise from discussions that recognize that everyone at the child welfare table is well-intentioned with different and valuable ideas and multiple and conflicting constraints. Unless we can begin more open and vigorous conversations, we may find ourselves looking back on running out the clock at McDonald’s as a very benign way of managing an impossible situation. In the meantime, maybe the realities facing caseworkers dictate that there should, at the very least, be warm blankets and healthy snacks available when there simply is no safe alternative to an overnight in an office waiting room.
Please visit ahomewithin.org to learn about how A Home Within helps foster youth to build relationships and meet their seemingly-impossible challenges.
By Toni Heineman
Most children who enter the child welfare system have been neglected by their parents—some have also suffered physical or sexual abuse—but, by and large, foster children simply have not received the care they need from their parents or other relatives. Their most basic physical needs have not been met and their emotional needs have received even less attention. Sometimes we behave as if we simply can’t bear to see the pain in their lives.
While there may be a single event that calls attention to their plight, these children have spent most of their lives in an environment defined by “toxic stress” – chronic, unrelenting stress stemming from some combination of poverty, community and/or domestic violence, inadequate medical care, and poor educational opportunities for them or their caregivers. One or both parents may suffer from mental illness, have a history of substance abuse, or incarceration.
In short, children in foster care have not had an easy start in life and, as a result, they are generally not easy-going children. With good reason, they are angry, scared, distrustful, and short on the emotional and social skills crucial for forming and sustaining relationships.
Parenting is never easy; parenting mistreated children is just plain hard. Keeping the Promise, summarizes findings from the Donaldson Adoption Institute’s study of adoptive families, which indicates a significant need for and lack of services and support to help adoptive families succeed. The findings of this study are not surprising; what is surprising is that we need a study to detail what common sense should tell us. When you ask people to do something hard, if you want the job done right, you must give them the tools they need and teach them how to use them.
In many ways the needs of adoptive parents and foster children are very straightforward—they need help in forming and maintaining relationships. The particular form of the support each family needs will vary, depending on the strengths and challenges the children and parents bring to the mix. What does not change is the need to focus on family relationships.
With 130,000 foster children waiting to be adopted, this is an issue we cannot afford to ignore. The emotional needs of mistreated children will not disappear just because we choose not to see them. The inherent challenges of parenting mistreated children will not go away if we choose to ignore them. These parents and children face very real and difficult challenges in the process of creating a family. They need our help and we cannot help until we recognize that need.
It’s time to get our heads out of the sand.
By Toni Heineman
Once upon a time, not so very long ago, “service providers” in the mental health field were referred to as “psychiatrists,” “social workers,” “psychologists,” or counselors.” These designations gave some indication of the professional education and training of the people in the field. Referrals were made to people, based on their training, interests, and areas of expertise.
A referral to a “service provider” suggests that the recommendation is more about the program than the person delivering it. Indeed, in the current climate, it seems that we often lose sight of the importance of the relationship between two people—one seeking help for psychological distress and one trained to help people address and overcome emotional suffering.
Mental health is fundamentally about relationships. Human beings are hardwired to form connections; infants cannot survive without adults tocare for them. Adults depend on each other for love, companionship, shared knowledge, and connections to the networks of relationships that friends, family, and acquaintances offer. Without these connections individuals can and do fall into isolation, depression, and despair.
We learn about relationships through having relationships. Books, movies, songs, instructional materials, and psycho-educational programs can all offer glimpses into what makes relationships work or not work. But an emotional grasp of the nuances of relationships comes from actually negotiating different kinds of relationships.
Unfortunately, foster children and youth too often have not had a healthy relationship with a primary caregiver that forms the core of all other relationships. A therapeutic relationship with an experienced and skilled clinician can, over time, help them to understand and negotiate the thousands of large and small cues and responses that determine successful interactions. This comes, not from being taught about relationships but from being in the therapeutic relationship. This core connection allows for and supports the expansion of what is known—consciously and unconsciously—about relationships to a world of ever-increasing connectedness.
When we introduce foster children and youth to too many new programs offered by too many new people at one time we may easily overwhelm their fragile relational capacities and unwittingly drive them further into isolation and depression. No matter how well-intended our efforts to address the myriad needs of foster youth when they enter the system, it behooves us to remember that they are best served by developing one stable relationship with a caring adult. It is from the safety and security of this relationship that they will, in time, be able to take full advantage of the many well-designed programs intended to address discreet social and cognitive issues that threaten their capacity to build successful relationships.
Healthy relationships grow from relationships, not from programs.
By Toni Heineman
Unfortunately, foster children lose once again to politics. Virginia’s State Board of Social Services voted yesterday (washingtonpost.com) to continue its ban on adoptions by gay couples. It’s hard to know how that vote serves the children who are waiting for a loving family. Through no fault of their own, they have no family to return to. In somecases, their parents may have abandoned them or willingly relinquished them for adoption.
Many children remain in foster care because the state has determined that their parents were unable to care for them adequately and terminated the parents’ legal rights. Those children, too, are free for adoption—by heterosexual couples. No homosexual couples need apply in Virginia or 33 other states.
When states terminate the rights of parents they make an implicit promise to the children that they will provide better care for them than their parents would. Spending years—even an entire childhood—in foster care is NOT better care. Even if children remain with only one foster family, which is the exception, not the rule, they have no sense of permanency. Children need to know that they belong and that the home and family they leave in the morning will be the one they return to in the evening.
Young adults need to know that the family they grew up with will still be there, even when they leave home. It is the memories of the traditions, and the certainty of the unconditional love that allows them to leave home. Virginia has the highest rate of youth aging out of foster care in the country. Fully 32% of youth in Virginia’s foster care system leave without a permanent connection to a family or an adult to care for them.
Turning 18 may mean legal adulthood, but it does not translate into developmental adulthood. And adulthood does not mean that we no longer need the support and love and care of family and friends. Sadly, the state of Virginia has held steadfast in its position that some children are better off without a family than with a family that happens to be headed by two mothers or two fathers.
I wonder what the 1300 children in Virginia waiting for parents would say.
Maybe next time we should ask the children.
By Toni Heineman
That was the reason a clinical psychologist in her thirties gave for her parents’ divorce when she was eight years old. She “knew better.” She was smart and well educated and, as an adult, fully aware that marriages didn’t break up over a glass of spilled milk. But sometimes—maybe when she was having a restless night—she was racked with the same fear she had felt that night when she spilled the glass of milk as she listened to her parents exchange angry words. Later, when they told her that they would be divorcing, that scene flashed before her eyes. She knew what had happened; it was all her fault.
Children, particularly young children, have very little actual control over the events in their lives. Adults tell them when to wake up and when to go to sleep; they decide which clothes and food and toys and activities are suitable. Even when they want to be in charge, children don’t have the skills or the resources to manage their lives. So they pretend. They can be mommy or daddy – a teacher, shopkeeper, policeman, movie star, prince or princess – just by the power of imagination, sometimes aided by a few props.
The world of fantasy knows no bounds. The magic that allows for wishing on a star is the same that gives spilled milk its destructive powers. Magical thinking leaves children convinced that their actions – or sometimes just their thoughts – can control adults’ behavior.
If bad thoughts or behavior can lead to catastrophic consequences, then it follows that good thoughts or behavior can make the world right again. Children who believe that they are responsible for their own misery may decide to take matters into their own hands. We wouldn’t be surprised to hear that the little girl who held herself responsible for her parents’ divorce suddenly announced that she no longer liked milk, having decided—without telling anyone—that drinking it just wasn’t worth the risk.
When we disrupt children’s lives, we are often quick to reassure them, “This is not your fault,” before asking them how they make sense of what is happening to them. If we stop to ask and are willing to wait patiently for the answers, we might learn the particular ways in which children explain their parents’ divorce, a parent’s failure to visit at an appointed time, or one of the many disappointments that we knowingly and inadvertently cause children.
“There’s no use crying over spilled milk,” may just miss the point entirely.
By Toni Heineman
Rejection hurts. That’s hardly a surprise to anyone who has been shunned by a friend, ostracized from a group, mocked by a co-worker, or been the one left behind at the end of a romantic relationship. The surprise comes from research recently published in the Proceedings of the National Academy of Sciences demonstrating that social rejection stimulates the same parts of the brain as physical pain.
In other words, under some circumstances the brain does not differentiate between emotional and physical pain. This finding should stop us dead in our tracks when we think about the impact of –repeatedly– moving foster children from one home to another.
When young children are taken out of a familiar foster family they are exceedingly likely to experience that event as a rejection.
Regardless of the explanations offered, it hurts—just as if we had inflicted physical pain.
We would never condone inflicting deliberate physical abuse on foster children—in fact, we remove children from the care of foster parents if they physically mistreat children. Yet, we repeatedly create situations in which foster children will experience the pain of rejection.
We assign them to one caseworker, knowing that we will move them to another when their legal status changes. We place them in emergency foster care, knowing that they will be moved to a more stable placement after a short time. We refer them to a clinic for psychotherapy knowing that they will be seen by an intern who will leave them after a few months.
From the egocentric viewpoint of children, every one of these losses will be experienced as a rejection of their own making. Foster children no more believe that they have not caused these rebuffs than the spurned lover who is told, “it’s not you, it’s me.”
All children need to know that adults will keep them physically and emotionally safe. When we create programs to serve foster children we must remember that, from the perspective of the child’s brain, repeated losses are the intolerable equivalent of physical maltreatment.
Please support the therapists who volunteer their time through A Home Within so that foster children do not have to endure the pain of losing one therapist after another.
By Toni Heineman
We brought Guinness home from the shelter about two years ago. In preparation for his arrival, I bought a gate to put at the head of the stairs from the deck to the yard. I had in mind that he, like our previous dog, would like to be outside, but I didn’t want him to have access to the neighboring yards. About two weeks ago, he ventured off the deck on his own, finally brave enough to go exploring without a human companion.
We know almost nothing about the first eighteen or so months of Guinness’s life. We know that he was in a shelter in Mendocino before he moved to the SPCA in San Francisco. Obviously, he started out someplace. That makes our home the fourth place he has lived.
“Frantic” best describes Guinness when he first arrived. Every time someone came into or left the house he jumped, pounced, and madly twirled in circles. Our efforts to calm him only added to his excitement. In the park, he enthusiastically approached other dogs; his boisterous play sometimes becoming aggressive. He was never hostile toward new people and never shied away from strangers.
It took him months to settle down. We didn’t know if he was, by nature, a frantic, boisterous dog that sometimes got carried away and played too rough, or if he just needed consistent love and discipline.
Fortunately, we now know that he is, by nature, a sweet and even-tempered animal who expects little more from life than a smile, a few scratches, the occasional biscuit and regular walks in the park. Now, he approaches other dogs with either caution or a friendly wag of the tail to invite them to run with him in endless circles through the park.
Over the time he has been with us, we have concluded that he was not abused, but clearly neglected and desperate for love and attention. With consistent discipline, we have convinced this 88-pound creature that he is not, as he once thought, a lap dog.
Not surprisingly, as we have adjusted to Guinness and he to us, I have thought many times about the uncertainties foster parents and children face as they learn to know and trust each other. Guinness had no reason to expect that we would treat him well; and we didn’t know if he could become the companionable pet we wanted.
In my work as a clinical psychologist and Director of A Home Within, I repeatedly remind people that it takes a very long time to build relationships. As someone who adopted an animal who had been abandoned, I have consistently been surprised at how long it took for him to feel securely at home. He is a constant reminder that even if we could hurry love, you can’t hurry trust.
By Toni Heineman
On this the tenth day of National Foster Care Month we are launching a celebration of ten years of service to the foster care community. From a small group of therapists working only in the San Francisco Bay Area, we have grown to a network of private practice clinicians working in fifty large and small communities across the country. Because of the dedication of these social workers, marriage and family therapists, professional counselors, and psychologists, well over a thousand children, youth, and young adults have received long-term, individual psychotherapy at no cost to them, their families, or the agencies responsible for their care.
The length and depth of treatment we offer is what makes A Home Within
different from most of the therapy foster youth receive. While we have seen positive changes in some aspects of foster care over the last ten years, there has been unfortunately little improvement in the mental health services available to youth in the foster care system.
An important impetus for the creation of A Home Within was our recognition of the destructive impact on foster children who repeatedly lost important relationships when the interns they were seeing in therapy graduated or moved on to a new clinic. Unfortunately, this continues to be the rule, rather than the exception.
Another aspect of mental health care that hasn’t changed is the frequency with which the emotional pain of foster youth is met with medication. “All I wanted was someone to talk to and what I got was pills,” is a comment we heard too often ten years ago, and one we hear even more often today.
It’s often said that the ultimate goal of every non-profit is to put itself out of business. It would, indeed, be a joyous occasion if I were writing to tell you that on our tenth anniversary we were closing our doors because what we offer is no longer needed. Instead, I’m writing to tell you that we intend to keep doing more and better of what we have been doing for the last ten years—offering high-quality, pro bono mental health services that create and strengthen the relationships of current and former foster youth and those who care for them.
Last year we provided over $1.2 million in pro bono professional services. We intend to do more this year and every year after that—“for as long as it takes.” I hope that your interest and support will continue and grow with us over the next ten years.
By Toni Heineman
The recent failed attempt to pass a bill that would open California’s dependency courts to the public, highlights the complexity of simultaneously trying to protect the rights and privacy of children in the foster care system. As courts across the country are moving to allow the public to attend hearings concerning the lives of foster youth, it’s imperative that we consider the gains and losses of tipping the balance toward a maintenance of the status quo or toward revamping the current system.
Dependency court hearings are part of the process of determining the future of individual foster children. Those in favor of opening dependency courts argue that closed hearings allow courts to operate without accountability when making life-altering decisions for an extremely vulnerable group of children and adolescents.
However, these hearings may also include reviews of children’s histories, including details about the abuse or neglect that resulted in their being removed from their parents’ care. Those opposed to open hearings argue that the privacy of this vulnerable group will be compromised by allowing public scrutiny.
Protecting children in foster care is not easy. It is hard enough just to provide physical protection. Neglectful or abusive foster parents slip through the cracks of the vetting process. And, unfortunately, victimized children who have been placed in a foster family may victimize other children placed with the same family. When these instances of failure to protect come to light, we are understandably outraged, wondering how “the system” could have allowed such failures.
For better or for worse, there is no “system”–just a collection of people charged with caring for children who have no stable family to care for them. The legal and psychological issues facing those working to protect foster children are enormously complex and rarely offer simple “either/or” solutions. The lives of these children are difficult to comprehend. It is even more difficult to figure out how to address their many, often contradictory needs. The courts and the supporting characters—social workers, attorneys, advocates, foster parents, therapists, pediatricians—to name a few, often must craft delicately balanced solutions.
We need to protect children’s privacy AND we need to know that those charged with their care are working responsibly, ethically, and within the law to promote the best interests of children in foster care. This is not an easy task; it will most likely require a delicate balance between sometimes competing needs.
How would you begin to think about protecting BOTH rights AND privacy for foster children?
By Toni Heineman