The child welfare system is mandated to ensure the safety of the children in its care. For a variety of complex reasons, this is not an easy task, with sobering potentially horrific consequences if and when the system fails to meet this responsibility. Although statistics are elusive, some estimates suggest that children in foster care are four times more likely to be abused than children living with their parents. The causes of this pervasive problem are more easily understood than addressed.
Photo credit: sokabs / Foter / CC BY-NC-ND
Children who have been the victims of abuse are vulnerable to continuing the cycle of abuse, either as perpetrators or victims or both. They may re-enact traumatic experiences out of anxiety and/or attempts at mastery. Having been the helpless victim, they may seek comfort in taking on the role of the aggressor. Alternatively, they may be unerringly drawn to those who will aggress against them because they know no other way of seeking or maintaining attention.
The chances of child on child abuse are heightened in situations such as group homes or foster family placements with multiple children. When the ratio of adults to children is low, those charged with the care of these children simply do not have the time to provide the close attention and supervision needed for adequate, let alone therapeutic care. Indeed, in many cases, the adults—staff and foster parents alike—are asked to care for these children and teens without training in interventions designed to prevent further abuse. Although far from easy solutions to child on child abuse, more homes and more training for the adults caring for foster children would begin to address the problem.
The situation is different when it is the adults caring for these children who perpetuate the abuse. The recent conviction of a former foster parent in Pennsylvania on fifteen counts involving sexual molestation of five children is a painful reminder that foster care does not always guarantee children’s safety. Three of the five children were foster children who had been placed in his home for safety and protection. Sadly, some of the abusive acts might have been prevented if earlier complaints from children had been taken more seriously.
Photo credit: Bindaas Madhavi / Foter / CC BY-NC-ND
Children’s allegations of mistreatment at the hands of other children or adults stir many and complex feelings, too often making it hard—nay, sometimes impossible—for us to hear what they are saying. This, along with the scarcity of resources for recruiting, screening, and training staff, is surely a contributing factor to the heightened incidence of abuse in the foster care system. However, understanding the contributing factors is merely an exercise unless we are willing to act on what we know to protect vulnerable children. We, as members of a community that values the dignity and promotes the right to safety of all children, must not contribute to the problem by blaming or turning away from the child welfare system. What the children and the system alike need to hear from all of us is, “Tell me how I can help.”
By Toni Heineman
“I’m not a therapist, but I’d like to help.” When we get calls and emails like this throughout the year, I often find myself stumped, not wanting to give the lame response, “Well, you could make a donation,” figuring that most people didn’t reach out in order to be told that they could give money. To start the New Year, I resolved to try to be a little more creative and think of ways that people might be helpful to foster children in general and A Home Within in particular. I’m also assuming that most people know that there is a continual demand for foster parents and would be calling another organization if they wanted to explore foster parenting. This still leaves the question, “What can you do to help?”
SUPPORT A FOSTER PARENT
Parenting foster children is hard, often thankless, work. If you know a foster parent, you might consider inviting him or her for coffee or for a walk. Foster parents often forget to take care of themselves. A break from the routine and a show of appreciation can help to brighten a day.
BUILD COMMUNITY
If you don’t know a foster parent, think about contacting a local foster parent group and offering to help with childcare at an upcoming meeting or arranging to supply snacks for both adults and children.
ENTERTAIN A FOSTER CHILD
Many foster parents have access to respite care for an overnight or a weekend, but taking a child to a park or a movie can be a gift for both parents and children.
BRING SIBLINGS TOGETHER
It may be difficult for brothers and sisters living in two or more foster homes to get together because of distance or time constraints. Periodic outings can be memorable events for separated siblings.
MENTOR A FOSTER CHILD
Mentoring and CASA (Court Appointed Special Advocates) programs are always in need of volunteers. Through programs like these, community members can provide important relationships to foster children and teens.
ACKNOWLEDGE CASEWORKERS
Caseworkers manage large caseloads of vulnerable children and parents through a myriad of rules and regulations. It’s often hard for them to leave the worries of their work at the office. Consider recruiting a friend or two to adopt a unit in a child welfare agency and arrange to provide lunch or afternoon tea once a month. The message that people are thinking of them will be as important as the food.
CREATE AWARENESS
Help spread the word about the needs of the foster care community by hosting an educational event. Contact A Home Within or an organization in your community to invite someone to speak to your friends and neighbors about the needs of the foster care community and the work they are doing to meet those needs.
OFFER YOUR SKILLS
Non-profits need volunteers of all ilk, from board members committed to fundraising to people who are happy to spend an afternoon stuffing envelopes. If one organization doesn’t need the help you have to offer, call another.
RESOLVE TO MAKE A DIFFERENCE
I hope that you will add a commitment to doing just one thing to improve the foster care community to your list of New Year’s resolutions. The staff and board of A Home Within join me in sending best wishes for 2015.
IF YOU ARE INTERESTED IN MORE INFORMATION VISIT OR AHOMEWITHIN.ORG
Over the last twenty years we have been amassing evidence that negative experiences in early childhood have life long deleterious effects on physical and emotional health. Early maltreatment results in years of emotional pain, chronic illness, and, too often, premature death.
As David Brooks reminds us the multiple lenses through which we have been able to view the initial findings of the survey of over 17,000 patients at Kaiser Permanente have contributed to an increasingly sophisticated and nuanced understanding of the wide and long range effects of early adverse experiences. In some ways, the knowledge that the more children are exposed to adverse experiences—such as divorce, a substance abusing parent, abuse, domestic violence, or significant contact with an adult with serious mental illness—the more they will suffer has been woven into the fabric of our understanding of child development.
However, this knowledge has not been well integrated into programs designed to prevent or treat maltreatment. The reasons for this are multiple and complex and must draw on an appreciation of individual psychology, systems theory, the interface of political and economic forces and historical shifts in the ways in which we view children, maltreatment, and individual responsibility.
Although we know that adverse events in children’s lives rarely occur in isolation, we too often create programs designed to address a single issue or, recognizing that there are multiple problems, we introduce “wrap around” programs that bring together a team of experts to address the identified symptoms. Unfortunately, these professionals rarely have the time or funding to address the underlying issue, which often could best be described as chronic and unrelenting family and community chaos.
Consider, for example, children in the foster care system. The overwhelming majority of foster children have been removed from the care of their parents because of physical neglect (one of ten adverse childhood experiences). However, neglect typically results from parental substance abuse and/or mental illness, each adding an adverse experience and, most likely emotional abuse, adding yet another. Taken together, it is not difficult to imagine a child living in an environment that is wildly unpredictable with no certainty about the parent’s mood from day to day or hour to hour, no reason to assume that dinner will be on the table or that the night will not be interrupted by angry shouting.
For these children, whose lives are rife with adverse experiences, the whole is greater than the sum of the parents, particularly when the events stretch over weeks and months and even years. When they enter the foster care system, they need not only physical and emotional safety, but the security and sense of well-being that comes from a consistent, stable, caring relationship. Instead, they are often introduced to multiple people—each of whom has an important role to play—but none of whom is fully responsible for the child. This is not to discount the importance of what caseworkers, foster parents, attorneys, educational specialists, therapists, and community volunteers have to offer foster children.
What is missing for these children is the parental mind that mediates all of the child’s experiences—positive and negative. Without that single mind, the child lives in a fragmented world with no means of creating a coherent narrative. This is echoed in the systems that are supposed to be addressing the problems; they work in silos—sometimes at cross purposes, whether strategically or inadvertently.
Brooks suggests that we might begin to address these issues by bringing people together. That might be a first step or it may be just one more conference that sounds important and accomplishes little. We must not just talk about the importance of early experiences and children’s need for healthy relationships in order to thrive. We must integrate this knowledge into the fabric of every institution and program. Until we shift our culture to one that supports children and families we will continue to pay the price of psychological and systemic dysfunction.
By Toni Heineman
Clinicians who offer pro bono therapy through A Home Within bring not only their skills, but also their hearts to their work. Because they understand the crucial importance of stable, lasting, loving relationships, they very frequently find creative ways of maintaining the connection to a child they see in therapy. Nora’s therapist reached out to us when Nora was in danger of losing not only her family, but her therapist, too.*
It seemed that nine-year-old Nora had finally found a family, and she had a formal family portrait to prove it. But then the parents who had planned to adopt her decided that she just wasn’t quite the child they had in mind. This was the fourth family Nora had lost. First she lost her mother to drugs and the streets. Then she lost the relatives she had been living with when they couldn’t adequately care for her. After a brief time in emergency foster care, Nora thought she had found a family that would be hers forever.
Sadly, Nora’s therapist was planning to leave the clinic where she had been seeing her at about the same time Nora would move to a new family. Then a colleague told her about A Home Within. “I was so relieved and pleased when I learned that I didn’t have to transfer her to a new therapist in the clinic, but could continue to work with her through A Home Within.”
Nora is now settled into a new adoptive home. Instead of losing her therapist and feeling rejected by yet another person, Nora has had her therapist’s help through this very difficult transition. Nora and her new adoptive parents are still getting to know each other, but the family dog has become her constant companion. She continues to work to make friends in her new school. Her teachers are working with her therapist to help Nora control her temper and learn better ways of approaching people.
Nora has been able to work with the same therapist for over three years. Without this continuing support, her feelings of rejection and anger might have put too much strain on the relationship with her new foster parents, leading to yet another loss.
Happily, this is not an unusual story. The clinicians who are part of the network of A Home Within give their all for the child they agree to see “for as long as it takes.” Valentine’s Day is a fitting time to honor these clinicians and the love that they infuse in their work.
They are truly the heart of A Home Within.
If you would like to volunteer, please contact us at ahomewithin.org or call 888-898-2249.
By Toni Heineman
On the day that eight-year-old Joey* learned that he would never be returning to live with his biological mother, he explained to his therapist that she hadn’t been coming to visit as often because he hadn’t been obeying his foster mom. It took Joey over two years to feel safe enough to share ideas like this with his therapist. She tried to help him understand that he was not responsible for his mother’s less frequent visits, but she also knew that this idea gave him some sense of control over the events in his life, over which he actually had absolutely no say.
Only a few weeks earlier, Joey’s foster mother had insisted that his older brother be moved to a different home because the two boys fought too much. His new caseworker, the third in two years, was worried that the foster mother would have Joey removed, too, if his behavior didn’t improve. While Joey had begun to be more verbally expressive, he did still wet himself when he was anxious and acted out when stressed. The combined loss of his brother and the hope of returning to his mother in the space of a few weeks had certainly contributed to some regression.
Joey’s therapist was stunned when she received an excited call from his caseworker, announcing that a therapist at a clinic near the foster mother’s home, whose work she knew well, had an unexpected opening and was willing to see Joey. She had already scheduled an appointment for him for the following week. The therapist who had been seeing Joey through A Home Within expressed her concern that his stopping therapy with her would mean yet another loss at a critical time. She worried that he would regress even more and lose his newly developing verbal capacities. If his acting out escalated in response to an additional loss, which seemed more likely than not, his foster mother might actually ask to have him removed.
However, the caseworker was adamant, explaining that it would be so much more convenient for the foster mother to get Joey to his appointments at the clinic and that she and her supervisor had already informed the foster mother of the change. Joey’s attorney, who had referred him to A Home Within because he thought that Joey really needed a long-term relationship with a therapist, also tried unsuccessfully to intervene and have him continue with the person he had finally come to trust. The combined voices of the therapist and attorney about the importance of lasting relationships could not compete with the expectation that the new therapist could somehow turn things around quickly, especially since Joey could get many other services at the clinic.
Sadly, his therapist explained to me, “I did everything I could to protect my relationship with Joey. I really care about him but I couldn’t prevent his having yet another loss—this one completely unnecessary. I’m worried that the caseworker is expecting the new therapist to work miracles. They just keep adding services—as if more people and new people are more important than familiar people and relationships that last. What if this doesn’t work and Joey does get moved and the clinic isn’t convenient for the new foster mother and he has to start over again? Why not try to support the relationships that are already in place instead of creating yet another transition without the support that it needs to succeed?”
When faced with a relationship under stress—as was the case with Joey and his foster mother—it is often tempting to make a change in the hope that a fresh start will erase the problems at hand. And changing a therapist seems less disruptive than changing a foster home.
Under externally- and internally-imposed expectations that placement stability must be maintained above all, caseworkers and supervisors often feel as if they have little choice but to respond to the demands or desires of the foster parent, even when doing so places additional demands on the child. And, unfortunately, even when they want to offer services to support and sustain the placement, there may be few resources available.
Joey’s A Home Within therapist was unable to stop the transfer to the new therapist. However, she was able to slow the transition and support Joey through it. She made clear to all of the adults involved in Joey’s care that she would like to stay in touch with Joey, through occasional notes, phone calls, or visits. The new therapist promised to stay in touch and let her know whether and when maintaining contact with Joey would be helpful to him.
Even though Joey did get a new therapist, it is not clear that it was necessary for him to lose someone he had only slowly come to trust and count on. The fact that he will continue to have therapy does not mitigate the loss of a relationship with someone who had become important to him. We cannot prevent every unnecessary loss, but we will continue to carry the message that lasting relationships are essential for healthy development and every loss has lasting negative consequences.
* The child’s name has been changed and identifying information has been eliminated.
By Toni Heineman
Envisioning a brighter future for children and youth in foster care does not require much imagination. The current system of care allows so many youth to leave care facing years of hardship that are likely to include unemployment or underemployment, homelessness, poverty and multiple brushes with law enforcement that it’s easy to identify room for improvement. However, it takes not only imagination, but thoughtful analysis of pertinent research and current policies to envision the changes that should and can be implemented to transform foster care into a system that could promote the physical, social, cognitive, and emotional well-being of children and youth touched by the foster care system.
Bryan Samuels, Commissioner of the US Department of Health and Human Services’ Administration of Children Youth and Families has that vision. The flight home from the Summit on Healthy Adolescent Development and Well-Being convened by the Center for the Study of Social Policy and the Jim Casey Youth Opportunities Initiative gives me time to try to absorb both the enormity of the changes Commissioner Samuels imagines for the child welfare system and to relish the thought that he just might make them happen.
The primary charge of the child welfare system has been to ensure the physical safety of the children in its care with more recent attention to the reduction of risk. Fortunately, Commissioner Samuels is not alone in his insistence that this is not good enough for foster children, or for any children, for that matter. There is a large and growing chorus of voices demanding that our policies and programs must integrate those approaches known to protect and promote the well-being of all children and youth, but most particularly, those who are the most vulnerable.
There are many risk factors that can impair or impede children’s healthy development – among them, poor nutrition, poverty, lack of medical care and inadequate education. But if we don’t ensure that all children have a good relationship with an adult who loves and cares for them we deprive them of the single most robust predictor of healthy development.
Most parents and substitute caregivers do their best to make sure that their children have access to medical care, educational opportunities, and community support. For many complex reasons, not all adults can provide this for the children in their care. But their love for the child and their continuing care through adversity offers the child protection from the overwhelming emotions that impede development. A relationship with a caring adult creates the psychological space children need for healthy development.
As Bryan Samuels attests: “resilience is not good fortune arising from chance encounters with a supportive friend, peer or partner.” Resilience grows from ongoing relationships – this is the gift children most need from the adults who care for them.
By Toni Heineman
“I just wanted to talk to someone.” We hear this time and again from young people in the foster care system. These children and adolescents have a lot on their minds. For whatever reason, their parents were unable to care for them. That fact alone contributes to the unusually high levels of depression and anxiety in this population. Add to that the frequent changes among those charged with their care. Change and uncertainty are a way of life for foster children as caseworkers come and go and they move from one foster home to another — often without warning or explanation. They want to make connections — to have someone to hear about what is making them so unhappy that it is difficult for them to think and learn, to make friends, and to enjoy life. However, as the New York Times reports, when these children want someone to lend an ear, they are often given pills instead. And the drugs they are given, even at a very young age, are powerful psychotropic drugs, formulated to treat the most serious of mental illnesses.
Researchers from the University of Maryland, Johns Hopkins University, and the University of Pennsylvania analyzed the distribution of psychotropic medication among nearly 17,000 Medicaid-enrolled youth in one mid-Atlantic state. Among three groups — youth in foster care, disabled youth receiving Supplemental Security Income (SSI), and those receiving Temporary Assistance for Needy Families (TANF) — foster youth were more likely to be prescribed more than one psychiatric medication and to be maintained on those medications for longer than youth in the other two groups.
The findings of this study are extremely disturbing.
First and foremost, as the authors note, “concomitant antipsychotic use is not empirically supported.” While the evidence does not suggest that youth will benefit from a regime that includes two or more of these powerful drugs, the evidence does demonstrate that even one of these “atypical antipsychotics” can produce dangerous and lasting side effects. For example, metabolic changes induced by these drugs can lead to obesity, high cholesterol levels, and diabetes and patients taking these medications should be carefully monitored.
The need for ongoing medical supervision points another concern arising from this study. Life in foster care is notoriously unstable. When children move from one foster family to another, there is no guarantee that they will remain in the same community or that there will be continuity in their medical care. Indeed, “Medical Passports” were created to address the need for foster children to carry their records with them because of the great likelihood that they would receive medical care in different places and from different people. In attempting to understand the results of their study, the authors posit a number of possible clinical explanations and suggest that some “might lack a reasonable clinical rationale.” These explanations might be directly related to larger systemic issues. For example, it may be that as a result of multiple changes and the lack of a consistent adult, foster youth remain on medications longer than other children because they simply didn’t have consistent follow-up appointments.
No doubt, there are many possible clinical, systemic, and other ways of explaining the outcomes of this study. One issue that must be kept in mind is role of the parent or caregiver throughout the medication process. Parents are called on to describe the child’s symptoms, participate in the decision making-process, administer medications, monitor effects and side effects, and maintain communication with physicians and other professionals involved in the child’s care. This is a complex and lengthy process that depends on the parent or parent substitute knowing a child well enough to detect behavioral and affective changes over time and in different context. Most parents can offer this to their children. When they can’t, we owe children long-lasting relationships with other adults who can.
By Toni Heineman
Being a parent is hard.
Being a single parent is harder.
Being a teen parent is even harder still.
Being a single teen parent who grew up in foster care is nearly impossible.
And yet some of these young parents – overwhelmingly mothers – manage to raise physically and emotionally healthy children, while simultaneously finding their way through the developmental tasks of adolescence. The odds are not in their favor.
Parents who grew up in foster care are six times more likely than others to lose their children to the foster care system. Why do some succeed when so many fail? We explored that question this past week at two conferences focused on working with adolescent parents: ‘Caregiving Orientations’ in Dallas, Texas and ‘Nurturing Adolescents’ in Denver, Colorado.
Clearly, inherent individual differences contribute to success in parenting, as in other aspects of a teenager’s life. However, beyond that, the single most important factor may be the teen parent’s contact with caring, supportive adults who can help her navigate the complex and often conflicting developmental tasks of adolescence and parenting. Sometimes teens have the support of parents and extended family, particularly if they have grown up in a culture that readily accepts early parenting.
However, teen parents in foster care rarely have the support of their families. In fact, many of those who become pregnant while in care will lose their foster families as a result. These young people are ill-equipped for independence, either as individuals, still in the throes of development, or as parents, attempting to promote the healthy development of another.
Fortunately, some of them have access to programs like “How to Read Your Baby” or “Reaching HOPE,” that recognize that consistent relationships are the key to helping teenagers do the best they can for themselves and their children. Successful programs are built on the realization that the adults who work with these young parents must find ways of keeping hope alive for themselves and their clients.
The internal and external challenges facing any one of these young parents are daunting. Staff members must often hear one story after another with seemingly no way to get to a happy ending. Every day they are asked to hold the hope in the face of situations that appear hopeless. Sometimes even a glimmer of hope is hard to find, but sometimes that is enough.
Programs that maintain hopefulness in their staff also support hope for the young parents and children they serve. Sometimes a sense that things might be better tomorrow – even if just a little better – is enough to get through the day. And sometimes, just getting through the day creates a sense that things just might be better the next day.
By Toni Heineman
This week’s settlement marks the end of a hard-fought battle to improve mental health services for California’s foster youth. We should applaud the work of the advocates and state agencies that struggled for over nine years to craft an agreement designed to improve the emotional well being of foster children and youth.
I am always inclined to greet news like this with cautious optimism, ever hopeful that good intentions will result in more and better services for these vulnerable young people. Cautious because, however difficult it might be to arrive at far-reaching plans and programs, implementing them will be even tougher.
Children who are already in or in danger of entering the foster care system have led hard lives. Most have been neglected by parents who have been unable to care for them adequately because of mental illness or substance abuse. Some have been physically or sexually abused. Many have been in the care of a number of different friends or relatives before they enter care. Once in care, they may cycle through multiple foster homes, caseworkers, pediatricians, and therapists.
Extreme instability in a child’s life creates a psychological instability that presents daunting challenges for even the most experienced and well trained mental health professionals. If the state of California is going to deliver on the promises of this settlement, it will need the support and expertise of professionals from both the public and private sectors.
One of the simple reasons that foster children don’t get adequate mental health services is that there are not enough resources in the public sector to meet the very substantial need. Unfortunately, legal settlements and legislation don’t create more professionals with the education and experience required to meet the complex needs of these children and families.
We know from personal experience that clinicians in the private sector are willing and able to do their part to help address this issue. Through A Home Within, mental health professionals in twelve communities across California volunteer their time so that foster children can have weekly pro bono psychotherapy with a consistent therapist “for as long as it takes.”
Our organization is not alone in mobilizing private sector resources to meet a public need. For example, through Give An Hour, therapists provide free sessions of psychotherapy to returning veterans and their families. And in clinics and offices across the country doctors and nurses, attorneys and accountants donate professional time to help meet the needs of those who depend on public services.
If we can create more opportunities for professionals in the private sector to work with our public agencies, we will all benefit. In addition to the direct advantages this gives the individuals involved, increased contact between these groups can help to narrow the gap between our public and private sectors and help California realistically to provide the quality care this settlement mandates.
We live in hope.
By Toni Heineman
This Labor Day weekend I’m reminded that those who shoulder the responsibility for managing the care of foster children get even less attention than those in their care. With state budgets shrinking the burdens on these workers will only increase.
When positions are cut, caseloads increase. The Child Welfare League of America recommends that child welfare workers have responsibility in the range of twelve to fifteen ongoing cases. It’s important to remember that managing “a case” does not mean simply monthly visits with a child in foster care. It often means that the caseworker has contact with biological and foster parents, with siblings, grandparents and other members of the child’s extended family. It may also mean conferences with teachers, physicians, mental health specialists, and attorneys. Of course, these people are not in one easily reachable place and are often difficult to contact. Dropping even one more case on a worker’s desk dramatically increases her workload.
And it is likely to be “her” workload. Approximately 70% of child welfare caseworkers are women who earn in the range of $25,000 to $30,000 annually. According to one online site, salaries posted for caseworkers are 23% lower than all job postings nationally. Not surprisingly, turnover in this population is high; over 30% of caseworkers leave their posts every year.
We are used to thinking about the impact of repeated and unexpected losses on foster children, but the chronic loss of coworkers and colleagues also depletes the morale of the caseworkers who are left behind. Of course, low morale affects job performance. Caseworkers enter the child welfare workforce because they want to do well by children; when they are not able to do their jobs as well as they would like, their self-esteem suffers even more.
Caseworkers have really, really hard jobs. On a daily basis, they see children who have been abused and neglected. They meet with parents who are distraught over losing their children. They encounter family members and attorneys who are in pitched battles over what is best for a given child. And when that part of their work is done, they sit in front of a computer to complete seemingly endless forms to document their work.
The stories of the caseworkers who do their jobs well day after day do not make front page news. When negligence or overwork or a perfect storm of factors results in the injury or death of a foster child, headlines often demonize the caseworker because it’s easier than addressing the contributing complexities of the foster care system.
Labor Day is an annual opportunity to honor those whose work often goes unnoticed and unsung. I speak for the board, the staff, and the volunteers of A Home Within across the country in saying “thank you” to all the caseworkers who willingly take on the extraordinary responsibility of caring for foster children and youth.
By Toni Heineman