Recent research confirms what common sense tells us: loneliness hurts. Not only does it hurt, it can make us sick. In short, without the protection of social relationships, people tend to feel besieged and respond with the predictable “fight, flight, or freeze” response that prompts us to react appropriately in the face of danger. The problem is that this heightened state of physiologic preparedness takes a toll on our immune system, leaving us vulnerable to physical, as well as emotional, illness.

It makes sense that feeling that there is no one to turn to leads to anxiety and depression, which can result in increased isolation. Experts also note that social isolation does not necessarily mean being entirely alone, but can occur even when surrounded by people. This is certainly true when people feel disconnected and is a chronic problem for foster children and youth.

We repeatedly demand that foster youth figure out how to fit in to entirely new situations, usually without preparation or advance warning. When they move to a new foster home, they have to learn completely new rules and grapple with unfamiliar expectations. If they also have to adjust to a new school, it is without the relief of returning to the familiarity of home at the end of the day. New schools and new communities also mean having to make new friends.

 Image courtesy of Vermario.

One of the many hurts that we inflict on foster children and youth is the loss of friends that results from multiple moves. Even for those children who make friends relatively easily, the process of getting acquainted over and over and over again can be exhausting and demoralizing. And repeated moves mean that, while they may enjoy the silver of new relationships, they rarely have the opportunity to cherish the gold of old friendships.

As we learn more about the importance of friendships in middle and old age, it behooves us to attend more to them in the earlier years. Children and adolescents who do not learn how to make and sustain friendships will not be well equipped to develop life-enhancing social relationships later in their lives. Fortunately, we can help children, and adults, for that matter, begin to develop friendships. It can be as simple as learning to ask questions about another person’s likes and dislikes, an event from the last week, or plans for the week ahead. The discovery of mutual interests can lead to longer conversations of more depth. Over time, conversations get woven into friendships.

Sometimes in our concern about the repeated separations from family members—parents, siblings, aunts and uncles—we forget about the importance of lost friendships in the lives of foster children. We do them a disservice if we don’t honor the importance of their friends and help them grieve their loss.

By Toni Heineman

Yesterday I had a call from “Ann”, a woman I have known for over fifteen years. I first met Ann when she came to me for psychotherapy in her mid-twenties. After about three years of therapy we agreed that she was on emotionally solid ground. She was better able to manage and grow her relationships, she was happy with her professional choices, and she was ready to start a family. In other words, Ann was “launched” from the uncertainties of youth into adulthood.

Since then I have had periodic contact with Ann. She returns for short-term help with various events and changes in her life. The most recent call, for example, came in response to conflicts in her extended family that were beginning to impinge on her immediate family.

I mention Ann because she demonstrates the importance of continuity in relationships. Ann could just as easily have called a therapist in her new community, which certainly would have been more convenient. But she wanted to talk with someone who knew her—someone for whom she did not have to provide history or create context. Perhaps of most importance, each time Ann called it was with confidence that I would make time for her. She did not feel the need to ask permission to return, she rightly assumed that she was entitled to reach out to me and that I would respond.

 Photo credit: Kevo89 / Foter / CC BY-NC-SA

Contrast Ann’s experience with that of a young man in foster care, “Don”, who was seen in a community clinic. A few weeks after completing therapy he left a message for his therapist asking if he could talk to her by phone for a few minutes. In response to this “boundary violation”, the therapist was required to file an “incident report” with her supervisor, who, in turn, had to report the call to her supervisor. The therapist was not allowed to return the call without written permission. Permission was granted, but only for her to tell Don that she could not talk with him because therapy had ended and a continuation of their relationship would be inappropriate.

The therapist documented the “incident”, noting that Don was extremely distressed when she told him that she couldn’t set up a time to talk with him, commenting, “Oh, so I guess you stopped caring about me when therapy ended.” Her explanation that she was bound by clinic policy did little to comfort him, nor did telling him that he could ask his caseworker for a referral and go through another screening if he wanted to try therapy again.

Policies that treat any attempt to extend therapeutic contact as a boundary violation demonstrate a fundamental lack of understanding of human relationships and our need for continuity in our connections to those we care about. Maybe Don’s call did stem from a wish to establish a personal relationship with his former therapist. Maybe he had something important to share. Maybe he just wanted to know if she did still care. She will never know, because she was not allowed to ask. And maybe Don was left to conclude that therapy, like psychoactive medications comes only in carefully measured doses—in some cases, with no chance for a refill.

By Toni Heineman

While April 15th is far from a national holiday, it is an occasion that brings together millions of Americans, often for complaining and commiserating rather than celebrating. Indeed, in 2014 the IRS received 136,887,000 tax returns, some eligible for refunds and others accompanied by a payment to make up a shortfall in money owed. Some of those tax dollars go toward maintaining the child welfare system and supporting the foster children whose parents are, for a myriad of reasons, unable to care for them.

Unfortunately for all of us, when these young people leave care at the age of 18 or 21, depending on the state where they live, most will not be joining the ranks of taxpayers. Of the approximately 18,000 young adults who age out foster care each year, fewer than 50% will be steadily employed. Many who do find and maintain work will be underemployed. A multi-state study by Chapin Hall at the University of Chicago found that more than 70% of former foster youth earned less than $25,000 annually (http://www.childrensrights.org/unemployment-rampant-among-former-foster-youth/), and many do not have skills that could allow them to work at jobs earning more than minimum wage.

With few exceptions, those who are unemployed are not happy about their situation, and struggle to change it. They engage in exhaustive and exhausting job searches, or take classes to upgrade their skills. Many take part-time or temporary jobs to at least partly fill their days and their wallets while waiting for a more desirable position to become available.

For most Americans, the right to complain about paying taxes is just one piece of the employment package that adults take for granted and, in many spoken and unspoken ways, binds workers together. After all, children start preparing for work even before they enter school — imaginary play often transports them into the working world of adulthood, for along with pretending to be princesses and superheroes, they experiment with being teachers, firefighters, movie stars, and athletes.

Our failure to prepare foster children for gainful employment and the opportunity to pay their fair share of taxes has consequences that extend beyond depriving them of the chance for financial security.  Employment can provide not only earned income, but a sense of satisfaction and accomplishment, a chance to connect with co-workers and possibly form friendships that extend beyond the working hours, and, even in the midst of a commuting slog, the feeling of being part of the crowd—one of those who belongs.

Because unemployment and underemployment perpetuate former foster children’s sense of not belonging, we also cheat them of the satisfaction that comes from all of the daily, and yearly, pleasures and pains that come with being a contributing member of one’s community. Of course, the entire community suffers as well, not only from lost tax dollars, but from the ongoing financial costs of supporting those who are unable to care for themselves, and the societal costs of maintaining significant numbers of disaffected members. In this context, we have an obligation to our communities as well as to the foster youth in our collective care, to do more to help them join the Taxpayers’ Chorus as it raises a collective voice in the annual April 15th lament.

By Toni Heineman

It was 1995, and we had just started A Home Within. Seven-year-old Kelsey was one of the first foster children referred for open-ended therapy, but she was NOT happy about it. She routinely and loudly told her therapist, Dr. B, that he was dumb and didn’t understand anything at all about kids. She didn’t like his toys and didn’t want to play any of his games. Mostly, she announced that she didn’t understand why he didn’t have snacks, which was for her the clearest evidence that he was stupid.

Dr. B, a young therapist at that time, turned to his consultation group for help. He told the group that, despite Kelsey’s continuing disparagement of him, he admired her spunk and noticed that her complaints did demonstrate that she was really paying attention to him and the office. He liked this little girl and wanted to find a way to make her more comfortable. The consultation group leader suggested that Kelsey was telling him exactly what she needed: snacks. She was hungry for relationships, but she first needed the concrete reassurance of his care that actual food would provide.

Like many traumatized children, Kelsey had little reason to trust that adults would care for her. She had been moved from one foster home to another. Dr. B was just one more in a series of adults who came into her life. She had no reason to believe that he would be different—that he would stick around.

Much to Kelsey’s delight, Dr. B, heeding her pleas and the advice of his consultation group, began bringing a cookie for each of them to therapy. Kelsey loved starting her sessions with these weekly tea parties. One day, several months after they had begun meeting, as she nibbled on her cookie, Kelsey happily looked at Dr. B and asked, “How long can I come here?” Remembering that we promised children therapy “for as long as it takes,” he responded, “Well, for as long as you want.”

Kelsey continued, “Can I come when I’m in middle school?” “Yes,” her therapist replied. “What about when I’m in high school?” Again, he reassured her. “When I’m grown up and have kids, can I bring them to see you?” With a bit of wonder about what he had signed on for, Dr. B answered, “Yes, you can bring your children to see me.”

Early in 2015 we got a call from Dr. B, who long ago had finished therapy with Kelsey—or so he thought. But she remembered his promise and when her daughter, now about seven, was having trouble, she sought him out. In the intervening 20 years, Dr. B has shifted his practice and is no longer able to work with children. That, along with Kelsey’s move to a community a considerable distance from San Francisco, makes it impractical for Dr. B to see Kelsey’s daughter in long-term therapy. However, he is working with Kelsey and with the office of A Home Within to keep his promise that he will be available to her “for as long as it takes.” He is committed to helping Kelsey find a therapist who will offer her daughter a lasting, caring relationship. He is equally determined to find one who will also have the good sense to know that sometimes good therapy begins with a tea party.

African American father and daughter playing tea — Image by © Annika Erickson/Blend Images/Corbis

By Toni Heineman

A recent story out of Florida is among the more glaring examples of our failure to meet the mental health needs of America’s most vulnerable children—those in foster care. A sixteen-year-old girl who had been sexually molested by her father and then her grandfather was denied mental health services and, instead, referred for treatment of substance abuse.

It’s hardly surprising that a teen with a history of untreated trauma resulting from sexual abuse would turn to street drugs for comfort. Tragically, in this case, there were no facilities for residential drug treatment, while (costly) beds were available for in-patient mental health services. So, with both her Post Traumatic Stress Disorder and drug use untreated the girl was returned to foster care. She promptly ran away as she had before. She is most likely doomed to prostitution, life on the streets, and an early death.

Post Traumatic Stress Disorder (PTSD) is rampant among children in foster care; the incidence is higher among this population than among veterans returning from active duty in Iraq and Afghanistan. Untreated, PTSD can have serious, sometimes irreversible emotional and physical consequences. Children who are so anxious that they can’t stay at their desks have “behavior problems” and are often punished rather than helped. Those who experience the normal jostling in the school hallways as physical aggression and lash out may be seen as perpetrators rather than victims and sent to “anger management.”

Photo courtesy of Pink Sherbet Photography

Children whose nervous systems are so frazzled that they cannot control their feelings or actions disrupt family routines. They don’t sleep well, often keeping other children and parents awake night after night. They shout instead of talking. They see danger around every corner and they can’t soothe themselves or easily accept comfort from others. Because they live at a feverish pitch—acting without the capacity to reflect—they are in danger of inadvertently harming themselves or others.

As a result, foster parents ask to have them removed—whether out of anger, despair, fear or a combination of overwhelming feelings. In the next family, the behavior escalates and the placement ends even more quickly. And so goes the life of a foster child whose original trauma was sexual abuse at the hands of an adult who was supposed to be caring for her.

Untreated PTSD affects not only the child, but also those around her. The children in the classroom who don’t know how to predict or protect themselves from the explosion have reason to be fearful. The other children in the foster families who have their routines and sleep disrupted find themselves more anxious and less able to function well in school. The foster parents who give up and have a child sent away are left to struggle with guilt and self-recrimination.

PTSD is not something that children outgrow. They don’t just “snap out of it.” These children need care from professionals trained to address their emotional needs. When we take children into the child welfare system, we make an unspoken promise to care for them. Failure should not be an option.

By Toni Heineman

Thanks to the determined efforts of young people in the foster care system, President Obama recently signed into law a bi-partisan, bi-cameral bill, H.R. 4980, The Preventing Sex Trafficking and Strengthening Families Act. This act brought together several initiatives aimed at improving the lives of children in the child welfare system.

The provisions include giving adolescents and young adults greater say in plans for their future, by mandating that they have the opportunity to participate in case planning meetings, accompanied, if they wish, by two people of their choosing. Parents of teenagers are usually acutely aware that a part of healthy adolescent development is learning to form and offer opinions. In the process of trying to convince parents that they should have a larger allowance, a later curfew, or full and unbridled use of the family car, adolescents learn to gather information and craft arguments to support their positions. Over time, they also usually learn that it may be to their advantage to avoid arguments that they are likely to lose and that some opinions are better kept to themselves.

By the time they are teenagers, most young people do have opinions about their likes and dislikes and ideas—sometimes very fervently held—about how they want to spend their time. The child who endured piano lessons to please her parents, may, as a teenager, insist that she switch to guitar so that she can join her friends in a newly forming band. The choices teenagers make often grow from earlier experiences with a variety of activities—team and individual sports, art and music lessons, or spending time at the library, in a crafts studio, or at favorite outdoor haunts. Prior to the passage of this law, foster parents and group home supervisors typically did not have the authority to determine whether the children and youth in their care could participate in extracurricular activities. The requirement that states establish “prudent parenting” guidelines puts this kind of decision-making where it belongs—in the home.

Because home and family, crucial for healthy development, are painfully absent in the life of too many foster youth, the importance of these efforts to bring normalcy to their lives cannot be overstated. Many of the requirements this bill imposes on the child welfare system are interactions and activities that are a matter of course for responsible parents—for example, helping children make decisions about events and interests and providing and caring for important documents. The fact that activities such as these must be legislated underscores the difficulty of replacing normal, expectable parenting with a massive system and the rules and regulations required for its smooth functioning.

When we so often hear, “being a parent is the hardest job I’ve ever done” we should not be surprised that analyzing and implementing the multiple components of parenting is a formidable task and, like good parenting, demands continual reassessment and revision. We owe thanks and congratulations to the foster youth who persevered with their reasonable demands for responsible care in the absence of responsible parents.

By Toni Heineman

Very young children do not know who they are. They learn about themselves from those who care for them—those who narrate their days for them, who describe their likes and dislikes, who tell them what makes them laugh and what makes them cry.

 Photo credit: rcvnl / Foter

Parents hold children’s memories for them until they can hold them for themselves. Remembering is a learned skill and, like other skills, takes time and practice. Research about how children’s memories are created, retained, and retrieved underscores the importance of social interactions in building the capacity to remember.

A recent Wall Street Journal discussed three specific and different ways that childhood memories promote emotional well-being. Some memories help to direct our behavior, i.e., they help us learn from our mistakes and profit from our successes. Children who remember the pleasure of doing well on a test after making the time to study can draw on that memory to improve study habits.

Other memories promote social relationships. Individually or with others we remember shared experiences. Social bonds can be strengthened by recall as well as by interpersonal interaction. Repeating pleasurable activities that we once shared with family and friends also helps to bring those people to mind. Reading a bedtime story to a child may bring to a father’s mind being read to by his father.

Still other memories establish a sense of self, beginning with the memories that parents and caretakers keep and give to very young children.“ Today we’re going to the same park we went to yesterday,” fixes children’s activities in time and space.

Parents who help children remember and talk about their activities are teaching them the art of storytelling. They learn how to talk to others about who they are and how the important people and events in their lives fit together. Children and adults draw on memories to help maintain a sense of continuity of self. We can look back and see the ways in which we were the same over time and the ways in which certain events or experiences changed us in some way.

 Photo credit: Thomas Hawk / Foter

These studies consider the development of children’s memories in the context of the parent child relationship. They do not examine the fate of memory when there is no consistent parent or caregiver to hold the child’s memories. When children move from home to home, as foster children do, it is not only clothes and toys that are sometimes left behind, but memories and fragments of experience that never get stored as cohesive, retrievable memories. This loss is one of the more subtle, but crucial, factors that undermine the sense of well being of children who grow up in foster care. “Memory books,” holding stories and pictures for children as they move from one home to another, are an attempt to rectify this loss, but they are not an adequate substitute for a parent who keeps the memories of a child’s history in mind.

By Toni Heineman

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