Considering the best interests of infants in foster care placed separately from their siblings

This article offers a perspective on the child welfare practice of placing infants and their siblings in foster care using the theoretical frameworks of attachment and infant mental health. The authors highlight issues for child welfare workers to consider when determining if moving an infant or young child from one home to another for the purpose of placing him with his siblings would cause trauma or disruption; and also issues to consider when determining the infant or young child's best interest when separated from siblings. First, the authors summarize the literature regarding attachment relationships and attachment disruptions. Then, they review outcome studies of children residing in foster care who are placed with their siblings and of those who are placed separately. Finally, the authors conclude with specific recommendations for child welfare workers to aid in making such difficult decisions about placing infants in foster care.     

Child development in foster family care – what really counts?

Previous research has demonstrated that children who grow up in foster family care – along with other child welfare recipients – manage less well in adulthood compared to those children who do not. Given this challenge, this integrative literature review locates the critical factors that either positively or negatively affect a child’s development in foster family care. The articles were analysed using theory-driven content classification in relation to Bronfenbrenner’s bioecological framework on child development. The results of the review suggest that there is a wide range of factors that could impact on a child’s development in foster family care. Child­related factors such as the child’s age, gender, behavioural or mental health problems, etc. were mentioned most often in the data. Micro­environmental factors are also essential to a child’s development. Linkages taking place between two or more of the child’s circumstances, such as the relationship between the child’s birth and foster families and between the foster family and the social worker, were also identified as being influential. Service usage and political and legislative factors, as well as attitudes towards children in care, were also indicated to be strongly influential. It is suggested that the factors identified in this review should be carefully considered as important aspects of care for fostered children and care documentation.     

FamilyLive: Parental Skill Building for Caregivers with Interpersonal Trauma Exposures

Mental health treatments for emotionally traumatized children incorporate family and caregiver-child therapy sessions to promote child recovery and minimize developmental disruption. Such sessions require that caregivers regulate their emotions to remain productively engaged in the therapeutic process. However, caregivers with histories of unresolved interpersonal trauma have difficulty with emotional regulation. Interpersonal trauma also negatively affects the ability to reflect on one’s own and others’ feelings and intentions. This limitation interferes with caregiver engagement in psychotherapy relationships aimed at supporting child trauma work. FamilyLive is an innovative caregiver-focused family therapy model that uses a one-way mirror, a specially trained reflecting team, structured routines and individualized verbalizations to address this complex clinical phenomenon. Guided by the literature on attachment and trauma, FamilyLive has yielded anecdotal successes and positive pilot results. FamilyLive is a viable approach to engaging caregivers with histories of interpersonal trauma in trauma-focused child and family therapy relationships.     

A review of literature: An examination of the correlation between attachment styles and adolescent girls’ sexual behaviors

ABSTRACT

This literature review examines eight studies of parental attachment styles, sexual behavior, and health outcomes among adolescent girls. The review focuses on studies that analyzed the perceived relationships between parents and their adolescent daughters and whether instabilities of life experiences correlated with risky sexual behaviors and if high-risk sexual behaviors were associated with an increase of sexually transmitted infections, unplanned pregnancies, and other poor health outcomes in adolescent girls. Findings show adolescent girls with insecure parental attachment styles were at a higher risk of sexual behaviors, early pregnancies, and transmission of sexually transmitted infections (STI’s). The most common finding in the studies reviewed was the significant association of how higher parental communication and monitoring may prevent risky sexual behaviors at an earlier age. Recommendations for mental and health care providers include the development of treatment programs to address the importance of parent-attachment relationships and multifaceted health needs of adolescents girls. Programs can be strengthened by involving other family members, improving parent-daughter communication and relationships and emphasizing system-level change (policy, procedure, practice). Adding these elements may ultimately lead to sustained improvements over time. Future research on other family social factors (e.g., divorce and separation of attachment figure, poverty, and single-parent homes) associated with attachment and high-risk behaviors is warranted. More research is needed to exam how secure attachments among adolescent girls may prevent earlier sexual encounters, unplanned pregnancies, and STI’s.     

Signs of resilience in sexually abused adolescent girls in the foster care system

In a sample of 99 sexually abused adolescent girls in the foster care system (64% in congregate living situations and 36% in family/foster care homes), nearly half were psychologically functioning well despite having experienced moderate-to-severe emotional, physical, and sexual abuse. It was hypothesized that these girls with resilient trajectories would differ from the currently symptomatic girls on several protective factors: education, future orientation, family support, peer influence, and religion. The results revealed that the girls with resilient trajectories were significantly more certain of their educational plans and optimistic about their future and had more positive peer influences.     

Family Systemic Approaches for Borderline Personality Disorder in Acute Adult Mental Health Care Settings

This thematic literature review explores the contribution of family/systemic approaches in the treatment and care of people with borderline personality disorder (BPD) in acute adult mental health care settings. It recognises the importance of early childhood trauma, family dynamics, and relationships in the aetiology of BPD and outlines key benefits and constraints of a family systems approach. The article discusses institutional, cultural, and power structures that influence the diagnosis and treatment process for adult clients with BPD and the value of relational ethics in guiding or mediating care between the family, healthcare system, and community.     

Predictors of attachment styles of children in foster care: an attachment theory model for working with families

The purpose of this study was to examine the attachment styles of children in foster care and to use this information to inform clinical practice (N = 110). When examining the relationship between attachment style and child characteristics, no significant differences were found. A structural equation model hypothesizing the relation of individual characteristics, losses, and family contact to avoidant attachment was then tested. Results provided tentative support for the hypothesized model. Implications for therapists include being attentive to attachment injuries, and working to create safe therapeutic environments when working with families involved in the foster care system.     

The Youngest Victims of Violence: Examining the Mental Health Needs of Young Children Who Are Involved in the Child Welfare and Juvenile Justice Systems

Children placed in the state’s custody due to neglect, abuse or maltreatment are one of America’s most vulnerable populations. Seventy-five percent of child victims of maltreatment are under the age of 12. Not only is their suffering a problem, these children are also at increased risk for delinquent behavior later in life. While research has documented the potential long-term consequences of child abuse and neglect, the mental health needs of young children involved in the foster care and juvenile justice systems have been largely overlooked. This study examined the social, emotional and behavioral difficulties of 670 children, age 3–11, who were involved in the child welfare and juvenile justice systems. Children in this study were living in residential treatment facilities, group homes, foster care homes or were receiving intensive home-based services. To assess the children’s mental health needs caregivers completed the parent form of the Strengths and Difficulties Questionnaire (Goodman, Journal of Child Psychology and Psychiatry 38:581–586, 1997). The findings indicated a high prevalence of mental health problems, with 81 % of the children in the sample having a total difficulties score in the borderline or abnormal range and 90 % of the children having borderline or abnormal scores on at least one of the subscales (conduct, emotional, peer or attention problems). When characteristics such as gender, race and age were considered significant differences were found among boys and girls, Caucasian and minority children, and age groups. The findings highlight the importance of mental health assessment and interventions that are gender and culturally sensitive and developmentally appropriate.     

Displacement,caregiving, and the ecological system of youth in foster care: a theoretical perspective

Children involved in the child welfare (i.e., foster care) system are at a greater risk for numerous negative outcomes in adolescence and adulthood (e.g., lower educational attainment, higher risk for a criminal record). For children in foster care who experience placement disruption (i.e., removed from a foster home and placed in another nonpermanent placement), the risks significantly increase. Informed by the ecological systems model, the authors propose a theoretical perspective to explain the unique aspects of a foster child’s development and discuss how this framework informs child welfare practice and intervention for foster children at risk for placement disruption. This perspective has the potential to provide a framework that has implications for foster caregivers and child welfare professionals and to inform future policies.     

Improving Relationships in Child Welfare Practice: Perspectives of Foster Care Providers

Foster parents care for our nation’s most vulnerable children and adolescents. Their ability to provide care is impacted directly and indirectly by their interactions with public child welfare agencies and workers. This study examines the perspectives of 1095 foster parents in a southwestern state in the U.S. regarding what they believe child welfare workers are doing well and their suggestions for ways to improve relationships between foster care providers and child welfare workers. Foster parents commended caseworkers who were responsive to their needs and provided ongoing concrete and emotional support, and believed there was a need for improved communication and enhanced teamwork. Foster parents consistently acknowledged an overwhelmed child welfare system and the impact on child welfare workers and child welfare-involved families. Understanding the perspectives of foster parents can improve relationships between child welfare workers and foster parents, improve recruitment and retention efforts of foster parents, prevent disruption of children from foster homes due to license closure, and improve the overall well-being of child welfare-involved children and families.     

Understanding Responses to Foster Care: Theoretical Approaches

Foster children making the transition from birth to foster homes or from foster homes to foster homes often present problematic behaviors. Limitations of attachment theory and reactive attachment disorder are presented, and three alternative approaches for understanding behaviors exhibited in foster settings are presented: conservation of resources, child alienation model, and developmental trauma disorder.     

Culture loss: American Indian family disruption, urbanization, and the Indian Child Welfare Act

This study examined the perceptions and views of urban American Indian parents regarding foster care and American Indian family issues. Findings highlight four themes: (1) discouragement from working with the current foster care system, (2) the role of culture in caregiving, (3) differing definitions of family and relatedness, and (4) the effects of historical pain due to past family disruption. These themes are used to formulate guidelines for the development of an American Indian foster care and child welfare program.     

Levels of burden and satisfaction among Spanish foster carers

The aim of this study was to analyse the levels of burden and satisfaction among foster families in Spain, as well as the relationships between these variables and characteristics of the foster children and their carers. Participants were 86 foster families (comprising 71 foster fathers and 86 foster mothers) and the 104 children who they were fostering (56 boys and 48 girls). The instruments used were the Zarit Burden Interview and a questionnaire on foster carers' satisfaction with the preparation and support they had received. The results revealed low levels of burden among the families. Levels of burden were directly correlated with the amount of time the children had spent in residential care and with the age of foster fathers, and inversely correlated with how long the child had been with the current foster family. Higher levels of burden were reported by carers whose foster child was academically delayed. Regarding satisfaction, the highest ratings corresponded to items referring to the work of professionals, while the lowest were given for items concerning the information that foster families had received about the child's personality and the material and financial support available to them. The implications of the findings for professional practice are discussed.     

Military Deployment of an Adult Child: Ambiguous Loss and Boundary Ambiguity Reflected in the Experiences of Parents of Service Members

ABSTRACT

This study explored the experiences of parents of service members, military family members who are often overlooked even though they are likely a vital source of support for their military adult-children. Reflections on deployment of military adult-children were gathered from 21 parents in semistructured group interviews. A framework of ambiguous loss, boundary ambiguity, and ambivalence was used to analyze comments reflecting pre-deployment, deployment, and post-deployment experiences. Pre-deployment anticipation of leave-taking was associated with boundary ambiguity and ambivalence for parents, tempered by safety concerns. During deployment ambiguity in parental role expectations and parameters complicated parents’ attempts to manage physical absence and maintain psychological presence. Post-deployment challenged parents with ambiguous psychological presence and disruption of family boundaries, complicated by changes associated with the effects of war.     

Body-Related Emotions in Posttraumatic Stress Disorder Following Childhood Sexual Abuse

Traumatic experiences are associated with emotions such as anxiety, shame, guilt, disgust, and anger. For patients who have experienced child sexual abuse, these emotions might be triggered by perceptions of their own body. The aim of this study was to investigate the extent of the association of the body to traumatic experiences and to discern the emotions linked to trauma-associated body areas. Ninety-seven female participants were assigned to four groups: post-traumatic stress disorder following child sexual abuse with co-occurring borderline personality disorder, post-traumatic stress disorder following child sexual abuse without co-occurring borderline personality disorder, borderline personality disorder without post-traumatic stress disorder, and healthy controls. Participants rated 26 body areas regarding their association with trauma and 7 emotions. Emotions were assessed by questionnaires. Results suggest that specific areas of the body are associated with trauma and linked to highly aversive emotions. In post-traumatic stress disorder patients, the areas associated with highly negative emotions were the pubic region and inner thighs. Thus, the patient’s body may act as a trigger for traumatic memories.     

Family environment and adult attachment as predictors of psychopathology and personality dysfunction among inpatient abuse survivors

The current study explored the role of early family environment and adult attachment style in explaining long-term outcomes among child abuse survivors. Adult patients (N = 80) in a trauma treatment program were assessed for clinical diagnosis and administered a multiscale questionnaire. Hierarchical regression analyses were significant for dissociative identity disorder (DID), substance abuse, anxiety disorder, posttraumatic stress, somatization, and six personality disorder dimensions. Adult attachment styles were significant predictors of most outcome variables. Of particular note was the strong contribution of attachment avoidance to DID. Five family environment scales (Independence, Organization, Control, Conflict, Expressiveness) also contributed to various psychopathological outcomes. Evidence emerged supporting a mediating role for attachment style in the link between family independence and five personality disorder dimensions.     

“I Deserve a Family”: The Evolution of an Adolescent’s Behavior and Beliefs About Himself and Others When Treated with Theraplay in Residential Care

This article chronicles a seriously disturbed adopted adolescent’s experience in an attachment focused residential program at which the primary treatment was Theraplay^®. Adopted at age four following significant abuse and neglect, Tom lived in institutions for 5 years before participating in Chaddock’s Developmental Trauma and Attachment Program (DTAP). He now resides successfully in the home of therapeutic foster parents. Theraplay treatment directly meets attachment needs through adult-guided, highly positive, engaging and nurturing interactions to change the child’s working models of attachment and to develop affect regulation. Theraplay was especially useful with this adolescent who was born addicted and who had little ability to participate in insight oriented therapy. Topics include adolescence and attachment, Theraplay theory, process and applications, and the DTAP milieu and treatment program. This case study demonstrates that it is possible to improve the outcome for adolescent development by directly meeting the adolescent’s attachment needs through the Theraplay model.     

Examining risk,strengths, and functioning of foster families: Implications for strengths-based practice

ABSTRACT

Foster families provide safe and stable homes for children and youth who are removed from their homes due to maltreatment. Despite the stressors associated with bringing children in and out of a family’s home, many maintain healthy family functioning and continue fostering for many years serving an essential function in the child welfare system. This study sought to understand the factors that explained higher levels of family functioning within foster families. Collaborating with one statewide public child welfare agency, 681 licensed foster parents participated in an online survey that examined the association between family functioning with family strengths and risk factors. Findings from this study can inform strengths-based practice including training, assessment, and interventions for new and existing foster families to strengthen families and improve the well-being of children and youth in their care.     

Adoption in the Media

Abstract

This article reviews four print pieces from national magazines and newspapers. They cover the subjects of adoption of older children from foster care, importing pregnant women from foreign countries to facilitate American adoptions of their babies, the death of a child with reactive attachment disorder, and the adoption of Chinese girls in New York City.     

Lessons From ‘The Hitting Place’: Reflections of a Family Therapy Novice

This case study is an account of a post‐traumatic family attempting to come to terms with life after violence, and the effectiveness of family therapy in supporting this transition. The fighting between two young girls had maintained the violence in the family dynamic and their highly anxious adolescent brother remained unable to let go of his protective position and move forward with his own life. The backdrop of the case was a novice family therapist and a mother with borderline traits who found it difficult to keep the therapeutic work within the bounds of the therapy sessions. Despite these difficulties meaningful change could be seen after only seven sessions of family therapy.