Reducing Separation Trauma

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Reducing Separation Trauma
Kathleen I. W. Brundage
University at Buffalo, SUNY
© 2005- 2006 CDHS College Relations
Group Buffalo State College/SUNY at
Buffalo Research Foundation
“Attachment and separation are
the heart of child welfare work”
– Fahlberg (1991)
© 2005- 2006 CDHS College Relations
Group Buffalo State College/SUNY at
Buffalo Research Foundation
Overview
• Attachment Review
• Separation: Emotional & Psychological
Effects
• Promoting Attachment in the Foster
Home
• Current Research Study
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Attachment
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What is Attachment?
• The emotional bond that forms between a child and his
or her first primary caregiver and sets the stage for all
of the child’s future relationships and the ways in which
the child interacts with the world (Bowlby, 1988)
• The capacity for emotional security, closeness, and
autonomy which develops in response to a predictable
pattern of warmth, sensitivity, responsiveness, and
dependability from a significant caregiver (Karen, 1994)
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The Attachment Cycle
• The child has a need
• The child expresses the
need by fussing, crying,
or otherwise raging
• The need is gratified by a
caregiver, who provides
movement, eye contact,
speech, warmth, and/or
feeding
• This gratification leads to
the development of the
child’s trust in others
NEED
AROUSAL
TRUST
(Rage/Fussing)
GRATIFICATION
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Secure Attachment throughout the
Lifespan
• Greater curiosity and persistence as a toddler
• Positive peer relationships in preschoolers
• Advanced cognitive functioning during middle
childhood
• Development of a social conscience and
positive self-concept in adolescence
• Healthy, reciprocal relationships in adulthood
– Webster (1999); Allen & Ladd (1999); Feeney (2000)
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Secure Attachment
•
•
•
•
•
•
•
•
•
Emotional Resilience
Adaptability to new situations
Self-reliance and feelings of self-worth
Ability to cope with stress and frustration
Flexible thinking
Ability to modulate emotion
Attain full intellectual potential
Able to sort out perceptions and think logically
Development of social emotions and able to trust
others
• Conscience development
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– Kagan (2004)
Attachment Styles
• Secure
• Insecure
– Insecure-Avoidant
– Insecure-Ambivalent
– Insecure-Disorganized
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Insecure Attachment
• Avoidant
– Act distant
• Ambivalent
– Constantly clamor for attention and nurturance,
never comforted
• Disorganized
– Contradictory behavior with the caretaker
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School-Age and Adolescence
• Avoidant
– Affective disorder
(depression)
– Obsessive Compulsive
Disorder
– Histrionic, borderline, and
schizotypal personality
disorders
• Ambivalent
– Conduct disorder
– Substance abuse
– Narcissistic or antisocial
personality disorder
• Disorganized
– Aggression
– Oppositional Defiant
Disorder
- Lyons-Ruth (1996); Rosenstein & Horowitz (1996)
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Attachment Problems Can Cause:
• Problems with Emotional development
• Problems with Psychosocial development
• Problems with Cognitive development, esp. Language
delays
• Motor delays
• Physical health problems
• Neurological problems
• Growth delays
• Problems with Behavioral regulation (see Handout 1)
– Carlson et al.(2003); Fahlberg (1991); Feeney (2000); Leslie et al. (2002);
Moss (2205); Schore (2001); Seigel (2001)
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Attachment Disorder
• A constellation of aberrant attachment behaviors and
other social behavioral abnormalities resulting from
“pathogenic care” (APA, 2000, p 130)
• Affects children who have been
–
–
–
–
Traumatized
Neglected
Parents suffering from depression, mental illness, addictions
Experienced physical, sexual, and/or emotional abuse
– APA (2000); Keck & Kupecky (2002)
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…AD
• Two clinical patterns:
1) Emotionally withdrawn/inhibited
2) Indiscriminately social/disinhibitied
• Have learned that the world is unsafe and have
trouble trusting others
• Characteristics (see Handout 2)
– APA (2000); Cline (1990); Keck & Kupecky (2002); Levy & Orlans (1998)
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AD in Adolescence
•
•
•
•
•
•
Oppositional Defiant Disorder
Attention Deficit Hyperactivity Disorder
Affective Disorders (Depression)
Serious criminal behavior
Hard drug use
Psychiatric disturbances in adulthood
– Greenberg (1999); Ladnier & Massanari (2000); Dozier et al. (1999)
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Attachment and Foster Children
•
•
•
•
•
Loss of primary caregiver
Often experience multiple placements
70%+ are removed due to abuse and/or neglect
About half have disordered attachments
Expectations & adaptive strategies learned in
original attachment relationship are maladaptive
in context of new relationships
– CWLA (2002); Finzi et al. (2001); Newton et al. (2000)
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Separation
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What do Foster Children lose?
• Parents/caregivers
• Siblings (in some
situations)
• Grandparents, other
relatives
• Friends
• Pets
• Home
• Neighborhood &
community
• Belongings
• Image of themselves
and their families
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Emotional Response to
Separation
• Fear
• Helplessness
•
•
•
•
•
•
•
Horror
Sense of loss
Anger
Sadness
Guilt
Confusion
Loneliness
Trauma
Grief
• See Handout 3
- Chapman et al. (2004); Hughes (1997); Johnson et al. (1995); Kagan (2004); Kobak
(1999); Mauk & Sharpnack, (1999); Waddell & Thomas (1998)
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Behavioral Responses
to Separation
•
•
•
•
•
•
Bullying and hostile behavior
Lying
Stealing
Aggression toward peers
Thoughts of suicide
Substance abuse
–Delaney (1991); Hughes (1997); Newton et al. (2000); Penzerro &
Lein (1995); Rosenstein & Horowitz (1996) Sroufe et al. (2003)
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When Separation Trauma Remains
Unresolved:
• Disproportionately high involvement in mental
health, juvenile justice, and adult criminal justice
systems
• Difficulty in future relationships
– Delaney (1991); Hughes (1997); Newton et al. (2000); Penzerro & Lein
(1995); Rosenstein & Horowitz (1996) Sroufe et al. (2003)
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Factors Affecting the Severity of a
Child’s Reaction to Separation
•
•
•
•
Child’s age and stage of development
Significance of the lost person(s)
Past experiences with separation
Child's perceptions of the reason for
separation
• Length of the separation
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Factors Affecting the Severity of a
Child’s Reaction to Separation
• Child’s behavior and temperament
• Preparation for the move
• Post-separation environment, including
caregiver state of mind
– Barber (2001); Barber & Delfabbro (2003); Bernier & Dozier (2003);
Chapman et al. (2004); Cournos (2002); Fahlberg (1991); Heinicke &
Westheimer (1966); Mauk & Sharpnack (1999); McFadden (1992);
Newton et al. (2000); Penzerro & Lein (1995); Redding et al. (2000);
Rycus & Hughes (1998).
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Promoting Attachment in the
Foster Home
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Child Barriers to Attachment
• Prior relationship disruptions give a sense of
relationships as inconsistent and undependable
• Disturbed expectations about relationships
• Disturbances in interpersonal relatedness
• Developmental delays (esp. speech and language)
• Behavior problems
• Disturbances in sense of self
• Emotion regulation problems
– Zeanah & Smyke (2005)
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Foster Parent Barriers to Attachment
• Trained in previous era when foster parents were told
not to “get too attached”
• The child is not raised by the foster parent from birth
• Misrepresentation of child’s needs and experience
– Viewing child as “damaged goods”
– Believe the child “merely” needs structure and affection
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…Foster Parent Barriers
• Stepping around/covering up the child’s
traumatic history and painful feelings
• Foster parent’s unresolved losses
• Insecure attachment style of foster parent
– Bernier & Dozier (2003); Dozier et al. (2001); Zeanah & Smyke (2005)
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• Adults who care for needy children are often
those who have experienced childhood trauma
themselves
– Cournos (2002); Redding et al. (2000)
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Foster Parent Attachment Styles
Foster Parent
Population
Adult
Population at large
Secure
32%
70%
Insecure
68%
30%
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– Steele et al. (2003)
The Issue of Foster Parent
Attachment
• Foster parent state of mind with regard to
attachment is a stronger predictor of infant
attachment than age at placement, and may
mediate the effects of abuse/neglect history.
– Children under 2 y/o, 3 months after placement:
• Secure foster parent – 79% secure foster children
• Insecure foster parent – 37% secure foster
children
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– Dozier et al. (2001)
Insecure Attachment
• Caregivers with insecure attachment styles tend
to step around the child’s trauma
• They tend to distance themselves from troubling
emotions
– Steele, Kaniuk, Hodges, Haworth, & Huss (2003)
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Secure Foster Parent Attachment
• More accurate interpretation of child’s behavior
(recognize anger and despair underlying acting
out behavior)
• Accurate understanding of child’s
developmental level (important for attunement
to child’s needs)
• Better foster parent-foster child bonding
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– Bernier & Dozier (2003)
Training is Key
• Foster parents need to understand:
– The developmental status of the child
(Handout 4)
– The child’s particular background
• Personality
• Attachment history
• Thoughts & feelings about the family
– Bernier & Dozier (2003); Mennen & O’Keefe (2004); Rycus & Hughes
(1998)
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…Training & Support
• Foster parents benefit from training in
recognizing what young foster children actually
need, not necessarily what they signal that they
need
– Children placed later than 12 months old typically
display behaviors of insecure attachment styles
– Foster mothers tend to respond “in kind”
– “Powerfully self-perpetuating cycle”
– Dozier et al (2002); Stovall & Dozier (2000); Mennen & O’Keefe (2005);
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Zeanah & Smyke (2005)
Group Buffalo State College/SUNY at
Buffalo Research Foundation
…Training & Support
• Assessments of foster child attachment
• Regular phone contact with support teams (Child
Welfare Workers)
• Support Groups
• Regularly scheduled foster parent training
sessions (child development, attachment,
behavior modification)
Significant decrease in child behavior problems (even
for children with AD)
– Mennan & O’keefe (2005); Zeanah & Smyke (2005)
© 2005- 2006 CDHS College Relations
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…Training and Support
• Supporting collaborative relationships between foster
parents and social workers promotes foster parent selfefficacy and removes barriers to attachment
– Foster parents should be valued for their ability to provide
input regarding child development
• Social workers should be encouraged to provide foster
parents with needed info but also to be open to foster
parent input
– Mennan & O’Keefe (2005); Zeanah & Smyke (2005)
© 2005- 2006 CDHS College Relations
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Current Study
Needs Assessment for Reducing
Separation Trauma:
Foster Child & Foster Parent Attachment and
Preparation for Placement
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Preparation for Placement
– History of abuse or
neglect
– Developmental level
(especially
communication level)
– Habits and preferences
for things like eating,
sleeping, and bathing
–
–
–
–
Medical needs
Interests and skills
Behavior problems
Fears and anxieties and
how the child typically
expresses those and is
accustomed to being
comforted
Do foster parent and social worker reports agree?
Do foster parents need more preparatory support?
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Child’s Behavior & Temperament
• Attachment Disorder Checklist (Becker-Weidman, 2001)
– 50% of foster children nation-wide present clinically significant
symptoms of AD
– Many foster parents are under-trained to recognize possible
signs of AD
 Foster Parent and Child Welfare Staff reports of child behavior
to i.d. whether symptoms of AD are recognized at the rate
specified in the research literature
 Implications for future research: may add to limited body of
knowledge on school-age and adolescent foster child
attachment
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Foster Parent State of Mind with
Regard to Attachment
• Foster Parent self-report assessment of attachment
style
• Child Welfare Worker observations of foster parent
attachment behaviors
 Does self-reported attachment style agree with social worker
reports of attachment behavior?
 Need for education about attachment-promoting attachment
behaviors?
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Research Questions
Overall, do foster parent and child welfare
worker reports agree?
Are there relationships between preparation
for placement and foster child
behavior/foster parent attachment?
Is there a relationship between foster child
attachment behavior and foster parent
attachment style?
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Thank you.
Questions?
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© 2005- 2006 CDHS College Relations
Group Buffalo State College/SUNY at
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Group Buffalo State College/SUNY at
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