Channeling King Solomon:
Reducing DisruptedRelationships
&
Improving Permanency
Judith Silver, Ph.D., Co-Director
Safe Place: Center for Children’s Safety & Health
Questions to Ponder
How does removing
children from their
family impact them
emotionally?
How can we shape
practice early in a
child’s encounters with
the courts & child
welfare system to
reduce adversity?
Focus of Today’s Discussion
• Impact of disrupted relationships
• Promoting stability through:
– Placement decisions
– Visitation practices
– Permanency planning
Placement Instability &
Disrupted Relationships
• Instability:
– the quality of being unstable. Especially lack of
emotional stability
• Unstable:
– Not firm or fixed, characterized by the inability to
control the emotions
• Disrupt:
– To break apart, to throw into disorder, to cause to
break down
» Webster’s New Collegiate Dictionary
Northwest Foster Care
Alumni Study (N = 1500)
Compared to the general population,
Foster Care alumni more likely to experience
rates of mental illness:
–Post Traumatic Stress:
–Substance Abuse:
–Anxiety Disorder:
–Depression:
6 times
4 times
2.5 times
2 times
54 %
43 %
22 %
25 %
16 %
20 %
10 %
4%
12 %
3%
Casey National Alumni Study
Alumni who succeeded-What works?
• Delayed first placement due to family
support efforts
• Fewer placement disruptions
– Largest + effect on High School Completion
• Promoting a positive relationship
between child and foster parent
– Twice as likely to complete High School
Casey National Alumni Study
Alumni with a higher number of
placements were more likely to
experience:
–Decreased likelihood of reunification
–Greater severity of behavior problems
–More time in residential care
Theories on why
placements disrupt
1. Is it due to the
System?
2. Is it due to the kids?
Theories Why Placements Disrupt
Behavior
Problems
Placement
Change
Research Study
What is the impact of placement stability
on children’s behavior problems
after entering foster care?
N = 729 children 15 years old & younger
Behavior evaluated @ entry to FC
Placement Stability eval’d after 12 months FC
Behavior evaluated after 18 months
Rubin, D., et al (2007) Pediatrics, 119, 336-344.
Placement Stability
• Early Stability
• Late Stability
• Unstable
52%
19%
28%
Probability of Behavioral Problems at 18 Months, by Child's
Placement Stability & Baseline Risk for Problems
100.0%
Probabiltiy of Behavioral Problems
Early
80.0%
Late
64%*
51%
Unstable
*
45%
60.0%
36%*
25%
47%
32%
29%
40.0%
22%
20.0%
0.0%
Low
Med
High
Child's Baseline Risk for Placement Instability
* p < 0.05
36%
22%
25%
Conclusions
• Placement Stability Strongly Associated with
Behavioral Outcomes
• Children in FC experience placement
instability unrelated to their baseline
problems
• Placement instability has significant impact on
their behavioral wellbeing
• It’s critical to improve placement stability as a
means to improve children’s outcomes
• Rubin, D. , et al (2007). Pediatrics, 119, 336-344
Changing Placements =
Disrupting Relationships
When we move a child in care from one home
to another home…or one placement to
another placement…
We are moving a child from one relationship to
another relationship
Dorothy Henderson, LCSW, Through the Eyes of an Infant: Why
Early Relationships are Important, Jewish Board of Family &
Children’s Services, NYC
Why do Relationships Matter?
Early Relationships
• Relationships: the building blocks of
healthy development
– What children learn
– How they react to people & events
– What they expect from themselves & others
• Deeply based on relationships with
parents
National Research Council & Institute of Medicine (2000)
Neurons to Neighborhods
Emergence of Early Relationships
Newborn babies are completely
vulnerable & depend on
caregivers for:
• Temperature regulation
• Neuroendocrine regulation
• Protection from infection
• Food
• Protection from danger
• Comfort
Dozier, M. [ccc]
Emergence of Early Relationships
• Infant is hard-wired to recognize patterns
• Infants begin to recognize patterns
through repetitions of daily caregiving
routines
– Feeding, play, diaper changes, bedtime
Baby Cries => Mother Arrives
=> Soothes Baby
=> Baby Learns through all 5 Senses
• Sound
• Sight
• Scent
• Touch
• Taste
Parent-Infant Interactions
• Baby learns from these episodes of
engagement:
– What it’s like to be with mother & others
– What can I expect to happen?
– What usually happens
– What is “normal”?
• Babies use internal models to evaluate
current situations
Stern, Daniel (2002). The First Relationship. Harvard U
Press
Video clip:
Infants’ Expectations of Mother
Still-Face Paradigm
Edward Tronick, Ph.D.
Harvard University
Children’s Hospital, Boston
www.youtube.com/watch?v=7AGJFg6twjg
www.youtube.com/watch?v=HD3_nHXFkmw
Implications for
Child Welfare & Courts
• Even tiny infants will have a profound
response when moved from:
– Placement to placement
• When we move a baby in care from one
home to another home…or one placement to
another placement… what we are really
doing is….moving a baby from one
relationship to another relationship.”
Dorothy Henderson, LCSW , Jewish Board of Child & Family Services,
NYC
Attachment Formation
• Children internalize how to
–Calm down, feel soothed
–Protect self
• Ideas about Trust
–The Right to be Cared for
–The Right to be Safe
Grieving Disrupted Relationships
• Adults don’t recognize when very young
children grieve
• Children’s behaviors are misinterpreted:
– Withdraws or Avoids Contact
– Appears not to need comfort when hurt
– OR
– Indiscriminant in showing affection
• M. Dozier, 2002
Promoting Attachment
for Young Children in FC
• Very young foster children need frequent &
consistent contact with their parents
• Frequent visits have been found to:
– Reduce pain of separation
– Promote attachment
– Increase parent’s motivation to change
– Help parents practice skills
– Increase likelihood of timely permanency
• Smariga, 2007; Potter & Rothschild, (2002)
Unique to babies involved with
child welfare system
Extraordinary Stressors:
• Prolonged Neglect for most
• Physical Abuse for some
• Separation from Family
Impact:
– Infants’ biological stress responses
– Their coping strategies can threaten their
well-being
“David” Enters Foster Care
• 7 month old boy
with several
fractures. Placed in
foster care wearing
a body cast
• No eye contact, flat
emotions or piercing
high pitched cry
8 Weeks Later
• Happy & engaged
with foster family
• Hysterical if
someone
approaches his legs
• Terrified of loud
noises
Developmental Considerations
in Placement Decisions
• Children’s reactions to separation from
parents differ by developmental stage
• Children between 6 months & 3 years old are
most vulnerable to separation
• Older children, though vulnerable, have the
language skills to better understand loss and
cope with change
• Young children need frequent contact with
their parents
• Smariga, 2004
Channeling King Solomon
Decisions must ensure
• Safety & wellbeing
• Permanency
How can we minimize
instability for
children?
• ASFA & Fostering
Connections
Legislation
Promoting Commitment
& Stability
• Concurrent planning:
– Support child’s attachments to family AND
to consistent foster caregiver
• Keep relationships stable whenever possible:
– Don’t move child when not necessary
– Engaging & Finding Family
– Biological relationship does not trump stability &
commitment
Judicial & Child Welfare
Decision-Makers Can Ensure
• At onset placement decisions promote longterm stability
• Placement decisions promote healthy childcaregiver attachments
• Ties are maintained with birth parents &
siblings with frequent quality visits
• Permanency decisions respect bonds children
have forged in out of home care
– NCJFCJ, ABA, Zero to Three (2009). Healthy
Beginnings, Healthy Futures: A Judge’s Guide
Family Interaction to
Promote Permanency
Placement location supports:
• Frequent, meaningful visitation
• Parents’ involvement in healthcare
appointments
Ensure visits are in the child’s best interests:
• Family’s willingness to get help
• Child’s reaction to visits
• Therapeutic needs of child
• -Ginther & Ginther
Family Interaction
Visitation Plan
Develop Family Interaction Plan:
– Individualized
– Developmentally appropriate
– Promotes Permanency
Guided by ongoing assessment of parents’
ability to:
• safely care for children
• Interact positively with children
The Caregiver Capacity Checklist
 What are the specific challenges faced
by the caregiver in caring for this child?
 What are the learning requirements for
caregivers to meet the child’s needs?
 What are the specific illustrations of this
caregiver’s ability to meet the child’s
needs?
Dicker & Gordon, 2004
“Devon”
• 26 months old with
Failure to Thrive
• Weekly visits focus on
mother-child feeding
behaviors
• Referred for pediatric
evaluation
Learning Requirements for
Devon’s Parents
• Make appointments with several medical
specialists
• Attend Appointments with Devon
• Follow Through with Surgery
• Follow Up with Medical Recommendations
• Follow Medication Regimens
Family Interaction
Visitation Plan
Meaningful activities of daily living
Adequate level of supervision
Sensitive to parents’ & children’s emotions
– It’s natural for children to become dysregulated
and does not mean the parent erred during visit
– Monitor child’s reactions over time
E. Leonard, 3003; M. Smariga (2007).
Visitation: Relationship-Based
& Competency-Based
INITIAL Phase:
• Maintain ties between parent & children
• Assess parent’s capacity to care for child
• Develop goals
If progress is minimal:
• Reconsider reunification as proper goal
Rose Wentz, Best Practices in Visits.
www.hunter.cuny.edu/socwork/nrcfcpp/
Caregiver Capacity
Red Flags!
For parents with addictions:
– Noncompliance with substance abuse
treatment
– Random drug testing critical
For parents with psychiatric disturbance:
– Noncompliance with treatment /medication
– Dicker & Gordon, 2004
Caregiver Capacity
Red Flags!
Noncompliance with child’s health
appointments & medication or
therapeutic regimens
– This impacts Safety, as well as Wellbeing
A child’s poor growth
– Need to have Growth Curve plotted by
healthcare provider
– Dicker & Gordon, 2004
MIDDLE Phase:
Activities to help parent learn & practice
new skills & behaviors
Now visits are:
–More frequent
–Longer
–In a Variety of settings
Gradual reduction in supervision
TRANSITION Phase
Smoothing Transition to Reunification
Maximize contact
Least Restrictive Setting
Evaluate Remaining stressors
Ensure services to help parent meet
child’s needs
Ginther, N. & Ginther, J.
Reunification
Aftercare
– Monitoring & Services
– Arrange visits with foster parent to
maintain relationships
Overcoming Barriers
• Prioritize Cases
• Involve Foster Parents
• Collaborate with Community
Stakeholders
The Judge’s Role
• Develop clear, enforceable, written visitation
orders for each case
• Develop local rules that address visitation
• Facilitate collaborative community efforts to
improve visitation practices
• Encourage Cross-System Training for all
participants in dependency court re:
– child development
– Strategies to improve quality of visitation
• L. Edwards (2003)
The End
References & Resources
• Dicker, S. & Gordon, E. Ensuring the Healthy Development of
Infants in Foster Care: A Guide for Judges, Advocates, & Child
Welfare Professionals. Zero to Three Policy Center. 2004
www.zerotothree.org.
• Dozier, M. et al. Intervening with Foster Infants’ Caregivers:
Targeting Three Critical Needs. Infant Mental Health Journal,
23, 541-554. 2002
• Edwards, L. Judicial Oversight of Parental Visitation in Family
Reunification Cases. Juvenile and Family Court Journal, 54, 124. 2003
References & Resources
• Ginther, D. & Ginther, N. Family Interaction: The Expressway
to Permanency-Visitation. The Institute for Human Services.
www.dhs.state.ia.us/docs/10.09_Family_Interaction_Practice
_Bulletin.pdf
• Healthy Beginnings, Healthy Futures: A Judges Guide. National
Council on Juvenile & Family Court Judges, ABA Center on
Children & the Law, Zero to Three. 2009.
• National Resource Center for Permanency & Family
Connections. www.hunter.cuny.edu/socwork/nrcfcpp/
• Rubin, D. et al. The Impact of Placement Stability on
Behavioral Well-being for Children in Foster Care. Pediatrics,
119, 336-344. 2007
References & Resources
• Smariga, M. Visitation with Infants and
Toddlers in Foster Care: What Judges and
Attorneys Need to Know. ABA Center on
Children & the Law. 2007