Strengthening Family
Relationships

Remember the Core Competencies of PRIDE:
1. Protecting and Nurturing Children
2.
Meeting Children’s Developmental Needs and
Addressing Developmental Delays
3. Supporting Relationships Between Children and Their Families
4. Connecting Children to Safe, Nurturing
Relationships Intended to Last a Lifetime
5. Working as a Member of a Professional
Team

Supplemental Handouts for This Session
• Copy of Ecomap Diagram Exercise for your homework
• Resources to bolster your community support:
– List of Medicaid HMOs
– List of WIC Office Locations

What is the connection between family relationships and a child’s self-esteem?
• How children feel about themselves is related to their sense of family and belonging
• How children feel about themselves is related to the respect and dignity they feel about their cultural and ethnic affiliation

Why Are Children In Foster Care At Risk Regarding
Developing Positive Self-esteem and Personal and
Cultural Identity?
• Children may feel they are responsible for bad things happening to them because they are not loveable or valuable
• Cultural identity can be negatively affected if placed out of their own culture and heritage
• Foster parents cannot provide children with a legal status, social status, continuity of parenting and commitment that comes from being with one’s own family

The Bluest Eye by Toni Morrison
“Each night, without fail, she prayed for blue eyes.
Fervently, for a year she had prayed. Although somewhat discouraged, she was not without hope. To have something as wonderful as that happen would take a long time.
Thrown, in this way, into the binding conviction that only a miracle could relieve her, she would never know her beauty. She would see only what there was to see: the eyes of other people.”

Can You Help Me Know Who I Am?
• Much of the way in which our identity forms has to do with how others see us, react to us and provide feedback to us.
We tend to pick up cues about who we are from other people.
• We begin to form our sense of who we are from the messages we receive from those who surround us.

Cultural vs. Racial Identity
• Cultural identity is a part of every child’s development. Race is only one aspect of a child’s cultural identity.
• Through cultural identity, children develop values, life routines, communication patterns and religious beliefs, as well as a taste for certain foods and a knowledge of how life is celebrated and honored.
• Children of the same race may still have differences in their cultural identity.

Development of Racial Identity
• Racial identity may challenge resource families when working with children
• We ask ourselves, “When do children begin to notice that skin colors differ?”
• PRIDEBook Page 163 describes one model of how racial identity develops

Development of Racial Identity
• From birth to age 3, toddlers become aware of physical race and skin color difference and learn names for specific groups. They do not comprehend the real meanings of these labels.

Development of Racial Identity
• With young toddlers, how would you promote a sense of positive racial identity?
– Have dolls, toys and books that reflect the child’s racial and cultural identity
– Ensure that children learn appropriate names for specific groups
– Acknowledge differences in skin colors if the child asks or seems to notice
– Avoid long explanations- indicate acceptance of differences through smiles, physical gestures and positive comments.

Development of Racial Identity
• From ages 4 to 6, preschoolers can usually identify their own racial or ethnic group and may place a positive or negative value on their own and other groups.

Development of Racial Identity
• With preschoolers, how would you promote a sense of positive racial identity?
– Continue to have dolls, toys and books that reflect the child’s racial and cultural identity
– Model positive feelings about the cultural affiliations
– Closely monitor television and other media to ensure that the child is receiving positive messages about his/ her identity
– Ensure that the child sees other people who look like him/ her
– Acknowledge differences in a positive way and encourage the child to begin to talk about how he or she views differences

Development of Racial Identity
• From ages 7 to 11, children usually have a firmer understanding of their own racial and ethnic identity and- given the opportunity- will explore what it means to be a member of this group.

Development of Racial Identity
• With children of this age, how would you promote a sense of positive racial identity?
– Continue to have dolls, toys and books that reflect the child’s racial and cultural identity
– Be prepared to talk honestly about the differences and how the child experiences the differences
– Help the child to find a positive role model who reflects the child’s racial identity and is willing to spend time with the child
– Get the child involved in organizations and groups with a cultural focus
– Participate in activities that support the child’s cultural identity (cook special foods together, attend festivals, parades or events that promote the child’s culture)

Development of Racial Identity
• From the ages 12 to 18, adolescents do a lot of exploration related to identity including determining the significance of race, ethnicity, culture, adoption and examining how these apply to the individual.

Development of Racial Identity
• With teenagers, how would you promote a sense of positive racial identity?
– Many teens will enjoy some of the activities discussed for latency age children- festivals, groups, music, etc.
– They may adopt traditional dress and hair styles and seek to become immersed in the culture
– There is a critical need to talk honestly and deal with the concerns that teens present
– Do not become defensive and try to refrain from minimizing or denying racial and cultural concerns

Challenges of Cultural and Racial Identity
• What are some of the challenges you may face regarding a child’s cultural or racial identity?
– School projects that involve family history
– Other children may make cruel or inappropriate comments
– Children may feel embarrassed that they look different than your family
– Lack of historical photos/videos of the child’s life
– Lack of historical photos/videos of the child’s family

How Do You Respond to Racial Bias?
• I can go shopping alone most of the time, fairly well assured that I will not be followed or harassed by store detectives.
• I can turn on the television or open to the front page of the newspaper and see people of my race widely and positively represented.
• I can go into a bookshop and count on finding the writing of my race represented; into a supermarket and find the staple foods that fit with my cultural traditions; into a hairdresser’s shop and find someone who can deal with my hair style.
• I can do well in a challenging situation without being called a credit to my race.

How Do You Respond to Racial Bias?
• I am never asked to speak for all the people of my racial group.
• I can be reasonably sure that if I ask to talk to “the person in charge,” I will be facing a person of my race.
• I can easily buy posters, postcards, picture books, greeting cards, dolls, toys and children’s magazines featuring people of my race.
• If a traffic cop pulls me over, I can be sure that I wasn’t singled out because of my race.
• I can choose blemish cover or bandages in “flesh” color and have them more or less match my skin.

Situations You May Experience
Your family has known the Smiths for years and you consider them to be good friends. The children in your families grew up together. They played often, participated in activities together and were close friends.
Your minority son is now 16 years old, as is the Smith's oldest daughter. Your son asks their daughter to go to the prom with him as his date. She tells your son she can't go with him because he is not white. Your son comes to you questioning why he could be her friend all these years but can't take her to the prom.
• What would you tell your son?
• As a parent, how would you feel?
• How would this affect your relationship with the Smiths?

Situations You May Experience
Your adopted daughter, Tina, who is twelve years old and of mixed race, comes home from school visibly upset. When questioned, she begins to cry and tells you that her friend, Joyce, told her that the Bible says it's a "sin" to mix the races. She was also told that Joyce's mother said that, not only is your family a sin, but because Tina is mixed race, her birth was a sin. Tina loves to go to church and religion is becoming important to her. She is very troubled about what Joyce told her and wants to know if this is true.
• What is your initial reaction?
• What will you tell Tina?
• Will you approach Joyce’s mother?

Situations You May Experience
You are grocery shopping with your 6-year-old adopted daughter, who is of a minority race. A woman approaches you in the aisle, smiles at you and asks, "Is your child adopted?" You reply that she is. She comments, "What a wonderful person you are! God will certainly reward you in heaven. What a lucky little girl she is!"
• How would you feel?
• How would you respond to the woman?
• What concerns might you have about the way that your child might interpret the woman’s comments?

Challenges of Cultural and Racial Identity
• What kinds of things can you do as a family to help deal with some of these challenges?
– Immerse yourself in school projects with your child – it will be an educational experience for you as well
– Reassure your child that the hurtful comments of their peers are probably because they don’t understand
– Participate in foster/adoptive family association functions – children see other similar families
– Take as many pictures/videos of the child as you can
– include their photos with your family’s

Multiethnic Placement Act of 1994 (MEPA)
• Federal law enacted as part of the Improving America's
Schools Act
• Designed to:
– Decrease the time children wait for adoption
– Prevent discrimination in the placement of children
– Facilitate the identification and recruitment of foster and adoptive families that can meet children's needs http://www.acf.hhs.gov/programs/cb/laws_policies/policy/pi/pi9523a5.htm#overview

Multiethnic Placement Act of 1994 (MEPA)
• Prohibits foster care and adoption agencies from delaying or denying or otherwise discriminating in making a placement decision on the basis of race, color or national origin
• Prohibits agencies and entities from categorically denying the opportunity for any person to become an adoptive or foster parent solely on the basis of the race, color, or national origin of the adoptive or foster parent or the child
• Requires states to develop plans for the diligent recruitment of potential foster and adoptive families that reflect the ethnic and racial diversity of children in the state for whom foster and adoptive homes are needed

In What Ways Can You Work With the
Team to Support Family Relationships?
• Support family visits
• Talk positively to children about birth families
• Encourage birth parents’ participation in decision making for the child
• Obtain pictures of the birth family
• Take the child back to visit community/church/school
• Plan for telephone calls or letters
• Have the child draw pictures/artwork for birth family
• Include birth family in child’s prayers at bedtime

In What Ways Can You Work With the
Team to Support Family Relationships?
• Ensure that items given to the child by their birth family are respected
• Reassure the child that the birth family cares for him/her despite the difficulties the family has had in meeting child’s needs
• Be courteous and respectful to the birth family in front of the child
• Help birth family cope with their losses
• Do not talk negatively about birth family in front of or to the child
• Ask for birth parents’ input or assistance on a parenting issue

Remember …
Foster care is a support for families
Your role is to ensure that the children in your care have the opportunity to develop to their fullest potential

The Ecomap Diagram
The Ecomap diagram, along with the
Genogram that we discussed in Session 2, are tools that can help us understand our family relationships, and how these relationships contribute to our self-esteem, personal identity and cultural identity.

Ecomap Diagram – Conventions
• Strong relationship
• Weak relationship
• Stressful relationship / / / / / / / / / /

Ecomap Diagram – The Basics
• Members of my family include _______.
• Important friends of our family include _______.
• The network to meet my family’s developmental needs includes _______.
• My family’s employment and income is met through __________.
• The teams and voluntary networks in which my family is involved include ________.
• Changes or transitions in my life, some of which are positive and some negative include ______.

Ecomap Diagram
As an example of an Ecomap, either use
Bud’s Ecomap or the Hanson Family
Ecomap from the PRIDEBook (redundant to use both). Both sets of slides are included here. Just omit the exercise that isn’t used.

Work
Friends
Cannaveno Family Ecomap
(Before Becoming a Resource Family)
Friends & Neighbors
Joy H.
Changes/Transitions
Bud’s sister having 1 st baby
Andrea classified in school
Plaza
Family
Care
Rx
Dr. Ed
(Dentist)
Cory
Neighbors
Bud’s
Parents
Aunts &
Uncles
Family
Bud’s
Sister
J
M B
L
Pets
A
Family
Car
(minivan)
Sports &
Recreation
Scouts
Community/Other
Resources
Church
W.T.
Schools
Developmental
Needs Providers
Michelle
At Home
AT&T
(Bud)
Employment/
Income

Cannaveno Family Ecomap
(Today)
Therapy
(OT,PT,ST)
Friends & Neighbors
Work
Friends
Other
Resource
Families
Changes/Transitions
John’s career
Bud’s job uncertain
- Shania may go home
- Andrea will be driving
Doctor/
Dentist/
Rx
DYFS W.T.
Schools
Developmental
Needs Providers
Neighbors
Cory
Pets
M B
Brandon’s
Birth
Family
D
J
J
A L
R B M
S
Bud’s
Parents Aunts &
Uncles
Family
Bud’s
Sister
Cars
(Suburban/ wagon)
Sports &
Recreation
Scouts
Shania’s
Birth
Family
Michelle
At Home
Employment/
Income
AT&T
(Bud)
Church
Community/Other
Resources
Foster
Parent
Assoc

The Hanson Family Ecomap
• PRIDEBook Pages 168-169 show the
Hanson Family ecomap both before they became resource parents and after.
• What are some of the most notable changes you can identify?

The Hanson Family Ecomap
• The “after” ecomap is much more complicated and involved.
• There are many more people and agencies that were added.
• There are new relationships with birth families.
• Other resource families appear to be the friends in the support network.
• The strength of some connections had to decrease in order to make room for all of the new connections (like
Emma no longer working outside the home).
• Some of the connections have become stressful (like
Carlton’s union) because the family has less free time.

Ecomap Diagram
Friends
Changes and
Transitions
Developmental
Needs
Network
Family
Teams/
Voluntary Networks
Employment/
Income

The Child Health Program
• Partnership between the UMDNJ School of Nursing
( Francois-Xavier Bagnoud Center ) and DCF/DYFS, established in 2008
• The purpose of the Child Health Program (CHP) is to support DCF/DYFS to ensure that the medical/dental/mental health needs of children in out-ofhome placement are met
• The CHP develops child-specific health care plans
• The CHP adheres to recommendations of the American
Academy of Pediatrics (AAP)

The Child Health Program
“Health Care Management is the responsibility the of the child welfare agency, but it is a function that requires medical expertise.” 1
• Numerous studies indicate that children and adolescents in foster care have multiple physical, emotional and developmental needs
• Health Care Management is provided by the CHP to overcome barriers to ensure that children & adolescents receive high-quality, comprehensive and coordinated health care
1 Fostering Health: 2nd Edition, Task Force on Health Care for Children in Foster Care, AAP, 2005

The Child Health Program
• Responsible for managing the health care needs of children in out-of-home placement through Health
Care Case Management
• Ongoing interaction with DYFS staff regarding health and medical needs of children in placement
• Provide nursing summary and Individualized Health Care
Plan for children

Components of Health Care Services
• The American Academy of Pediatrics indicates there are four primary components to health care services:
1.
An initial health screening (pre-placement exam) within 24 hours of placement
2.
A comprehensive medical and dental assessment (CHEC or
CME) within 30 days of placement
3.
A developmental and mental health evaluation (part of CHEC)
4.
Ongoing primary care and monitoring with the child’s Medical
Home
• Continuity of care for children in out-of-home placement is paramount!

Initial Health Screening
• Pre-placement or re-placement physicals are completed within 24 hours of placement/re-placement
• Physicals are to be completed by CHU nurse, Urgent
Care Center or Medical Home
• DYFS policy prohibits pre-placement and re-placement physicals in hospital emergency rooms unless deemed necessary by the Local Office Manager

Comprehensive Medical Exam
• Comprehensive Health Examination for Children (CHEC) includes a mental health assessment (detailed interview and evaluation)
• Comprehensive Medical Examination (CME) includes a mental health screening (just a few general questions)
• CHU Staff Assistant will coordinate and schedule – must be completed within 30 days of placement

Developmental & Mental Health Evaluation
• If during CHEC/CME needs are identified, CHU will follow up to assure that appropriate follow-up is obtained
• Children under age 3 should have an evaluation by the
Early Intervention Program (EIP)

Ongoing Primary Care and Monitoring with
Medical Home
• Medical Home refers to child’s primary care physician
• Medicaid HMO must be selected
• Continue with prior Medical Home when feasible
(continuity of care)
• Early Periodic Screening, Diagnosis and Treatment
(EPSDT) exams at specified intervals as per Bright
Futures/AAP
• Immunizations per Centers for Disease Control (CDC)
• Routine dental exam and care every 6 months, starting at age 3*.

How It Works: The Child Health Unit
• Group of child health care staff (nurses and assistants), dedicated to serving DYFS children in a given area:
– Ensure that children receive their immunizations, dental and medical appointments according to the American Academy of
Pediatrics and Bright Futures TM
– Access immunizations records
– Obtain medical records and medical information
– Assist Resource Parents with advocating for a child’s health care needs
– Manage the health care needs of children in out of home placement

How It Works: The Child Health Unit
• Group of child health care staff (nurses and assistants), dedicated to serving DYFS children in a given area:
– Health care resources, support, and education for Resource
Families
– A “bridge” to the healthcare community
– Communicates with those involved in care of child, keeping them informed of child’s health status and participating in key case conferences concerning the child
– May attend regional placement conferences, family team meetings, court hearings, etc.

The Child Health Unit
Ensuring That A Child’s Health Care Needs Are Met
• Physical Health Needs
– Children receive Early and Periodic Screening Diagnostic and
Treatment (EPSDT) examinations in accordance with the periodicity schedule
– Children receive timely immunizations
– Children receive appropriate follow-up care to address their health needs (includes follow-up of the recommendations of health care providers)

The Child Health Unit
Ensuring That A Child’s Health Care Needs Are Met
• Mental Health Needs
– Children receive mental health assessments
– Child Health Unit will work with DYFS to ensure referrals that service are in place
• Dental Health Needs
– Children 3 years and older receive semi-annual dental examinations- unless indicated otherwise. New recommendations began screening at age 1.

The Child Health Unit
Communication is KEY!
• In-Person Contact:
– The Child Health Nurse will contact Resource Parents and make a home visit within 2-3 weeks of placement and visit about every
24 months depending on the child’s healthcare needs.
• Phone Contact:
– Resource Parents are expected to contact their child health nurse to inform them of any changes in health care status of the children in their care, doctor visits, new medications, etc.

The Child Health Unit
• In the Beginning …
– Ensure pre-placement and re-placement physicals for children in placement are completed within 24 hours of initial placement or a change in placement.
– The child health nurse will complete a DYFS form that is the child’s Health Passport . This is mailed or given to the Resource
Parent.
– The nurse may be calling you to discuss significant health care issues before receipt of the Health Passport .

The Child Health Unit
• Ongoing care…
– A child health care plan is developed by the Child Health Nurse which will include their nursing plan and recommendations from health care providers and other community sources as well (e.g.
School).
– The Health Care Plan is a living document and so it changes as the health care of your child changes. The Child Health Unit staff and Resource Parents will be communicating often .

Child Health: YOUR Responsibilities
• Maintenance of a “Medical Log” by the Resource Parent is expected and will be reviewed by the nurse at visits.
The Medical Log should include all health care visits
(well & sick), medications, illnesses, injuries, appetite.
• According to DYFS policy, if a child has a fever of
100.4
° F , you must contact your child’s primary doctor.
• The Resource Parent must maintain a copy of the child’s immunization record.
• Psychotropic medications require DYFS approval
• CPR Certification is recommended for all Resource
Parents and caregivers.

The Child Health Unit

How Visits Support Family Connections
• The most significant way in which family connections are supported is through family visits.
• Research has consistently shown that visits are the key to reunifying families, because the relationship and bond are maintained !

• Different members of the team may have different goals for the visit:
– The child needs to know he or she is loved and lovable and that parents are all right
– The birth family needs to know that the child is being well cared for and that the child has not forgotten them
– The resource family needs to understand the family relationships/dynamics in order to support the child in his or her attempt to understand the birth family and their situation
– The Caseworker needs to provide direct input into the parentchild relationship, observe parenting skills and obtain data to make decisions

Common Concerns About Family Visits and
How They Are Addressed kidnap the children.
been terminated. Visits are mandated .
with their relatives.

• PRIDEBook Pages 171-174 provide information about how to prepare for visits and what to expect about their location, frequency and length
• NOTE: DYFS policy mandates that the birth family be provided with a visit within 5 working days of placement.

What are some things that a child needs in order to be well prepared for a visit?
• A clear understanding of the visiting arrangements
• As much information as possible about the visit ahead of time
• To be prepared for the parent’s reaction
• To be prepared for his/her feelings and reactions
• To understand that emotions are complicated and unpredictable, and that the visit may bring up a range of these feelings

In what ways can we help children at the end of a visit or after a visit?
• After saying goodbye, remove the child as quickly and as calmly as possible from the visiting location
• Let the child know that you are there to listen, but do not question them about the visit
• Tell the child when the next visit will be
• Make a statement that allows the child to know that he or she can express feelings
• After visits, be prepared to pick up the child’s cues – some children want to be left alone, others need to be with someone, many children need to sleep
• Don’t force the child to eat or push them to be affectionate

• Think about how a lack of family history might be a problem for someone …
– Unable to answer medical history questions
– Unable to give mother’s name for identification
– Unable to tell children about their ancestors
– May cause someone to experience a grieving reaction or trigger an identity crisis
• Lack of family history can be an issue for children in foster care or who are adopted

Foster
Family
Other
(group home, residential, hospital)
Foster
Family
Kinship
Family
Adoptive
Family
Birth
Family

• The families can meet and get to know one another, plan for transition, and share information
• There should be pre-placement visits for adoption
• Families can maintain contact after the child is placed or moved
• Share pictures and letters
• Talk to the child about the transition

• A Lifebook is a tool that can be used to build a sense of history and continuity
• It is a child’s record of families and connections, both past and present
• A Lifebook can be a photo album, a loose-leaf binder, folder or composition book, a scrapbook, or even a video
• The collection should include information about why the child came into care, pictures of where he/she has been, names of significant people and important life events
• Contributions to Lifebooks can be from you, the child, the birth family, the caseworker or any other person in the child’s life
• Maintaining a Lifebook is a DYFS licensing requirement.

CLOSURE
• Review Key Points , PRIDEBook Pages 183-188
• Review You Need to Know!
, PRIDEBook Pages 189-192
• Read Birth Parent’s Perspective , PRIDEBook Page 193
• Complete the PRIDE Connection exercise on
PRIDEBook Pages 194-195 (copy in packet)
• Read Making A Difference!
, PRIDEBook Page 196-197
• Session 6: Meeting Developmental Needs: Discipline

Supporting Family Connections and Continuity
Will’s World
• PRIDEBook Page 152 tells the story of
Will as he enters foster care
• What connections are at risk for Will?

Supporting Family Connections and Continuity
Will’s World
• His family (mother, grandmother, uncle)
• His friends (Jim, other neighbors, couple upstairs)
• His mother’s former boyfriend
• His teachers and school (gym teacher)
• His school counselor
• Little League
• The neighborhood health clinic

How Can The Team Work to Maintain These
Connections for Will?
• Support regular visits with his mother
• Support regular visits with his grandmother
• Explain to him that his uncle is sick
• Allow him to continue playing on his little league team
• Encourage him to write letters to his family, friends, teachers, etc.
• Continue his health care at the neighborhood clinic
• Allow him opportunity to say good-bye to his teachers and school adjustment counselor
• Ensure that he is connected to a new school adjustment counselor
• Provide him with as much information as possible about his new family, school and community
• Discuss his history with him so that he will be more able to understand how his foster family fits within his life

What message are we sending to Will when we work to maintain these connections?
• We demonstrate unconditional acceptance of who he is
• We show respect for his personal connections
• We help him to be more self-accepting
• We bolster his self-esteem and assure him that his circumstances are not his fault

What message would we be sending to Will if we did not support these connections?
• We would send a message that there is something bad about him
• We would be rejecting his family, friends and community, and therefore be rejecting him
• He would learn that he cannot trust his new caregivers, who have already failed to meet his needs for connection and belonging

• Four video vignettes:
– Norma, age 15
– Mike, age 5
− Michele, age 9
− Charlie, age 10
• For each vignette, think about these questions:
– Why might the child behave this way or feel this way?
– How can you handle the immediate situation?
– What long-term tasks might you identify for the foster care team?

• As you watch the video think about the following…
1. What concerns does Annie seem to have as she approaches the visit with her mother?
2. In what ways does the resource parent address these concerns and/or help to prepare Annie for the visit?

Preparing Annie for a Visit

• Think about the goals we talked about for the different members of the team. In what ways were some of these goals accomplished during the visit?
– For Annie?
– For her mother?
– For the resource family?
– For the caseworker?

Annie’s Visit Experience

What were some of the issues or challenges that came up during the course of the visit?
• The mother was late for the visit
• The mother seemed to be questioning
Annie’s care
• The mother was unable to support Annie’s efforts in school

• As you watch this last video clip, consider the following:
– Why do you think Annie is behaving this way?
– What strategies might you use to help Annie with her behaviors?
– How might you feel about handling a child’s behavior after a visit?