- Center for Development of Human Services

Reducing Separation Trauma:

A Resource Manual for Foster Parents, Social

Workers, and Community Members who Care for

Children and Youth

Kathleen I. W. Brundage, PhD. student

Deborah Gerrity, Ph.D., Assistant Professor,

State University of New York at Buffalo

Counseling, School and Educational Psychology

Meg Brin, Child Welfare Administrative Director

Tom Needell, Child Welfare Trainer

Mary Jane Irwin, Child Welfare Trainer

CC02 Child Welfare / Child Protection Services Common Core Training for

Caseworkers

Funding for this research project was provided by NYS Office of Children and Family

Services, Contract year 2004: Project 1037122, Award: 31183; Contract year 2005:

Project 1044698, Award 34851, through the Center for Development of Human Services,

College Relations Group, Research Foundation of SUNY, Buffalo State College.

© 2004-2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation

Contents

Chapter 1: Introduction

Chapter 2: Attachment



The Importance of Attachment



Attachment Development



Styles of Attachment



Attachment and Developmental Problems



Attachment Disorder



Attachment and Foster Children



Effects of Neglect and Maltreatment



Promoting Trust and Attachment

Chapter 3: Normal Child Development and Implications for Separation and

Placement

Chapter 4: Children’s Reactions to Separation and Placement



Factors that Influence Reactions to Separation



The Traumatic Impact of Multiple Separations



Emotional Responses to Separation



Behavioral Responses to Separation

Chapter 5: Grief as a Reaction to Separation and Placement

Chapter 6: Fostering Attachment and Resiliency: Supporting Children and

Youth through Transition and Minimizing the Trauma of Separation



Creating Successful Transitions



Supporting Children throughout the Placement Process



Building a Relationship with the Child



Other Factors that Reduce Separation Trauma



Creating a Lifebook



Handling a Child’s Departure from the Caregiving Home




Caregiver Self-Care

Chapter 7: Resources



Internet Resources



Books for Adults



Book for Children



Games to Promote Communication



Therapists and Mental Health Resources

References

Appendix: Attachment Disorder Checklist


Chapter 1: Introduction

At some point in our lives, we will all experience a loss or separation from someone or something dear to us. Significant losses are always painful and are sometimes frightening and even life-changing. Whether due to death, relocation, the breakup of a close friendship or partnership, or a child leaving home, many people react to losses in predictable ways. Sadness, depression or despair, accompanied by anger, anxiety, fear, and loneliness, and sometimes, loss of self-esteem or direction in life, are typical reactions to loss and separation (Bloom, 1980; Bowlby, 1961, 1973; Fahlberg, 1979;

Kubler-Ross, 1972; Parkes, 1972; Rycus and Hughes, 1998).

Children who are removed from their homes and placed in substitute care are all too familiar with the pain and uncertainty of losing important people, places, and things in their lives. They often experience many, repeated, and often sudden, losses, which can make their adjustment very difficult. They lose their parents, siblings, grandparents and extended family members, friends, neighbors, teachers…the list of important people goes on. In addition, they lose their familiar surroundings, their toys, clothes, pets, and other meaningful objects. Their losses are often compounded by damaging home lives that have left them emotionally scarred and behaviorally troubled.

In 2002, Child Welfare investigated nearly 3 million of claims of child abuse and neglect. Of those, 926,259 were substantiated (Child Welfare League of America,

2002b). Many of these children found their way into the foster care system. Foster children with backgrounds of neglect and abuse suffer three to seven times as many acute and chronic emotional problems as other children (Rosenfeld et al., 1997) and often experience compromised development that leads to disproportionately high involvement in the mental health, juvenile justice, and adult criminal justice systems (Briere, 1992;

Cahill, Kaminer, & Johnson, 1999; Finzi et al., 2001). This increased risk is partly due to difficulties in attachment created by the abusive and/or neglectful situations that characterize their developmental years, as well as trauma caused by repeated separations from caregivers as they move from home to home (Kates, Johnson, Rader, & Strieder,

1991).


But do not despair! Not all separations are equally distressing, and there is hope even for children who have experienced repeated separation traumas. Research studies, clinical case studies, and reports from foster children themselves echo the sentiment of hope for foster children who receive appropriate care from alternative caregivers (e.g.,

Dozier, Stovall, Albus, & Bates, 2001; Festinger, 1983; Holmes, 1993, Hopkins, 2000;

Kenrick, 2002; Lopez & Dworkin, 1996; Parkes, Stevenson-Hinde, & Maris, 1991).

Although problems associated with traumatic separation from attachment figures can contribute to emotional and behavioral troubles and difficulty in future relationships, children who experience a caring relationship with an adult who is knowledgeable of the special needs of these children can form healthy relationships and expect to go on to lead healthy and fulfilling lives (ex., Lopez & Dworkin, 1996; Kenrick, 2002)If care givers are aware of the factors that lead to traumatic separation, they can better understand the impact on a child of separation from his or her family and be better equipped to limit the damage done by the separation and repair some of the damage caused by early abuse.

This manual will present theory and research on issues of attachment, separation, grief, and development for children in foster care and ideas and resources to help care givers ease their children’s transition into placement. Attachment theory (see Ainsworth,

1967; Ainsworth & Witting, 1969, Bowlby, 1969, and Bretheron, 1992) is presented as a framework to help care givers understand the emotional and psychological world of the children they look after, helping them recognize typical reactions to removal from the home and behaviors that may indicate a more serious problem.

The goal of this manual is to illuminate the experience of children in care so that foster parents, social workers, and other people involved with the children can understand the reasons for their behavior and the emotional turmoil behind them. This manual also includes specific steps that can be taken to minimize the impact of separation and placement and reduce separation trauma. This information is intended to ensure that caregivers are equipped with the knowledge to understand and effectively deal with a child who is transitioning to a different home.

It will take knowledge, patience, and dedication to care for a child with a background of abuse and the difficult task of moving to a new home. But with patience,


care, training, and support, caregivers can make a life-long difference in the quality of a child’s life.

Notes about Language in this Manual

This resource contains much discussion of the relationships between children and the adults who provide care for them. Research reflects cultural biases, such as considering the mother to be the primary source of nurturance and support for an infant.

With fathers, grandparents, and many others filling this role in current times, this book attempts to demonstrate sensitivity to the many possible relationships and family configurations by using language that is more inclusive. Particularly in the chapter on attachment, terms such as “primary caregiver” or “primary attachment figure” are used in place of “mother” of “father”.

Certain other terms are used to describe persons involved with children in the child welfare system. The term “caregiver” is used here to describe parents, foster parents, family foster caregivers, adoptive parents, intimately involved clergy or other community members, and others who take on the role of providing for a child’s needs.

Finally, an attempt to remove gender bias has been made by including both the masculine and feminine pronouns when referring to a child in care (for example, his/hers;

(s)he). It is acknowledged that this can at times reduce clarity and readability, but this is a necessary compromise in balancing the language in this manual to reflect the fact that foster placements, attachment disorders, and other problems described in this manual effect both genders equally (Thomas, 1997).


Chapter 2: Attachment

Intimate attachments to other human beings are the hub around which a person’s life revolves, not only when he [or she] is an infant or a toddler or a schoolchild but throughout his [or her] adolescence and in his [or her] years of maturity as well, and on into old age. Form these intimate attachments a person draws his [or her] strength and enjoyment of life and, through what he [or she] contributes, he [or she] gives strength and enjoyment to others. These are matters about which current science and traditional wisdom are one.

-John Bowlby (1980, p. 441)

Attachment is a complex process. The ways in which humans form relationships and how those relationships influence all aspects of development, are highly studied subjects; the base of knowledge about the complexities of how people’s attachments form and function continues to grow. It is imperative that people involved in making major life decisions for children have a basic understanding of attachment theory and what is currently known about how human relationships work. This knowledge is especially important for people who look after children in the child welfare system, for “attachment and separation are the heart of child welfare work” (Fahlberg, 1991. p. 19).

The bond between an infant and his or her primary caregiver serves several important purposes. Attachment figures are a source of safety, and they satisfy an infant’s physical needs for nourishment and protection. In addition, the attachment bond provides socialization and promotes connection with others, stimulates intellectual development, and is essential for the development of a sense of one’s self. Research on the effects of inadequate interpersonal relationships reveals a variety of emotional, behavioral, social, and even neurological and physical problems for children who do not have stable ties with supportive parent figures (e.g., Greenberg, 1999). Many of these problems can be long term. A child’s style of attachment can also give insights into the functioning of his or her family and the environment into which he or she was born. In light of the farreaching implications of attachment, “the significance of intimate interpersonal relationships and the importance of early caretaking in learning how to make such attachments have become the canons of the child welfare and mental health professions.”


(Watson, 1997, p. 160). An understanding of how attachment normally develops is critical for social workers and caregivers.

The Importance of Attachment

Foster children have often come from homes in which circumstances have severely limited the formation of healthy, nurturing, parent-child relationships. The emotional and physical bond that forms between an infant or young child and his or her primary caregiver through their relationship is known as attachment. Infants and young children who have been abused and neglected are at high risk for developing problems with attachment, as are children who have survived early, prolonged, or traumatic separations from their primary caregiver (Levy & Orlans 1998; Bowlby 1973).

Attachment is important for all aspects of a child’s development. The emotional bond that forms between a child and his or her first primary caregiver * (see note in

Introduction) sets the stage for all of the child’s future relationships and the ways in which the child interacts with the world (Bowlby, 1988). This first, and most important, relationship teaches the child how to view the world and how to respond to it. A child’s relationship with his or her first attachment figure creates a template for future relationships, a sort of lens through which all people are viewed. The attachment lens colors people and situations in a way that is similar to the child’s experiences with his or her primary caregiver, such that the child behaves, at an almost instinctual level, in the same way that he or she did with the first primary caregiver.

If a child’s first attachment figure responds to the child in a sensitive, consistent, and effective way, the child learns to trust the primary caregiver and seek her out in times of need, creating the building blocks for healthy relationships. At the same time, the child learns to be autonomous, exploring the environment with a sense of confidence that his or her caregiver will not allow anything bad to happen to the child (Ainsworth et al., 1978).

This confidence will become a part of the child’s template, and (s)he will encounter new people and new situations with the capacity to interact in a way that is flexible and appropriate. These children are more able to cope with stress, form relationships, and experience the positive aspects of life (Fahlberg, 1991). Children who develop secure attachments are more able to:




Attain full intellectual potential



Sort out perceptions



Think logically



Develop social emotions



Develop a conscience



Trust others



Be resilient



Become self-reliant



Cope better with stress and frustration



Reduce feelings of jealousy



Overcome common fears and worries



Have increased feelings of self-worth

If the child does not experience a healthy attachment relationship with the primary caregiver, or if the attachment with the caregiver is disrupted, the child will not develop the same flexibility, and healthy development of social, psychological, behavioral, and even physical health are compromise. Children who do not maintain a healthy attachment will not learn to trust other people, themselves, or their environment. They will develop behaviors that protect them as well as possible in these undesirable circumstances. As these children grow and develop, these protective behaviors will no longer be sufficient to get their needs met; they will not learn how to interact with the world and people in it in an effective way.

Children who have problems with attachment may develop behaviors that seem extreme in order to cope with the inadequate conditions in their relationships with primary caregivers (see Lyons-Ruth for review of aggressive behavior problems associated with attachment). Many of the “problem behaviors” expressed by children in care are in fact survival skills they have learned in order to make their way in their troubled lives. Poor attachment and the behavior problems associated with it can seriously interfere with adjustment in foster placements, for the child and for the family, and can increase the risk of placement disruption (Fahlberg 1991; Levy & Orlans 1998;

Pinderhughes & Rosenberg, 1990). It is important for caregivers to put these sometimes


outrageous and incomprehensible behaviors into context, so that they can maintain their empathy and understanding for a troubled child and prevent further disruptions to the child’s attachment system through repeated moves. Later in this chapter, behaviors associated with attachment problems will be discussed, as well as the reasons for some undesirable behaviors and the purposes they have served for children.

Despite the many problems associated with attachment problems, some children who grow up in relatively deprived environments retain the capacity to overcome their beginnings and learn to trust and love (Cline 1992; Cournos, 2002; Egeland & Sroufe,

1981; Fahlberg 1991; Hughes, 1997; Kagan, 2004; Kenrick, 2000; Levy & Orlans 1995;

Toth & Cicchetti, 1996). Researchers agree that a major factor in promoting this resiliency is the presence of a caring, committed, adult who can provide a stimulating and supportive environment. Even children with severe attachment disorders can be helped to develop trusting, intimate, meaningful relationships given the caring, dedicated, and patient support of caregivers who serve as attachment figures.

Attachment is an important concept in the development of children’s identities and their relationships with others, and it is among the most influential theories informing child welfare practice today (Rycus & Hughes, 1998). Knowledge of attachment issues is essential for people who care for foster children because this group is at increased risk for problems with attachment (Main, 1996), which can lead to serious disruptions in a child’s emotional and behavioral development and can cause problems that last a lifetime if not appropriately addressed. Caregivers who are aware of issues concerning attachment will be better equipped to understand the experiences of children involved with the child welfare system and to handle transitions in a way that inflict as little harm as possible on vulnerable children. This chapter attempts to provide the necessary information about attachment. It will 1) define attachment and describe the ways in which attachment normally develops; 2) identify the effects of weak attachment, including attachment disorder, and the ways in which weak attachment form; 3) describe the circumstances which often surround a foster child’s attachment development and the effects of unstable home environments; and 4) provide suggestions for strengthening weak attachments and promoting new ones for children in care.


What is Attachment?

To grow up healthy, an “infant and young child should experience a warm, intimate, and continuous relationship with his [or her] mother (or permanent mother substitute) in which both find satisfaction and enjoyment” (Bowlby, 1951, p. 13).

Attachment has been defined as “an affectionate bond between two individuals that endures through space and time and serves to join them emotionally” (Klaus, 1976).

Attachment represents the capacity for emotional security, closeness, and autonomy which develops in a child who has experienced a predictable pattern of warmth, sensitivity, responsiveness, and dependability from a significant caregiver (Karen, 1994).

Briefly, attachment is an enduring emotional bond, first developed between an infant and a sensitive caregiver, that influences a child’s capacity to love and be loved.

Young child develop a healthy attachment when they consistently receive from their primary caregiver the basic necessities such as food, shelter, and clothing in addition to

“the emotional essentials” such as touch, movement, eye contact, and smiles

(Moss, 2005). Primary attachments are so important that the capacity to form attachments has become a criterion of healthy maturity, and “Reactive Attachment Disorder” appears in the clinician’s handbook of mental illness (American Psychiatric Association, 1994).

The first attachment is “the hub around which a person’s life revolves.” (Bowlby, 1980, p. 441)

Attachment Development

What we know about human relationships is largely based on Bowlby’s (1969) concept of attachment. Bowlby’s influential theory of human development was inspired by his work with children and adolescents raised in institutions. While studying the relationships between these children and their mothers, Bowlby noticed that some of the children seemed unable to connect with others. This, he found, was due to disruptions in


attachment during the first few years of life. From birth to about the fourth year, infants rely on their caregivers to satisfy all of their needs. This is an important time in a person’s development, when sensory and cognitive functions grow rapidly and babies learn the rules of human interaction from their caregivers. Bowlby built a career and a literary empire investigating the causes and consequences of attachment relationships and their effects on human development. His work has been the foundation of much of contemporary theory and research on relationships.

In his early work, Bowlby (1958) described the nature of a child’s ties to his mother (or primary caregiver) and the basics of attachment. Attachment behaviors are innate, instinctual, responses that are used to get basic needs for food and safety met. In infancy, these attachment behaviors include sucking, clinging, following, and signaling behaviors (i.e., crying when hungry).

A sensitive parent (or other caregiver) can recognize the meaning of her infant’s nonverbal cues and respond quickly to the young child’s physical and emotional needs.

The sensitive caregiver feeds the infant when it is hungry; assures that the infant is warm, dry, and physically comfortable; and comforts and sooths the infant when it is distressed or frightened (Rycus & Hughes, 1998).

Attachment behaviors not only help a child satisfy needs, but also bond the child to the caregiver and the caregiver to the child. Children develop the strongest attachments with sensitive caregivers (Ainsworth, Blehar, Waters, & Wall, 1978) and form reciprocal relationships with them. For example, “the mother’s caregiving behaviors of feeding, holding, nurturing, smiling, cuddling, and talking to the infant reinforce the infant's attachment to the mother; and the infant's responses to its mother's care, including cooing, smiling, cuddling, and becoming quiet when held, strengthen the mother's attachment to the infant” (Rycus & Hughes, 1998).

As people mature, we continue to engage in attachment behaviors, although we generally modify them as our ability to communicate grows, our needs change, and we begin to recognize more people as important in our lives (Cassidy & Shaver, 1999). Even in adulthood, well-attached people seek closeness and reassurance from the most important attachment figures in their lives during times of distress (Hazan & Zeifman,

1999).


When separated from their caregivers, infants and children who have healthy attachments will respond with separation anxiety . Separation anxiety is the normal response to separation and includes 1) protest to the separation, 2) despair related to grief and mourning (when the child believes that the parent will not be returning), and 3) denial of detachment (Bowlby, 1958). The grief and mourning process is activated in children and adults whenever attachment behaviors are stimulated (when a person has a need for safety or security) but the attachment figure is unavailable. The grief reaction to separation is an important element in the experiences of children in foster care. We will explore the implications of grief in a later chapter.

Separation anxiety can become profound if the separation from the primary attachment figure is too long or too frequent (Bowlby, 1958). One of Bowlby’s original

(1958) findings, which has been substantiated in decades of research with children in care

(e.g., Greenberg, 1999; Kenrick, 2000; Paradek, 1984), is that an inability to form deep relationships with others may result when there are too frequent changes in caregivers.

This has serious implications for children in care, who are often repeatedly separated from their primary caregivers and/or moved from placement to placement, disrupting any attachments that form in those placements.

Stages of Attachment Development

Researchers have distinguished between normal and disturbed attachment behaviors in young children (e.g., Ainsworth et al., 1978; Bowlby, 1969; Cicchetti, 1989;

Crittenden, 1995; Greenspan,1988). Developmental attachment patterns emerge, in sequence, through the child’s relationship with the parent over the first 4 years of life.

Significant disturbances in the child’s development result from disruptions in the child’s attachment to the primary parent figure during that time. The following table distinguishes normal attachment behaviors over the first four years of life (adapted from

Rycus & Hughes, 1998 and Delaney, 1991).


Development of Normal Attachment Behaviors

Age Stage Description

Birth – 3 months Pre-attachment Infant orients toward the sound of the caregiver’s voice; (s)he tracks visually.

Infant smiles reflexively; increasingly responsive to interesting stimuli; relaxed and alert.

3-8 months

8-36 months

36 months-

Recognition/Discrimination Infant differentiates between primary caregiver and others. Smiles are based on recognition; very interested in primary caregiver. Infant scans the caregiver’s face with excitement. Infant greets caregiver and vocalizes differently to the caregiver. Infant is especially responsive to smiles and touch with interest and pleasure. Infant has full range of emotions.

Active Attachment

Partnership

Stranger reaction emerges. Infant shows clear preference for the primary caregiver. Infant checks back to the caregiver’s face. Child crawls or walks away from caregiver and explores without anxiety. Child acts intermittently in dependent and then independent ways.

Attachment solidifies. Child shows increased ability to communicate needs verbally and relates to others across a wide range of emotions. Child negotiates differences between self and others.


The Attachment Cycle

Attachment researchers and professionals illustrate healthy attachment as a cycle of need gratification, which, when disrupted, causes problems in a child’s development of sense of self and others (e.g., Hughes, 1997; Keck & Kupecky, 2002). They agree that a child’s first 18-36 months are vitally important to establishing attachment. In a healthy situation, the infant is exposed to love, nurturance, and appropriate care in which the following attachment is repeated over and over again.

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

TRUST

NEED

GRATIFICATION

ANGER

AROUSAL

RAGE


Styles of Attachment

A good knowledge of attachment styles is helpful for foster parents and other caregivers because it helps provide an understanding of the early experiences that influenced a child’s development and can be used to predict certain behaviors. While the styles that will be described below apply primarily to infants and toddlers, similar styles have been found to endure throughout childhood (Grossman & Grossman, 1991; Main &

Cassidy, 1988), adolescence (Urban, Carlson, Egeland, & Sroufe, 1991), and adulthood

(Hazan & Zeifman, 1999; Main & Cassidy, 1988). Knowing about a child’s background and the likely influences on his or her attachment style will be useful information for every caregiver.

Those who care for children in the pre-school or school-age years, or adolescents, will benefit from understanding how children develop their relational patterns; and those who care for very young children will be better equipped to identify behaviors that indicate problems in the relationship between a child and his or her primary caregiver, and which will likely contribute to problems in the child’s ability to form relationships.

Secure Attachment

Sensitive, responsive parents have children who are securely attached. The attachment cycle described above has been successfully completed many times throughout the child’s young life. A secure attachment style in infancy predicts many positive outcomes as a child develops, including greater curiosity and persistence as a toddler, positive peer relationships in preschoolers, advanced cognitive functioning during middle childhood (Webster, 1999); the development of a social conscience and positive self-concept in adolescence (Allen & Land, 1999); and healthy, reciprocal relationships in adulthood (Feeney, 2000). Secure attachments lead to flexible thinking, emotional resilience, ability to modulate emotion, and openness to new learning (Kagan,

2004). Securely attached children look to their parents to be comforted in times of stress and are able to be soothed by their parents’ care.


Indicators of a secure attachment style in infants and toddlers include:



Seeks interaction, closeness, and/or physical contact with parent after being separated for any length of time, then returns to play after briefly maintaining contact



Greets parent actively after a separation; for example, creeping to parent



Is readily soothed by parent when distressed



Openly explores and plays in environment

Insecure Attachment

Infants whose parents do not respond sensitively to their needs are less likely to form secure attachments. Repeated breaks in the attachment cycle (shown above) do not allow for the creation of the nurturing relationship necessary to promote healthy growth.

Following are the common causes of disruption in the attachment cycle (Hughes, 1997;

Moss, 2005).

Common Causes of Attachment Disruption (Highest risk if these occur in first two years of life.)*



Sudden or traumatic separation from primary caregiver (through death, illness, hospitalization of caregiver, or removal of child)



Physical, emotional, or sexual abuse



Neglect (of physical or emotional needs)



Illness or pain which cannot be alleviated by caregiver



Frequent moves and/or placements



Inconsistent or inadequate care at home or in day care (care must include holding, talking, nurturing, as well as meeting basic physical needs)



Chronic depression of primary caregiver



Neurological problem in child which interferes with perception of or ability to receive nurturing (i.e. babies exposed to crack cocaine in utero; Moss, 2005)


Insecure attachments result from disruptions in the attachment cycle and may take the form of any of three different attachment styles: avoidant, ambivalent, or disorganized. The first two categories (as well as the secure category described above) were first discovered by the early attachment researcher Mary Ainsworth and her colleagues (1978) when they observed the reactions of 12-month-old children when they were separated from, and then reunited with their mothers. The third category, disorganized, was discovered by later researchers Mary Main and Judith Solomon (1990) in a similar situation.

Based on their reactions to their primary caregivers, insecurely attached infants will either 1) act distant, as if they have no need for emotional connection (an avoidant attachment style); 2) constantly clamor for attention and nurturance, never being able to be comforted (ambivalent attachment style); or 3) show signs of contradictory behavior with the caregiver, being unsure whether to seek physical and emotional closeness with the caregiver or try to maintain distance (disorganized attachment style). A brief description of the insecure attachment styles will follow. For further reading on attachment behaviors in infants and toddlers in foster care, see Fish & Chapman (2004; vignettes to follow are adapted from Fish & Chapman, 2004).

Insecure-Avoidant Attachment

Avoidantly attached infants and toddlers appear to snub caregivers and act as if they are not distressed by the separation, when in reality, they are experiencing distress.

Ainsworth found that the parents of insecure avoidant infants were rejecting of their infants when they expressed their needs. The infants learned not to seek attention or connect with their parents. When avoidantly attached infants and toddlers are placed in care, they bring their memories of rejection with them and may deceptively appear as though they have no needs. This attachment style is associated with increased risk of serious mental health problems as adolescents, including affective disorder (depression),

Obsessive Compulsive Disorder (OCD), and some personality disorders, including histrionic, borderline, and schizotypal personality disorders (Rosenstein & Horowitz,

1996). In addition, many of the youths who age out of the system after drifting through


multiple placements due to alienating behaviors such as lying, stealing, sexual inappropriateness, physical violence, and substance abuse have avoidant attachment styles (Penzerro & Lein, 1995). Seemingly self-reliant foster infants with an insecureavoidant attachment style can frustrate caregivers who want to provide for the children.

For example:

Susan, now 24 months, had been in foster care since she was 18 months.

Her foster mother said that Susan does not really seem to need her. The foster mother was angry and hurt and felt herself distancing from Susan.*

Indicators of an avoidant attachment style in infants and toddlers include:



Does not cry upon separation



Pays attention to toys or environment, rather than parent



Actively avoids or ignores parent; moves away, turns away, or leans away from parent when picked up



Unemotional

Insecure-Ambivalent Attachment

Infants and toddlers with ambivalent attachments have been inconsistently responded to by their primary caregivers. Their parents have sometimes been attentive to their needs (for example, giving a bottle when the child cried), and sometimes not. These children have never known what to expect from their parents and so must look for attention all the time in hopes that eventually their cries will be answered. As a result, ambivalently attached infants and toddlers constantly seek attention but are never satisfied. Adolescents who have this attachment style are at greater risk for conduct disorder, substance abuse, and narcissistic or antisocial personality disorder (Rosenstein

& Horowitz, 1996). As with any insecure attachment style, caregivers should be mindful of the possible consequences and be alert to signs of insecure attachment.


For example:

John, 30 months, had been in his fifth foster home in 2 years. Whenever he was stressed, he became inconsolable. John would become very clingy and also angry. If held, he would arch his back and cry. The placement ended after 1 month when the family could “no longer take it.”*

Indicators of an ambivalent attachment style in infants and toddlers include:



Preoccupied with parent



Alternately seeks and resists parent while separated, or may be passive



Upon reunion after separation, fails to settle down or return to play; continues to focus on parent and cry

Insecure-Disorganized Attachment

The insecure-disorganized attachment style in infancy has been shown to predict aggression in school-aged children and the development of behavioral disorders such as Oppositional Defiant Disorder in later childhood and adolescence (Lyons-Ruth, 1996). Infants and toddlers who have histories of trauma and substance exposure often exhibit signs of disorganized attachment.

Infants and toddlers who fall into this category are emotionally conflicted and fearful. They learned to be afraid of their abusive parents but at the same time were dependent on them to take care of their needs. For example:

M, 20 months, in his third foster placement, began to wail inconsolably, when his new foster mother needed to speak to a visitor. No comforting helped and eventually he cried himself to sleep. This experienced foster mother felt a sense of growing helplessness about her ability to help this toddler.


Indicators of a disorganized attachment style in infants and toddlers include:



Reacts with fear to the primary caregiver



Inconsolable crying



Sleep problems



Inability to manage transitions



Appears disoriented from the environment (e.g., may freeze with trancelike expression for a few seconds)



Displays contradictory or confused behaviors in parent’s presence, e.g.: o clinging while leaning away o reaching out for parent while crying in fear at the same time o walking/crawling toward parent with head turned away

Disrupted attachments cause infants and toddlers to send out signals that are very difficult to read, and although foster parents may have a deep desire to connect with the infants/toddlers, the infants’/toddlers’ insecure attachment may undermine this commitment. Some researchers on infant and toddler foster children found that many foster parents become frustrated, angry, or distant when their infants’/toddlers’ behavior appears either withdrawn and uninterested in the foster parent, or angry, insistent, and seemingly insatiable (Stovall and Dozier, 1998; Kronstradt, 2000).

Familiarizing oneself with the behaviors listed above and the background represented by those behaviors may help caregivers put insecurely attached children’s behavior into perspective. Caregivers may be able identify the possible attachment style of young children in their care, and their own relationships with the child may benefit from understanding the conditions under which a child developed his or her relational style.


Attachment and Developmental Problems

Ample evidence exists that the problems in the relationship between children and their primary caregivers are linked with problems with physical health (see Feeney, 2000 for review) and child development (e.g., see Leslie, Ganger, and Gist, 2002). Growth delays (Fahlberg, 1991), neurological problems (Schore, 2001; Seigel, 2001), motor problems, delays in language development, and a host of other developmental delays and physical abnormalities are associated with problems with attachment (see Carlson,

Sampson, & Sroufe, 2003 for review). Fahlberg (1991) has compiled a list of some of the psychological, cognitive, developmental, and behavioral problems that are frequently seen in young people with attachment problems. While all of the following problems can have multiple causes, children with attachment problems tend to show cluster of symptoms (Fahlberg, 1991).

Psychological and Behavioral Symptoms of Poor Attachment

Conscience development



Does not show normal anxiety following aggressive or cruel behavior



Does not show gilt on breaking laws or rules



Projects blame on others

Impulse control



Exhibits poor control; depends upon others to provide



Exhibits lack of foresight



Has a poor attention span

Self-esteem



Is unable to get satisfaction from tasks well done



Sees self as undeserving



Sees self as incapable of change



Has difficulty having fun

Interpersonal interactions



Lacks trust in others




Demands affection but lacks depth in relationships



Exhibits hostile dependency



Needs to be in control of all situations



Has impaired social maturity

Emotions



Has trouble recognizing own feelings



Has difficulty expressing feelings appropriately; especially anger, sadness, and frustration



Has difficulty recognizing feelings in others

Cognitive Problems associated with Poor Attachment



Has trouble with basic cause and effect



Experiences problems with logical thinking



Appears to have a confused thought process



Has difficulty thinking ahead



May have an impaired sense (sight, hearing, touch, smell, taste)



Has difficulties with abstract thinking

Developmental Problems associated with Poor Attachment



Has difficulty with auditory processing



Has difficulty expressing self well verbally



Has gross motor problems



Experiences delays in fine-motor adaptive skills



Experiences delays in personal-social development



Has inconsistent levels of skills in all of the above areas


Attachment Disorder

Less than optimal care by a child’s primary caregiver during the critical first years of life can result in insecure attachment and any of the developmental, psychological, behavioral, or cognitive problems listed above. When the care provided is seriously negligent or abusive, the attachment system may be affected even more profoundly.

Researchers have discovered that maltreatment can cause children to develop severely disturbed attachment, a disorder called Reactive Attachment Disorder (RAD).

Many behavioral problems in foster children are the result of breaks in attachment that occur within the first three years of life (Keck & Kupecky, 2002). It is estimated that about half of all children in foster care have disordered attachments (Newton, Litrownik,

& Landsverk, 1995). These children were born into a dysfunctional environment, characterized by abuse and neglect, to parents who were not responsive to the children’s needs. As a result, children with severely disturbed attachments have a number of difficulties relating to others and adapting to new environments (Egeland & Sroufe,

1981). In the absence of a stable and secure attachment, these problems continue into the preschool years (Egeland, Sroufe, & Erickson, 1983), middle childhood (Sroufe, Egeland,

& Kreutzer, 1990), and adolescence (Weinfeld, Ogawa, & Sroufe, 1997). Children who with disordered attachment are known for an inability to engage in meaningful relationships; vigorous avoidance of intimacy, rejection of gestures of affection and caring, a pervasive lack of trust and a strong need to control and manipulate others; and engagement in behaviors that include explosive anger, hostility, and cruelty to animals and other people (Levy & Orlans 1998; Cline 1990).

Young children with attachment disorders are at increased risk for developing childhood disorders such as Oppositional Defiant Disorder (Greenberg, 1999), Attention

Deficit Hyperactivity Disorder (Ladnier & Massanari, 2000), or childhood depression

(Dozier, Stovall, & Albus, 1999); adolescent depression, serious criminal behavior, and hard drug use (Dozier et al., 1999); and several psychiatric disturbances in adulthood

(Dozier et al., 1999).

The abusive conditions which are known to cause attachment disorder constitute the primary reason for a child’s removal from biological parents. Upwards of 70% of


children in care are removed from their homes due to abuse and/or neglect (CWLA,

2002). For foster children, the early experiences of abuse and neglect, together with traumatic separations from primary caregivers, are the major causes of disruption of the attachment cycle leading to insecure attachment or attachment disorder (Main, 1996).

With so many children entering care from abusive homes that put them at high risk for problems with attachment, it is likely that caregivers will at some point look after a child who displays signs of attachment disorder. Their behaviors will be challenging, and caregivers are urged to be sensitive to the conditions that have lead to the development of these behaviors and to seek support for dealing with the children. Below are some distinguishing characteristics of children who may evidence serious disturbances in the attachment system and require additional support.

Indicators of Attachment Disorder

Children with attachment disorders often appear charming and self-sufficient on the surface but on the inside, they are filled with feelings of insecurity and self-hatred.

The anger, fear, and sadness from their childhood remain with them, and it is expressed through disturbing behaviors that keep caregivers at a safe distance. Parents and caregivers often react emotionally to their children’s unacceptable behavior, creating and intense and unsatisfying relationship (Moss, 2005). By pushing caregivers away, attachment disordered children keep themselves from receiving love and nurturance that could help them realize that they are not unlovable (Hughes, 1997). This creates a cycle of self-loathing and behaviors which make it difficult for others to love them and lead to more feelings of inadequacy.

These children need more support than normally developing foster children. They have been abused and/or neglected by their parents and desperately act to protect themselves from further injury. Hughes (1997) describes the following characteristics of children with disturbed attachments:



An intense, compulsive need to control all situations, especially the feelings and behaviors of their caregivers, teachers, and other children



Thrive on power struggles and are compelled to win them


 Feel empowered by repeatedly saying, “No!”



They cause emotional, and at times, physical pain to others



They strongly maintain a negative self-concept



Very limited ability to regulate displays of emotion



Avoid mutual fun, engagement, and laughter



Avoid needing anyone and asking for help or favors



Avoid being praised



Avoid being loved and feeling special



Feel deeply shameful, with feelings of shame leading to outbursts of rage



Intense lying, even when caught in the act



Poor response to discipline: aggressive and defiant behavior



Lack of comfort with eye contact



Physical contact: wanting too much or too little



Interactions lack mutual enjoyment; anxiety during experiences of mutual enjoyment and affection



Disturbances in body functioning (eating, sleeping, urinating, defecating)



Increased attachment produces discomfort and resistance



Indiscriminately friendly, charming; easily replaced relationships; use charm to get their way



Poor communication: nonsense questions and chatter



Difficulty learning cause-and-effect, poor planning and/or problem solving



Lack of empathy for others; little evidence of guilt or remorse



Able to see only extremes; things are either all good or all bad



Hypervigilance or habitual dissociation (spacey)



Pervasive shame, with difficulty reestablishing a bond following conflict

Children with attachment disorders may exhibit some or all of the following behaviors (Cline, 1990). Caregivers who notice their children engaging in these behaviors should seek support from child behavior specialists, therapists, or other professionals who may be able to accurately identify and treat a potential problem. A list of resources is


provided at the back of this manual for caregivers who suspect their children may exhibit signs of an attachment disorder.

Indicators of Attachment Disorder

 Superficially engaging and “charming” behavior



Lack of eye contact on parental terms



Indiscriminate affection toward strangers



Lack of affection with parents on their terms (not cuddly)



Destructive behavior to self, others, and material things



Cruelty to animals



Stealing

 Lying about the obvious (“crazy lying”)



Lack of impulse control (hyperactive behavior)



Lags in learning



Absence of a conscience



Lack of cause-and-effect thinking



Abnormal eating patterns



Poor peer relations



Preoccupation with fire and/or gore



Persistent nonsense questions and incessant chatter



Inappropriate demanding and clingy behavior



Abnormal speech pattern

A professional assessment is necessary to determine the presence of an attachment disorder. However, if any of these symptoms are present, it is recommended that caregivers refer to the “Attachment Disorder Checklist” provided in Appendix A for further assistance in determining possible problem areas.

Treatment for Children with Severe Attachment Problems

Children with disordered attachment usually require specialized parenting and intensive therapies with highly trained professionals to heal the hurts of their childhood


and work toward creating new attachments. Professional help by therapists who are skilled in treating attachment disorders should be sought for children who demonstrate severe attachment problems, and for children who do not respond over time to attachment-strengthening interventions by their caregivers (see Hughes, 1997; Levy &

Orlans, 1998; Thomas, 1999; Keck & Kupecky, 2002)

Holding therapy (see Cline, 1990, 1991) is used when a child’s fear and rage are so great that traditional therapies have been ineffective at breaking through the child’s anger. This intensive approach, conducted by skilled therapists, includes holding the child across one’s lap in a position that resembles holding an infant, and utilizes nurturing touch, eye contact, and physical and emotional closeness to try to help the child work through his or her anger and access the deeper emotions, such as hurt and love, that have been covered up by it.

The treatment just described is for children with attachment disorders only, and should be conducted only by a trained therapist. If such a professional is needed, caregivers may find it helpful to refer to the ATTACh website listed in the Resource chapter of this manual, for help in finding and selecting a therapist. In addition, Susan

Ward (n.d.), an adoption specialist with an extensive background in attachment, recommends that caregivers seeking an attachment therapist ask the following questions:

Questions to Ask when Selecting an Attachment Therapist



Where, and under who has s/he trained? Most attachment therapists have worked with/under some of the "big" names, such as Gregory Keck, Evergreen Center,

Daniel Hughes, Foster Cline, etc.



Is s/he a member of Attach, the national attachment organization, www.attach.org?



What kind of on-going training does s/he undergo? Good attachment therapists regularly attend workshops and seminars on attachment, grief and loss, etc.



How are parents involved in the therapy sessions? Parents should always be in the room, or on the few occasions they are not in the room, the therapist should have an audio or video monitor for you to use. Attachment therapists do not do one on one therapy with a child because they know that kids with RAD are likely to be charming, lie, and manipulate.




What modalities does s/he use? Most therapists use multiple formats, including

Storytelling, EMDR, Theraplay (not the same as play therapy), psycho-drama, nurturing holds.



What role does s/he see the parent as having in therapy? Attachment therapists look at therapeutic parenting as essential for healing.



How familiar is s/he with the disorders that often co-exist with RAD, such as

PTSD, ADHD, mood disorders, etc.? Does s/he interact with other professionals who can help with these inter-related diagnoses and/or mediation needs if your child requires it?



Will s/he be able to help you with related resources, such as respite, support groups, etc.

Attachment and Foster Children

Most of the more than half million children in foster care in the Unites States have known only repeated abuse and prolonged neglect. They have never experienced a longterm, nurturing, stable environment during the early years of life (Sedlak & Broadhurst,

1996). Under these conditions, they have learned to protect themselves by refusing to rely on others for any reason. They have limited skills for engaging in mutually rewarding relationships with other people, have delays in emotional, cognitive, and behavioral development, and are adept at putting up walls between themselves and others (Cicchetti,

1989). Many of these children find themselves in foster care when their home environments become too dangerous to ensure their safety, after much damage has already been done to their attachment systems.

Although there has been little systematic research on the attachment styles of children in care (Sedlak & Broadhurst, 1996), many prominent figures in the fields of child welfare and mental health utilize the attachment perspective to understand and treat foster children (e.g., Cline, 1990; Dozier et al., 2002; Fish & Chapman, 2004’ Hughes,

1997; Levy& Orlans, 1998); and research studies on attachment, child development, and pre-placement conditions are abundant.

Of the more than 524,000 children in substitute care each year (Child Welfare

League of America, 2002a), 60% are removed from their homes as a result of neglect

(failure to provide or failure to supervise); 10% are removed due to physical and/or


sexual abuse; 14% are removed due to emotional, moral/legal, or educational abuse, or abandonment; and 8% are removed for reasons other than abuse or neglect, such as for mental health services or domestic violence (U.S. Department of Health and Human

Services, 2001).

Effects of Neglect and Maltreatment

Most children who end up in long-term care (as many as 83%) enter the system after being mistreated and/or neglected in their original families. These children display extensive problems with attachment (Schleiffer and Muller, 2004), which manifests in problem behaviors, extreme difficulties in relationships with others, and serious consequences to the children’s emotional health.

Children who have been neglected have had to work incredibly hard to get their needs met. With mentally ill, drug-abusing, or otherwise unresponsive parents, the children had to learn to get louder, more demanding, more persistent, more irritating, or more charming to get their basic needs met. They have developed with a fear of not getting food, attention, and soothing ingrained into their way of being in the world and into their biochemistry.

On a purely biological level, childhood maltreatment can influence development in a way that alters brain structures. The regions of the brain which manage emotional control and social attachment are developed by the age of 6 months, and continuous exposure to poor parenting by that young age can severely harm brain development in these regions (Lach, 1997 in Ladnier & Massanari, 2000). Children who do not receive the kind of care that they need as infants may be at risk for life-long problems with deficits in self-regulation and relating skills. Serious emotional and behavioral problems can result, including the development of childhood behavioral disorders such as

Oppositional Defiant Disorder (ODD) and Attention Deficit Hyperactivity Disorder

(ADHD). The importance of these early experiences in relation to the primary caregiver is illustrated by the fact that some researchers refer to ADHD as “ Attachment Deficit

Hyperactivity Disorder” (Ladnier & Massanari, 2000).


Neglected children’s continuous fight to get their needs met causes a constantly high level of the stress hormone that is naturally present in every person, causing a change in the child’s reactions to and ability to cope with stress (Kaufman & Henrich,

2000). They can fight harder and longer because they have learned how to do it, and because their bodies are primed for action by hormonal surges under stress.

The constant pushing and hyper-vigilant behavior of neglected children can be exhausting for foster parents who try to offer them a loving, caring, and joyful home.

Neglected children organize all of their experiences according to a template formed by those early experiences, and are unable to accept fun or affectionate moments, for fear that slowing down will result in losing any of the security that they have.

Children who have been abused display the same hyper-vigilance as those who have been neglected. In addition, these children are uncertain that their caregivers can keep them safe. Early experiences have taught them that expressing a need or seeking attention resulted in harm and punishment. They have learned that no adult is going to take care of them. These children typically try to be their own parent, and will do everything within their power to maintain control over their caregivers in a frantic effort to stay safe.

From an attachment theory perspective, these children are at risk for difficulties associated with attachment for several reasons:

1.

Foster children often experience multiple placements, creating multiple disruptions in their relationships with primary caregivers. Disruption in these relationships leads to serious emotional and behavioral problems.

2.

Foster children have often been abused and neglected and come from unstable family environments. These conditions are related to insecure attachments and attachment disorder.

3. Foster children entering a placement have experienced the loss of a primary caregiver. This separation constitutes a trauma, because it disrupts the attachment between the child and the primary caregiver (Center for Adoption Research,

1999).

4.

Foster children’s early experiences often cause them to have problematic attachments. The expectations and attachment strategies they have learned in their original attachment relationship are maladaptive in the context of new relationships.


Because of the elevated risk of harm due to disrupted attachments, the people who look after children in care must be knowledgeable of attachment theory and strategies for helping foster children maintain primary relationships and engage in new ones while in placement.

Promoting Trust and Attachment

Dr. Vera Fahlberg (1991) is continuously cited in the research literature as an expert in attachment and separation for children in out-of-home placements. She identifies three types of caregiver behaviors that are essential for forming attachments.

These include: 1) responding to the natural arousal-relaxation cycle experienced by a child during stressful times; 2) initiating positive interactions; and 3) engaging in claiming behaviors.

Children in care will naturally experience periods of intense arousal, including anxiety, fear, anger, or other strong emotions. These are normal feelings; after all, leaving home and adjusting to a new environment is certainly a stressful situation. Caregivers can use these situations to demonstrate their support for the child and help strengthen attachments by being supportive and empathic – demonstrating that you understand why a child is feeling the way he is. For example, when a child rages or throws a temper tantrum, caregivers should stand by the child and not try to stop the child. When the child’s rage subsides and the child’s tense body relaxes, the child will be most vulnerable and open to attachment. The same process occurs when a child experiences extreme positive emotions. Allowing expression of feelings and providing physical comfort at these times takes advantage of the arousal-relaxation and shows the child that the caregiver is willing to support the child and can be trusted. Fahlberg (1991) notes that adults often try to minimize a child’s emotional outbursts or avoid situations that cause intense feelings. Caregivers who are trying to promote trust in children with attachment problems must allow children to experience their emotions in a safe and supportive environment, no matter how uncomfortable those emotions may seem.


Initiating positive interactions and engaging claiming behaviors are the other important parts of developing a trusting relationship and promoting attachment.

Caregivers have to be proactive in initiating positive exchanges with children from the moment a child arrives in the home. A simple “Good morning,” or “Great job getting the dishes clean” are statements that can facilitate good feelings and positive exchanges.

Playing a game, helping with a chore, reading a story, and remembering to smile are all ways to initiate positive interactions. Claiming behaviors include things that caregivers and families can do to make a child fell welcome and included. Focusing on similarities, including the child in family events, and familiarizing the child with family customs help make a child feel at home and create a sense of belonging. Following are recommendations based on Dr. Fahlberg’s work with foster children that can be used by caregivers to promote attachment in the children in their care.

Activities that Encourage Attachment

Responding to the Arousal-Relaxation Cycle

 Use the child’s tantrums to encourage attachment



Respond to the child when he is physically ill



Accompany the child to doctor and dentist appointments



Help the express and cope with feelings of anger and frustration

 Share the child’s extreme excitement over his/her achievements



Help the child cope with feelings about moving



Help the child cope with confused feelings about this birth family



Respond to the child when he is hurt or injured



Educate the child about sexual issues



Initiate

Initiating Positive Interactions



Make affectionate overtures: hugs, kisses, physical closeness



Read to the child




Play games with the child



Go shopping together for clothes and toys for the child



Go on special outings: circus, plays, movies, etc.

 Support the child’s outside activities by being the driver or a group leader



Help the child with homework when he needs it



Teach the child to cook or bake

 Say “I love you.”



Teach the child about extended family members through pictures and talking



Help the child understand family jokes and sayings



Teach the child to participate in family activities (bowling, camping, skiing, etc.)



Help the child meet expectations of other people

Claiming Behaviors

 Encourage the child to practice calling parents “mom” and “dad”



Add a middle name to incorporate a name of family significance



Hang pictures of the child on the wall



Involve the child in family reunions and similar activities



Involve the child in grandparent visits



Include the child in family rituals



Hold religious ceremonies or other ceremonies that incorporate the child into the family



Buy new clothes for the child as a way of becoming acquainted with the child’s size, color preferences, style preferences, etc.

 Make statements such as “In our family, do it this way” in a supportive fashion

Now that caregivers have been introduced to attachment theory and the importance of promoting healthy attachments, our attention turns to the practical matters of separation. The following chapters will explore children’s reactions to separation, strategies for identifying traumatic separation, and ways in which the traumatic impact of separation can be minimized.


Chapter 3: Normal Child Development and Implications for Separation and Placement

Children and youths who are placed in foster families have changed families once, twice, or more often. In fact, some move upwards of seven times before the age of

18 (New York State Office of Child and Family Services, 2003). Initial foster placement disrupts a child’s attachment relationships and is threatening to his perception of those relationships, his perception of himself, and his future. Subsequent moves compound these problems.

Many children in care recognize separation from their families as a key life marker, dividing their lives into pre-removal and post-removal (McFadden, 1992).

Children often experience separation from their families as traumatic, and each subsequent move contributes increasingly to negative consequences for the child’s wellbeing. Hailing from backgrounds that have already made them vulnerable to disruptions in attachment (see Chapter 2) and other problems associated with maltreatment, children in foster care are particularly vulnerable to the traumatic effects of separation. The multiple traumas of troubled home lives and repeated separations affect children’s psychological and behavioral development in ways that must be understood so that foster care can be therapeutic and sensitive to the children’s needs.

Following chapters are full of information that describes “typical” reactions to separation. The information presented is informed by extensive clinical work and research on children and youth’s reaction to separation; however, while the reaction to loss is in many ways somewhat predictable, every child will experience and react to separation in a unique way.

Among the leading determinants of a child’s emotional and behavioral response to separation and placement is the child’s age and developmental level (Fahlberg, 1991;

Pasztor & Leighton, 1993; Rycus & Hughes, 1998). The degree of development of cognitive skills has a great deal to do with how well a child can understand what is happening to him or her during a placement period. Young children, for example, have trouble with the concept of time and so cannot understand a separation from their parents as temporary – they often believe that they have been stolen from their parents and will


never see them again. Cognitive skills also influence a child’s ability to communicate, which has a great deal to do with how the lets caretakers know what his or her needs are during a placement.

Emotional and social development both impact children and youth’s ability to cope with separations. The amount of anxiety experienced during separation and the ability to emotionally connect with others give emotional development a prominent role in children’s ability to form new relationships and adjust to the changes of a new placement. Social development dictates how children perceive others around them and how they see their own role in the separation. Their developmental level will influence whether they see social workers and foster parents as people to be trusted or feared.

Greater social development can have both the advantage of allowing foster children to recognize others who are allies and the sometimes self-deflating ability to perceive themselves as somehow “different” from their peers.

Much of the information throughout this manual will be presented in a developmental context so that caregiving practices and interventions can be appropriately planned to suit children’s needs at their particular developmental level. This chapter will serve as a foundation for gaining familiarity with child development. The information to follow in this chapter has been adapted from a leading source of information on working with children and families involved with the child welfare system, the Child Welfare

League of America’s

Field Guide to Child Welfare (Rycus & Hughes, 1998)*.

Listed below are important developmental characteristics of children at various ages, and the implications of these developmental variables for children during separation and placement. The characteristics listed here are typical for normally developing children. However, children who have been abused or neglected are often delayed in their cognitive, social, and emotional development. Caregivers and caseworkers should identify each child's developmental age and should plan interventions accordingly.


Infancy: Birth - Two Years

Cognitive Development

 Infants have not developed object permanence; when things are out of sight they are gone! Even temporary losses of significant caregivers are experienced as total.

Infants cannot comprehend that their caregiver "will be right back."

 Infants have a short attention span and poor memory.

 Infants do not understand change; they only feel its disconcerting effects. Without an understanding of events, they are easily frightened by environmental changes and unfamiliar sensory experiences, sights, noises, and people.

 Infants lack language ability and, therefore, have few means to communicate their needs or distress to others, except by crying. They also cannot be verbally reassured that they will be cared for.

Emotional Development

 Infants are fully dependent upon others for physical care and nurturance to meet their basic survival needs.

 Infants generally form strong and trusting emotional attachments to their primary caregiver and turn to that person when in need. Their scope of trusting relationships is very limited. After five to six months, infants can easily discriminate between people, display anxiety in the presence of unknown persons, and often cannot be comforted by others when distressed.

 Infants often experience anxiety in the face of even small changes. Emotional stability depends upon familiarity and continuity in the environment, and the continued presence of their primary caregiver.

Social Development

 Without language, infants have few ways to communicate their distress or needs.

Most communications are nonverbal. If adults are not familiar with infants' cues, and do not recognize or understand the source of their distress, their needs may remain unmet.

 Social attachments are limited to infants' immediate caregivers and close family members. Infants do not easily engage in relationships with unfamiliar persons.


Adults must generally initiate and reinforce interactions. Infants also vary in the speed with which they will interact and be comfortable with strangers. Many infants are temperamentally cautious, and need considerable time to become comfortable in the presence of new people, much less turn to them when distressed.

Implications for Separation and Placement

 Infants' cognitive limitations greatly increase their experience of stress. Without a well-developed cognitive perception of the event, any change is threatening. Infants will be extremely distressed simply by changes in the environment, and the absence of trusted caregivers.

 Infants have few internal coping skills. Adults must protect and provide for them by eliminating their distress, and meeting all of their needs. When deprived of the trusted, familiar adults upon whom they depend, they are more vulnerable to the effects of internal and external stresses.

 Infants experience the absence of caregivers as immediate, total and complete.

Infants do not generally turn to others for help and support in the absence of their primary caregiver. Infants who have lost their primary caregiver often cannot be comforted by a caseworker, foster parent, or others.

 If traumatic separation occurs during the first year, it can interfere with the development of basic trust. This has serious implications for the infant's subsequent development of interpersonal attachments.

 Infants who are easily frightened by change and new people may react more strongly and exhibit more distress than a placid, more adaptable infant. This does not mean, however, that less temperamental infants do not experience severe distress during the placement process.

 Infants' distress during placement will be lessened if their environment is familiar or can be made very consistent with their old one. Caseworkers should also assess infants' attachments to adults, and should identify persons with whom infants have the strongest attachment. This is not always the parent; it may be an extended family member, a neighbor, or a babysitter. In the best situation, an infant's regular caregiver should visit frequently, preferably daily, and provide direct care in the placement setting.

 Seriously abused or neglected infants may appear to have no secure attachments with any caregiver. Infants who have not developed attachments, or who have insecure attachments, may not exhibit distress when placed. These infants will often be remote and withdrawn. Such attachment disorders should be of considerable concern to workers, as they indicate these children are at serious risk developmentally. Placement planning for children with attachment disorders


should include the identification of primary caregivers, who can be a constant in the children's lives. Continuity in relationships with trusted caregivers will promote the development of basic trust.

 If the plan is to reunite infants with their families, parents should be included in all phases of placement and permanency planning, and the parent/child relationship should be maintained through regular visitation while the infant is in placement. Similarly, when infants are placed from foster care into adoptive families, the foster caregivers should remain actively involved until the infants are securely attached and fully integrated into their adoptive homes. This

"transitional" approach to placement prevents the total disruption of critical attachments for infants, and can help to prevent the serious negative consequences of traumatic separation on development [Gerard & Dukette 1954]. The consistent involvement of a nurturing caregiver is essential to promote the development of healthy attachment. Once it has developed, separating an infant from his or her primary caregiver should be approached with extreme caution.

Preschool: Two to Five Years


 Preschool children use language to communicate, but they have a limited vocabulary, and do not understand complicated words or concepts. Many thoughts or feelings cannot be fully expressed. This makes it difficult for them to understand complex events or to fully communicate their concerns and distress.

 Preschool children do not have a well-developed understanding of time. They cannot discriminate between "next week," "next month," and "next year."

 They have difficulty understanding causality and are often unable to discern how events relate to one another, to explain why things happen, or to predict what may happen next.

 They are cognitively egocentric. They are not able to understand perspectives that are different from their own. The world is as they perceive it. Other people's explanations of events may make no sense to them, and they will stubbornly cling to their own perceptions and explanations. Their logic may be faulty by adult standards but seems rational to them.

 Preschool children may display magical thinking and fantasy to explain events, and may believe that their actions or thoughts have exaggerated effects on events in their environment.


 They may not generalize their experiences in one situation to another. They may be unable to draw logical, even obvious, conclusions from their experiences. For example, despite the fact that his house and all his friends' houses have kitchens, a child may still doubt the existence of a kitchen in the foster home until he sees it for himself.


 Preschool children are still dependent on adults to meet their emotional and physical needs. The loss of adult support leaves them feeling alone, vulnerable, and anxious.

 Development of autonomy and a need for self-assertion and control make it extremely frustrating for children this age to have limits and restrictions imposed by others. When thwarted by adults, they are likely to create and engage in battles with adults to maintain some degree of control.


 Preschool children are beginning to relate to peers in reciprocal, cooperative, and interactive play.

 They relate to adults in playful ways, and are capable of forming attachments with adults other than parents. They can turn to other adults to meet their needs.

 "Good" and "bad" acts are defined by their immediate, personal consequences.

Children who are bad are punished; children who are good are rewarded. Selfesteem is often influenced by how "good" children believe they are.


 Preschool children are still essentially dependent and have limited coping abilities. They need dependable adults to help them manage day-to-day events.

However, emotionally healthy children of this age can turn to substitute caregivers or to known and trusted caseworkers for help and support during the placement process. Having a relationship with an adult in the new home prior to placement also helps to reduce the stress of placement.

 Preschool children will display considerable anxiety about their new home.

Because they are still unable to make logical inferences from much of their experience, preschool children may be unable to predict the seemingly obvious.

Therefore, any change in environment can have exaggerated ambiguity, and be


ominous and foreboding. They will be concerned about being cared for, but may not have adequate language to express the concerns in detail. Their insecurity may be expressed with questions such as, "Do they have bandages at their house? Does their dog bite?" They need reassurance that they will be fed, clothed, and that the new family will care for them when they are sick. While verbal reassurances are helpful, children will often not be comfortable until they actually experience the environment as safe and nurturing.

 Due to their immature conception of time, any placement of more than a few weeks is experienced by preschool children as permanent. Without frequent contact with their parents, these children may assume that their parents are gone and are not coming back. They may abandon hope relatively quickly, grieve the loss, and attempt to establish a permanent place for themselves in the substitute care home. This makes reunification at a later time, at best, another traumatic separation, and at worst, impossible.

 Preschool children are very likely to have an inaccurate and distorted perception of the placement experience and the reasons for their placement. They may feel personally responsible for the family disruption. Many children view separation and placement as a punishment for bad behavior. Egocentric thinking limits preschool children's ability to understand the reasons for placement. That they had to leave home because someone else (their parent) had a problem is beyond their conceptual capabilities. Children this age will cling to their own explanation for the placement, despite attempts by adults to explain otherwise. This self-blame threatens children's self-esteem and increases their anxiety.

 Forced placement without proper preparation may generate feelings of helplessness and loss of control. This may interfere with the development of selfdirected, autonomous behavior. Children this age may learn that they cannot influence the environment, and may become placid and unassertive; or, they may become engaged in a power struggle with adults in an attempt to assert and assure their autonomy.

 Because preschool children do not fully understand the reasons for the placement, they often perceive the absence of their parents as abandonment, and they learn to expect abandonment in other relationships. They often express concern about the new family leaving them, or about having to move again; they are also anxious about whether the caseworker will return for them. Caseworkers are often these children's only perceived link to their family and prior life, and for this reason, the workers can take on extreme importance to them. The children's anxiety about abandonment is exacerbated if the caseworkers who conduct their placement

"disappear" from their lives, which often occurs when the case is transferred after placement. The need to maintain continuity in all these children's relationships, including the casework relationship, cannot be stressed enough. A continuous parade of new faces in their lives is disruptive, and seriously damaging to their emotional development.


School-Age: (Six to Nine Years)


 School-age children have developed cognitively to the stage of concrete operations. They understand cause and effect, and can often discern logical relationships between events. They will, however, have difficulty understanding abstract relationships. "Your mother placed you for adoption because she loved you and wanted the best for you," is a difficult concept for children to understand. In their concrete view of reality, people don't give away things they love.

 School-age children have developed some perspective-taking ability. They can, at times, understand other people's feelings and needs, and they are beginning to understand that things happen to them which are not their fault.

 School-age children usually experience the world in concrete terms. They are most comfortable if their environment is clearly structured, if they understand the rules about how things should be done, and if they have a clear definition of what is right and wrong. They are concerned with fairness, and often have difficulty accepting ambiguity, or changes in previously defined rules.

 School-age children have a better perspective regarding time than do younger children, and are able to differentiate between days and weeks, but still cannot fully comprehend longer time periods, such as months or years. A school year is often perceived as an eternity.


 Children this age are performers. Their self-esteem is strongly affected by how well they do in their daily activities, in school, and when playing.

 They become very anxious and distressed when they are not provided with structure, or when they do not understand the "rules" of the situation. If expectations for their behavior are ambiguous or contradictory, they do not know what is right, and often feel helpless to respond properly. A significant change in expectations, such as occurs when children are placed in a home of a different socioeconomic class or culture, can create serious disruption and anxiety for them.


 The primary identification for school-age children is with their family. Their sense of self and their self-esteem are closely tied to their perception of their family's worth. If other people talk about their family in negative terms, it is an assault upon their self-worth.


 School-age children can relate to many people, and can form significant attachments to adults outside the family and to peers.

 They derive considerable security from belonging to a same-sex social group. For many children this age, their friends are the focus of most activities and social interactions.

 They recognize that being a foster child is somehow "different" from other children at a time when it is very important that they be more like them and accepted by them. The tendency for school-age children to be critical of differences, and to ignore or tease children who do not "belong," exacerbates foster children's isolation and feelings of rejection.

 School-age children may be fiercely loyal and exclusive in their relationships, and may feel they must choose between relationships. They may not understand how they can care for old friends and new ones too, or love both mother and foster mother. They may feel they must choose between the old and new life, which creates emotional conflict and guilt. This is exacerbated when foster caregivers expect them to "become a part of their family," and subtly or openly expect children to lessen their attachments to their primary family.

 The value system of school-age children has developed to include "right" and

"wrong," and they experience guilt when they have done something wrong.


 School-age children can develop new attachments and turn to adults to meet their needs. If previous relationships with unrelated adults have been positive, they will be likely to seek out help from adults, including a known and trusted caseworker, when they need it. This increases their ability to cope in stressful situations.

 Their perception of the reason for the separation may be distorted. They may verbalize that they are not at fault, particularly if this is reinforced by persons they trust, but they may not fully believe it. They will not want to accept that their parents are at fault either. Their self- esteem is closely tied with their parents' worth, and they need to view their parents positively. However, in the cognitively


concrete world of school-age children, someone must be blamed; and often the caseworker, the agency, or the foster parents are faulted.

 School-age children will compare foster caregivers to their parents, and the caregivers will generally lose the competition. This may be expressed in a statement such as, "My mom's hot dogs are better than these old things."

Caregivers must allow children to retain a positive attachment to their family without feeling threatened. They must also be able to talk with children in positive terms about their family, and reassure them that they can like the foster caregivers and care about their family, too.

 The loss of a stable peer group and trusted friends can be quite traumatic. Making new friends may be difficult. School-age children may be embarrassed and selfconscious about their status as foster children, and they may feel isolated. Maintaining contact with friends is helpful. Workers can also help these children by developing an explanatory story about the reasons for their placement to be used with peers.

 Children this age will be very confused if the rules or expectations in the substitute care home are different from those to which they are accustomed. They will be anxious and uncomfortable until they fully understand what is expected of them. They may also perceive differences in rules as unfair and protest the changes.

 School-age children have an improved conception of time. They can tolerate placements of a few months, if they understand they will eventually go home.

Longer placements may be experienced as permanent. Because children this age need concreteness, if they cannot be told exactly when they are to return home, their anxiety increases.

 School-age children, who are placed after some perceived misbehavior, may feel responsible and guilty, and may be anxious about their parents accepting them back. Repeated placements are perceived as rejections, and threaten their selfesteem. Children who have been subjected to multiple placements often express a belief that they are not wanted by anyone.


Preadolescence: (10 to 12 Years)


 Most of preadolescent children's thinking is still concrete. However, some children begin to show an ability to think and reason abstractly, and to recognize complex causes of events.

 At the preadolescent stage, children develop the ability to better understand perspectives other than their own. Some children at this age have developed insight, and can recognize and respond to the needs and feelings of others. They may recognize that their parents have problems that contributed to the need for placement - "My Dad is nice until he gets drunk, and then he gets mean and hits us."

 Preadolescents also have a better and more realistic conception of time. They understand weeks and months, and they can recall events that occurred months and probably years earlier. They are also able to maintain a sense of continuity over time.

 Preadolescents can logically generalize from their experiences. For example, they will not question whether the foster family has a kitchen, even though they have never been to the foster home, because they understand that houses have kitchens.

 Children this age understand that rules often change depending upon the situation, and they can adjust their behavior to meet the expectations of different situations.

This does not mean that changes are not stressful; however, the ability to adapt their behavior helps them cope with the changes.


 Self-esteem and identity are still largely tied to the family. Adolescents often feel that negative comments regarding their family reflect upon them as well.

 Preadolescents have an increased ability to cope independently for short periods of time. They can feed, dress and care for themselves, and travel independently around the neighborhood. They can manage some problems and resolve them without assistance from adults. However, they still turn to significant adults for approval, support, and reassurance, and for help when things are difficult.

 They may be very embarrassed by their foster child status. They are selfconscious about their "differentness."



 The social world of preadolescents has expanded to include many people outside the family. Peers are extremely important. Most peer relationships are of samesex. Both boys and girls may have best friends who form their social support network, as well as peer groups with whom they identify.

 Children this age still need trusted adults for leadership, support, nurturance, and approval.

 "Right" and "wrong" are complicated and evolving concepts. For most children this age, right and wrong are determined by principles which they believe apply to all people, including their parents. While children may not understand the sources or reasons for this moral code, they can begin to understand that their parents have the capacity to do wrong.


 Preadolescents have a better capacity to understand the reasons for the separation and placement. With help, these children may be able to identify the causes of the family disruption. They can be helped to realistically assess the degree to which their behavior contributed to the problems. With proper assistance, they can often develop a realistic and accurate perception of the situation, which can help prevent unnecessary and unreasonable self-blame.

 These children can benefit from supportive adult intervention, such as casework counseling, to help sort through their feelings about the situation. Some children this age are able to acknowledge their anger and ambivalent feelings, and talk about them. This helps them to cope.

 If given permission, preadolescents may be able to establish relationships with caregivers without feeling disloyal to their parents. If this is possible, placement in substitute care may not be as threatening.

 Preadolescents are often aware of the perceptions and opinions of other people.

They may be embarrassed and self-conscious regarding their family's problems and inadequacies, and regarding their status as foster children. This may contribute to the development of low self-esteem.

 These children may be worried about their family as a unit, and may demonstrate considerable concern for siblings and parents. They will want reassurance that they are okay, and are getting the help they need.


 The loss of best friends and peers may be particularly difficult for children this age. It may be difficult to replace these relationships in the foster care setting.

They may be lonely and isolated.

Early Adolescence: (13 to 14 Years)


 Youths' emerging ability to think abstractly may make complicated explanations of reasons for placement more plausible. However, they still may be confused if the factors are too abstract. As with adults, the ability to think abstractly may depend upon general intellectual potential and level of education.

 These youth may have an increased ability to identify their own feelings, and to communicate their concerns and distress verbally.


 Early adolescence is a time of emotional lability. Early adolescents may experience daily (or hourly) mood swings and fluctuations. At its worst, this can be a chaotic time. At best, youth of this age are still unpredictable and emotionally volatile.

 Physical and hormonal changes, including significant and rapid body changes, generate a beginning awareness of sexuality. Early adolescents experience many new feelings, some of which are conflictual and contradictory. Emotional changes may be accompanied by solicitous and exaggerated behavior toward the opposite sex, or anxious withdrawal. Many youth display both behaviors at different times as they experiment with new feelings.

 Early adolescents begin to feel a desire to be independent. However, they are not emotionally ready for true independence. Independence is often expressed primarily through verbal rejection of parental values and rules, and adhering, instead, to the values of their peers.

 Despite a verbalized rejection of adult rules and values, youth this age experience considerable anxiety when deprived of structure, support, and clearly defined limits.



 Early adolescents may be embarrassed to admit their need for adult approval, support, and nurturance. This makes it difficult for them to enter into relationships with adults, particularly when in an authority or parental role.

 Many early adolescents are conscious of their status or popularity, and their selfesteem is often derived from being accepted by the right peer group. These groups and their membership may change from day to day. Some youth may reject their childhood friends for acceptance into a more popular subgroup. Standards of acceptance are rigid, and many youth this age typically feel they do not adequately measure up.

 Many early adolescents may feel a need to keep up appearances, and may defend their family in public and to adults, even if they personally believe their parents to be at fault.

 At this stage, youth are beginning to become aware of social roles, and they experiment with different roles and behaviors. Consistent social role models are needed. Because sexual identity is becoming an issue, improper or atypical sexual behavior on the part of a youth's parents (sexual abuse, prostitution) may be of increasing concern.

 Although many youth will have developed a moral attitude with clearly defined

"rights" and "wrongs," these values may take a back seat to their friends' opinions and attitudes regarding their thoughts and actions. The values of the peer group often supersede their own.


 Early adolescence is emotionally a chaotic period. Youth experience many stresses as a result of internal, biological changes, and changes in expectations for their behavior. Any additional stress has the potential of creating a "stress overload" situation, and may precipitate crisis.

 Early adolescents may resist relationships with adults, and may describe adults in uncomplimentary terms. In their minds, dependence upon adults threatens their independence. They may not be able to admit their need for support, nurturance, and structure from adults. Without these, however, they may flounder and experience considerable anxiety. By rejecting adults, they deprive themselves of a source of coping support. The peer group, to whom a youth may turn, cannot generally provide the stability and help needed.

 At this stage, youth may deny much of their discomfort and pain. This prevents them from constructively coping with these feelings, and they may be expressed


through volatile, sometimes antisocial behavior. The general emotional upheaval of this developmental period may be exhibited in mood swings and erratic, temperamental behaviors.

 Separation from parents, especially because of family conflict and unruly behavior on the part of a youth, may generate guilt and anxiety.

 At a time when identity is an emerging issue, youth may have difficulty in realistically dealing with their parents' shortcomings. The parents may either be idealized, and their shortcomings may be denied; or, they may be discounted, verbally criticized, and rejected.

 The emotional and social nuances of emerging sexual relationships may be very frightening without the support of a consistent, understanding adult.

 Early adolescents have the capacity to participate in planning, and to make suggestions regarding their own life. This provides a sense of involvement, selfworth, and control. They will be less likely to resist or thwart a plan if they have been involved in developing it.

 Persistent, repeated attempts by caseworkers to engage youth can have very positive results. Even if they never acknowledge that their caseworkers are of help, they may greatly benefit from the workers' support and guidance.

Middle Adolescence: (15 to 17 Years)


 By middle adolescence, youth have often developed the ability to understand complex reasons for separation, placement, and family behavior. They can understand that things happen for many reasons, that no one person may be at fault, and that their parents aren't perfect. They may not, however, be able to accept their situation emotionally.

 The ability to be self-aware and insightful may be of help in coping with difficult situations and their conflicting feelings about them.

 At this stage, adolescents have greater ability to think hypothetically. They can use this ability to plan for the future, and to consider potential outcomes of different strategies.



 Middle adolescents are developing greater self-reliance. They are more capable of independent behavior, and can contribute to decisions about their life and activities. This helps them to retain some control of their situation, which helps reduce anxiety.

 Identity is being formulated by considering and weighing a number of influences, including family, peers, and their own values and behaviors. These adolescents are beginning to formulate many of their own beliefs and opinions. Many behaviors and ways of dealing with situations are tried, and adopted or discarded, in an attempt to determine what seems to be right for them.

 The development of positive self-esteem may depend as much on acceptance by peers of the opposite sex as by same-sex peers.


 Considerable social behavior is centered around exploration of sexual relationships and concerns around intimacy. Much social behavior is centered around dating. Group identification is important, but less so. Individual relationships are becoming more important.

 Adolescents become very interested in adults or older youth as role models. They will be very responsive to people who are honest and who will talk about their ideas without enforcing behavioral expectations or values. They are often willing to listen and to try new ways of thinking and behaving.

 Adolescents are beginning to focus on future planning and emancipation, and are experimenting with and developing self-reliance. But they still need the consistent support of their family.

 Toward the end of middle adolescence, many youth may begin to question previously held beliefs and ideas regarding "right" and "wrong," and they may be less influenced by peer attitudes. An emergence of independent ethical thinking may be evident.


 Adolescents will often reject a family's supporting, nurturing, and guiding efforts as they struggle to express their need for independence. This often results in conflicting, labile, and ambivalent emotions and feelings toward their family.


Separation during this time further complicates an already complicated developmental dynamic. Youth in placement may need help and counseling to sort through their ambivalent feelings regarding their family.

 Adolescents' need for independence may affect their response to placement in a substitute family setting, especially if the caregiving family expects them to

"become one of us." Adolescents' family identity may remain with their biological family, and they may be unwilling to accept the substitute family as more than a place to stay. This may be perceived as their failure to adjust to the placement, even though it is a healthy and reasonable response.

 Adolescents may not remain in a placement if it does not meet their needs. Some would rather find their own solutions and placements.

 Adolescents may constructively use casework counseling to deal with the conflicts of separation and placement in a way that meets their needs without threatening their self-esteem and independence. A strong relationship with a trusted caseworker or therapist can provide support, offer guidance and direction, and help them develop realistic, accurate perceptions of a situation and their role in it.

* From Rycus, J. & Hughes, R. (1998) Field Guide to Child Welfare, Vol. II (pp. 709-721). CWLA Press:

Washington. © 1998 CWLA/HIS. Reprinted by permission of the publisher. www.cwla.org

.


Chapter 4: Children’s Reactions to Separation and Placement

Dealing with the separation experience is one of the greatest challenges faced by foster parents, workers, and others who are involved in caring for vulnerable children who have been forced to leave their homes (Pasztor & Leighton, 1993). For most foster children and families, the separation experience is difficult to manage.

Separations make people feel angry, sad, lonely, frightened, guilty, confused, helpless, and a host of other painful and sometimes overwhelming feelings. For young people in care, the experience of separating from their family, no matter how long the placement, feels like losing their family for good; and the way that these separations are handled will impact the remainder of a child’s life. Their young age, developmental level, and/or previous experiences with separation cause children in care to react to separation and placement in a way that is similar to experiencing the death of their family members

(e.g., Fahlberg, 1991). The experience undermines a child’s sense of predictability and safety and is fills them with feelings of fear, helplessness, and loss of control (Herman,

1992).

The fear, helplessness, horror, and sense of loss children experience in response to separation are the defining characteristics of traumatic experiences (American Psychiatric

Association [APA], 1994). When not handled properly, “the lingering grief and uncertainty of loss of parental figures colors the child’s view of the world like a lens”,

(McFadden, 1992, p. 2) causing children to view everything as a threat to their wellbeing. The trauma of separation fills their inner world with feelings of terror and confusion (McFadden, 1992), and they are in need of support for understanding and working through this scary time.

Adults who can recognize the signs of a child’s pain will be best equipped to support him through times of need. The intensely painful feelings that result from separation and placement can lead to behaviors that are unpleasant or even dangerous. It is important to remember that acting out behaviors are expressions of emotions and needs and are used as a means of coping with difficult situations (e.g., Hughes, 1997). When the feelings associated with separation become too distressing to manage, some youths in


care may try to cope by acting out with bullying and hostile behavior, lying, stealing, aggression toward peers, thoughts of suicide, substance abuse, and other destructive behaviors (e.g., Delaney, 1991; Newton, Litrownik, & Landsverk, 1995; Penzerro &

Lein, 1995; Rosenstein & Horowitz, 1996; Sroufe et al., 2003).

Children have to be helped to understand that their feelings of fear, anger, sadness, and guilt are normal. They also have to be helped to learn how to cope with the separation and express their feelings in ways that are appropriate and healthy. It is the responsibility of caregivers and social workers to ensure that they understand the impact of separation on foster children, and can recognize and appropriately react to signs of distress. According to Child Welfare professionals,

Disruptions often occur when foster parents … do not have the patience, skill, or understanding to help children manage their losses, and when social workers do not have the patience, skill, or understanding to help children, youths, and families in stress. (Pasztor & Leighton, 1993, p. 7)

The goal of this chapter is to describe the nature of separation and the signs and symptoms of separation trauma, including: 1) factors that influence reactions to separation; 2) the traumatic impact of multiple separations; and 3) some emotional and behavioral reactions to separation and placement.

Factors that Influence Reactions to Separation

Knowledge of the conditions that contribute to or minimize the traumatic impact of separation and placement is recommended by child welfare professionals as one of the primary needs for foster parents and social workers. Rycus and Hughes (1998) point out that “not all separations are equally distressing. By understanding the variables that contribute to traumatic separation, we can gain insight into why the separation of children from their families is potentially one of the most damaging and traumatic of all separation experiences.” The personal experiences of foster children, parents, workers, therapists and others involved with the child welfare system has added to the research literature on


separation. The identification of several key factors that affect the severity of a child’s reaction to separation and placement has resulted from this union.

Many researchers and clinicians have written on the factors the contributing factors to separation distress and adjustment (e.g., Chapman, Wall, & Barth, 2004;

Fahlberg, 1991; Heinicke & Westheimer, 1966; Maccoby & Feldman, 1972; Mauk &

Sharpnack, 1999; McFadden, 1992; Penzerro & Lein, 1995; Rycus and Hughes, 1998).

There is currently much agreement about the most important determinants of a child’s reaction to separation. The following section draws from current research on the topic and describes the factors that have been identified throughout the years as influential to a child’s reaction to separation and adjustment to placement.

The child’s age and stage of development

Children do not think in the same way as adults. They do not have the wisdom from years of experience that adults have, and their thinking is concrete and egocentric.

In fact, people are not fully capable of rational though and reasoned judgment until the age of 15 (Piaget, 2003). As a result, children see things from a limited perspective. The changes associated with a new home can be very scary because new events that are not a part of a child’s customary routine are often anxiety-provoking – they have limited experience in dealing with new situations. For example, Rycus and Hughes (1998) tell the story of five-year-old Lisa who, in the car on her way to a pre-placement visit, anxiously asked her social worker whether the new family had a bathroom at their house.

While the question may seem surprising, the little girl had never seen the foster home and had no idea what to expect. From her limited experience outside of her own home, she was unsure whether every home had a bathroom, or just hers.

The natural egocentricity of childhood additionally interferes with a child’s ability to comprehend and adjust to separations and placement. As described in the previous chapter on child development, young children interpret every event as somehow caused by, or otherwise related to, them. Children often blame themselves for the separation, compounding their distress, because they are not cognitively mature enough to comprehend the reasons for their removal (Delaney, 1991; McFadden, 1992). Caregivers


should also expect children to regress somewhat in terms of recently acquired skills when they are separated from their families (Fahlberg, 1991). For example, toddlers may regress in language skills because they have to adjust to picking up on different communication patterns in new people. The stages of child development and implications of separation and placement are further discussed in Chapter 3 of this manual.

The significance of the lost person(s)

The stronger the child’s relationship with the person(s) from whom s(he) has been separated (including parents, siblings, and other important figures in the child’s life), the greater the likelihood of trauma (Fahlberg, 1991; McFadden, 1992). A child’s fear at losing a parent figure often results in the child idealizing the person, as a way of keeping the memory of that person intact (McFadden, 1992). When this happens, the child can see no fault in the parent for abandoning or maltreating him/her and assumes responsibility for placement. The idealization of the parent provides children with comforting fantasies that the parent can provide love and safety and will return. These fantasies and problems associated with lowered self-esteem brought on by guilt over causing the separation

(Delaney, 1991), interfere with a child’s ability to adapt to changes and cope with separation.

Attachment styles, as discussed at length in the chapter on attachment, also play a significant part in the degree to which a child is negatively affected by separation and placement. Some clinicians consider disordered attachments directly responsible for the traumatic impact of separation and describe foster children who “display exceptionally clear patterns of alienation in relation to transitions form placement to placement”

(Penzerro & Lein, 1995, p. 351).


Past experiences with separation

Research consistently shows that a history of multiple placements predicts poorer outcomes for children in care (e.g., Barber & Delfabbro, 2003; Fahlberg, 2001; Newton,

Litrownik, & Landsverk, 2000; Paradek, 1984; Rubin, Alessandrini, Feudtner, et al.,

2004). In the case of children who are repeatedly moved, the trauma of separation is replicated again and again, and its effects are compounded with each placement. Children in this situation never have the chance to settle into a placement and resolve their fears and anxieties over separation from the previous attachment figure before they are expected to start the process all over again.

The traumatic impact of multiple separations may not be obvious on the surface, making it all the more dangerous. Children who have experienced multiple moves often evidence very little sign of distress at moving to yet another home, appearing to have grown accustomed to it with practice. However, those who have little difficulty moving to a new home have developed defenses against re-experiencing the pain of earlier separations. They have become “emotionally paralyzed by the fear of rejection”

(McFadden, 1992, p. 6). They have closed themselves off to developing relationships and are at substantial risk for drifting through the system unattached (Fahlberg, 1991). The impact of multiple separations is such an important concept that a section of this chapter will address it specifically.

The child’s perceptions of the reasons for the separation

It is human nature to want a degree of control over what happens to us. When things do not go right, people tend to hold themselves responsible. This tendency is particularly troublesome for children, since their guilt is made worse by their egocentric thinking – they see everything that happens around them as somehow influenced by them. Most children in care firmly believe, and often express, that they were unwanted by their families and "sent away" because they were "bad." (Rycus & Hughes, 1998).Most

Feelings of guilt and self-blame worsen normal feelings of loss associated with separation and increase the emotional distress and separation trauma (Rycus & Hughes, 1998).


Taking the blame for placement off the child can be facilitated by taking out the

“fault” altogether (Fahlberg, 1991). Caregivers want to tell their children that what happened to them is not their fault.

Fahlberg (1991) cautions that this approach may be ineffective because children do not reason on a rational level, and using the word fault implies that the assignment of blame is easy and primary. If adults are able to easily identify one primary person as at fault for the separation, then the child assumes that it can easily be his/her own fault.

Instead of talking terms of fault , adults should discuss responsibility with children

(Fahlberg, 1991). Focus on reciprocity in relationships: What were the child’s needs?

What were the parents’ needs? What was the family doing to try to meet those needs?

Were things working well to meet the family’s needs? Discussing individual needs and individual responsibilities can help the child further understand the situation while acknowledging the control he has over his own behaviors and the lack of control he has over others’ behaviors. It takes the emphasis off of blaming and focuses on the more positive quality of responsibility.

Preparation for the move

Abrupt moves are more traumatic than those that have been planned (Fahlberg,

1991; Cournos, 2002; Rycus & Hughes, 1998). Familiarity with caregivers has been identified as a protective factor during separation and placement (e.g., Chapman, Wall, &

Barth, 2004; Festinger, 1983; Maccoby & Feldman, 1972). The environment into which a child is placed is critically important to his ability to cope with the separation, and a feeling of being accepted and supported by the caregiving family is important for a child’s sense of safety and well-being. To adequately support a child and me his or her needs, the family must be well-acquainted with the child prior to moving and must be prepared with detailed information about the child. Information about the child’s habits and preferences, medical needs, interests and skills, behavior problems, fears and anxieties, developmental level, history of abuse or neglect, and other important influences on the child is valuable for creating an environment that maintains continuity in the child’s life and reduces the stress of moving (Rycus & Hughes, 1998).


The child must also be prepared for the move. Children often feel that they are being kidnapped or given away, especially if separation and placement are sudden

(Pasztor & Leighton, 1993). Caseworkers can relieve children of many fears and anxieties by providing detailed information about the need for placement and by familiarizing children with the new home (Rycus & Hughes, 1998). Caregivers can use pre-placement visits as opportunities to get to know the child entering their home. Rycus and Hughes (1998) recommend that one foster caregiver should take on the role of the child’s primary contact person for the new family, taking time to talk privately with the child and develop a relationship before immersing the child fully into the family life.

The length of the separation

Typically, the longer a separation, the more traumatic it is for a child. Longer separations from a child’s family and primary attachment figures increase the extent of the child’s detachment and interfere with the attachment system (Heinicke &

Westheimer, 1966). A major reason why placement is traumatic is that children often react to temporary separations as if they were final. “While most separations in child placement are considered "temporary" by the placing agency, in the young child's mind, a few weeks is eons, and a few months is permanent” (Rycus & Hughes, 1998). As will be discussed in the chapter on the grief reaction to separation, many children in substitute care experience the emotional turmoil seen in persons suffering the death of loved ones.

Children who are permanently removed often have difficulty recovering from the loss of their biological parents because many of the factors described previously are working against them. They may not have other established attachment figures to help them cope with the loss; they may be emotionally underdeveloped due to the circumstances of abuse or neglect that necessitated their removal; and they likely have been in multiple placements, incurring multiple losses without having a chance to work through them (Mauk & Sharpnack, 1999).


The post-separation environment

The comfort of the new home and caregiving family, the experience of the local neighborhood and school, and the availability of contact with familiar and trusted people all contribute to the post-separation environment for a child (Chapman, Wall, & Barth,

2004; Fahlberg, 1991; Rycus & Hughes, 1998). Stress is reduced and trauma is minimized if this environment contains as much familiarity as possible for children who are separated from the usual support of known family, friends, neighbors, teachers, and other important figures. Supportive relationships with social workers, familiar caregivers, and others can help alleviate the feelings of loneliness and isolation that children experience during placement (Rycus & Hughes, 1998).

Visitation with biological family members and the assurance that visitation is okay is another important part of creating a positive post-separation environment

(Chapman, Wall, & Barth, 2004; Eagle, 1994; Fagin, 1966; Trause et al., 1981). Helping children communicate with their biological parents or other family members though letters, e-mail, phone calls, and visitation shows children that caregivers are supportive of their feelings toward their biological family. This kind of support facilitates the development of trust between the child and caregivers, while also reducing trauma by providing continuity in the child’s life (Kagan, 2004). Continued contact with biological family members is cited by children in care as one of their main concerns (Chapman,

Wall, & Barth, 2004), and is also a primary concern of child welfare policy (Rycus &

Hughes, 1998).

The child’s behavior and temperament

Children’s behavioral problems are often cause for foster placement disruption

(e.g., Barber, 2001). Children’s acting out behaviors and/or attempts to isolate and distance themselves from caregivers can prove incredibly frustrating for alternative caregivers. These problems develop as the result of emotional stress created by the effects of abuse and neglect, multiple moves, unresolved grief at the loss of parents and other significant people, and the child’s natural temperament (Falhberg, 1991; Kagan, 2004).

Some children react to separation by withdrawing physically and/or emotionally.

Physical withdrawal is characterized by isolation, boredom, or running away; emotional


withdrawal is evidenced by children who are unresponsive to others and do not respond to attempts to engage the child in relationships (Fahlberg, 1991). These behaviors can prevent children from effectively coping with the separation. Perceptive adults can learn to recognize changes in children’s behavior and help children identify the feelings that underlie the changes. Using the child’s behaviors as signals for troubles on the inside helps children learn how to put their temperaments to good use (Fahlberg, 1991).

In summary, there are a number of factors that influence how a child reacts to placement. Every child’s experience will be different, and people involved with a child’s placement should pay careful attention to creating an environment that takes into account the child’s personal needs and is appropriate for that particular child. Sensitive responding to the child’s development, issues related to prior experiences with abuse, neglect, maltreatment, or problems with primary caregivers, the child’s temperament, and the child’s needs for contact with family are of primary concern. Caregivers, social workers, biological families, and others who are significantly involved with a child in should work together (Rycus & Hughes, 1998) to create conditions that promote the smoothest experience possible for a child who separated from his or her family.

The Traumatic Impact of Multiple Separations

The Child Welfare League of America maintains a website devoted to tracking the incidents and outcomes of children in out of home care in the United States (Child

Welfare League of America 2002a; 2002b). The organization’s most recent report indicates that in 2002, the number of children in out of home care climbed to more than

524,000. More than 2/3 of these children are placed in non-relative foster care.

Nationally, more than 60% of children who are placed in out of home care do not return to the home within one year, and nearly 30% stay in care for at least 3 years (Child

Welfare League of America 2002). Research shows that children who spend at least one year in foster care are at substantially greater risk for problems with attachment, subsequent social and cognitive impairments, and continuing developmental problems


whether or not they remain in foster care (e.g., Kerman, Wildfire, & Barth, 2002;

Taussig, 2002; Taussig & Talmi, 2001).

The high percentages of children remaining in care for extended periods are of concern particularly because the longer a child is in care, the more likely he is to experience multiple movements with the system (Barber, 2001., Kenrick, 2000; U.S.

Department of Health and Human Services, 2004), each of which has the potential to further traumatize a child already suffering from broken attachments to biological parents and families. Research shows that problems adjusting to new placements are often associated with poor attachment (Fahlberg 1991; Levy & Orlans 1998; Pinderhughes &

Rosenberg, 1990), and several studies show that the more placements a foster child has, the worse the effect on the child’s psychological well-being (Barber, Cooper, &

Delfabbro, 2001; Barber & Delfabbro, 2003; Fahlberg, 2001; Newton, Litrownik, &

Landsverk, 2000; Paradek, 1984; Rubin, Alessandrini, Feudtner, et al., 2004).

Multiple separations are associated with a number of clinical emotional and behavioral problems. Even those children who have been relatively well-adjusted before removal from their homes experience significant personal problems due to the trauma of separation (Barber & Delfabbro, 2003; Newton, Litrownik, & Landsverk, 2000). Anxiety, depression, physical health complaints, and aggressive and defiant behaviors all increase as the number of moves increases.

National data on the number of movements a child makes within the foster care system is somewhat difficult to obtain. Several sources do, however, provide statistics on movements by state (e.g., Child Welfare League of America, 2002; New York State

Office of Children and Family Services, 2003; U.S. Department of Health and Human

Services, 2004). The New York State Office of Children and Family Services (2003) estimates that in the quarter ending in June 2003, more than 40% of the 33,319 children in out of home care in New York state experienced more than one placement within the first year after removal from their homes. This figure jumps to nearly 80% of children who were in care for 3 years. Startlingly, of those children experiencing multiple placements, approximately 50% stayed in 3 or more homes, more than 25% stayed in 4 or more homes, and nearly 5% stayed in 7 or more homes. With this large number of children experiencing multiple, and sometimes frequent movements during the formative


child and adolescent years, it is important to understand the effects that multiple placements can have on a child.

Children who are moved repeatedly have already lost early attachments to birth parents and families due to removal by protective services, as well as attachments to previous foster parents. Terr (1991) describes the two types of trauma that foster children experience as a result of disruptions in relationships with attachment figures. She defines a child’s reactions as the result of “Cumulative Trauma,” or the, “mental result of one sudden external blow or series of blows, rendering the young person temporarily helpless and breaking past ordinary coping and defensive operations. Trauma includes situations marked by intense surprise as well as those marked by prolonged anticipation” (p. 11).

Trauma resulting from “prolonged anticipation” is what many foster children experience prior to placement: repeated abuse, neglect, or other damaging experiences in the child’s relationships with parents or primary caregivers (described in Chapter 2). The former trauma, a “sudden external blow” describes the impact of the sudden removal of a child from his or her home and current relationships and placement in an unfamiliar foster family. Foster parents can anticipate dealing with the consequences of both types of trauma and will benefit from furthering their knowledge of a child’s reactions to separation and indicators of separation trauma.

Emotional Responses to Separation

Reactions to separation are similar to other traumatic events, such as disaster or the death of a loved one (Waddell & Thomas, 1998).

It is very difficult for a young adult or adolescent to function well without a meaningful attachment to his or her parent(s)

(Hughes, 1997). Foster parents and other caregivers should be sensitive to the impact that leaving home and possibly cutting or weakening ties with parents may have on children’s sense of safety, stability, and well-being.

Studies have examined the separation experience for children, both at the time of removal and in the months and years immediately following removal (Chapman, Wall, &

Barth, 2004; Fanshel & Shinn, 1978; Johnson, Yoken, & Voss, 1995). Most foster children report feeling sad, depressed, or upset on the day they are removed from their


parents' care (Fanshel & Shinn, 1978), and as many as half of children will say that they miss their parents most of the time in the months and years following removal, no matter what their home life was like (Chapman, Wall, & Barth, 2004; Johnson et al., 1995).

It is common for children to have very mixed feelings about being separated from their parents, feeling both relief at no longer being looked after by neglectful and/or abusive caregivers, and sad because they miss their homes, their parents, and their familiar way of life. They often grapple with conflicting feelings about loyalties to biological families and creating new ties with foster families and other new caregivers

(Kagan, 2004). In addition, they often blame themselves for the separation, since developmentally, children are not able to fully comprehend the complexities of the situation that lead to their removal (Fahlberg, 1991; Kagan, 2004). The feelings of guilt and shame add to problems with self-esteem created by weak or insecure attachments

(e.g., Delaney, 1991).

When children are removed from their homes, they leave behind every person, thing, and custom that is familiar. They have to adapt to new surroundings, new people, new rules, and they often have to do so without the support of their family, friends, and other trusted members of their support network. They often feel out of place and fear being ridiculed or ignored in their new settings (Mauk & Sharpnack, 1999; Rycus &

Hughes, 1998). They feel abandoned, angry for being put in this situation, helpless, and hopeless (McFadden, 1992). They fear for their own safety and the safety of their families and feel confused about their roles and responsibilities (Chapman, Wall, &

Barth, 2004).

If you ask foster children what moves from home to home are like, most report that their changes of home were unsettling and confusing (Festinger, 1983). Many foster children have shared their experiences within the foster care system in books and articles over the years. While the stories sometimes include feelings of being loved and cared for by their foster parents (Sharif, 1996; Stockwell, 1996), a more common theme emerges in the negative feelings they have about each move.

From their stories, we learn that foster children often feel scared, lonely, and disappointed with themselves every time they are placed with a new foster family (Jones,

1990; Lopez & Dworkin, 1996; Rhode-Shimer, 1996). Not only do these children have to


deal with the pain and uncertainty of moving to unfamiliar homes, but they also blame themselves for creating the situation. The self-blame and doubt are often on top of low self esteem related to feeling unwanted and abandoned by his or her birth parent(s)

(Sharif, 1996).

The separation experiences of children in care are very much like those of any person who is forced for some reason to separate from their known environments and loved ones. From infancy through adulthood, people’s reaction to separation includes specific and fairly predictable emotions. Fear, anger, sadness, ambivalence, and guilt

(especially for children), typically accompany separation experiences. These emotions are part of the instinctual attachment system and serve important functions when humans are faced with separations from attachment figures and familiar, safe, surroundings (see review by Kobak, 1999).

The intensity with which a child may experience some of these feelings, and the resulting behavioral expressions of them, may make it easy for caregivers to personalize a child’s reactions to separation. It can be difficult to maintain perspective on a child’s rejecting, defiant, hurtful, or otherwise inappropriate or seemingly unwarranted behaviors when caregivers are doing the best they can for a child and still being pushed away.

Foster children often feel very little control over their lives when they are moved into or around in the foster care system (e.g., Sharif, 1996). Some foster children who do not have stable attachment figures will go to extreme measures to gain a sense of control or to get the attention that they so desperately need. Toft (1997) shares the stories of current and former foster children in One of the stories shared by Toft (1997) was that of

Sebastian, a former foster child who recalled that he was removed from his mother’s care because he was physically abused by his mother’s boyfriend. Sebastian had also watched while the man abused his mother. Sebastian shared his feelings of powerlessness as being placed in foster care, and the experience of finally feeling powerful when, at age 11, he beat a dog to death. Animal cruelty such as this is one extreme form of acting out behavior that may be demonstrated by children with severe emotional problems caused by or worsened by traumatic separation.

Caregivers should remember that the emotions that a child experiences, and the behaviors displayed as a result, are natural responses to being separated from his primary


caregivers and should not immediately be interpreted as a caregiver’s failure to connect with the child. Fear, anger, and sadness, even when extreme, are instinctual reactions that result in behaviors that are intended to help children cope with the separation.

Adults have to be sensitive to the enormous impact that separation has on children and help children find appropriate and constructive ways to express and deal with them

(Fahlberg, 1991). Below are some common emotional reactions to separation children experience in response to separation and placement.

Fear

When a child is abruptly separated from his or her family or other attachment figures, a natural reaction will be fear. From an attachment theory perspective, fear serves a purpose for children separated from their primary caregivers: fear activates behaviors that normally result in gaining access to the attachment figure. That is, fear of losing a parent or other attachment figure prompts a child to seek attention in order to draw his caregiver close to him. Fear also acts as a signal that communicates the child’s distress to his caregiver and elicits comforting.

Caregivers should be sensitive to what a scary situation it can be for children who suddenly find themselves separated from everything familiar and their main sources of support. They fear the unknown of a new situation and are anxious about personal harm.

They worry about whether they will have food to eat, clothes to wear, and shelter to protect them (Rycus & Hughes, 1998). Recall from the earlier discussion of the significance of stage of development that children and youths in substitute care may not have enough experience with the world to know that safety can be obtained in environments outside of their home. Children are basically dependent upon their caregivers for all of their needs. When separated from the parents or other adults who have had that responsibility, children naturally fear that those needs will not be met.

Children in care report that their initial separations from their families during their first placements are rife with fear. They are often anxious and withdrawn during the first

4 months of placement (McAuley, 2000). They report fear of the unknown, fear of abandonment or permanently losing their parent(s), fear of the future, and fear of being


harmed (McFadden, 1992). They worry about what will happen to themselves and to their family while they are gone, wondering whether their families are safe or if they have forgotten them (Rycus & Hughes, 1998). Children who are separated from their parents worry about whether classmates will ask about their situation because they fear the possibility of crying at school and being embarrassed by the loss of control (Bertoia &

Allan, 1988). Bedtime is commonly very difficult for children when initially removed from their homes because sleeping leaves children very vulnerable. They may have nightmares, wet the bed, or refuse to go to bed (Beckman, 1990; Fahlberg, 1991; Gray,

2002; Pasztor & Leighton, 1993; Waddell & Thomas, 1998). When fear becomes extreme, children may describe panic as a sore throat, tightness in the chest, or difficulty in breathing (Beckmann, 1990).

Anger

Foster children who are forced to move multiple times often feel angry about spending their childhoods in and out of different placements (Jones, 1990; Lopez &

Dworkin, 1996; Rhode-Shimer, 1996). One grown foster child stated in a book that she wrote about her experience, “for 13 years, life for me was being shifted from one agency to another, from foster home to institutions, like a sack of potatoes” (Jones, 1990, p. 4).

The bitterness and anger she expressed is similar to what other former foster children express. For example, Hicks (1996), expressed anger with the foster care system for leaving her with no family ties. In a book that shares the stories of teenagers in foster care system (De Setta, 1996), Hicks voiced her resentment over being separated from her younger brother, her only remaining family contact after five years in the system, without even being allowed the chance to say goodbye. She shares that she and her brother had moved through the foster care system together; but eventually, her younger brother was adopted, leaving Hicks to navigate the system alone, through six different social workers and five different law guardians during her eight years in foster care.

Increased anger and hostility are usually observed as the length or number of separations persists. Bowlby (1973) suggested that when separations are temporary, anger serves two functions for a child: 1) it motivates a child to overcome obstacles to reunion;


and 2) it communicates reproach to the parent or primary caregiver so as to discourage the caregiver from putting the child in that situation again.

It is important to understand that children’s hostility when entering a new placement is a natural and instinctual response. Caregivers have to react with sensitivity and support, because “anger can easily become destructive and dysfunctional for the child when the caregiver misreads the child’s anger and responds with anger or disengagement.” (Kobak, 1999, p. 36).

The anger of children in placement can be upsetting not only to caregivers and others around the child, but to the child as well. Rycus and Hughes (1998) note that children in placement are often frightened by their own anger and believe that they will be punished for angry behaviors. In fact, this is often the case. Although anger is a natural response to separation, its expression can dangerous if it causes caregivers to respond with anger of disengagement (Kobak, 1999). Children in care are indeed often reprimanded for angry behaviors such as tantrums, whining, defiance, and aggressiveness

(Stewarrd & O’Day, 2000), and so learn that it is necessary to suppress angry feelings if they are to survive (Rycus & Hughes, 1998). Suppression of these feelings may be even more dangerous to a child (Fahlberg, 1991). Regardless of our discomfort with anger, children have to be allowed to express it. Otherwise, unexpressed anger may emerge in the form of negative behaviors or in passive aggressive ways (Rycus & Hughes, 1998).

Sadness

Children typically rely on familiar and trusted adults, such as their parents, as their main source of support. Without those supports, children are much less able to cope with stressful situations (Rycus Hughes, 1998). Sadness is a natural consequence of realizing that one’s family or other attachment figures are not available.

Sadness tends to overshadow anger as a child begins to accept the loss of the attachment figure. A child who experiences sadness over the loss of his family or other attachment figures may withdraw in order to have time to accept the change. The typical progression of feelings from anger to sadness will be discussed in the chapter on separation as grief. That chapter will also more fully explore children’s experience of


sadness and depression in response to the loss of their families through separation and placement.

Guilt

We have already seen how a child’s developmental level influences his or her understanding of the separation and experience and contributes to a sense of self-blame for the situation. In the Child Welfare League of America’s guide to Child Welfare

(1998), Rycus and Hughes explain that “young children do not have the cognitive maturity to understand the reasons for placement, and complicated explanations about their parents' problems make no sense to them” (Rycus & Hughes, 1998). They often believe themselves to be at fault and interpret separation as punishment for something that they have done wrong. Particularly for children with abuse histories and poor attachments, their guilt contributes to low self-esteem and confirms their image of themselves as “bad” (Delaney, 1991).

Adults who can provide accurate information to the child about the situation that lead to his or her removal may be able to begin to help the child understand that s(he) is not to blame for the placement. As discussed previously, talking about the personal needs and responsibilities of each family member, and whether the family’s actions were meeting those needs, is a way to take the focus off of blame and place it on the more constructive and realistic notion of responsibility.

Emotional Conflict

Damien is a former foster child whose story appears in a collection of interviews with young adults who had lived in the foster care system (Toft, 1997). Damien’s story is one of anger, distrust, and resentment towards the foster care system, despite the fact that the foster care system rescued him from a life of abuse at the hands of his abusive mother. It speaks to the vehemence with which some foster children sometimes cling to the thought of reunification with their biological parents, as well as the emotional torment


that these children experience. Although Damien knew that he had been sexually abused by his mother, he desperately wanted to reunite with her.

Delaney (1991) explains why a child would even prefer to remain with an abusive parent than be separated. “To disengage from the relationship with the parent is terrifying because the child would be alone. Thus, the child seems to prefer being with an abusive, unavailable parent instead of being separated from the parent and being alone. The child comes to expect that interactions with his or her caregiver(s) are unpredictable and may be unsatisfying. With that comes a sense or inner turmoil and insecurity, which results in the child resisting independence and an inability to attend to his or her needs confidently.” Thus explains how conflicted a child can become at the loss of a parent.

In another example of personal conflict, Dr Francine Cournos writes of her experience when she first learned that she would be placed in foster care: “I could barely distinguish between the fury I felt at my relatives and the rage I turned in on myself for being so helpless” (Cournos, 2002, p. 148).

Competing loyalties to biological families and substitute families may also be a source of much emotional conflict. Children often yearn to return to their biological families and feel as though they are betraying their families when they are able to develop strong relationships with substitute caregivers (Chapman, Wall, & Bath, 2004).

As a defense against dishonoring their biological parents, children in foster care will often project the cruel or neglectful characteristics of biological parents onto their foster careers and may accuse a warm and concerned caregiver of being abusive (Hopkins,

2000). The turmoil of such emotional conflicts is associated with some of the most sever behavior in foster children, such as suicide attempts (Chapman, Wall, & Barth, 2004).

Behavioral Responses to Separation

The emotions experienced by children and youth who are separated form their families and their main sources of support are powerful. Separation produces “intense and enduring emotional distress that outsiders seldom appreciate” (Mauk & Sharpnack, 1999, p.

4). Without adequate emotional support, children may become overwhelmed during the separation and placement process (Rycus & Hughes, 1998). When children are emotionally


overwhelmed, they must psychologically repress their painful feelings. They are forced to push their pain to the back of their minds.

"Repression bottles up the various impulses and prevents their full expression. It makes necessary the maintenance of unrealistic, childhoodderived behavior patterns. It freezes psychological energy that would otherwise be available for meeting and mastering new life situations. It reduces the child's emotional flexibility, and prevents him from functioning at his full physical, intellectual, and emotional capacities" (Littner, 1956).

Repression of emotions during the emotionally taxing time of separation and placement reduces children’s ability to cope with new situations, which further frustrates children and effects self-concept and identity formation, interpersonal relations, schoolwork, family involvement, and overall psychological well being (Mauk & Sharpnack, 1999). When emotions cannot be expressed, they manifest in behavioral problems.

Children’s behavioral responses to separation are personal and unique. Not every child will experience the separation in the same way, nor will he/she express distress in the same way.

Age and stage of development are, as discussed before, among the most important determinants of the reaction to separation.

Familiarity with the typical behaviors associated with loss of attachment figures in children and youth is an important tool for helping adults care for children in distress. Paying careful attention to changes in behavior gives clues to the depth and length of the child’s distress (i.e., behaviors that are more pronounced and longer-lasting signal greater emotional disturbance), and the disappearance of certain behaviors can signal adjustment to the new situation (Mauk & Sharpnack, 1999).

Preschool children

Egocentric thinking plays a large role in the behavior of preschool children during a separation. Anxiety and emotional distress are caused by concern about basic safety and security needs, such as who will feed, clothe, and shelter them. Emotional distress is also caused by these young children’s beliefs that they are responsible for the separation, through wishes or thoughts, bad behavior, anger, or neglect of responsibility (Mauk & Sharpnack,

1999). Behaviors indicating separation distress in preschool children include:



Fear of abandonment



Difficulty forming new attachments




Beliefs about causing the loss



Temper tantrums



Eating and sleeping problems



Children under age two may temporarily exhibit loss of speech



Thumb sucking



Bedwetting and bowel or bladder problems



Clinginess



Sleep disturbance



Loss of appetite



Fear of the dark



Regression in toileting habits



Withdrawal from friends

School-age children

School-age children are less susceptible to the magical thinking of their younger peers. By this age, most children have a better understanding that their behavior is not necessarily the cause of the separation and that their behavior alone is also not going to bring about a reunion (Mauk & Sharpnack, 1999). Typical behavioral reactions include fearing that separation will be permanent and seeking ways to avoid this. Behaviors indicating separation distress in school-age children include:



Phobic responses



Imagined illness and injuries



Aggressive acts; physical fights



Eating or sleeping problems



Idealization of parents



Learning problems



Irritability



Clinginess



Nightmares



School avoidance



Poor concentration




Withdrawal from activities and friends



Increased conflict with siblings and other children

Adolescents

The emotional pain of adolescents in response to separation can lead to impulsive behaviors that serve to distract them from their pain (Mauk & Sharpnack, 1999). Adolescents place increasing importance on their friends and peers and may avoid expressing their pain in order to avoid being rejected by their peers. As described earlier, the repression of painful thoughts and feelings can effect many areas of an adolescent’s life and have dire consequences for personality development, self-concept, school performance, and interpersonal relations. Behaviors indicating separation distress in adolescents include:



B owel or bladder problems



Stomachaches



Eating complications – loss of appetite or gorging



Headaches



Rashes



Sleep disturbances - more or less rest



Loss of interest in important peer activities



Isolating self



Defiant behaviors



Antisocial behaviors; stealing, vandalism, promiscuous sexual activity, and using drugs



Poor school performance



Irritability



Poor concentration



Lack of energy



Irresponsible or delinquent behavior

Obviously, the intense feelings and associated behaviors children and youth experience as a result of being removed from their homes and loved ones can be extremely disruptive to a child and those in the caregiving environment. Adjusting to a totally unfamiliar environment without the support of the trusted people who were left


behind, and exacerbated by a limited ability to comprehend what is happening, is an extremely frightening experience. As noted earlier, the fear associated with separation is a defining characteristic of trauma.

Recognizing the traumatic emotional impact that separation has on children is a crucial first step in understanding how caregivers can make placements as positive and supportive as possible for children in care. In order to effectively deal with the problems presented by the children, caregivers must equip themselves with knowledge of the behavioral signs of distress so that they can make themselves available and stand by supportively as children experience a range of powerful emotions. They must also be mindful of the factors that influence a child’s reaction to separation and placement and strive to create conditions that will contribute to a positive placement experience.


Chapter 5: Grief as a Reaction to Separation

Separation from parents or other loved ones is a tremendous loss for a child.

Children in care are not necessarily placed due to the death of a caregiver, but the experience of separation and placement often feels just as significant for a child as the death of a parent (Gray, 2002; Fahlberg, 1991; Lanyado, 2002; Rycus & Hughes, 1998).

The effects of separation have been studied for decades, and for children in care, the process of separating from birthparents and other caregivers with whom they are attached may resemble bereavement, or the grief reaction to the death of loved ones.

Grief responses are natural reactions to separation – grief helps children and youth separate themselves from their losses to survive without their parents and make changes that are necessary to build new attachments ( Mauk & Sharpnack, 1999). Familiarity with the grieving process in children and youth can help caregivers know what types of reactions are typical of children who have been removed from their homes and separated from their attachment figures.

Current knowledge about the experience of children in care is informed by the work of such influential thinkers as Charles Darwin, Sigmund Freud, John Bowlby, and other important people who have studied children and families and contributed to our knowledge about the process of separation (see Bloom, 1980, for a review). Evolutionary theorist Charles Darwin (1872) studied body language and facial expressions of people from cultures around the world to shed light on similarities in human nature. He was the first to demonstrate the existence of a universal grief reaction in humans.

Freud’s (1917) studies of loss exposed some of the psychological effects of losing a loved one. He found the most notable reaction to separation to be a period of painful feelings of dejection, apathy toward the outside world, loss of capacity to love, and disinterest in activity. He observed that this reaction, which he called “mourning,” is intensified in the absence of a healthy attachment to the lost loved one. In this case, as in the case of a child who has been neglected or abused by his or her parents, a person will have a pathological reaction to the loss, including a severe disturbance in self-regard that


increases the individual’s pain and suffering. The mourning ends when a new attachment is formed.

Bowlby (1961, 1973) agrees that grief over separating from a parent is characterized by the kind of despair observed by Freud. Through his work with children separated from their mothers, Bowlby developed a 3-stage model of child-parent separation, including the stages of a) protest, b) despair, and c) detachment. In the protest stage the child attempts to regain attachment with the parent by defying the separation.

This stage is characterized by tears and anger. In the second stage, despair , a child will be sad, distant, and unresponsive to attempts by surrogate parents to develop a warm relationship. At this time, the child is attempting to come to terms with the reality of separation. In detachment , the third and final stage, the child regains the ability to feel the warm feelings associated with attachment to another person, returns to activity, and gains an openness to new relationships. In this final stage, the child has come to terms with the

“loss” of his or her birth parent and is looking to form an attachment to a new parental figure.

The insights provided by early research on attachment, separation, and grief provide the foundation of current knowledge about the separation experience of children in foster care. Among the most widely accepted theories informing practice with children and youths separated from their families by placement is the 5-stage grief process proposed by Elizabeth Kubler-Ross (1969).

People ordinarily experience a fairly predictable, although complex set of emotions and behaviors in response to the loss of a loved one . They gradually work through stages of emotional numbing, anger, sadness and depression, yearning and searching for the lost loved one, feeling that their world is meaningless without the lost loved one, and despair at continuing on without the person. Gradually, they come to reorganize their lives without the lost loved one, overcome the painful experiences of the grieving process, and grow emotionally as a result (Kubler-Ross, 1969; Parkes, 1972).

When losses are complicated by factors such as abuse, neglect, or multiple losses, the grief process becomes even more complex and may not lead to a healthy resolution

(Lanyado, 2002).


Moving to a new place with new caregivers may be wrapped in layer upon layer of loss. Children entering a new home may be grieving not only the loss of parents or other caregivers, but also siblings, friends, belongings, and even for themselves. For example, children who realize their innocent role in maltreatment often grieve the loss of an image of themselves as undamaged (Gray, 2002). In addition, insecure attachment organizations or attachment disorder interfere with healthy resolution of feelings of loss

(Penzerro & Lein, 1995). The role of past experiences with separations is also not to be overlooked. Ongoing emotional and behavioral problems in foster children are often the result their separation experiences. As noted by child therapist Monica Lanyado (2002),

“a great deal of [foster] children’s anger and violence can be understood as being rooted in undigested experiences of loss.” As many as one in four children in long-term placements continue to experience unresolved issues of grief and loss related to separations from their families (Schleiffer and Muller, 2004). It will be important for caregivers to be mindful of what children have left behind and what the move means to them.

The presence and support of a caring attachment figure, even if this person is not the primary attachment figure (Rycus & Hughes, 1998), has been established as one of the most important factors in helping children through their losses (Fahlberg, 1991; Gray,

2002; Kubler-Ross, 1969; Mauk & Sharpnack, 1999; McFadden, 1992; Parkes, 1972).

Foster parents and other caregivers can fill this role by being sensitive to the grieving process and providing a safe environment in which children are allowed to express their emotions, no matter how painful (Kagan, 2004).

The reaction to loss typically includes a series of phases, which all together, are known as the grief, or mourning process. The stages include shock or denial of the loss, anger, depression, bargaining, and acceptance or resolution (Kubler-Ross, 1969). Stages are thought to occur in sequence, but not every person will experience each stage, and stages do not always occur in this order. Or, children may exhibit behaviors from multiple phases at the same time, or regress to a previous phase. For example, a young person who is removed from his home may feel angry, then sad, then angry again, or both at the same time. However, the following five phases provide a useful starting point for


foster parents and other caregivers to understand the experience of foster children during separation and placement.

The Grief Process of Children and Youth in Care

Stage 1: Shock/Denial

For a period of time after the move, children often settle into what is commonly referred to as the “honeymoon period” (e.g., Pasztor & Leighton, 1991; Rycus & Hughes,

1998). The honeymoon period is deceptive phase that may last from a few hours to several days (Rycus & Hughes, 1998). During this time, children appear calm and compliant and show little evidence of being distressed by the move. They may appear to have adjusted to the change, but they are actually in emotional shock.

Shock is a numbing reaction. It “serves as a protective shield around the youth” and causes their body systems to temporarily shut down (Beckman, 1990). Children who are in shock are disconnected and appear as though the loss of their home and family were of little significance. Emotional numbing is a defense against the pain of the separation. People who evidence the emotional flattening of the shock/denial stage have been described as appearing “robot-like,” “stunned,” “shell-shocked,” or “dazed”

(Beckman, 1990; Goodman, 2004; Rycus & Hughes, 1998).

Children and youth in the shock/denial phase will often deny that the separation has really happened ("No, it isn't true. I can't believe it. This isn't really happening”)

(Rycus & Hughes, 1998) or that it has had an impact on them. They may refuse to talk about their families, they may act “extra good” to see if the situation will be reversed, or they may deny the importance of their families and others from whom they have been separated ( Mauk & Sharpnack, 1999). Following are some common behavioral expressions of the shock/denial stage.


Behaviors associated with the Shock/Denial Stage:



The child seems indifferent in emotion or behavior and does not react strongly to the move

 The move appears to be “taken in stride;” for example, as when a child is observed to “wave good-bye at the door, she was all smiles and went off to play with the children and all the new toys” (Rycus & Hughes, 1998)



The child appears to make a good adjustment for a period of time

 The child’s behavior is robot-like; (s)he goes through the motions of normal activity but shows little conviction, commitment, or excitement



The child is unusually quiet, and easy to please; appears passive

 The child denies the loss and makes statements such as, “I’m not staying here.

Mommy will get me soon” (Goodman, 2004)



The child may refuse to talk about his/her family or home life



The child may use rhythmic behavior, such as rocking, foot-tapping, bouncing balls, banging objects, or masturbation; or may ask repetitive questions, as an emotional release (Pasztor & Leighton, 1993)



Infants may exhibit physical symptoms, including respiratory or intestinal upsets or infections, and feeding or sleep disturbances (Rycus & Hughes, 1998)

Cautions regarding the Shock/Denial Stage:

 A child’s compliant and unemotional behavior after a move may be easy to misinterpret. Caseworkers, caregivers, and parents may believe that the move was easy for a child and that he or she handled it without distress. In later stages, as the emotional numbing is replaced by anger, the child’s behavioral signs of distress are often not recognized as separation trauma and part of the grieving process. When caseworkers and caregivers are not familiar with this part of the grieving process, the children’s angry behaviors are often mistaken for more serious emotional or behavioral problems. Punishing children for these behaviors intensifies their distress and deprives them of help and support



Children who show no emotional reaction to the move at all are likely those who have not developed strong attachments to their parents or primary caregivers.

Developmental delays and emotional scars resulting from childhood maltreatment can limit children’s emotional and mental resources to cope with loss; their usual behaviors often demonstrate flattening of affect, emotional withdrawal, or denial of negative feelings, resulting in the inability to process their losses.



If children in placement continue to show no emotional response to separation beyond the first few weeks, caregivers and caseworkers should be concerned.

Continued emotional numbness may indicate an underlying emotional disturbance.




Caseworkers and caregivers will be best equipped to recognize whether the absence of emotion is a reaction to separation or a sign of emotional disturbance if they are familiar with the child. Observing children prior to placement and gathering information on the child’s pre-placement behavior can help determine the cause of emotional numbing.

Supporting Children and Youth through the Shock/Denial Stage:



Recognize that the absence of outward expression of feelings does not mean that the child does not have feelings about the move. Adults can help children express their feelings by drawing upon their own experiences with loss to respond empathically to the child (Cournos, 2002; Redding, Fried,& Britner, 2000). Say things like, “It’s scary to live in a new place, but you are safe here,” or “It’s okay to feel angry or sad about what happened to you.”



Give children information about why they were moved, what has happened to their parents or siblings, when they will see them again, and what is going to happen. For example: “Your mother was not able to take care of you, but it is not because you did something wrong.” “Your brother and sister are with another foster family, and we can call them.” “You are going to stay here until your mom and social worker make a plan for how you can be safe at home.” “Your foster family misses you, but they are okay. We can make plans to see them.”



Help children feel safe to eat and sleep. Provide food in smaller portions more frequently, or take them to the grocery store to help plan menus. Help children sleep by providing a nightlight and a favorite toy or something brought from home; buy new pajamas, and reassure children that no one will touch them while they are in their own bed– or any other time – without permission.



Provide opportunities to appropriately use up energy and rhythmic behaviors, such as playing ball, jumping rope, watching TV in a rocking chair, or choosing a new CD to listen to.



Provide consistent responses to questions and reassurance that it is okay to ask.



Give permission to hold onto a cherished object without having it washed, taken away, or ridiculed.



Obtain medical attention for real illnesses and injuries, and provide reassurance that imagined illnesses are not serious.



Provide close supervision to avoid injuries.



Give permission to make mistakes.



Reassure children that they are valuable and worthwhile, and remind them that they are safe.


Stage 2: Anger/Protest

As the shock of the move wears off and the loss can no longer be denied, emotions begin to resurface. The first emotional response is usually anger. The anger of children and youth in placement may be directionless or can be directed at whatever or whomever they perceive to be responsible for the separation. Frequently, anger is not directed toward the true target, but is displaced and focused on people or things that are less threatening (e.g., parents, siblings, teachers, objects, or anyone whom the child believes may have been able to prevent the loss). Children’s anger may be focused on

God for allowing this to happen, on the parents for abandoning them, or on themselves if they feel responsible for causing the situation (Mauk & Sharpnack, 1999). Anger is often directed at foster parents and other substitute caregivers as a defense against having to blame biological parents for the placement (Hopkins, 2000). Guilt, blame, accusations, protest, and other behaviors associated with anger are common.

Behaviors associated with the Anger/Protest Stage:



Oppositional behavior; talking back, swearing



Hypersensitivity



Tantrums - emotional, angry outbursts that are easily precipitated and seem excessive for the situation.



Withdrawal, sulking, pouting, and refusal to participate in social activities

(especially in school-aged children)



Carelessness about hygiene and clothing



Bed-wetting or soiling themselves



The child appears irritable, short-tempered, and hard to satisfy



The child engages in aggressive, rough behavior with other children; bullying

(especially in school-aged children and adolescents)



The child causes damage to property or pets



Acting sexually aggressive or promiscuous (especially in adolescents)



Antisocial behaviors: breaking toys or objects, stealing, lying, cheating, drug use, overtly and/or covertly oppositional and defiant behaviors (especially in schoolaged children and adolescents)



Self-mutilation




The child refuses to comply with requests; disobedience and defiance



The child compares the foster home with his/her own home and states his/her preference for own home



The child criticizes substitute caregivers and new surroundings (especially in older children and adolescents)



Sleeping or eating disturbances (especially in infants and younger children)



The child may not talk (especially in younger children)

Cautions regarding the Anger/Protest Stage:



Children and youth will express their anger in different ways, depending on their age and developmental level. Infants and preschool children commonly demonstrate their anger with physical symptoms and emotional outbursts.

Younger children may refuse to eat, sleep, or talk. School-aged children and adolescents may direct their anger into destructive, aggressive (bullying), or antisocial (lying and stealing) behaviors. Tantrums are common at all ages and developmental levels. Anticipating the ways anger is expressed for children of different developmental levels can help caregivers recognize that a child is beginning to react to the loss of his/her usual family and way of life.



It is difficult to live with children who are angry. The child's oppositional behavior can be very disruptive to the caregiver and the caregiving home.

Confrontations between the child and caregivers often lead to power struggles and battles for control. Caregivers must recognize that many behaviors are expressions of anger about losses. Children need permission to feel angry and guidance in learning to express anger in ways that are not harmful. Foster parents, caseworkers, and other caregivers must also be skilled in using behavior management techniques such as baselining, contracting, positive reinforcement, and alternatives to physical punishment (Pasztor & Leighton, 1993). See Gray’s

(2000) chapter on “Relaxing the Grip of Anxiety and Control” for some techniques that help with control battles.



A high degree of ambivalence and anger toward the biological parents prior to the separation interferes with children’s ability to emotionally cope with the separation; the child continually feels anger toward the parents but is never able to express it (and thus redirects it toward foster parents and other caregivers).



Children in the anger/protest stage may be inappropriately diagnosed as "severely behaviorally handicapped," or "emotionally disturbed," or may be punished for misbehavior (Goodman, 2004). Caretakers can be more supportive and helpful in redirecting the child’s feelings into appropriate expressions if the behavior is appropriately identified as part of the grief process.



The behaviors common to the anger/protest stage are also typical of children who have been abused and neglected (see Chapter 2), and it can be difficult to identify whether the cause of the behaviors. In addition, separation and placement


exacerbates the problems of children who are already emotionally damaged.

However, caregivers and caseworkers should always assume that children who are acting out in the first weeks and months of a new placement are experiencing separation trauma (Rycus & Hughes, 1998), and they should respond in a supportive and helpful manner.

Supporting Children and Youth through the Anger/Protest Stage:



If their behavior is properly identified as an expression of normal grieving, caregivers are generally more able to provide support, and give them opportunities for appropriate expressions of angry feelings, while gently setting firm limits for their behavior.



Because these behaviors are also typical of children who have been abused and neglected, it may be difficult to distinguish such behaviors from placementinduced stress. However, caseworkers and foster caregivers should recognize that separation and placement of already emotionally damaged children can exacerbate their problems at the same time it potentially protects them from further maltreatment. We should always assume that these children are experiencing separation trauma, and respond accordingly in a supportive and helpful manner.



Give children permission to feel angry; help them recognize that angry feelings are normal and help them identify their anger



Help children learn to express anger in ways that do not hurt themselves, others, or property – physical activity, creative expression through art, music, or play, and talking are good ways to express anger.

Stage 3: Bargaining

Bargaining is a child’s final attempt to regain a sense of control over their lives.

Children and youth in this stage may believe that if they think or behave in a certain way, they can reverse the decision that was made to place them or can prevent their losses from becoming final. They attempt to bargain their way out of a placement by resolving to do better from now and/or by acting extra nice to the people they believe to have the power to change the situation. The foster caregivers, caseworkers, or agency may be seen as having this power and will probably be the target of a child’s pleading.

Bargaining requires fairly complex cognitive and social skills, and so this stage is typically exhibited by school-aged or older children. These children have the cognitive maturity to recognize cause-and-effect relationships and to believe that their behavior can


influence a change in their circumstance (Rycus & Hughes, 1998). Children’s behavior during the bargaining stage is determined by what or whom they perceive to be the cause of the separation, because they will attempt to engage in behaviors that will influence the forces that caused the separation. For example, a child who believes that she has been sent away because she refused to eat her dinner may attempt to eat everything put in front of her in order to undo the behavior that she believes caused the separation (Rycus &

Hughes, 1998).

Sometimes, bargaining behaviors are not as concrete as trying to cut deals with adults to be good in exchange for family reconciliation. Seemingly illogical thoughts and behaviors may also be bargaining chips. A person may come to believe that a certain way of behaving or thinking will reverse the loss. For example, “a child may believe that by washing his face every day, or by being helpful to the foster mother, he can bring about a reunion with his family” (Rycus & Hughes, 1998). Rycus and Hughes (1998) also note that “some ritualized behaviors may be noted, reflecting both their obsession with returning home, and the emotional intensity of the compulsion to do whatever is necessary to achieve this goal.”

Behaviors associated with the Bargaining Stage:



The child is eager to please and makes promises to be good



The child may believe that he/she or she has caused the placement and try will try to undo what he/she feels he/she has done wrong



The child may try to negotiate agreements with caregivers and caseworkers, offering to do certain things or behave “perfectly” in exchange for a promise that the child will be allowed to return home

 The child’s behavior may appear moralistic – he/she may behave like “a perfect angel” – in order to uphold his/her end of the “bargain”



The child may have conversations with him/herself or imaginary conversations with parents, other family members, or friends who have been lost

 The child may use inappropriate behaviors as a way of getting “kicked out” and sent back home, or wherever he/she wants to be

Cautions regarding the Bargaining Stage:



The child's behaviors are a desperate attempt to control the environment and to defend against the emotional turmoil of loss and fear. While some behaviors may


seem positive, they do not represent changes in the child’s character. Caregivers and caseworkers should guard against being fooled by the superficial quality of good behavior during the bargaining stage.



In most circumstances, the reality is that no matter how well a child behaves, there is little chance that his/her behaviors will produce the desired results for reunification.



Children in the bargaining stage have not yet accepted the reality of their position.

They will need support when they realize the ineffectiveness of their bargaining strategies. Caregivers and caseworkers who understand this stage can provide the needed support when children are hit with the full emotional impact of their losses.

Supporting Children and Youth through the Bargaining Stage:



Provide children with regular opportunities to talk and express feelings about their family of origin, previous foster parents, friends, or others whom they have left behind.



Help children maintain regular in-person contact, as appropriate, with the people with whom the children desire to be reunited.



Give consistent, non-threatening, supportive reminders that no matter what they do, they are not going to be kicked out. Remind children that this is their home, weather temporary or permanent.



Give children permission to express angry, sad, and guilty feelings. Give permission to feel relieved at being out of an abusive or unsafe situation and reassure children that they are now safe.

 Explain that their ability to return home depends upon their family’s behavior and not their own.

Stage 5: Depression

During this stage, children have fully recognized that the separation from their home and family is real. They finally experience the full emotional impact of the loss.

Children in the depression stage of grieving have been described as appearing to have lost hope (Rycus & Hughes, 1998). This stage is characterized by expressions of despair and futility. Children withdraw, become listless, and have a general lack of interest in people, surroundings, and activities. They may go through episodes of fear and panic. People in the depression stage see their loss as real, permanent, and as having devastating personal


consequences. They often cannot be comforted. Depression is the longest stage of grieving and is the most difficult to overcome.

Behaviors associated with the Depression Stage:



The child withdraws socially and emotionally; others cannot connect with the child



The child may be refuse to participate in activities at home, school, with friends, and elsewhere



The child may seem anxious and easily frightened

 The child may be “touchy” and cry or become emotional with little provocation



The child may be easily frustrated or overwhelmed by minor stressors



The child appears listless and without energy

 The child’s activities are completed without direction, investment, or interest



The child may have difficulty concentrating and trouble following even simple instructions or rules



Regressive behaviors are common in the depression stage, such as bed wetting, thumb sucking, and baby talk (especially in pre-school and school-aged children)



The child may whimper, cry, whine, rock, hang his/her head



Physical symptoms often include refusal to eat, sleeping too much, trouble with the digestive tract, and susceptibility to colds, flu, and other illnesses (physical symptoms are often found in younger children)



The child may say that he/she does not know anything or cannot do anything; gives up easily



Suicidal thoughts, plans, and actions may occur if the depression is severe



The child may put him/herself down and talk about him/herself as being stupid, ugly, or worthless



Infants and young children may cling to adults, “but the clinging has an ambivalent, remote, forlorn, and detached quality” (Rycus & Hughes, 1998)

Cautions regarding the Depression Stage:



Depressed children may appear listless and disinterested in their activities. When they do play, work, or interact with others, their behavior may be mechanical – although they are “going through the motions,” their lack direction, interest, energy, enthusiasm, or emotional investment. They may be easily distracted and may have trouble following through on directions or completing tasks, and they may be unable to concentrate. Their distractibility and disinterest in activities,


their environment, and the people around them may result in school problems or problems with peers, which do even more damage to their already low selfesteem.

 The depression stage is a critical period in the child’s relationship with his/her parent(s). Experiencing and working through depression is one of the final tasks of grieving; once the grief process is completed, it is very difficult to re-establish the parent-child relationship if it has not been maintained through visitation

(Goodman, 2004). Care must be taken to provide adequate visitation in order to prevent the child from detaching from his/her parent(s).



Depressive symptoms may not occur right away after the initial separation. There may be a time lapse before children begin to express depressive behaviors.

Caregivers and caseworkers will have to remember that grieving takes time and should recognize depressive behavior during placement as a likely expression of a later stage of the grief process.

 Circumstances may limit caregivers’ ability to help children experience and express their grief – they may not have access to information about the biological family to help the child reminisce; or they may be invested in seeing the child as happy as possible in the new home and discourage the expression of sadness or other negative emotions. Caregivers are strongly reminded to be mindful of their task to help children express painful emotions, and not to inadvertently distract children from their pain or otherwise try to take their pain away.



Children may not have contact with other family members who are mourning the separation and so do not have people to share the experience or model the expression of feelings about the loss.



Children and youth in the depressive stage of the grief process are typically very difficult to comfort. The children’s extreme emotional turmoil is very often difficult to witness, and caregivers may feel frustrated by their inability to help the struggling child. Recognize that depression is a necessary part of the grief process, which eventually leads to healing.

Supporting Children and Youth through the Depression Stage:



Caregivers and caseworkers must familiarize themselves with the signs of the depression stage so that they can provide the necessary support and increase the frequency of visitation (Rycus & Hughes, 1998). Increased visitation with parents or other attachment figures during the depression stage may help maintain the relationship and prevent the child from emotionally detaching from the parent(s).



Help children deal with sleep problems and changes in appetite by providing enough time to eat and sleep and by making these activities safe (see suggestions under Supporting Children and Youth through the Shock/Denial Stage).



Caregivers may need to be extra patient in order to help children pay attention, follow rules, and complete tasks. Use gentle, non-threatening reminders, and give children extra help and support if they need it.




Allow children to have time alone to feel sad before participating in activities.



Encourage children to try participating in activities for short periods of time (even

5 or 10 minutes).



Praise children for participating in any activity and for every accomplishment, no matter how small. For example, “You got up this morning without even being asked. That’s great!”



If a child makes comments about suicide, take them seriously. Talk with the child’s social worker, teacher, and therapist immediately.



Give sincere compliments



Reassure children that they are lovable, valuable, worthwhile, and important.

Stage 5: Resolution

Depression causes tremendous emotional pain and takes an enormous amount of emotional energy. Most people cannot tolerate to carry on in a depressive state for extended periods of time, and so they naturally begin to refocus their energies and become more active in the world and in relationships. If children have previously had strong attachments and positive relationships, they will usually direct their energy toward building and strengthening relationships. This may be more difficult for children with weak attachment histories or who have lost contact with previous attachment figures

(Rycus & Hughes, 1998). Some children with histories of abuse or neglect may be well into their adult years before they are able to complete the grieving process, if ever

(Pasztor & Leighton, 1993).

Resolution of grief is accomplished when people cease to focus solely on the past and become actively involved in the present and in new relationships. They find ways of compensating for their losses and reorganize their lives to adapt to their new situation.

Symptoms of depression and distress subside, and the child begins to respond to people around him/her and to his/her environment in a normal, healthy, active manner.

Behaviors associated with the Resolution Stage:



The child begins to build stronger relationships with people in the new home and demonstrates stronger emotional attachments to people in the home



The child may identify his/herself as part of the family and try to establish his/her own place in the family




The intensity of general emotional distress decreases, and the child does not react as strongly to stressful situations

 The child’s energy level increases



The child begins to experience pleasure in normal childhood play and activities



The child begins to engage in goal-directed activities; the child’s behavior becomes more focused and purposeful



The child is better able to concentrate



The child begins to reach out to engage others in positive social interactions

Cautions regarding the Resolution Stage:

 It is especially important to be aware of the child’s plan for reunification as the grief process progresses. Behaviors that suggest resolution are positive signs only if the case plan includes permanent separation of the child from his/her family

(Rycus & Hughes, 1998). It is inappropriate and harmful for a child to resolve the loss of his/her family if the case plan includes reunification. Resolution of grief generally indicates that previous attachments have been replaced by new ones.

This can seriously interfere with reunification.



Resolution of grief and attachment to members of the substitute family is also a problem if the child’s case plan includes separating from his/her newly formed family due to reunification or a different placement. The child may be forced to struggle through resolving the loss of the new attachment figures. Unresolved grief resulting from removing a child before he/she has completed the grief process is believed to be a leading cause of trauma, distress, and behavioral maladjustment in children in care



Resolution of grief may take time, and a person who has overcome their grief may still go through periods of sadness or experience other symptoms of the depression stage. This is especially true around holidays, birthdays, or other traditional or organized events that remind the child of his/her family and life before the placement.

 Inadequate care or multiple separations in infancy limits a child’s ability to fully comprehend separation and interferes with his/her ability to fully mourn losses.



The grief process is facilitated by an understanding of the finality of death; this is impossible to achieve in the case of children in care when the parent is known to be alive, and hope of reunification exists.



Children are often unable to understand and/or accept the reasons for placement; those who have been maltreated make excuses for their parents and maintain an unrealistically positive image of them in order to avoid confronting the

“unacceptable implications they might draw about themselves and their parents in acknowledging what has really happened” (Eagle, 1994, p. 426).


Supporting Children and Youth through the Resolution Stage:



Some children and youth in care may not be able to come to accept the hurts they have endured. Understanding what happened to them and why it happened, and not necessarily reaching full resolution of their grief, may be a more realistic goal for some children (Pasztor & Leighton, 1993). Children can be helped, according to their age and developmental level, to understand the events that precipitated placement and to manage their feelings and behaviors in healthy ways.



Provide children with opportunities to talk about their feelings. Children who have resolved their losses should be able to express why they feel angry, sad, guilty, or glad to be separated from their families.

Tasks for Bereaved Children and Youth

Grief is the normal and predictable response to loss. The concern of caregivers and social workers is whether the experience is healthy and functional for the child or dysfunctional (Parkes, 1990). Good grief helps the child stay psychologically healthy and strengthens his or her capacity to cope with future losses (Fox, 1989 in Mauk & Sharpnack,

1999). Fox (1989, in Mauk & Sharpnack, 1999) and Gray (2002) identify the tasks of healthy grieving in children and adolescents. They include:



Understanding the separation . Understanding involves knowing that the separation is real and will last permanently or for a period of time. It requires that adults provide honest and age-appropriate information about the factors that influenced the separation and plans for reunion or permanence.



Fully experiencing grief . Repressing the painful feelings that accompany separation results in behavior problems and the possibility of severe consequences to children’s self-concept and identity formation. Helping children avoid the negative consequences associated with repression requires that children and youth are allowed and encouraged to experience and express their feelings of sadness, anger, and guilt.

 Commemorating the child’s family life before placement

. A major task for a child in working through the loss of a parent is to find a way to hold onto the positive parts of the parents’ identities. This is especially important for children under the age of six, who have not completely formed identities as separate from their parents (Gray, 2002). They need their parents in order to feel complete, and to a young child, a loss of a parent is a loss of part of the child’s self. Because children see themselves as one with their parents, it is necessary for them to have a positive image of their parents (Gray, 2002). The parents and the family life


before placement should be honored and remembered, either formally or informally. This helps to confirm the reality of the separation, to recognize the value of healthy relationships, and to help young children feel that they are valuable.



Building a positive image of him/herself . Helping a child distance him/herself from the negative parts of the parents helps reduce some of the self-blame associated with separation. The negative experiences in the child’s early life must be understood as an aspect of the parents’ functioning, not as part of the child’s identity. Whatever bad experiences the child had when he lived with his parents, they were not because the child was bad, but because that was how his parent(s) functioned.



Going on . After completing the previous tasks, children and youth have to

“resume the usual activities of living, learning, and loving” (Mauk & Sharpnack,

1999, p. 9). Adjusting to the new situation, whether temporarily or permanently, means learning to live without the usual influence of family, friends, or others from whom the child is separated.

The process of separating from parents and trusted caregivers as a result of placement is as real a threat to children’s sense of well-being as losing attachment figures due to death. Children and youth in out of home placements typically react to their losses by going through the grief process. This process reflects the various stages of emotional reactions and behavioral manifestations as children struggle to comprehend the changes brought about by this massive change in their support network and their way of being in the world. Only by equipping themselves with knowledge of the behavioral signs of grief and the psychological processes that underlie those behaviors will adults be able to help children thorough this difficult time in their lives.


Chapter 6: Supporting Children and Youth through Transition and

Minimizing the Trauma of Separation

It is a caregiver’s role to assist children and youth through their grief when separated from attachment figures. Young people do not have the emotional strength to do it alone. However, it is only after a child has gained some stability and has gotten to know and to trust his or her caregiver(s) that the healing can take place. This chapter presents tips and techniques to minimize separation trauma. It includes practices for preparing children, families, and caregivers for the move; building a relationship with a child; supporting children throughout the placement process; and obtaining the support caregivers need to cope with troubled children.

Creating Successful Transitions

In a chapter on managing transitions, the authors of a book published by The Girls and Boys Town foster program (Temple-Plotz, Stricklett, Baker, & Sterba, 2002) describe the experience of one child on her first morning in a new home:

It’s morning. As Robin awakens, she looks around the unfamiliar room. She slept little last night. Her mother had always warned Robin about strangers, and now she’s in the midst of them. Robin hears people up and about. “What am I supposed to do?” she thinks frantically. “Lie in bed until someone comes and tells me to get up, or get dressed and go downstairs? Did anyone tell me last night? I can’t remember. Where are mom and dad? I want to see them! Do they know where I am?” As these questions engulf and overwhelm Robin, she pulls the covers over her head to try and block them out. (p. 289)

This is an example of how profound, frightening, and confusing the move from one home to another can be for a child who has not had adequate preparation. Many


foster children will have gone through this experience several times, and the separation generally only gets worse each time. To lessen the trauma that foster children experience each time they move in and out of a home. Trauma can be prevented or minimized by paying close attention to the needs of children in during separation and placement.

Researchers have identified several primary needs of children who are transitioning to new placements (e.g., Day, 2002; Gray, 2002; Pasztor & Leighton, 1993; Rycus &

Hughes, 1998). They include: 1) information; 2) reassurance and support; 3) permission to feel scared, sad, and angry; 4) demonstration of “OK” ways to express feelings; and 5) time to adjust and heal.

Information

Children and youths entering a placement have many questions. They need to hear the answers to those questions, even if they don’t ask directly. Providing them with information about what has happened and what has happened can reduce their anxiety and minimize trauma. Children need to repeatedly hear the answers to the following questions:



Who are the people with whom the child will be or is living?



Will the child be safe here?



What is happening to the family or families the child left behind?



Will the child see those people again? When? How?



What should the child do if (s)he feels sick, hungry, or lonely? What will happen if the child wets the bed or gets her period?



How long will the child stay?



Where would the child go if (s)he left?



Who is making decisions about the child?



How does the child let the decision makers know what (s)he wants?



What is going to happen to the child?

Ways to provide Information may include:



Talk about the importance of asking questions – it takes time to get to know someone, and the more you know about a person, the easier it is to get along.




Talk about the foster family and their interests, activities, rules, responsibilities, and relationship with the agency that placed the child.

 Talk about the child’s new school – its location, transportation, teachers, other children who attend, and how to register.



Talk about how and when visitation with birth parents or other important people will occur. Can visits be scheduled regularly? How long will visits last? Who will be present during visits? Where will they occur? Etc.



Talk about how the child can maintain contact with friends and other relatives that

(s)he may not get the chance to see as often – phone, e-mail, letters, sending, pictures, etc.

 Discuss the importance of the child’s involvement in making decisions about what will happen to him/her. Encourage the child to give input on important decisions like visitation, reunification, and other aspects of his/her case plan.

 Discuss the situation that lead to the child’s removal and the goals that biological family members are working on before the family can be reunited; or discuss the child’s placement goals and how foster parents, social workers, and families are working together to achieve those goals.

Reassurance and Support

As we have seen, children and youths often blame themselves for causing a placement, and they fear what will happen to themselves and their family members while they are separated. They need to hear repeatedly that they are not responsible for their placement, that they are important people, and that they are safe. They need to hear over and over again that it is the responsibility of adults to protect and care for them, and that they did not cause a placement and are not responsible for making sure that they are reunited with their families. Again, even if they do not ask, children and youth in care need frequent reminders that the adults who are looking after them are in charge of their safety and can be trusted to ensure that the children will be protected from physical, sexual, and/or verbal abuse. Let children and youth know that their new home is safe.

Furthermore, regular reminders that they are worthwhile and important are a must.

Encouragement and praise should be given toward every goal and for every accomplishment, and they need to know that it is okay to make mistakes.


Ways to Provide Reassurance and Support may include:



Show the child what to do if (s)he is hungry – should the child help him/herself to food in the refrigerator or ask and adult for a snack?



Show the child what to do if (s)he is feeling sick – should the child have access to headache or stomach ache medicine? Whom should the child tell when not feeling well?



Explain family rules about privacy.



Tell the child over and over that home is a safe place – no one will be hit, touched inappropriately, sexually abused, verbally assaulted, neglected, or otherwise hurt.



Tell the child that the caregivers and social worker have a genuine concern for him/her and will work closely together to make things go well for the child.



Tell the child that (s)he will have a home here as long as (s)he needs.



Find ways to praise the child for accomplishments, no matter how small.

Permission to Feel Sad, Scared, Anxious, Angry, etc

Empathy is important for children in placement. Surprise, anger, sadness, guilt, disbelief, confusion, ambivalence, anxiety, frustration, fear, hurt, shock, anticipation, curiosity, and many other emotions (Pasztor & Leighton, 1993) are all associated with leaving home and losing loved ones. Intense feelings are natural reactions to separation.

Children and youths need to hear that it is their right to have all of these feelings. After all, they have been through some incredibly difficult things, and anybody would react in the same way.

Ways to Provide Permission to have Feelings may include:



Tell the child that this move means a lot of changes, and that it is normal to feel anxious, worried, scared, frustrated, angry, or even relieved.



Help the child talk about his/her feelings.



Help the child correctly identify and label his/her feelings – use the child’s behavior, what (s)he tells you about his/her feelings, and past experiences to identify feelings.



Be a good listener – restate or rephrase what the child said in order to make it clear that you understood; ask questions, give verbal and nonverbal signs that you


understand (say “uh huh,” or nod your head), and let the child say whatever it is that is on his/her mind.

Demonstration of Appropriate Ways to Express Feelings

The feelings children and youth experience during a separation are all natural and normal. However, they have to be expressed in ways that are not harmful to themselves, others, or property. Fighting, hurting pets or other children, throwing things during a tantrum, abusing drugs or alcohol, or inflicting injury on one’s self are dangerous ways to express anger, sadness, and anxiety. It is the responsibility of caregivers, social workers, and other involved adults to help children and youth learn appropriate and harmful ways to express all of their terrible feelings.

Ways to Demonstrate Appropriate Expression of Feelings may include:



Let the child know that some feelings can really hurt, but that it feels better if you talk about them.



Teach the child that family rules help him/her set both positive and negative consequences for behavior.



Help the child problem-solve appropriate ways to get his/her needs met – asking for help is more appropriate and more effective than demanding; physical exercise is a good way to release pent-up anger or frustration; artistic expression can communicate many emotions; etc.



Model (demonstrate) appropriate ways to express feelings in your own actions every day. Find constructive ways to release tension and frustration, and try not to lose your temper.



Praise the child for all positive expressions of feelings.

Time to Adjust and Heal

There is a lot to learn about a new home and a lot of pain and shock to overcome when a child leaves his or her home. They will have a lot of question (whether spoken or unspoken) and may not feel like they know or can trust any of the people in their new home. Answering their questions, overcoming their pains, and building relationships take time. Caregivers may not even begin to see a child’s “real” self emerge from the shock of transition for several months (McAuley, 2000). All separations are traumatic for children


in care, and many are complicated by problems with attachment. Considerable time and patience on the part of their caregivers are needed to allow them to adjust.

Ways to allow Time to Adjust and Heal may include:



Let the child know that it takes time to get to know what to expect of people and how to get along.



Set realistic expectations for what the child can achieve, given his/her development, loss, and attachment history – children with histories of poor attachment and those with young developmental levels may need more time, or many never reach complete stability in placement.



Measure success in progress made toward goals, not in number of goals achieved.

Transitioning

Allowing sufficient time to adjust to a placement is of critical importance to the child’s ability to cope with the move. It is so important that it is one of the main goals of the placement process supported by the Child Welfare League of America.

“Transitioning” as a placement strategy (see Rycus & Hughes, 1998) entails completing a move in a series of manageable steps, so that children and their families get to know the substitute caregivers, become familiar with their own roles in the placement, and are allowed time to adjust to the changes.

Easing the transition in this way can often prevent emotional trauma from the separation and avoid serious long-term harm to children and their families (Rycus &

Hughes, 1998). The idea that “transitioning” to new caregivers prevents or minimizes trauma was introduced in 1943 by Anna Freud and Dorothy Burlingham (in Rycus &

Hughes, 1998). They suggested:

If separation happened slowly, if people who are meant to substitute for the mother were known to the child beforehand, transition from one (caregiver) to the other would appear gradually... By the time the ... child had (to) let go of the


mother, the new... (caregiver) would be well known and ready at hand. There would be no empty period in which feelings are turned completely inward...

Regression occurs while the child is passing through the no-man's land of affection; i.e., during the time the old object has been given up before the new one has been found.”

The transition method of placement is intended to “place the child in a new home only after he has developed some familiarity with it and gives evidence of a beginning affection for and dependence upon the new parents" (Gerard & Dukette 1953).

Familiarizing the child with the home and establishing a relationship with the substitute caregivers is accomplished through a sequence of activities that are designed to create a less stressful experience for the child and provide an emotionally supportive environment. The Child Welfare League of America (Rycus & Hughes, 1998) recommends the following six steps in creating transitions that cause the least amount of trauma:

Steps in Creating Transitions

1) Avoid unnecessary changes and slow down the rate of placement if children or their families are experiencing significant distress. Conducting transitions over time, rather subjecting children and families to abrupt removals, decreases stress and helps prevent children from becoming overwhelmed.

2) Involve children and families in planning and preparing for the move, and conduct placement activities in small, manageable steps. Their involvement in the process strengthens their ability to cope with stress.

3) Provide a supportive environment in which children and their families will have opportunities to talk about their feelings and needs as they grapple with the issues that precipitated placement. Understanding the reasons for placement is essential for children and their families if any changes are to be made.

4)

Caregiving families and caseworkers must work together to make the child’s adjustment to the placement as smooth as possible.


5) Children all have different needs. Caregivers have to pay attention to children's unique physical, emotional, and developmental needs, and work with caseworkers to strengthen their ability to recognize and provide for those needs.

6) Visitation and other involvement by families reduces trauma when the child’s case plan calls for reunification. Appropriate family involvement also preserves and strengthens the parent-child relationship and promotes prompt reunification.

Preparing for a Child’s Arrival

It is not always possible to avoid abrupt removals in order to accomplish a successful transition. Whenever possible, however, the preceding steps should be taken to ensure that children obtain a degree of comfort with their new caregivers and new environment. In addition, caregivers will want to take other measures to ensure that they are prepared to welcome the child into their homes under as little stress as possible.

Get Appropriate Training

It is recommended that caregivers obtain as much training as possible (Temple-

Plotz et al., 2002) when preparing to receive a new child. Get to know as much about the child’s history as possible and use the resources at the placing agency to learn more about issues of attachment, childhood loss, behavior modification, developmental delays, and any other subject that may pertain to the child.

Caregivers also need to familiarize themselves with their particular state’s rules and regulations about fostering. Identify appropriate discipline techniques and consequences. Be familiar with the state’s licensing regulations and stay in compliance at all times.

Set Expectations

To further aid the child’s transition, set clear expectations from the beginning.

Think about the family’s routines, traditions, and patterns of behavior. Routines are our established ways of doing things – we do these every day without much thought. Sitting down for dinner at the same time evening, the distribution of chores, and the “morning


routine” are all examples of daily activities that take place in much the same way day after day.

Traditions are passed down through families from generation to generation. They are built from religious, ethnic, cultural, and personal experiences and are often a large part of family life (Pasztor & Leighton, 1993).. The way a family celebrates holidays and birthdays, what happens during vacations, how children treat their elders and vice versa, and who is expected to pay the bills or maintain the home are all examples of family traditions.

Patterns of behavior also vary from family to family. Family behavior patterns focus on communication, problem solving, and decision making (Pasztor & Leighton,

1993). Does the family talk things over as a group to make decisions? Do the parents make all of the rules? How do family members express their feelings – do they praise one another? Show affection? Who is in charge of discipline? How do family members ask for support? Family members typically do not need to think about the answers to these questions; their patterns are set. Children coming into the home will need help to become familiar with how the family communicates and solves problems.

Family routines, traditions, and behavior patterns may be so entrenched that family members do not have to think about them – they just happen. However, a new child entering the home does not have the same experience with the family and is coming in with his or her own set of expectations about how families function and what people do at home. Including the child in the family’s routines and traditions can help welcome the child into the family and reduce uncertainty and stress. The caregiving family may want to work together to set the house rules about:



Meal times



Bedroom and bathroom privacy



Appropriate affection and boundaries



Clothing



Touching



Appropriate playtime activities



Daily routines



Keeping secrets




Etc.

Compromise

Making expectations clear from the beginning is important and can help children know what to expect when they enter a home. It reduces role confusion and minimizes stress. However, flexibility is another of the characteristics of successful caregivers

(Steward & O’Day, 2000). The ability to compromise on how the family operates may be just as important as making expectations clear (Pasztor & Leighton, 1993).

Change is very difficult for foster children. They have already suffered many losses and often are lacking the internal resources to cope with stress on their own or to form attachments to persons who might help them cope (See Chapter 2). Having often been bounced around from placement to placement, or coming from backgrounds of neglect or abuse, foster children quite frequently have histories that are fragmented and lacking consistency. The habits they have developed provide them with a sense of comfort in their chaotic lives – they hang on tightly to what is known because they fear the so-often devastating consequences of change. It may be much easier for a whole family to make some changes to accommodate the child than for the child to make many more changes to fit in with the family (Pasztor & Leighton, 1993).

Substitute caregivers can help ease the transition by obtaining as much information as possible about the child who is about to enter their home. Having detailed information about the child allows caregivers to structure the environment in a way that maintains some continuity in the child’s life. Having this information allows caregivers to incorporate some of the child’s routines, traditions, and patterns of behavior into the family’s daily functioning. Anticipating a child’s habits, medical needs, interests, anxieties, and other parts of his or her life helps caregivers prepare for the task of providing for the child’s unique needs. Pre-placement visits can be used to get to know the child, as well as to gather this information from the child’s family and case worker.

Talking directly with the child’s family provides the most complete and accurate information (Rycus & Hughes). Following is a list of information that is recommended

(Rycus & Hughes, 1998) to gather about the child in order to help reduce the child’s stress when moving in.


Collect Information about the Child



The child's sleeping, bathing, and eating habits and schedules: food preferences, culturally-specific dietary requirements and preferences; history of bed wetting, nightmares, or other sleep disturbances; whether the child sleeps with a light on, in a crib or bed, covered by a blanket or not covered, in pajamas or other apparel



The child's medical care needs, medications, and special physical problems: the location of the child's medical records; the child's medical and inoculation history; the child's nontraditional medical experiences, and the family's expectations for medical care



How the child is accustomed to being comforted when upset



The child's interests, skills, and favorite activities



Behaviors and behavior problems that can be expected, and recommended methods of handling the child's problems: how the child has been disciplined in the past, and how the child should and should not be disciplined



The child's fears and anxieties, and how they are typically expressed



The child's school behavior, academic ability, extracurricular involvement, and special academic needs



The child's verbal ability and ability to communicate, and words that are important to the child that the caregivers may not understand



History of abuse, neglect, or sexual abuse, and how this may affect the child's development and response to the foster caregivers



If the child and caregivers are of different cultural backgrounds, culturallyspecific caregiving practices should be stressed: strategies to help children maintain their cultural identity and affiliations while in placement; culturallyspecific caregiving and hygiene practices

Preplacement Visits and Activities

As previously described, preplacement visits and activities should be divided into small steps. Large changes are overwhelming; smaller changes are more manageable and help children maintain a sense of control in their lives. Dividing separation tasks into smaller parts also allows children to experience small successes in achieving the change.


Each completed step of the process or successful visit increases confidence and makes subsequent changes less threatening (Rycus & Hughes, 1998).

Child Welfare experts Rycus and Hughes (1998) advise that two or three preplacement visits conducted in as many days prior to the placement is generally sufficient to allow children to develop familiarity with and comfort in their new home.

Some children will require more time; and the number of visits should be planned according to a child’s individual needs and level of stress through the process.

The length of preplacement visits should be limited to a few hours, especially for toddlers and preschool-aged children, who easily become restless and do not typically tolerate lengthy changes in their routine. For these children, visits should be scheduled to include important caregiving events, such as meals and nap times. This gives caregivers and children a chance to test one another out and feel more secure about these critical moments before losing the hands-on support of the child’s parents or usual caregivers.

School-aged children can tolerate visits that last several hours. This time can be used to get to know the child and help him or her feel more comfortable in the home.

The first visit should include a tour of the home. The tour should be given earlyon to familiarize the child with his or her new surroundings. Point out the areas that will be the child’s such as the child’s bed, closet, dresser drawers, toy box, etc. Caregivers should also let children know that their private areas, such as their bed, are safe places, where no one will touch or hurt them (Pasztor & Leighton, 1993). Encourage the child to use his or her space during the first visit by hanging his or her coat in the closet, putting his or her sweater in the child’s drawer, taking a nap on his or her bed, etc. Also point out where the bathroom is, where the food is, where other household things that the child will have access to (television, radio, etc.). The purpose of the first visit is to help make the child feel as secure and comfortable as possible in the home.

A critical task in making a child feel secure in a new home is helping the child develop a relationship with someone who lives there. Prior to the first placement, a single member of the caregiving family (usually a parent) should be identified as the person who will greet the child and begin to develop a relationship with the child. Preplacement visits should focus on developing this relationship. It is too difficult for children to try to


get to know and trust many people all at the same time. The identified caregiver will be the child’s bridge into the family.

No more than one or two family members should be home during preplacement visits in order to avoid overwhelming the child. “Children should never be greeted at the door by parents, a group of children, grandparents, dogs, and curious neighbors.

“Children need a single, trusting relationship with someone in the home to provide them with support and comfort during the early adjustment period” (Rycus & Hughes, 1998).

Relationships with other members of the caregiving family should not be expected to form right away, they can be developed as the child is ready. Some children who feel more comfortable with other young people than they do with adults may be more ready to bond with other children. In this case, a foster sibling or biological child of the foster caregivers can bond with placed child and "show him/her the ropes."

Supporting Children throughout the Placement Process

Several factors in the caregiving environment have been shown to help children adjust to a new placement and lessen the trauma of separation from biological families and primary caregivers (Day, 2002; Gray, 2002; Pasztor & Leighton, 1993; Rycus &

Hughes, 1998). Some of the factors that are agreed upon by experts in separation, placement, and childhood loss include:



The presence of a competent adult to provide support and care for the child;



An environment in which the child is able to express painful or conflicting thoughts, feelings, and fantasies;

 Stability and consistency in the child’s environment;



Accurate information about the loss;



Assistance in reality testing (what factors really lead to the separation?); and



Help determining what part he/she played in the process.


Competent caregivers are those who receive training in child development, child care practices, and specific problems that affect their children (Pasztor & Leighton,

1993); and those who have a genuine concern for the children in their care and are invested in helping them achieve rewarding futures (Hallas, 2002; Redding, Fried, &

Britner, 2000). These caregivers also know how to engage children in conversation. They are able to accurately empathize with them, can help them express their feelings, and can help them explore traits of their family functioning in a way that creates a deeper understanding of the situation (e.g., Day, 2002). This will be illustrated more clearly in a vignette that follows. Characteristics of successful caregivers will also be illustrated later in this chapter.

For children in alternative care, a stable and supportive environment can be difficult to obtain, since the process of moving children to safer homes disrupts stability, and developing trust takes time. Nevertheless, caregivers can incorporate parts of the child’s life before placement into his or her new routine. The first several weeks of a placement should be the time of greatest compromise. Maintaining as much continuity as possible for children during their first several weeks greatly helps to reduce the stress and trauma of separation (Rycus & Hughes, 1998). Let them pick out and wear their own clothing, feed them familiar foods, and use gentle guidance and discipline to help them learn the rules of the home. As children become more settled in the placement, their schedules can be gradually revised to conform better to the caregiving family’s usual routines.

Caregivers usually do a wonderful job of welcoming children into their homes, but sometimes are quick to downplay children’s beliefs that they caused the separation

(Gray, 2002). It is more helpful to acknowledge children’s sadness, fear, and guilt to invite questions for discussion. Caregivers need to listen to what children have to say about their experience in order to provide them with the necessary support. The following vignette (adapted from Day, 2002) describes Christopher, a child who has been in his first placement for a few months, and a conversation with his foster parents. The vignette may help illustrate how caregivers can provide effective emotional support.


Vignette: Caregivers’ Role in Assisting Children through Separation Trauma

After adjusting to his foster parents for a few months, Christopher confided that he had caused his removal and placement. In doing so, he was making a clear request for parental emotional support and reality testing. His foster parents replied that it must worry him. Taking time with him, they sat down. They normalized his reaction by saying that any child would worry about feeling that he caused a placement. They wondered how he had come to such a conclusion. He explained that he had misbehaved for the day care provider, so that she had called his mother home from work. His birthmother had warned him that she could miss no more work. He had continued to act out at day care, and was eventually place for adoption.

By taking him seriously, Christopher’s foster parents could supply other facts, balancing his picture. They described his birthmother’s earlier interest in infant adoption, her desire for a father for him, and her renewed interest in adoption months before he acted out in day care. Christopher wished that he had not acted up. But he decided that his responsibility was teeny. As a result he felt unburdened. He admitted that he had tried the same behaviors since the placement, but with a different outcome – an involuntary naptime.

A further discussion occurred, with Christopher’s foster parents talking about good things that Christopher had done with his birthmother. He remembered ways that he had tried to help. He cried after the discussion, with his foster parents there to dry his tears.

The example of Christopher describes the positive steps that his foster parents took to help him through his grief. They supplied emotional support by being available to

Christopher, taking time to sit down with him, and allowing him to express his feelings of guilt about the separation; provided him correct with information about the loss and the events that lead up to it; and helped him with reality testing by helping him see his role in the separation more clearly.


Building a Relationship with the Child

A positive relationship between a child and a trusted adult is essential for helping a child adjust to a placement. The support and comfort of trusted adults during a separation experience can lessen its traumatic effects. “Supportive relationships help an individual cope during a period of grieving, and can help temper feelings of loneliness and isolation. By contrast, the absence of such supports may exacerbate emotional distress and despair” (Rycus & Hughes, 1998). The role of supportive adult usually goes to foster caregivers. This is a difficult role, because the attachment behaviors of most children in alternative care will be different from other children (Schleiffer & Muller’s,

2004). The effects of neglect and abuse by their parents and earlier caregivers, unresolved trauma from previous separations, and the emotional and behavioral problems that caused experience make it necessary to approach caring for foster children in unique ways.

Children entering a new placement have typically been removed from their homes because of conditions of neglect or abuse (CWLA, 2002). The conditions in their homes often cause them to develop a confused view of parent-child relationships (see Chapter

2). Adults who provide substitute care for these children have the critical role of teaching children about healthy relationships. Strong relationships built in placements serve as models that can help children build healthy attachments with their family of origin

(Pasztor & Leighton, 1993). The ability to form attachments is also essential for young people who are destined for adoption, and those who will be leaving foster care for independent living. In this case, successful transition to community living and other responsible, rewarding relationships is facilitated largely by attachment to a foster family

(Pasztor & Leighton, 1993) and the rules of relationships that children learn during foster placements.

Children have a “natural tendency to form attachment relationships [and]… express a serious need for close personal relationships with adults” (Schleiffer & Muller,

2004, p. 71). Children in care report that one of their greatest desires is to feel like part of a family (Hallas, 2002). In the absence of biological family members, this need is


transferred to foster parents and other caregivers, who should make themselves available as attachment figures.

In a variety of studies, former and current out-of-home residents discussed the importance of feeling accepted by their caregivers and having supportive relationships with them (Barth, 1990; Festinger, 1983). Children rate caregiver warmth as one of the most important factors in their relationship (Fanshel et al., 1990). As many as two thirds of foster care alumnae report ongoing contact with their foster families in adult life

(Fanshel et al. , 1990), and children frequently incorporate their foster parents into their perception of who is in their family (Gardner, 1996).

Many researchers have investigated the personal factors that contribute to the formation of successful child-caregiver relationships during placement (see Redding,

Fried, and Britner, 2000, for a review; also see Steward & O’Day, 2000; Hallas, 2002;

Hughes, 1997). Even after a child has experienced multiple unsuccessful placements and has been severely traumatized, a single foster caregiver with whom the child is able to connect can provide the support necessary to “repair the damage” created by repeated trauma and create the foundation for a successful relationship (Hallas, 2002). Listed below are some of the characteristics possessed by caregivers who have successfully engaged foster children in positive, life-enhancing relationships.

Characteristics of Successful Foster Caregivers



Patience; the ability to establish rules for foster children and have patience as the children attempt to conform to those rules



Caring; daily activities demonstrate that the child has worth and is wanted and accepted by the caregiver



Strong motivation to parent foster children based on personal needs; either the foster parent is unable to conceive and desires to parent a child; or the foster parent has had troubled personal experiences similar to the child’s and has persevered and become emotionally mature and stable

 Adherence to “conventional” gender roles (Redding, Fried, & Britner, 2000). o Females are respectful of authority, orderly, practical, emotionally stable

(mature, calm, cool under pressure, and able to make reasonable decisions), and have high levels of enthusiasm and liveliness.


o Males are very masculine and practical; prefer physical activity over thinking and feeling; sensitive (tender-minded, prefer using reason over force); and have higher levels of suspiciousness (hard to fool).



Older age of foster parents (44-55) predicts more successful placement outcome, possibly because careers and other aspects of the foster parents’ lives may be more stable.



Flexibility



Ability to stay calm and matter-of-fact in the face of unreasonable behavior



Well-grounded, not needing to always be “right”



Able to choose appropriate and logical consequences

 Interested in a parenting “challenge” without being invested in “winning”



Able to give emotionally without expectations for immediate reciprocation



Look for emotional support from other adults, not the child

 Able to separate the child form the child’s behavior

 Views self as the child’s protector



Is a good role model; leads by example and teaches children survival skills, proper behavior, and self-control



Feels a sense of commitment to the children in their care, to other foster children, and to the foster care system



Has a good sense of humor in which the ability to laugh at self is evident; humor is not based on sarcasm, hostility, or put-downs



Avoids power struggles



Comfort with conflict (do not avoid it; do not become angry or rejecting)



Highly nurturing



High degree of empathy ( not sympathy!)



Provides firm and consistent discipline



Provides a consistent, structured environment that sets limits and clear rules



Has fewer children in the home



Provides of a variety of stimulation for the child(e.g., activities to stimulate language, learning, and academics)



Has an interactive parenting style (holds high expectations for the child, believes children are responsible for their actions, and is punitive when child misbehaves)


This list is not a cookbook for the “perfect” caregiver. It is simply a list of characteristics that have been found in caregivers who have been able to develop and maintain life-long, positive relationships with the children in their care. Some of the traits of other successful caregivers may not have been included in this list; and caregivers need not necessarily conform to every one. It is most important that caregivers first and foremost provide consistent environment in which the child is able to express his feelings, wants, and needs (Day, 2002).

While the personality of the caregiver is important to the success of a relationship, it is not the only variable that affects it. The temperament and background of the children and their families also influence the success of a placement (Redding, Fried, and Britner,

2000). For example, children with normal attachment behaviors tend to fare better at obtaining a bond with their caregivers than those whose attachments are disordered.

Attachment-disordered children are exceptionally difficult to engage in meaningful relationships. Other child behaviors that predict successful placement include good school conduct, good social skills, and non-aggressive behavior. Children who experienced acute (rather than chronic) family problems precipitating removal, who have had fewer prior placements, and who are satisfied with the amount of contact they are able to have with their biological family also tend to have an easier time bonding with new caregivers (Redding, Fried, and Britner, 2000).

Even if conditions are not perfect (and they never are!), caregivers can take steps to develop the best relationships possible with the children in their care. Interactions should build trust, decrease anger, and meet the child’s real needs. (Keck & Kupecky,

2002). They should be focused on gaining a better understanding of how the child is feeling and letting the child know that you would like to help. Following are some recommendations from experts in fostering and child care (e.g., Hallas, 2002; Hughes,

1997; Keck & Kupecky, 2002; Temple-Plotz et al., 2002) for building relationships with foster children.


Techniques for Developing Healthy Relationships with Children in Care



Be honest about the placement - be direct with the child from the start that the caregiver’s role is to teach the child how to get close to and trust the caregiver so that that the child can go on to have a similar relationship with biological or adoptive parents



Be sure the child arrives with some personal possessions



Keep the child active



Demonstrate how much you care for the child; have “heart-to-heart” talks; include the child in all aspects of family life; meet the child’s basic needs; include the child in family trips and vacations; etc.



Be consistent



Be supportive and empathic



Praise the child at every possible opportunity



Identify activities and behaviors that represent your family, and include the child in them



Identify something each caregiver can do every day with the child for 15 minutes that will be pleasurable for the child and caregiver



Identify a special role and responsibility for the child in your family



Help the child to have mementos and memories of all significant people



Help children talk about their families



Help children express feelings of loss or missing their families; accept grief and anger as natural and help the child work through them; try to recognize the feeling underlying the child’s actions and put it into words (see Chapters 3 and 4), such as

“Being away from home is hard. I can see you are feeling really sad about this.”



Don't deny the seriousness of the situation; saying to a child "Don't cry, everything will be okay" does not reflect how the child feels and as far as the child knows, is not true.



Identify non-harmful ways the child can express anger, frustration, or sadness



Allow for the fatigue that accompanies times of stress and changes in sleep patterns



Help children to remain connected to and have contact with significant people form their past

 Identify familiar and pleasurable things form the child’s past and incorporate those things into your home



Contact the Foster Care agency you are working for toe seek professional help for the child when needed




Provide warmth and caring – ask questions; include the child in conversations; seek the child’s opinion in family activities to create a sense of belonging; talk with the child about things he likes; give pats on the back or hugs; use smiles and a concerned tone of voice



Listen to the child – restate or rephrase what the child said or ask questions to help him get to the root of the problem; teach the child to correctly identify and label feelings



Be respectful – listen without judging or criticizing; let the child make his own decisions, when appropriate; don’t tease the child about personal characteristics about which they are sensitive (the way they look or talk; wetting the bed; learning disabilities, etc.)



Expect to be treated with respect in return – hold the child to standards of using good manners (saying “please” and “thank you”), not arguing with you, apologizing if (s)he hurts someone, asking to borrow someone else’s possessions and returning borrowed items in good condition, etc.



Give the child your full attention when (s)he is talking to you



Respect privacy and possessions

 Respect the child’s attachment to his/her family



Respect cultural differences



Be nice to your own kids or your pets to model appropriate interactions



Show concern and understanding – see life from the child’s perspective; remember that all children develop emotionally, mentally, and physically at different rates



Use appropriate humor and fun – a good sense of humor shows that you are human and approachable; laughing provides a healthy break from stress



Show empathy and trustworthiness – try to understand the child’s situation and feelings; validate the child’s feelings by assuring him that the confusion, sadness, or anger he is feeling is okay and normal for the situation



Offer plenty of praise and encouragement – be specific with praises at first, so that the child knows exactly what behaviors (s)he did well and should repeat; gradually move on to more general praise, like a simple “good job!”



Retain the bond that is formed even after the child leaves


Techniques that do not help build Relationships with Foster Children



Rewards – offering a child an incentive to behave is, in essence, bribery. Children should not be rewarded for behavior that is expected. The stakes will only get higher and higher.



Withholding love – the child has lost his or her parents. It is impossible to make the child feel worse than he or she already does. Caregivers should not try to outwait a child by withholding love until the child wants it.



Punishments – when consequences are given in anger, the child’s focus is on the parent and the anger, not on the behavior that caused the consequence. Foster children often come from homes where violence, anger, and turmoil are the norm.

They need a new experience of empathy and natural consequences in order to have a corrective experience.



Time outs – Children separated from their parents have already had time in isolation. They need more “time in” to bring them close to parents.



Grounding – grounding implies that the child is free to do whatever he or she wants unless he or she is grounded. Children should get permission for their activities. Structured activities, like sports, scouts, band, and youth groups are beneficial activities and help children develop peer relationships.



Deprivation – You do not want to take things away from a child who has already lost most of what he or she had – family, toys, clothes… everything that was familiar for a foster child is probably gone.



Anger – foster children are often very familiar with anger and love to cause others to be as angry as they are. Anger generates distance and is quickly ignored by a child who is used to it. The child may take notice when parents no longer respond with anger.

Using times of High Emotion to Build Trust

Times of high emotion, when a child is angry and his or her temper is raging or is intensely sorrowful, are often viewed as difficult or troublesome. Caregivers may dread a child’s angry and outburst or depressive sobs, but these are natural reactions to separation and can be used constructively. MUST impose their values on the child

Times of high emotion are best for building trust and strengthening relationships

(Fahlberg, 1991; Hughes, 1997; Kagan, 2004). People are most emotionally vulnerable after periods of intense emotion. Fits of rage or even extreme joy leave people emotionally drained, and therefore less guarded and more open to connecting with other


people (Fahlberg, 1991). Caregivers can take advantage of the body’s natural cycle of arousal and relaxation to build trust with their children.

At times when the child is angry, caregivers should display empathy. They should try to read the child’s behavioral signals to identify how the child is feeling and then acknowledge the validity of those feelings. Thus, when the child screams because he has not finished his homework and cannot play with his friends, the caregiver might say:

“You sure are angry at me. You must have really wanted to go outside and play with your friends. It is hard to stay in and miss the fun.” Hughes (1997) points out that parents do not need to add statements such as “next time you can go out if you finish your work” because the child may see such a statement as gloating or preaching, and the child will feel better when he or she makes good choices on his or her own.

Other Factors that Reduce Separation Trauma

Visitation

As many as 90% of children in out-or-home care report that they feel like part of the family and are generally happy with their placements; at the same time, the majority of these young people maintain hope of reuniting with their biological families and believe that “things will be different this time” (Chapman et al., 2004). Despite the fact that foster children more often depict themselves as being more emotionally close to their foster parents than to their biological parents (Haight et al., 2001), the majority state that if they could choose who they lived with, they would choose their biological parents

(Chapman et al., 2004). Research on the experiences of children in out-of-home care illustrates their emotional conflict when it comes to family loyalties. They are faced with the tremendously difficult task of building relationships with new caregivers who are to help them though difficult transitions, while maintaining ties with biological family members whom they often see no more than one or two times per month (Chapman et al.,

2004). Child welfare professionals recommend that practitioners and policymakers


respond to these dual needs by focusing their attention on “both sides of the out-of home equation – building strong relationships with current caregivers while promoting continued relationships with biological parents” (Chapman et al., 2004, p. 303).

Of greatest importance in the lives of the children and youth in out of home care is their need for continuity with primary attachment figures and an enhanced sense of permanence (Rycus & Hughes, 1998; Sprang, Clark, Kaak, & Brenzel, 2004). It has been repeatedly demonstrated that having contact with one’s primary attachment figure during periods of separation lessens the severity of the separation reaction (Trause et al., 1981;

Fagin, 1966). For example, the less a child sees a parent, the greater the tendency may be to idealize and fantasize about the parent. The idealization of the parent causes the child to further blame him or herself for placement (McFadden, 1992). Promoting visitation with biological families during foster placement is therefore a major objective of the child welfare system (Rycus & Hughes, 1998).

Family visits are crucial parts of helping a child adjust to a placement. They allow children a respite from the stressful changes in their routine (Rycus & Hughes, 1998), and for children whose case plans include reunification, visitation can contribute immensely to the reunification process. Maintaining relationships with biological family members facilitates successful reunification and short length of stay in foster care (Fanshel, 1978;

Kagan, 2004). If utilized properly, visitation can prove to children that their family members can keep them safe and prevent problems that lead to their removal. “Children need to see that family members, practitioners, foster parents, and authorities are listening and that everything possible is being done to help achieve permanency goals” (Kagan,

2004, p . 98). Empowering children to write, call, e-mail, or otherwise contact their parents, relatives, workers, and others involved with their care is one thing that foster parents can do to help children feel that their needs are being taken seriously.

Visitation also promotes satisfaction for the child’s biological parents. Biological parents become dissatisfied with a placement when they have insufficient contact and visitation with their child and feel that they are not informed of their child’s progress or involved in decision-making (Redding, Fried, and Britner, 2000). Again, when reunification is the goal, parental satisfaction, which is promoted through sufficient contact, contributes greatly to successful outcomes.


The role of foster caregivers in promoting visitation is to include biological parents in activities with the child, when appropriate. Caregivers may choose to invite the child’s biological parents to accompany the foster caregiver and the child to doctor visits, counseling appointment, school conferences, recreational activities, and other activities; or they may host visits in the foster home, if they cannot occur in the biological family’s home.

Foster caregivers also serve as role models for biological parents. “In the relaxed, informal, and natural setting of the foster home, parents can learn parenting and home management skills by modeling the activities of the foster caregiver… If parents concurrently attend parenting classes, the foster home can provide a safe environment in which to practice skills learned in class…The foster caregiver can be a teacher, a model, and a coach” (Rycus & Hughes, 1998).

Skills that trained foster caregivers model to biological parents can include:



Cooking, cleaning, and managing a household



Budgeting on a limited income and shopping economically



Providing physical care for an infant or young child



Learning and using effective and safe strategies to discipline their child



Playing with their children to stimulate cognitive and language development



Nurturing behaviors to develop and strengthen attachment



Establishing age-appropriate expectations for their children



Developing behavior management strategies



Accessing and using community resources and services



Developing social skills, including how to effectively communicate and work with others to resolve problems

Empowering the Child

One of the most important ways that to minimize trauma is to involve the child in important decision-making (Redding, Fried, & Britner, 2000). Some of the most common complaints made by foster children are that they are not adequately aware of their rights, do not know the truth about the nature and length of their placement, and are not involved


in making decisions about their placement. Some researchers find that more than half of children in foster care report that they had no role in placement decision that will influence the rest of their lives (Johnson, Yoken, & Voss, 1995).

Artistic Expression

Many children and youth in care missed out on the games and activities of childhood that help children learn about roles, relationships, and the rules of living

(McFadden, 1991). McFadden (1991) recommends that encouraging young people in care to come together in groups and engage in expressive activities, such as clay sculpting, can help them communicate and release powerful feelings about issues like separation. Drawing pictures about the child’s family and about the separation, writing poems or stories about it, painting, sculpting, and other forms of artistic expression all help children express feelings and cope with their stress (Day, 2000; Waddell & Thomas,

1998). They can also help communicate children’s needs to adults when children are not able to put them into words (e.g., Lanyado, 2002; Temple-Plotz et al., 2002).

The Use of Rules in Managing the Home

Some of the behaviors associated with separation trauma include oppositional and defiant behaviors. These are also symptoms of attachment disorder and other problems resulting from early experiences with neglect and abuse. Setting rules from the beginning can help a child in transition avoid some confusion about his or her roles and responsibilities in the home and can also make it clear that the child is being received as a new member of the family, whether permanently or temporarily. Hughes (1997) provides an extensive description of the ways in which the transition to a new home can be facilitated by setting clear rules. His suggestions are based on outcomes for children with attachment disorders. Since the majority of children in out of home care have clinical psychological disorders (Halfron et al., 1995; Rosenfeld et al., 1997; Sedlak &

Broadhurst, 1996), the guidelines proposed by Hughes for managing the home with attachment disordered foster children are appropriate for application with most children in care.


Children make the best adjustments to homes in which the rules are clear from the beginning. Hughes (1997) states that many foster children report that their foster parents were initially nice to them but became “mean” after a time. This happens when foster parents give the child “a clean slate,” believing that the child’s behavior will be appropriate and acceptable, and do not enforce rules early-on. If the child begins to exhibit disruptive behavior, particularly if the child has attachment problems and during the Anger/Protest stage of the grief process, the foster parents then tighten the rules, causing the children to feel betrayed. According to Hughes (1997), the three most important things that foster parents should teach their children in the beginning of their relationship are:

1.

what behaviors are expected in a given situation and the consequences of choosing to do it or choosing not to do it;

2.

that the child needs to ask about the rules before doing something that has never been discussed; and

3.

that every member of the family contributes by doing chores, communicating, and completing work before play.

Adopting a firm position on house rules from the moment the child moves in helps the child understand expectations. Caregivers are “simply doing their job and showing their love and commitment” by teaching their new child how the family functions (Hughes, 1997, p. 218). Hughes points out the following benefits of adopting such a position:

1.

It is easier to loosen rules than to tighten them once a child lives in the home for a while.

2.

Firm rules will help the child avoid “failure” by not placing extremely high expectations on the child’s behavior.

3.

Children are more receptive to rules during the first days of placement

4.

Choices and consequences are better understood as parental teaching rather than punishment or personal attacks in the first days. Rules can be framed as supportive attempts to help the child fit into the family.

5.

The caregivers and the child are less likely to be angry at each other in the first days. This reduces power struggles and helps parents have empathy for the child.

6.

Having clear expectations about behavior helps the child feel secure. The child learns quickly that the parents will relate to him or her in certain clear ways.


Medication

There are some disorders that have a biological basis, for which prescription medications can be helpful. Parents and caregivers should work with healthcare professionals, who can use their judgment and expertise, to determine whether medication may be appropriate for a particular child. For some children, medication can produce dramatic improvements, especially when accompanied by supportive therapy.

For others, there may be little or no change associated with using medication; and some children exhibit worse behavior after taking medication (Keck & Kupecky, 2002). The behavior of children taking medication should be carefully monitored. Caregivers should never attempt to alter dosage without first consulting the prescribing physician.

Providing Joyful Experiences

It is important for caregivers not to forget to provide joyful experiences to balance the hard work of understanding behavioral expectations. Parents must display empathy for how the child is feeling and respect. Using warm humor (never sarcastic) can also be children adapt to a new home and build relationships with new caregivers.

Respite from the Difficult Tasks of adjusting to a New Life

Children who are making the transition into a new home often benefit from taking

“breaks” from the home during the placement (Rycus & Hughes, 1998). The tasks involved with adjusting to new people, new rules, and new routines while at the same time grieving the loss of family members is exhausting. Periods of respite from the caregiving home allow children to regain their strength. Children should have opportunities to spend time with familiar people in familiar and comfortable surroundings, where they feel free to express their concerns and feelings without worry of being heard or reprimanded by the caregiver. Moments of respite can be taken in the child’s own home, a relative or friend’s home, or even in the social worker’s care (Rycus


& Hughes, 1998). The key point is that they experience a sense of being comfortable and free to express themselves in the company of a familiar and trusted adult.

Helping Children Create their Stories

An awareness of one’s personal history is essential for developing a strong sense of self and the ability to make conscious choices and take responsibility for one’s behaviors (Fahlberg, 1991). The family is ordinarily the source of information about a child and his past. Children who do not live with their families of origin therefore do not have ready access to information about themselves and their personal history. When this information is not available, a person’s personal history becomes fragmented. This can be particularly for children who are repeatedly separated from important people in their lives and moved from placement to placement.

Many practitioners working with children involved with the foster care system consider the creation of a narrative of a child’s history to be an important part of helping the child move forward (e.g., Fahlberg, 1991; Holody & Maher, 1996; Kagan, 2004;

Kliman, 1996; Rycus & Hughes, 1996). For example, Kliman (1996) found that using narrative, or the creation or a life story, can significantly decrease disruptions in foster family care. Narrative therapies break down problems of victimization and allow problem narratives to be recognized, labeled, and externalized. That is, problems are given names and treated as things separate from the child, so that a child is no longer considered a

“bad child,” but is simply fighting hard against something that has forced him to behave in certain ways. Narrative therapies work with stories and beliefs to attach more constructive meanings to the events of one’s life and generate possible solutions (Kagan,

2004). Narratives also provide an opportunity to expand positive stories of personal and familial strength and empower individuals to share solutions with others (White and

Epston, 1990; Freedman and Combs, 1996).

Healing stories and lifebooks are two forms of narrative therapies that can help children put their placement into context and deal with the thoughts and feelings they have about themselves, their families, and their situation.


Healing Stories

Creating a healing story (Kagan, 2004) is a way that children can reconnect with their past and build the hope and confidence to create a positive future. A healing story is one that corrects distorted beliefs, feelings, or perceptions and clarifies insights into what happened in the past. It reframes what lead up to a placement and can help children see themselves as heroes who have survived trauma. Instead of looking at behaviors as bad, a caring adult who helps a child create a healing story will help the child see how the child’s behaviors were really a heroic and necessary means of keeping him safe in his home situation.

A healing story brings to light the forces that worked against the family and blocked their success, and it casts the child in a hero’s light for doing what was necessary to survive. Helping children to tell their stories integrates their feelings, needs, and beliefs within the context of their own reality and allows children to release some of the toxic messages that they carry with them from troubled beginnings. Allowing a child to express his feelings of guilt and shame, and helping him to see how he, as an innocent young child, was unable to stop the trauma at home can help children forgive themselves.

Kagan (2004) summarizes the benefits of the healing story as such:

Caring adults help children to heal by showing children that they can tell their stories and remain loved. Children are natural storytellers and can use stories to share the goodness and hope they carry inside. Within the embrace of a caring adult, a child’s story very naturally unfolds, and with each story, a child learns to voice what ha been too frightening to say out loud. Telling the story helps a child to learn how to use words, to understand what happened, to consider alternatives, and to develop a new story of empowerment.

Lifebooks

A Lifebook is another form of narrative, which also incorporates artifacts from a child’s history and information from family members or other caregivers from the child’s past. It provides a timeline of a child’s life that helps him understand and remember what


has happened to him in the past (Fahlberg, 1991). It is a useful tool for helping the child put the events of his personal history into context, and it can also be used to share information with significant others in the child’s life, such as new parent figures.

Fahlberg (1991) recommends that a Lifebook should be started for each child in the child welfare system at the time he first enters care, and that the book should accompany him as he journeys through life. Following are Fahlberg’s (1991) descriptions of how foster parents can help children create and use Lifebooks.

Purposes of a Lifebook:

 Provide a timeline of the child’s life



Enhance self-esteem and identity formation



Help a child share his history with others



Assist in resolving separation issues



Identify connections between past, present, and future



Facilitate attachment



Increase trust for adults



Help the child recognized and resolve strong emotions related to past life events



Separated reality from fantasy or magical thinking



Identify positives, as well as negatives, about the family of origin

Contents of a Lifebook:

A Lifebook is a collection of words, pictures, photographs, and documents that provide an account of a child’s life. Information about a child’s developmental milestones and behavior in the home should be written in a way that is understandable to the child and accompanied by pictures whenever possible. A Lifebook should include:

 Information about the child’s birth (weight, length, what day of the week he was born, at which hospital he was born, etc.)



A baby picture (some hospitals keep records of infant photos, if one is not available otherwise)



Notes of health problems or abnormalities at birth




An explanation of why and how the child entered the foster care system and how subsequent decisions were made



Photographs of birth parents (duplicate one-of-a-kind photos and put a copy away for safe keeping)



A Genogram, including parents, siblings, and extended family members



Records and information about developmental milestones

Information to be compiled for a Lifebook by the Foster Family:



Developmental milestones



Common childhood diseases



Immunizations



Information about injuries, illnesses, or hospitalization



Ways the child showed affection



What he did when he was happy or excited



What things he was afraid of



Favorite friends, activities, and toys



Birthday and religious celebrations



Trips taken with the foster family

 Members of the foster parents’ extended family who were important to the child



Cute things the child did



Nicknames



Family pets



Visits with birth relatives



Names of teachers and schools attended



Report cards



Special activities (scouts, clubs, camping experiences, etc.)



Church and Sunday school experiences



Pictures of each foster family, their home, and their pets



Stories about amusing (in retrospect!) things the child has done



Letters and communications from birthparents, including anything as part of disengagement work


Sources of Information:



The child himself



Birth family members



Neighbors



Adult sponsors of activities



Previous caregivers



Social service records



Court records



Police reports



Scholl records (this can be a good resource for school pictures)



Previous caseworkers



Records from agencies that have had contact with the child (hospitals, mental health clinics, well baby, etc.)



Day care personnel



Teachers



Newspapers (for birth, marriage, or divorce announcements; obituaries; etc.)

Constructing a Lifebook:



There is no right or wrong way to do it!



Different children will prefer to start at different points in their personal histories



The use of words is important o avoid calling it a “scrap” book, as this may have a negative connotation; o avoid using the terms “natural” or “real” parents, as this conveys the message that foster or adoptive parents are “unnatural” or “unreal” o the term “forever” may seem overwhelming to a child; use “keeping” or

“growing up with” to explain permanency



The child should be helped to keep his contributions neat and legible, to avoid his seeing the book as “for little kids” as he matures



Be creative in getting a resistant child involved in creating his Lifebook


Specific tips for working with a child to develop his personal narrative and create a Lifebook are provided in Ryan and Walker’s (1985),

Making Life Story Books. The

Lifebook provides a structured means for foster parents to honor children’s biological family members by documenting and preserving the family’s customs, including rituals, celebrations, hairstyles, and personal histories. Kagan (2004) adds that it is very important for foster children to chronicle transitions, as these are very difficult times. A foster parent’s own expectations, fears, and what happened form the first moments the foster parent learned of a child should be included. Answer questions such as what attracted you to the child, what you learned, what you liked best, and how the child tested your love and commitment. Also include information from biological parents, family members, and others involved in any earlier placements to develop a story about the trauma of transitions and how the child has overcome those traumas.

Handling a Child’s Departure from the Caregiving Home

The transition of out the caregiving home has the potential to be just as traumatic for a child as the initial separation. This is especially true if children are not told directly about plans for reunification, adoption, or transition to another placement; or if have developed strong relationships with their caregivers. The move can also be traumatic for caregivers, and some caregivers may avoid talking about the separation in an attempt to decrease their own or the child’s distress. This is exactly the opposite of what should happen. “It is important that the child understand what is happening as it occurs. If not told directly, even very young children will sense that "something is happening," and will be more frightened than they would be if the plan were fully explained to them” (Rycus

& Hughes, 1998). Trauma can be greatly reduced if caregivers spend as much energy preparing for the child’s move out of the home as they did to prepare for the child’s moving in.


Researchers suggest that the move out can be eased by helping children honor the relationships they have formed in substitute care; encouraging expression of feelings about the move; recognizing that increased anxiety and distress may cause behavior problems; and maintaining contact, when appropriate (e.g., Fahlberg, 1991; Kagan, 2004;

Pasztor & Leighton, 1993; Rycus & Hughes, 1998; Temple-Plotz et al., 2002). Following are some tips for reducing the trauma of moving out:



Begin to prepare a child by talking about the move and encouraging the child to talk about his or her feelings



Provide opportunities for the child to express ask questions and express their fears and concerns



Help the child recognize and label feelings of sadness, anger, or fear



Foster caregivers should express their own feelings of sadness about the move - this can help show the child that (s)he will be missed and prevent the child from feeling that (s)he is being moved because of some personal fault or inappropriate behavior



Host visits between the child and the parents or new foster parents



Help the child bring closure to current relationships by hosting a going away party, making a scrapbook, exchanging addresses, etc.



Help the child prepare for the move by packing, taking pictures, etc.



Recognize the attachment between yourself and the child, and give yourself and the child permission to feel a sense of sadness and loss; set aside time for you and the child to discuss your feelings.



Encourage contact between you and the child and his new family after the child has moved; encourage the new family to support the child’s decisions to make contact, and be available for advice and suggestions if the new family needs help



Expect recurrences of acting-out behaviors – these are caused by anxiety in reaction to the impending separation



If the child has formed an attachment to the caregiver(s), contact with the child should be made immediately after the move



Telephone calls, letters, and visits reassure the child that the caregiving family still cares and is thinking about him/her.



Ongoing contact after the child has moved out can provide a source of support for the child and the parents or others with whom the child is living; it may be beneficial for the caregiving family to provide occasional respite care for the child


Support for Caregivers

The job of fostering is not an easy one. Caregivers may become frustrated when they feel like their efforts welcome a child into their home and their attempts to build a relationship are not well received. The demanding, confrontational, manipulative and sometimes frightening behavior of many children in care can also be disheartening.

Caregivers who look after “hurt” children, those who have sever problems associated with attachment disorder and the effects of abuse and neglect, often become much too serious about everything (Keck & Kupecky, 2002). They allow themselves no fun and do not take anything in stride, viewing even small issues as major issues. Their problems and miseries may alienate friends and family and lead to a loss of support. This can leave caregivers feeling isolated and alone.

Caregivers have to remember that many foster children have a history of abuse and neglect that greatly effects the child’s ability to relate in healthy ways, and that children enter into new relationships with the same expectations for being hurt, regardless of how caring or determined foster parents are to help the child. A poorly attached child will interact with foster parents in destructive and manipulative ways because that is how the child has learned to get his or her needs met. Foster parents must not take the challenging behaviors of these children personally, or else they are at risk for becoming angry, distant, and emotionally burned out.

In addition to recognizing the personal struggles of the children that sometimes make them seem so difficult to love, caregivers have to look out for their own well-being when caring for a difficult child or a child who is experiencing extreme distress (Hughes,

1997; Keck & Kupecky, 2002; Redding, Fried, and Britner, 2000; Rycus & Hughes,

1998). Like most people, foster parents, social workers, and others who work with children in care have their own unresolved psychological issues. Hurt children seem to have “button-locating radar” – they are skilled at finding and pushing people’s buttons, exposing and aggravating their issues (Keck & Kupecky, 2002). Having their buttons pushed by a child makes a caregivers more aware of their own issues, and for healing to


occur, caregivers need to understand their triggers and be less reactive to the acting-out behaviors of the children. They also need to take good care of themselves. When they do, they become stronger, more comfortable, and can laugh at things that used to be seen as major problems; and caregivers who become more aware of the good times at home gain a better perspective for encouraging and celebrating children’s growth (Keck & Kupecky,

2002). So take care of yourselves!

Self-Care Tips for Caregivers



Recognize your own signs of stress – Do you begin to lose your temper? Become anxious? Having trouble sleeping? Etc.



Participate in self-affirming activities – do things that you enjoy and that you are good at to boost confidence and give you a break from caregiving responsibilities



Have other meaningful and deeply satisfying relationships



Do not expect the child to provide a meaningful attachment

 Be willing to assume control over the child’s choices and consequences – recognize that rules are meant to be followed, not broken, and that it is the caregiver’s responsibility to present choices and deliver consequences



Get to know neighbors – they can provide support and quick respite for weary caregivers



Maintain at least a few good friendships



Attend support groups – they help caregivers feel understood by others, learn new parenting skills, express feelings and concerns with others who are understanding, and learn to empathize and work with the children’s biological family

A Final Note

Francine Cournos (2002) is a veteran of the child welfare system who blossomed into a successful child and adolescent psychiatrist and a professor of clinical psychiatry at

Columbia University. In a piece she wrote about her journey through placement, she offers 10 points that summarize some of the most important concepts to remember when


caring for a child who has suffered severe losses. These ten points summarize many of the ideas that this manual seeks to convey. When we take the time to learn about the children and to see the world through their eyes, we are reminded that separation trauma is very real, and very painful, but can be overcome. Remember:

1.

The impact of separation is mediated by the presence of familiar and trusted parent figures (foster parents, mentors, or other trusted and supportive adults).

2.

The dampening of feelings which initially accompanies traumatic separation is an instinctual coping mechanism that helps the child focus on physical survival. The extreme change that occurs when a child is removed from his or her home makes the child feel unprotected and unsafe, and blocking out emotions helps the child concentrate on survival.

3.

A child who refuses offers of emotional connection is feeling unsafe. Caregivers need to take the child’s lead and find a comfortable common ground and help the child feel safe in his or her new environment.

4.

Anger is the primary way that children with separation trauma engage with substitute caregivers. Anticipating that the caregiver will be treated with anger for all that the child has lost can help caregivers feel less rejected.

5.

The process of grieving begins after a child feels physically safe in his or her new environment. This is when he will confront intense emotions like fear, rage, despair, guilt, and mistrust.

6.

Healing from trauma takes time and occurs in stages. Caregivers have to tolerate the expression of rage and remain empathic throughout the entire process.

7.

No caregiver can give a child everything he or she needs, but any caring adult can contribute to the child’s life. Do not despair when it seems you cannot meet a child’s every need, because every child “patch[es] together bits and pieces taken from offerings of many different people” to get his or her needs met (p. 155).

8.

When caring parenting and professional treatment are not enough, traumatized children often benefit from medication.

9.

It is important to help children build their skills (academically, athletically, interpersonally, etc.) to boost their self-esteem and give them hope for a future that is better than their past.

10.

We bring our own personal histories with us into every relationship. Foster parents and helping professionals often take on the responsibility of caring for needy children after overcoming trauma themselves (see also Redding, Fried, and

Britner, 2000). Drawing from that experience should help caregivers maintain empathy for a child’s position.


In summary, it is hoped that foster parents, social workers, and every adult who affects the lives of children under the care of Child Welfare will consider the traumatic effect of leaving all people and things familiar for the strange and scary world of placement. Leaving home and being placed is often a traumatic experience that can profoundly affect the way a child interacts with the world and the people around him or her. A child’s reaction to separation most often resembles the deeply disturbing experience of the death of a parent, and if not handled properly, can result in further damage to the child’s emotional stability. It is important to recognize that children and adolescents in care often demonstrate unsettling behaviors with which many caregivers and families find it difficult to cope, but that these behaviors are the manifestation of great pain and suffering and are the survival skills children have learned over the course of their sometimes painful lives.

Arming themselves with the knowledge of the psychological turmoil that underlies the behaviors and the unfair conditions in the child’s early home life which lead to them, are important ways for caregivers to recognize a child’s needs and see his or her strength in the ability to carry on under adversity. Furthermore, recognize that although separation is often complicated by factors such as poor attachments and developmental delays caused by abuse and neglect in early childhood, well-informed and consistently supportive adults can make the difference in a child’s life. Competent and caring foster parents, social workers, and other important figures who make themselves available to children and youth during separation experiences can mean the difference between the child spiraling downward into self-destruction and antisocial behavior, or emotional healing and personal growth.

People who opt to spend their lives and their energies in support of children provide an immeasurable service and are to be congratulated for their patience, understanding, courage, and caring; and their sometimes selfless devotion to making life better for the children in their care.


Chapter 7: Resources

Resources on foster care, parenting, and the issues discussed in this manual are always growing and changing. Books, magazines, and articles devoted to children and families are published regularly. There are many that are published specifically for children and adolescents to help them handle the complicated time of separation and placement. Many resources exist to train foster parents and/or social workers in caregiving skills for supporting children and youth with attachment, transitions, grief, behavior problems, and more. There is also an incredible amount of information available on the Internet. Chat rooms and information are available on every aspect of foster care and attachment/separation. If you do not have access to the Internet, your local library can help.

Listed below are only some of the supports available to you in your search for knowledge about the child in your care or caseload. Remember…the information that you find on the web or in a book is not necessarily “one size fits all.” Each family and each child is unique. As you begin exploring the resources below you will likely discover many more.

Good luck! And thank you for doing the most important job of looking after our youth!


Internet Resources


Love and Logic http://www.loveandlogic.com

National Foster Parent Association http://www.nfpainc.org/


The Attachment Disorder Support

Group http://adsg.syix.com/

The Little Prince http://www.thelittleprince.org/

U.S. Department of Health and Human

Services, Administration for Children and Families, Administration on

Children, Youth, and Families,

Children’s Bureau http://www.acf.hhs.gov/programs/cb/

Zero to Three http://www.zerotothree.org/ therapeutic options, parenting techniques, the effects of childhood trauma, medication, parent feelings, a child's perspective of life in the child welfare system, nurturing activities, and much more. The site also provides bibliographies of adult and children's books, a listserv, and message boards.

This site features links to full-text articles regarding attachment disorder, international adoption, the effects of childhood trauma, foster care issues, adoption issues, and other children's mental health issues. It also features insightful and supportive articles written by parents of children with attachment disorder, as well as a listserv, message forum, and live on-line chats.

This website is about, "Surviving Life with

Reactive Attachment Disorder." Prepared by a mother who found and secured appropriate treatment for her child, it has first hand info for parents.

This is a major source of information and quite easy to use. It contains links to the

AFCARS data reporting system, as well as fact sheets reporting recent statistics on all aspects of foster care. Laws and policies are described. Children's Bureau program descriptions and funding announcements are on this site. Many government publications can be downloaded.

Zero to Three has as its mission promoting the healthy development of our nation's infants and toddlers by supporting and strengthening families, communities, and those who work on their behalf. This site contains articles of interest to parents in the areas of making decisions about daycare, discipline, enhancing development, etc. There are several articles designed specifically for fathers. The site also offers an on-site bookstore.


Books for Adults

Adopting the Hurt Child by Gregory Keck

& Regina M. Kupecky (1995). and

Parenting the Hurt Child by Gregory Keck

& Regina M. Kupecky (2002).

Attaching in Adoption: Practical Tools for

Today's Parents

(2002).

by Deborah D. Gray

Attachment, Trauma, and Healing:

Understanding and Treating Attachment

Disorder in Children and Families by

Terry M. Levy & Michael Orlans (1998).

This 2-book series is written for foster and adoptive parents of children who have experienced early abuse, neglect, and trauma. It focuses on parenting children with attachment problems. Acknowledges misperceptions people have of foster and adoptive parents of hurt children. The authors’ style is straight-forward and easy to understand, supporting parents rather than blaming them for children’s behavioral problems. Goal is to provide new hope for the children’s’ healing and growth. Deals directly with the kinds of difficulties that can arise for the families of hurt children. Provides specific strategies and recommendations for family activities to enhance attachment, offers advice about choosing a therapist, and gives case examples of other families’ struggles and successes.

This book is written to provide adoptive parents with current and specific information about the needs of adoptive children. Topics include: trauma, grief, attachment disorder, developmental delays, family challenges, support for the family, selecting a mental health provider, and more.

This is a treatment manual mainly for professional, but it is sensitively written and may be useful for inquisitive alternative caregivers. It uses real life examples from the author’s clinical work together with theory and research on attachment to provide help for understanding the experiences of the children and the caregivers. The book describes the roots of attachment, ways to assess unhealthy attachment, parental reactions and recommendations, and


Building the Bonds of Attachment:

Awakening Love in Deeply Troubled

Children by Daniel Hughes (1999).

Children Who Shock and Surprise: A guide to Attachment Disorders by Elizabeth

Randolph (1994).

Facilitating Developmental Attachment:

The Road to emotional Recovery and

Behavioral Change in Foster and Adopted

Children by Daniel A. Hughes (1997).

Field Guide to Child Welfare

Fostering Changes: The Handbook of

Attachment Interventions by Terry. M.

Levy (2000).

by Judith S.

Rycus, Ph.D., MSW & Ronald C. Hughes,

Ph.D., MScSA (1998). treatment alternatives.

This informative book exposes the tragedy of the attachment disordered child and a clinically sound framework and practical strategy for facing these children’s problems. The author is a clinical psychologist specializing in child abuse and neglect, attachment, foster care, and adoption. He presents the story of Katie, a fragmented, tormented, isolated little girl in foster care whose terror, shame, rage, and despair drive her horrific deeds.

This booklet is a quick and easy way for foster parents and other substitute caregivers to become educated on attachment in order to cope effectively with the children in their care.

This manual is written for clinicians and parents of children with severe attachment disorders. The book provides a history of attachment theory and research on the roles of parents, children, and therapists in treating attachment disordered children.

Uses case examples and provides some practical suggestions for facilitating attachment in the adoptive child.

This guide is written mainly for child welfare workers but provides useful information for anyone who is interested in learning more about the current best practices in fostering and adoption. It also provides a great deal of detailed information on topics of child maltreatment, separations, permanency planning, parenting, and more.

This is a valuable reference book for practitioners and interested caregivers. It provides current theory and research on attachment and separation across diverse populations. It includes general issues parents may encounter with an attachment


On Separation and Loss: A Handbook for

Foster

Rebuilding attachments with traumatized children: Healing from losses, violence, abuse, and neglect by Richard Kagan

(2004).

families by Jacob R. Sprouse.

Practical Tools for Foster Parent by Lana

Temple-Plotz, Ted P. Strickett, Christena

B. Baker, and Michael N. Sterba (2002). disordered child, special patient populations (the adopted child, military families, etc.) and techniques for intervention.

This is a manual designed as a selfinstruction or group training for foster parents. It provides a common sense definition to separation and loss issues, a discussion with coping strategies for the foster family, and an overview of the array of parenting difficulties and challenges in coping with children who are stressed by their loss and attachment issues.

This is an easy to follow skills book for foster parents, based on the Girls and Boys

Town’s Common Sense Parenting approach. It offers practical, step-by-step suggestions and a lot of examples for building a warm, trusting relationship with your foster child; working with the child’s family; handling transitions; teaching your foster child how to stay under control and make good decisions; learning how to deal with misbehavior and prevent your own and your child’s “blow ups”; and many other practical tools.

The author is respected for his work with traumatized children and his conviction that severely abused and neglected children can be helped to overcome the impact of earlier trauma. This book is a therapeutic guide intended primarily for use by therapists, but is written in thoroughly understandable language and includes many real-life stories and practical information that would be useful for anyone interested in learning current approaches to helping troubled children.

The book presents information on how to understand and overcome the impact of loss, neglect, separation, and violence on children’s development. It includes specific interventions, including creative arts


Theraplay: Helping Parents and Children

Build Better Relationships through

Attachment-Based Play by Ann M.

Jernberg & Phyllis B. Booth (1999).

When Love is Not Enough: A Guide to

Parenting Children with RAD - Reactive

Attachment Disorder by Nancy L. Thomas

(1997). projects and personal story-telling, that can be used to help children and their caregivers surmount problems of the past and rebuild a story of hope, strength, courage, and belonging.

This is a book filled with activities to help a poorly attached child and new caregiver form a new attachment. Recommended by several writers on attachment and adoption.

This is a very readable resource for parents of children with Reactive Attachment

Disorder (RAD). It presents information from the parent’s point-of-view and the child’s point-of-view. The manual focuses on “the dynamic dozen” parenting strategies for kids with RAD and includes worksheets, checklists, and resources.


Books for Children

A Boy Named it by Peltzer (1999).

Alexander and the Terrible, Horrible, No

Good, Very Bad Day

An Elephant in the Living room

Hastings and Typpo (1994).

Goodnight Moon

The

and

Harry Potter

(1997).

A Man Named Dave by Viorst (1972). by

by Brown (1947). series by J. K. Rowling

These books can help adolescents understand how people survive and grow despite neglect, violence, or abuse.

This is story about frustration that teaches a lesson that some days are “just like that.”

This book demonstrates overcoming secrecy that supports addictions.

This book uses attention to details and ritual at bedtime to create a sense of safety.

This series chronicles the adventures of a youth overcoming loss of his parents and neglect by his relatives. It teaches children about friends helping friends, the importance of consistent adults as teachers

Hatchet

(1940).

by G. Paulson (1987).

Horton Hatches the Egg by Dr. Seuss

I know Why the Caged Bird Sings

Angelou (1969).

by Maya and mentors, summoning courage to face terror, and a strong female hero.

This book is for older elementary school children. It is about a boy who crash lands and must learn to survive in the wilderness on his own.

This book teaches the meaning of parenting.

This book is intended to help adolescents understand how people survive and grow despite neglect, violence, or abuse.

The Little Engine that Could

(1961).

Love You Forever

by Piper

by Munsch (1986).

This book models determination.

This book is about a mother’s devotion to her son, and as the son grows and matures, his devotion to his mother.

Object Lessons by Anna Quindlen (1991). This book is for adolescents grappling with their parents’ strengths and mistakes.


The Runaway Bunny

Brown (1991).

by Margaret Wise

There’s a Nightmare in My Closet

Mercer Mayer (1968).

Where the Wild Things Are

Sendak (1963).

by

by Maurice

This book is for young children who are interested in nature and animals. It teaches about how it feels to be away from your family and feeling alone.

This book teaches a lesson about a young child mastering his fears.

This book is about a defiant child’s dream that incorporates becoming like monsters, starting a voyage (courage) and returning to the smell of a hot meal prepared by his mother (reunification).


Games to Promote Communication

The Ungame by Talicor

Reunion Game by USAopoly.

The Talking, Feeling, and Doing Game by

Richard A. Gardner, M.D.

The leading family communication game.

Players progress along the playing board as they answer questions such as "What are the four most important things in your life," and "What do you think life will be like in

100 years?" This non-competitive game can be a great ice-breaker or a serious exchange of thoughts, feelings and ideas.

The Family Reunion Game is a board game challenges players to recall memories, pass down traditions and reveal never-been-told stories and family secrets. Skeleton in the

Closet, Snapshots, “You’re not telling the whole story” and Family Secret cards provide lively competition allowing players to challenge stories and thwart opponents.

The first player to collect one photo from each category, (Traditions, Magic

Moments, Happy Days and Hand Me

Downs) wins. Losers tell all as the winner asks all players to reveal a family secret.

The play cards can be customized with players’ own photos, allowing players to trace their family history with the provided

Family Tree illustration.

This game is widely used in child psychotherapy. Players respond to questions on game cards, receiving reward chips for relevant answers. The child’s responses generally reveal psychological issues that are most pressing at the time.

When it is the therapist’s turn to respond to a card, he or she can formulate an answer that addresses the child’s needs and concerns. Because the therapist and the child communicate indirectly, through the game cards, they are often able to discuss sensitive issues that the child is unwilling or unable to bring up independently. The game can be played by the therapist and one to four children, in 30–45 minutes.


Social Security by Ungame

Game leaders should have a master’s degree in psychology, social work, or counseling.

This non-competitive game consists of a game board, six kinds of cards, a spinner, pawns, and a die. “Players, from six year olds to grandparents, will find themselves stretching their imaginations and practicing new communications skills." Players move around the board drawing, reading, and commenting on mildly thought-provoking cards. Some cards ask for an opinion on interpersonal issues, some present Ozzie and Harriet-type domestic problems then ask for possible solutions. Certain squares direct you to spin a large spinner built into the game box that directs similar tasks

("Share a time when you had good luck",

"Describe your favorite teacher")


Therapists and Mental Health Resources

Central Referral Services Links to services for people in the Western

New York region. http://www.wnyservices.org/

The Center For Family Development

Arthur Becker-Weidman, Ph.D.

6 Emerald Trail

Buffalo NY 14221

Phone: 716 636-6243

Fax: 716 636-6243

The Center for Family Development is

“Western New York's only attachment center specializing in the treatment of adopted and foster families with trauma and attachment disorder

.” It provides educational workshops and counseling for

5820 Main St., Caldwell Bldg, Suite. 406

Williamsville, NY, 14221 adoptive and foster families, adopted children and children in foster care. Also provides professional training and

Phone: 716-810-0790

Fax: 716-636-6243 consultation, court ordered custody evaluation & pre-placement home studies,

E-mail: Aweidman@Concentric.net

and post-placement supervision. http://www.center4familydevelop.com/

Liberty Resources, Inc./Adoption

Resolution

Registered Organization with the

Association for Treatment and Training in the Attachment of Children Christine Sweeney, CSW

1850 County Route 57 , Fulton, NY, 13069

Phone: 315-598-4642,ext28

Fax: 315-592-7978

E-mail : cswceney@liberty-resource.org

Martha Welch Center

Martha Welch, M.D.

952 Fifth Avenue

New York, NY 10021

Phone: (212) 879-6505

FAX: (212) 861-6816 http://www.marthawelch.com

The Martha Welch Center provides highly specialized complex, comprehensive and

Intensive Family Treatment therapy and training for families with children suffering from developmental, behavioral, and affective disorders including Reactive

Attachment Disorder and many other associated disorders.

New York Foster/Adopt Parent Assoc.

92-31 Union Hall

NYS Foster Parent Association

Daisy Boyd

134-39 224th Street

Laurelton, NY 11463

Phone: (718) 712-6990

E-mail: nysfapa@nyc.rr.com

Western New York Helpnet http://rin.buffalo.edu/s_huma/huma.html

PO Box 120-151

Jamaica, NY 11412

Phone: (718) 262-3214

(718) 557-1005

Fax: (718) 557-1006

On-line directory of health and human service agencies, New York State


subsidized health insurance programs, and programs that provide services for free or at reduced costs for individuals in need.

This directory includes services provided throughout the eight counties of Western

New York, including Erie, Niagara,

Orleans, Chautauqua, Cattaraugus,

Allegany, Genesee, and Wyoming counties


References

Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ:

Erlbaum.

Allen, J. P., & Land, D. (1999). Attachment in adolescence. In In J. Cassidy & P. R.

Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 319–335). New York: Guilford Press.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4 th ed.). Washington, D.C.: Author.

Barber, J., Cooper, L. L., & Delfabbro, P. H. (2001). The predictors of unsuccessful transition to foster care. Journal of Child Psychology and Psychiatrty , 42(6), 785-

790.

Barber, J. G. & Delfabbro, P. H. (2003). The first four months in a new foster placement:

Psychosocial adjustment, parental contact and placement disruption. Journal of

Sociology and Social Welfare, 30 (2), 69-77.

Bloom, M. V. (1980). Adolescent Parental Separation . New York: Gardner Press.

Bowlby, J. (1944). Forty-four juvenile thieves: Their characters and home-life.

International Journal of Psycho-Analysis, 25, 19-53, 107-128.

Bowlby, J. (1958). The nature of the child’s tie to his mother.

International Journal of

Psycho-Analysis, 39, 4-33.

Bowlby, J. (1961). Childhood mourning and its implications for psychiatry. American

Journal of Psychiatry , 118, 481.

Bowlby, J. (1969).

Attachment, in Vol. 1 of Attachment and loss . London: Hogarth Press.

New York: Basic Books; Harmondsworth: Penguin.

Bowlby, J . (1973) , Separation: Anxiety & Anger, in Vol. 2 of Attachment and loss.

London: Hogarth Press; New York: Basic Books; Harmondsworth: Penguin.

Bowlby, J .

(1980) Loss: Sadness & Depression , in Vol. 3 of Attachment and loss, London:

Hogarth Press. New York: Basic Books; Harmondsworth: Penguin.

Bowlby, J. (1988). A Secure Base . New York: Basic Books.

Bloom, M. V. (1980). Adolescent-parental separation . New York: Gardner Press.


Bretherton, I. (1992) The origins of attachment theory: John Bowlby and Mary

Ainsworth. Developmental Psychology , 28, 759-775.

Briere, J. N. (1992). Child abuse trauma: Theory & treatment of the lasting effects.

Newbury Park, CA: Sage.

Brooks-Gunn J, Duncan GJ (1997), The effects of poverty on children. Future Child

7:55–71.

Cahill, L. T., Kaminer, R. K., & Johnson, P. G. (1999). Developmental, cognitive and behavioral sequelae of child abuse. Child and Adolescence Psychiatric Clinic of

North America, 8, 827–843.

Carlson, E. A., Sampson, M. C., Sroufe , L. A .

(2003). Implications of Attachment

Theory and Research for Developmental-Behavioral Pediatrics.

Journal of

Developmental & Behavioral Pediatrics. 24(5), 364-379.

Cassidy, J. & Shaver, R. (1999). Handbook of attachment: Theory, research, and clinical applications . New York, NY: Guilford Press.

Center for Adoption Research (1999). Attachment: An overview . Retrieved June 19,

2005, from http://www.centerforadoptionresearch.org

Chapman, M. V., Wall, A. & Barth, R. P. (2004). Children’s voices: The perceptions of children in foster care. American Journal of Orthopsychiatry, 74 (3), 2930394.

Child Welfare League of America. (2002). Data and statistics: Out of home care, 2002

[data file] . Available from the Child Welfare League of America National Data

Analysis website: http://ndas.cwla.org

Cicchetti, D. (1989). How research on child maltreatment has informed the study of child development: Perspective form developmental psychopathology. In D. Cicchetti and V. Carlson (Eds.) Child Maltreatment . New York: Cambridge Universtiy

Press. pp. 377-432.

Cline, F. W. (1991). Hope for High Risk and Rage Filled Children. Golden, CO:

Evergreen Press.

Cline, F. W., and Fay, J. (1990). Parenting with Love and Logic.

Colorado Springs, CO:

Pinion Press.

Cournos, F. (2002). The trauma of profound childhood loss: A personal and professional perspective. Psychiatric Quarterly, 73 (2), 145-156.

Crittenden, P., and Ainsworth, M. D. S. (1989). Child maltreatment and attachment


theory. In D. Cicchetti and V. Carlson (Eds.) Child Maltreatment , pp. 432-463.

New York: Cambridge University Press.

Darwin, H. (1872). The expression of emotions in man and animals. London: John

Murray.

Delaney, R. J. (1991). Fostering changes: Treating attachment-disordered foster children . Fort Collins, CO: Walter J. Corbett Publishing.

Dozier, M., Higley, E., Albus, K. A. & Nutter, A. (2002). Intervening with foster infants’ caregivers: Targeting three critical needs Infant Menatl Health Journal , 23(5),

541-554.

Dozier, M., Stovall, K. C., & Albus, K. E. (1999). Attachment and psychopathology in adulthood. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 497–519). New York: Guilford Press.

Eagle, R. S. (1994). The separation experience of children in long-term care: Theory, research, and implications for practice. American Journal of Orthopsychiatry,

64 (3), 421-434.

Egeland, G. & Sroufe, L. A., (1981). Attachment and early maltreatment. Child

Development, 52, 44-52.

Egeland, L., Sroufe, A., & Erickson, M. (1983). The developmental consequence of different patterns of maltreatment. Child Abuse & Neglect, 7 (4), 459-469.

Fagin, C. M. (1966). The effects of maternal attendance during hospitalization on the post hospital behavior of young children : A comparative survey. Philadelphia: F.A.

Davis.

Fahlberg, V. I. (1991). A Child’s Journey through Placement.

Indianapolis, IN:

Perspectives Press.

Fanshel, D. (1992). Foster care as a two-tiered system Children and Youth Services

Review, 14, 39-60.

Fanshel, D. & Shinn, E. B. (1978). Children in foster care: A longitudinal investigation.

New York: Columbia Universtiy Press.

Feeney, J. A. (1999). Adult romantic attachment and couple relationships. In J. Cassidy

& P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 336–354). New York: Guilford Press.

Feeney, J. A. (2000). Implications of attachment style for patterns of health and illness.


Child: Care, Health & Development. 26 (4), 277-288.

Festinger, T. (1983).

No one ever asked us…A postscript to foster care . New York:

Columbia University Press.

Finzi, R., Ram, A., Shnit, D., Dov Har-Even, M., Tyano, S., & Weizman, A. (2001).

Depressive symptoms and suicidality in physically abused children. American

Journal of Orthopsychiatry, 71, 98–107.

Fish, B. & Chapman, B (2004). Mental health risks to infants and toddlers in foster care.

Clinical Social Work Journal, 32 (2), 121-140.

Freedman, J. & Combs, G. (1996). Narrative therapy: The social construction of preferred realities. New York: Norton.

Freud, S. (1917). Mourning and Melancholia. Standard Edition, 19, 12-66. London:

Hogarth Press.

Gerard, M. W. & Dukette, R. (1954). Techniques for preventing separation trauma in child placement. American Journal of Orthopsychiatry, 24 ,111-127.

Goodman, A. (2004). Children's reactions to loss: Common behavior patterns of the grieving process. Retrieved May 10, 2005 from http://www.nysccc.org/Video/HTMLversion/GriefLoss.htm

Gray, D. (2002). Attaching in Adoption: Practical Tools for Today’s Parents.

Indianapolis, IN: Perspectives Press.

Greenberg, M. T. (1999). Attachment and psychopathology in childhood.

In J. Cassidy &

P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 469–496). New York: Guilford Press.

Greenspan, S. I. & Lieberman, A. F. (1988) A clinical approach to attachment. In J.

Belsky and T. Nezworski (Eds.) Clinical Implications of Attachment , pp. 387-424.

Hillsdale, NJ: Lawrence Erlbaum.

Grossman, K. E. & Grossman, K. (1991). Attachment quality as an organizer of emotional and behavioral responses in a longitudinal perspective. In C. M. Parkes,

J. Stevenson-Hinde, & P. Marris (Eds. ), Attachment across the life cycle (pp. 93-

114).

Hallas, D. (2002). A model for successful foster child-foster parent relationships. Journal of Pediatric Health Care, 18 (3), 112-118.


Hazan, C. & Zeifman, D. (1999). Pair bonds as attachments: Evaluating the evidence. In

J. Cassidy & R. Shaver (Eds.), Handbook of Attachment: Theory, Research, and

Clinical Applications (pp. 337-354). New York: Guilford Press.

Heinicke, C. M. & Westheimer, I. (1966). Brief separations . Oxford, England:

International U. Press.

Holody, R., & Maher, S. (1996). Using lifebooks with children in family foster care: A here-and-now process model. Child Welfare. 75 (4), 321-335.

Hopkins, J. (2000). Overcoming a child’s resistance to late adoption: How one new attachment can facilitate another. Journal of Child Psychotherapy, 26 (3), 335-

347.

Hughes, D. A. (1997). Facilitating Developmental Attachment: The Road to emotional

Recovery and Behavioral Change in Foster and Adopted Children. North Bergen,

NJ: Book-mart Press.

Johnson, P. R., Yoken, C., & Voss, R. (1995). Family foster care placement: The child’s perspective. Child Welfare, 74, 959-974.

Kagan, R. (2004). Rebuilding attachments with traumatized children: Healing from losses, violence, abuse, and neglect . New York: Haworth Press.

Karen, R. (1994). Becoming attached: Unfolding the mystery of the infant-mother bond

and its impact on later life. New York NY: Warner Books.

Kenrick, J. (2000). Be a kid: the traumatic impact of repeated separations on children who are fostered and adopted. Journal of Child Psychotherapy 26 (3), 393-412.

Keck, G. H. & Kupecky, R. M. (2002). Parenting the hurt child: Helping adoptive families heal and grow. Colorado Springs, CO: Pinon.

Kerman, B., Wildfire, J., & Barth, R. P. (2002). Outcomes for young adults who experienced foster care. Children & Youth Services Review, 24 (5), 319-344.

Klaus, M. H. & Kennell, J. H. (1976). Maternal-infant bonding.

St. Louis, MO: C. V.

Mosby Company.

Kliman, G. (1996). The personal life history book: A psychoanalytically based intervention for foster children. Journal for the Psychoanalysis of Culture &

Society, 1 (2), 159-162.

Kobak, R. (1999). The emotional dynamics of disruptions in attachment relationships. in


J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 21-43). New York: Guilford Press.

Kubler-Ross, E. (1969). On death and dying . New York: Macmillan.

Ladnier, R. D. & Massanari, A. E. (2000). Treating ADHD as attachment deficit hyperactivity disorder. In T. M. Levy (Ed.), Handbook of Attachment

Interventions (pp. 27-66). San Diego, CA: Academic Press.

Lanyado, M. (2002). Creating transitions in the lives of children suffering from “multiple traumatic loss.” In L. Caldwell (Ed.)

The Elusive Child (pp. 93-112).

Leslie, L. K., Gordon, J. N., Ganger, W., & Gist, K. (2002). Developmental delay in young children in child welfare by initial placement type. Infant Mental Health

Journal, 23 (5), 469-516.

Levy, T. M. & Orlans, M. O. (1998). Attachment, Trauma, and Healing: Understanding and Treating Attachment Disorder in Children and Families. Washington, D.C.:

Child Welfare League of America Press.

Littner, N. (1956). Some traumatic effects of separation and placement.

New York: Child

Welfare League of America.

Lyons-Ruth, K. (1996). Attachment relationships among children with aggressive behavior problems: The role of disorganized early attachment patterns. Journal of

Consulting and Clinical Psychology, 64 (1) , 64-73.

Maccoby, E. E. & Feldman, S. S. Mother-attachment and stranger-reactions in the third year of life. Monographs of the Society for Research in Child Development, 37 (1)

86.

Main, M. (1996). Introduction to the special section on attachment and psychopathology:

Part 2: An overview. Journal of Consulting and Clinical Psychology, 64 (1) , 1-8.

Main, M. & Cassidy, J. (1988). Categories of response to reunion with the parent at age

6: Predictable from infant attachment classifications and stable over a 1-month period. Developmental Psychology, 24 (3), 415-426.

Mauk, G. W. & Sharpnack, J. D. (1999). Grief. In G. Mauk & J. D. Sharpnack (Eds.),

Children’s needs’ Development, problems, and alternatives. Bethesda, MD:

National Association of School Psychologists.

McAuley, C. (2000). Children's adjustment over time in foster care: Cross-informant agreement, stability and placement disruption. British Journal of Social Work,

30 (1), 91-107.


McFadden , E. J. (1992). The inner world of children and youth in care. Community

Alternatives: International Journal of Family Care, 4 (1), 1-17.

Moss, G. (2005). What is attachment? Retrieved May 10, 2005, from http://www.attach.org/whatisattachment.htm

Newton, R., Litrownik, A. J., & Landsverk, J. A. (2000). Children and youth in foster care: disentangling the relationship between problem behaviors and number of placements. Child Abuse & Neglect , 10, 1363-1374.

New York State Office of Children and Family Services. (2003). Quarterly Summary of

Characteristics of Children in Foster Care, June 2003 [Data file]. Available from

New York State Citizen’s Coalition. New York State Adoption and Foster Care

Data website: http://www.nysccc.org/statedata.htm

Paradek, J. T. (1984). Multiple placement of children in foster family care: An empirical analysis. Social Work , 29, 506-509.

Parkes, C. M. (1972). Bereavement: Studies of grief in adult life.

New York: International

Universities Press.

Pastor, D. (1981). The quality of mother-infant attachment and its relationship to toddler's initial sociability with peers. Developmental Psychology, 17, 326-335.

Pasztor, E. M. & Leighton, M. (1993). Homeworks: At-home training resources for foster parents and adoptive parents.

Washington, DC: Child Welfare League of

America.

Penzerro, R. M. & Lein, L. (1995). Burning their bridges: Disordered attachment and foster care discharge. Child Welfare , 74(2), 351-366.

Perry, B. & Azad, I. (1999). Post-traumatic stress disorder in children and adolescents.

Current Opinions in Pediatrics, 11 (14), 121-132.

Piaget, (2003). The language and thought of the child. In M. P. Munger (Ed.), The history of psychology: Fundamental questions.

(pp. 368-388). London: Oxford University

Press.

Pinderhughes, E.E., & Rosenberg, K. F. (1990). Family bonding with high risk placements: A therapy model that promotes the process of becoming a family.

Journal of Children in Contemporary Society, 21, 204-230.

Redding, R. E., Fried, C., & Britner, P. A. (2000). Predictors of placement outcomes in treatment foster care: Implications for foster parent selection and service delivery.

Journal of Child and Family Studies, 9 (4), 425-477.


Rosenfeld, A. A., Pilowsky, D. J., Fine, P., Thorpe, M., Fein, E., & Simms, et al. (1997).

Foster care: An update. Journal of the American Academy of Child and

Adolescent Psychiatry, 36 , 448–457.

Rosenstein, D. S., & Horowitz, H. A. (1996). Adolescent attachment and psychopathology.

Journal of Consulting & Clinical Psychology. 64 (2), 244-253.

Rudner, D. M., Alessandrini, E. A., Feudtner, C., Mandell, D. S., Localio, A. R., &

Hadley, T. (2004). Placement stability and mental health costs for children in foster care. Pediatrics, 113 (5), 1336-1341.

Rutter, M. (1981). Stress, coping and development: Some issues and some questions.

Journal of Child Psychology and Psychiatry , 22, 323-356.

Rycus, J. S. & Hughes, R. C. (1998). Field Guide to Child Welfare . Washington, DC:

Child Welfare League of America Publications. Electronic version available from http://www.cbasedsolutions.com/FieldGuideWeb/FieldGuide.htm

Schlieffer, R. & Muller, S. (2004). Attachment representations of adolescents in institutional care. International Journal of Child & family Welfare, 2004 (1), 60-

77.

Schore, A. N. (2001). The effects of early relational trauma on right brain development, a affect regulation, and infant mental health. Infant Mental Health Journal , 22, 201-

269.

Siegel, D. J. (2001). Toward a interpersonal neurobiology of the develoing mind:

Attachment relathioships, “mindsight,” and neural integration.

Infant Mental

Health Journal , 22, 67-94.

Sprang, G. Clark, J., Kaak, O., & Brenzel, A. (2004). Developing and tailoring mental health technologies for child welfare: The Comprehensive Assessment and

Training Services (CATS) project. American Journal of Orthopsychiatry, 74 (3),

325-336.

Sroufe,. L. A.; Egeland, B., & Kreutzer, T. (1990). The fate of early experience following developmental change: Longitudinal approaches to individual adaptation in childhood. Child Development , 61 (5),1363-1373.

Steward, D. S. & O’Day, K. R. (2000). Permanency planning and attachment: A guide for agency practice. In T. M. Levy (Ed.), Handbook of attachment intervention

(pp. 150-167). San Diego, CA: Academic Press.

Stovall, K. C., & Dozier, M. (1998). Infants in foster care: An attachment theory perspective. Adoption Quarterly , 2(1), 55-88.


Taussig, H.N. (2002). Risk behaviors in maltreated youth placed in foster care: A longitudinal study of protective and vulnerability factors. Child Abuse Neglect,

26 (11), 1179–1199.

Taussig, H. N & Talmi, A. (2001). Ethnic differences in risk behaviors and related psychosocial variables among a cohort of maltreated adolescents in foster care.

Child Maltreatment: Journal of the American Professional Society on the Abuse of Children, 6 (2), 180-192.

Temple-Plotz, L., Stricklett, T. P., Baker, C. B., & Sterba, M. N. (1998). Practical tools for foster parents.

Boys Town, NE: Boys Town Press.

Terr, L. C. (1991). Childhood traumas: An outline and overview.

American Journal of

Psychiatry, 148 (1), 10-20.

Thomas, N. (1997). When Love is Not Enough: A Guide to Parenting with Reactive

Attachment Disorder-RAD . Glenwood Springs, CO: Families by Design.

Toth, S. L. & Cicchetti, D. (1996). Patterns of relatedness, depressive symptomatology, and perceived competence in maltreated children. Journal of Consulting and

Clinical Psychology 64(1), 32-41.

Trause , M. A. (1981).

Separation for childbirth: The effect on the sibling.

Child

Psychiatry & Human Development, 12 (1), 32-39.

Troutman, B., Ryan, S. & Cardi, M. (2000). The effects of foster care placement on young children’s mental health.

Protecting Children , 16(1), 30-34.

Urban, J., Carlson, E., Egeland, B., & Sroufe, L. A., (1991). Patterns of individual adaptation across childhood. Development and psychopathology, 4, 97-112.

U.S. Department of Health and Human Services (2002), Administration for Children,

Youth and Families, Child Maltreatment, 2000. Washington, DC: U.S.

Government Printing Office (available at http://www.acf.hhs.gov/programs/cb/publications/cm00/index.htm ).

U.S. Department of Health and Human Services. (2004). The AFCARS Report:

Preliminary FY 2002 Estimates as of August 2004 (9) [online]. Retrieved May 25,

2005, from the U.S. Department of Health and Human Services, Administration for Children & Families Data and Information Systems website: http://www.acf.hhs.gov/programs/cb

Van IJzendoorn, M. H. & Bakemans-Kranenburg, M. J. (1996). Attachment representations in mothers, fathers, adolescents, and clinical groups: A metaanalytic search for normative data. Journal of Consulting and Clinical

Psychology, 64 (1) , 8-21.


Waddell, D. & Thomas, A. (1998). Disaster: Helping children cope . Bethesda, MD:

National Association of School Psychologists. Retrieved May 25, 2005 from http://www.naspcenter.org

Ward, S. (n.d.). What should you look for in an attachment therapist? Retrieved June 21,

2005 from: http://library.adoption.com

Webster, L. (1999). Considerations for the school psychologist when providing services for maltreated foster children: a developmental perspective. The California School

Psychologist, 4 , 5-17.

Weinfield, N. S., Ogawa, J. R., & Sroufe, L. A. (1997). Early attachment as a pathway to adolescent peer competence. Journal of Research on Adolescence, 36, 637-644.

White, M. & Epston, D. (1990). Narrative means to therapeutic ends, New York: Norton.

Wulczyn, F., & Brunner, K. (2000). Infants and toddlers in foster care. Protecting

Children , 16 (1), 4-11.


Attachment Disorder Checklist

A professional assessment is necessary to determine whether or not a child has an

Attachment disorder. This check list can help you identify areas of potential problem.

This check list is not meant to substitute for a professional assessment and treatment plan.

A child who exhibits several of the following signs and symptoms should be evaluated by a licensed therapist:

Place a check next to items that are frequently or often true.



Thrives on power struggles and are compelled to win them

 Feels empowered by repeatedly saying, “No!”



Causes emotional, and at times, physical pain to others



Strongly maintains a negative self-concept; low self-esteem



Very limited ability to regulate displays of emotion



Avoids mutual fun, engagement, and laughter



Avoids needing anyone and asking for help or favors



Avoids being praised



Avoids being loved and feeling special



Feels deeply shameful, with feelings of shame leading to outbursts of rage



Chronic and intense lying, even when caught in the act



Poor response to discipline: aggressive and defiant behavior



Lacks eye contact



Physical contact: wants too much or too little



Interactions lack mutual enjoyment; anxiety during experiences of mutual enjoyment and affection



Disturbances in body functioning (eating, sleeping, urinating, defecating)



Increased attachment produces discomfort and resistance



Indiscriminately friendly and charming; easily replaces relationships; uses charm to get his/her way




Indiscriminately affectionate with strangers



Poor communication: nonsense questions and chatter



Difficulty learning cause-and-effect, poor planning and/or problem solving



Lack of empathy for others; little evidence of guilt or remorse



Able to see only extremes; things are either all good or all bad



Hypervigilance or habitual dissociation (spacey)



Pervasive shame, with difficulty reestablishing a bond following conflict



Inappropriately demanding and clingy



An intense, compulsive need to control all situations, especially the feelings and behaviors of their caregivers, teachers, and other children



Poor peer relationships



Difficulty learning from mistakes



Poor impulse control



Abnormal speech patterns



Stealing



Destructive to self, others, property



Cruel to animals

 Preoccupied with “evil” (fire, blood, and gore)



Behavior focused only on immediate goals


- Center for Development of Human Services

Reducing Separation Trauma:

A Resource Manual for Foster Parents, Social

Workers, and Community Members who Care for

Children and Youth

Contents

Chapter 1: Introduction

Chapter 2: Attachment

The Importance of Attachment

Attachment Development

Styles of Attachment

Attachment and Developmental Problems

Attachment Disorder

Attachment and Foster Children

Effects of Neglect and Maltreatment

Promoting Trust and Attachment

Chapter 3: Normal Child Development and Implications for Separation and

Placement

Chapter 4: Children’s Reactions to Separation and Placement

Factors that Influence Reactions to Separation

The Traumatic Impact of Multiple Separations

Emotional Responses to Separation

Behavioral Responses to Separation

Chapter 5: Grief as a Reaction to Separation and Placement

Chapter 6: Fostering Attachment and Resiliency: Supporting Children and

Youth through Transition and Minimizing the Trauma of Separation

Creating Successful Transitions

Supporting Children throughout the Placement Process

Building a Relationship with the Child

Other Factors that Reduce Separation Trauma

Creating a Lifebook

Handling a Child’s Departure from the Caregiving Home

Caregiver Self-Care

Chapter 7: Resources

Internet Resources

Books for Adults

Book for Children

Games to Promote Communication

Therapists and Mental Health Resources

References

Appendix: Attachment Disorder Checklist

Related documents

Add this document to collection(s)

Add this document to saved

Suggest us how to improve StudyLib