Moving Children from Home to Home: How to Reduce Emotional Harm & Long Term Developmental Damage

Children’s Administration Supervisor’s ConferenceTacoma, WashingtonJuly 14, 2015Dee Wilson

Child welfare systems operate large foster care programs that involve multiple types of moves:

• Involuntary child removals• Voluntary placements• Changes in foster homes for administrative reasons• Placement disruptions• Planned changes in foster homes• Step downs from residential care to foster care• Foster home to adoptive home• Re-entry into care

It’s a safe bet that most experienced caseworkers and supervisors have occasionally asked themselves whether foster care does more harm than good, in part because children frequently have to endure so many potentially painful and damaging moves.

It has always been common to refer to the trauma of involuntary and emergency child removals; it’s not difficult to imagine how frightening it would be for strangers to appear at a family’s door and a few minutes later – after a disturbing scene – leave with one or more of the family’s children.

During the past few years, it has become common to conflate trauma, grief and adversity in general, especially in discussions of the Adverse Childhood Experiences (ACE) studies. However, there are lots of adversities that have negative effects on children that are not necessarily traumatic.

Many placement disruptions carry a strong message of rejection but may not be traumatic. Vera Fahlberg comments that trauma is likely when children are suddenly removed from caregivers with whom they have a strong positive emotional connection. However, children may not be attached to or emotionally connected with caregivers for various reasons.

Trauma and grief often result from a single terrifying event or be associated with a pattern of events, incidents, etc. One of the characteristics of trauma is feeling stuck, terrified and powerless at the same time; while grief, though painful, is potentially a healing process.

Trauma and Grief

Ideally, caregivers and professionals want to prevent trauma, reduce trauma and help victims recover from trauma, but when human beings experience losses of people they love, grief is both inevitable and necessary.

Separation and Loss

According to Vera Fahlberg, “separation involves fear which needs to be mastered and … loss involves grief which needs to be expressed.”

Children who have experienced losses need to be given permission to express their feelings. According to Fahlberg, “When children have strong feelings, they cry, scream or act out their anger.” Expression of children’s grief is not a pretty process.

The Cost of Easy Moves

“The easier it is to get a child out of a family – meaning that neither the child nor parent protests much – the more difficult it will be either to return the child to the home or help her/him develop close trusting relationships with adults elsewhere.”

Children, like adults, can become stuck in a grieving process, and when children “stuff” their emotions, it can be difficult to figure out what’s going on with the child.

Considering Alternative Hypotheses

Five year old Troy was removed from his birth mother three months ago after being beaten by his mother’s boyfriend; Troy was moved from a receiving home to a foster home two weeks after his removal from his mother’s home. Troy reacted to both moves with little or no emotion and has not responded to the caseworker’s attempts to talk with him about his feelings. Troy’s mother went to jail soon after her son’s placement and then disappeared after her release. Troy has not visited his mother since his entry into care.

Considering Alternative Hypotheses

The foster mother reports that Troy has a disconcerting way of sitting and staring off into space for long periods of time. He spends lots of time in his room sleeping or playing with toys. He does not like to be held and rarely make eye contact with adults. The foster mother believes Troy has an attachment disorder. What is alternative explanation of Troy’s behavior?

Considering Alternative Hypotheses

Four year old Rena was removed from her substance abusing mother six months ago due to neglect and possible sex abuse by the mother’s boyfriend. Rena’s mother recently died as a result of a drug overdose. Rena has begun to poke her arms with sharp objects and pick at the wounds. Rena’s caseworker and therapist think that Rena’s self-mutilation is a symptom of PTSD resulting from chronic neglect and sex abuse. What is an alternative hypothesis?

Considering Alternative Hypotheses

Two year old Justin was abandoned at birth by his mentally ill mother. He lived with his first set of foster parents for 18 months during which time he appeared to develop normally. At 18 months, Justin was placed with relatives in another part of the state but the placement failed after two months due to a serious illness of one of the caregivers. Justin is then moved to a pre adopt home. By the time of the most recent move, Justin was displaying severe developmental delays in language development and motor skills; however he made rapid developmental progress after enrollment in a therapeutic child care program.

Considering Alternative Hypotheses

Justin’s first foster family has asked that he be returned to them. The pre-adopt family’s attorney argued that Justin’s developmental problems indicated that he was poorly cared for in his first foster home. What is an alternative explanation?

Magical Thinking

According to Fahlberg, “a major part of helping to facilitate the grieving process is identifying the child’s magical thinking both about what may have led to a placement and about what behaviors on her/his part might lead to the outcome the child desires.”

Both grief and trauma are exacerbated by the abruptness of separations, that is by sudden unexpected losses. Involuntary emergency placements of children should be kept to a bare minimum.

Bowlby describes three stages of grief when well attached children are removed from caregivers:

• Protest• Despair• Detachment

Fahlberg asserts that from about age 4 children’s grieving process follows Kubler- Ross’ stages of grief:

• Shock (numbness)• Denial• Anger• Bargaining• Sadness/despair• Acceptance

How children perceive the reasons for separation and loss is important:

• When a child is removed from a caregiver’s home suddenly with little explanation, the child may feel that she/he was kidnapped.

• When a caregiver seems to cooperate with the placement, the child may believe she/he was given away due to some fault of their own.

• Some children may believe that she/he caused the move to happen based on magical thinking, or because the child told someone outside the family about being abused or neglected.

Children Need Information

Verbal children need to be given clear simple explanations regarding why they are being placed apart from their parents or moved from one home to another, and given assurances that adults care for them and are looking out for their welfare.

When Should Visits Begin?

Fahlberg’s rule is “the younger the child the more quickly visits need to begin following separation from caregivers.”

Trauma and Control

Children placed out of the home have often been traumatized by parental abuse and/or severe neglect, and may have been further traumatized by a sudden unexpected separation from parents. One way to help traumatized children feel safe and more in control of their lives is to give them choices whenever possible.

There is a difference between a child’s time limited expression of grief and an ongoing susceptibility to “meltdowns” resulting from early trauma and the inability to calm down. Foster parents and adoptive parents need to receive training in how to help children calm themselves.

Minimizing Losses

Caseworkers, guardian ad litems and helping professionals should think about how to minimize losses when children are placed out of the home: pets, toys, siblings, extended family members, friends neighborhoods, schools. What parts of the child’s life can be maintained?

Missing Parents is OK

Children need permission to care about and talk about those they have lost. Display of pictures of parents and siblings can be a way of making this permission obvious.

Loss of Foster Parents

Children who are attached to foster parents may have a strong feeling of loss when they return to the parent’s home or are moved to an adoptive home. Their emotional reaction to separation from foster parents may be as powerful as separation from birth parents.

The Quality of Foster Care

The quality of care following a loss is of great importance. Removing children from abusive and neglectful birth parents and then placing them with non-nurturing foster parents or relatives who use harsh punishment to control child behavior is a way of convincing children that there is no hope.

The National Study of Child and Adolescent Well Being (NSCAW) found that 6%-20% of children in foster care were receiving care that was highly punitive and low in responsiveness. Another study based on NSCAW data found that about one-fifth of foster children had not achieved stability in placement for at least nine continuous months during the first 18 months of out-of-home placement.

Attachment to Foster Parents

Mary Dozier’s research has found that young children’s capacity to form positive secure attachments with caregivers can be restored in a few weeks to a few months depending on the foster parent’s attitude and “state of mind”.

Nevertheless, the National Study of Child and Adolescent Well Being (NSCAW) has raised concerns regarding the effects of foster care on infants and toddlers. Foster care outcomes are compromised when very young children are moved from home to home and/or placed in overcrowded homes.

Placement Moves vs. Placement Disruptions

One important study of children exposed to opiates in utero found that infants were developmentally effected by every move. On the other hand, some studies of school age children have found that planned moves have minimal negative effects, but that placement disruptions have powerful effects on behavior.

Conduct Disordered Children

An Australian foster care study that found positive developmental effects for most children in foster care also found that conduct disordered children were “wretched in care” and “effectively homeless”.

Past Practices?

It was once common in Washington State to move children from foster home to foster home abruptly, with little or no preparation and with all the child’s possessions in garbage bags. Hopefully, these practices have changed. Nevertheless, it is easy for caseworkers who move children from home to home on a regular basis to become desensitized to the effects of these moves.

Placement instability can be reduced with better preparation and support of foster parents, especially foster parents caring for behaviorally troubled school age children and youth. These supports should include periodic respite care, timely mental health consultation, enhanced staffing levels, mentoring for new foster parents and training in trauma informed care. These supports need to be provided before a crisis occurs.

Drawing the Line

Foster parents who expel children from their homes without notice or discussion should not be used again for behaviorally troubled children.

Sticking with Transition Plans

Moves from foster homes to the homes of birth parents and from foster homes to adoptive homes should be carefully planned. It is common for all parties to become impatient with a lengthy transition from home to home; nevertheless, moves should be gradual and done in stages whenever possible.

In summary, the negative effects of moves (both immediate emotional pain and developmental harm) can be reduced when:

• Moves are expected, planned and gradual. • Children are given age appropriate information and

explanations of what is happening and what is planned.• Children are encouraged to express their negative

feelings regarding losses.• Children are allowed to bring toys, pets, pictures, etc. to

foster homes or adoptive homes.• Changes in schools and neighborhoods are avoided when

possible.

In summary, the negative effects of moves (both immediate emotional pain and developmental harm) can be reduced when:

• Children are given some degree of control.• Following removal from birth parents, visits are arranged

as quickly as possible. • Caregivers work together to minimize children’s conflicts

of loyalty and transfer attachments from one caregiver to another.

• Children receive nurturing responsive care following moves.