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Meeting the needs of Meeting the needs of foster children within the foster children within the EI SystemEI System
IECC ConferenceTacoma, WA—5/03/12
Julie Fisher, MSW, LICSW
Jill Reece, MSW, LSWAIC
Marnie Klaasen, Foster Parent
Kindering—Bellevue, WA
Questions guiding our Questions guiding our discussiondiscussion
Why foster children and EI?How to qualify foster children for
EI services?When to assess foster children
for services?Who is involved when you are
working with foster children?What is Infant Mental Health?
Where does it happen?
““Children who are removed Children who are removed from their homes and placed from their homes and placed into foster care due to abuse, into foster care due to abuse, neglect or abandonment, neglect or abandonment, almost by definition have almost by definition have special needs.”special needs.”
State Early Childhood Policy Technical State Early Childhood Policy Technical
Assistance NetworkAssistance NetworkJune 2003June 2003
Risk FactorsRisk FactorsNeglectPre or Post-natal Substance AbuseEarly losses/Multiple CaregiversDomestic Violence ExposurePhysical or Sexual abusePrenatal RejectionChild HospitalizationChronic IllnessCaregiver’s Mental IllnessFamily Members Incarcerated
Developmental ConsiderationsDevelopmental ConsiderationsIDEA & CAPTAIDEA & CAPTA
Part C (ages 0-3) of the Individuals with Disabilities Education Act (IDEA) was established by the federal government in 1986.
The Child Abuse & Prevention Treatment Act (CAPTA) of 2003 requires that infants and toddlers involved in substantiated cases of maltreatment be referred to EI services.
Foster children under age three experience developmental days at TEN times the rate found in the general population (NCCP, Sept. 2010)
Medical considerations & Perinatal Medical considerations & Perinatal InsultsInsults
Almost 80% of young foster children have prenatal exposure to substance abuse
More than 40% are born prematurely or at low birth weight, two additional risk factors
Over 50% suffer from physical health problems
--Columbia University’s National Center for
Children in Poverty
WA State Maltreatment WA State Maltreatment Statistics (from 2007) Statistics (from 2007)
10,000 children in foster care
1/3 of these children placed with relatives (in formal kinship arrangements)
42,300 referred to CPS
How to Qualify Kids?How to Qualify Kids?Breakdown by domains
◦Speech Receptive—particularly with infants, social
communication lacking Expressive—lack of opportunity/speech not
encouraged
◦Adaptive—feeding, sleeping, sensory issues, medical issues
◦Motor—hypertonic with drug exposure; delayed due to too much confinement
◦Social/Emotional—Behaviors; use of DECA-I/T & DECA-C as well as ICO
Importance of timingImportance of timingSchedule as soon as possible
after child comes into foster care—we have evaluation spots dedicated to foster children, as well as a dedicated FRC
Relationships with CHET screeners—CHET has to be out to the foster home within 30 days of the foster child coming into care
Who are the players?Who are the players?Foster Parent or Relative CaregiverBirth ParentChildren’s Administration Social
WorkerBirth Siblings--may be in a different
foster homeVisit SupervisorCASA/VGAL
Tips for Early Intervention staff Tips for Early Intervention staff regarding the Foster Care Systemregarding the Foster Care System
•What to call the foster child?•What to call the foster parents?•Who has legal rights?•Myths about foster parents•Differences between foster parents and kinship caregivers
What is CHERISH?What is CHERISH?CHildren Encouraged by Relationships
In Secure HomesCHERISH provides reparative and
preventative interventions for foster children and caregivers that address their traumatic experiences and developmental impacts.
Foster Children ages 0-3 living in King County, WA in out-of-home care are eligible for the CHERISH program
CHERISH Services for KidsCHERISH Services for KidsComprehensive developmental evaluationPsychosocial assessment in the home◦ Early history (risk factors)◦ Historical and current symptoms◦ Direct observation of relationship patternsDevelopmental therapies if there is a delayStepping Stones toddler preschool classesDyadic developmental psychotherapy (home visiting model)◦ Adjustment issues (i.e. infant temperament/caregiver fit,
grief & loss, transitions)◦ Bonding (forming an attachment)◦ Attunement (accurately reading and responding to the
social-emotional cues of another)◦ Trauma◦ Psychoeducation
CHERISH Support ServicesCHERISH Support Services“If we value our children, we must cherish their parents.”“If we value our children, we must cherish their parents.” - John - John Bowlby, MDBowlby, MD
Brief therapy for foster & relative caregivers
Systems consultation for staff and caregivers
Mamas & Papas kinship support group for relative caregivers (collaboration with Youth Eastside Services)
Topical trainings around parenting and children with special needs
Foster Parent SupportFoster Parent SupportAccording to researchers at the Oregon
Social Learning Center, supporting foster parents and helping them manage their stress are the biggest keys to placement preservation… (Healey presentation, 3/5/11)
“The interventions that have provided the most robust evidence of effectiveness…have typically focused on providing services to support the caregiver-child relationship (Dozier, et al., 2002; Fisher et al, 2006).”
CHERISH Program CHERISH Program OutcomesOutcomesChild & Caregiver well-being:
◦PIR-GAS Scores (part of DC: 0-3R)◦DECA-I/T Scores◦Parent satisfaction surveys
Placement preservation:◦In their first 12 months of care,
98.3% of our clients had 1-2 placements
◦The federal practice standard is 86.7%; King County stat is 66.6%
What is Infant Mental What is Infant Mental Health?Health?
Infant Mental Health (age 0-3) is the capacity of the child to experience, regulate, and express emotions; form close and secure interpersonal relationships; and explore the environment and learn.
IMH is synonymous with healthy social and emotional development.
- Zero to Three
What is Attachment?What is Attachment?The basic concept is that every infant needs at least one close, dependable relationship providing nurturance, security, responsive interaction and encouragement of exploration to develop to their fullest potential.
Attachment is a biologically-based process.
“Relationships with intimate caregivers promote physical, emotional, and behavioral regulation in infants through repeated interactions that are predictable, responsive, and nurturing.”
Zero to Three, July 2005
Attachment PatternsAttachment PatternsSECURE
INSECURE◦Avoidant: characterized by high
degrees of dissociation and withdrawal
◦Ambivalent: characterized by a persistent highly aroused, vigilant state
◦Disorganized: characterized by role-reversal with caregiver
Juvenile & Family Court Journal, 2004
When a Secure Attachment When a Secure Attachment is formed…is formed… Studies of resiliency have consistently found
that the most basic and important protective factor is the history of caregiver-child attachment.
Secure attachments are a primary defense against the development of severe psychopathology associated with adversity and trauma. In children who have been exposed to early loss and stress, the quality of parent-child attachment is the most important determinant of long-term damage. Even when securely attached children deteriorate in the school years due to extreme adversity, they are more likely to rebound later.”
Levy & Orlans, 1998
Neurobiology of Neurobiology of TraumaTrauma
Fight, flight, freeze alarm reactions to acute stress or danger is instinctive and normal
HOWEVER, traumatic experiences in infancy & early childhood can trigger prolonged alarm reactions which alter the neurobiology of the brain and the central nervous system
“Your brain will become the kind of brain you need.” --Stirling, MD 3/27/07
Symptoms of Maltreatment Symptoms of Maltreatment Developmental delays/skill regressionEating patterns—food refusal, stuffing mouth, hoarding, no knowledge of “full”Sleep issues (separation problems, falling asleep/waking up, night terrors)Self-soothing behaviorsEmotional functioning—incessant crying or not crying when should; refusal to make eye contact; dislike of touch; serious affect; clingy behaviorsAggression/IrritabilityHypervigilance & PanicDecreased exploration/play
Parenting Interventions—it Parenting Interventions—it all starts with building a all starts with building a secure attachment…secure attachment…Consistency, predictability, reliabilityParenting based on emotional age;
expect regression & ENCOURAGE it Understand reasons behind
behaviorsModeling, narrationPatience—repetition is the name of
the gameRepairs & Re-do’sSelf-care—caregiver HAS to attend
to own self-regulation
Reflective PracticeReflective Practice
“Kiss me when I’m bad, that’s when I need it the most.”
--Maura Stuard, age 9
Books for Foster & Adopted Books for Foster & Adopted ChildrenChildren
Kids Need to Be Safe by J. Nelson
The Way I Feel by J. Cain
Maybe Days by J. Wilgocki & M. Wright
Hug by Jez Alborough
Families Change: A Book for Children Experiencing Termination of Parental Rights by J. Nelson
My Many Colored Days by Dr. Seuss
Calm-Down Time by Elizabeth Verdick
Website ResourcesWebsite Resourceswww.talaris.org
www.adoptmed.org
www.abcintervention.com
www.nccp.org
www.circleofsecurity.org
www.zerotothree.org
www.childtrauma.org
www.cpeip.fsu.edu
Selected ReferencesSelected References
Gray, Deborah. 2007. Nurturing Adoptions: Creating Resilience After Neglect and Trauma. Perspectives Press.
Hopkins-Best, Mary. 1997. Toddler Adoption: The Weaver’s Craft. Perspectives Press.
Jones-Harden, Brenda. 2007. Infants in the Child Welfare System: A Developmental Framework for Policy & Practice. Zero to Three Press.
Levine, P.A. & Kline, M. 2007. Trauma Through A Child’s Eyes. North Atlantic Books.
Levy, T. & Orlans, M. 1998. Attachment, Trauma, & Healing. CWLA Press.
Siegel, D. & Hartzell, M. 2003. Parenting From the Inside Out. Tarcher/Penguin.