Fostering Hope by Bridging the Gap


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Helping parents find a new approach to dealing with difficult behaviors

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  • When, for example, the young child hears about one boy who broke 15 cups trying to help his mother and another boy who broke only one cup trying to steal cookies, the young child thinks that the first boy did worse. The child primarily considers the amount of damage--the consequences--whereas the older child is more likely to judge wrongness in terms of the motives underlying the act (Piaget, 1932, p. 137)
  • Ages 10, 13. and 16, Later added younger children, delinquents, and boys and girls from other US cities and from other countries Heinz Steals the Drug In Europe, a woman was near death from a special kind of cancer. There was one drug that the doctors thought might save her. It was a form of radium that a druggist in the same town had recently discovered. The drug was expensive to make, but the druggist was charging ten times what the drug cost him to make. He paid $200 for the radium and charged $2,000 for a small dose of the drug. The sick woman's husband, Heinz, went to everyone he knew to borrow the money, but he could only get together about $ 1,000 which is half of what it cost. He told the druggist that his wife was dying and asked him to sell it cheaper or let him pay later. But the druggist said: "No, I discovered the drug and I'm going to make money from it." So Heinz got desperate and broke into the man's store to steal the drug-for his wife. Should the husband have done that? (Kohlberg, 1963, p. 19)
  • Stage 5 never becomes very prevalent If Kohlberg is right about the hierarchic nature of his stages, we would expect that people would still be able to understand earlier stages but consider them inferior, In fact, when Rest (Rest et al., 1969; Rest, 1973) presented adolescents with arguments from different stages, this is what he found. They understood lower-stage reasoning, but they disliked it. What they preferred was the highest stage they heard, whether they fully understood it or not. This finding suggests, perhaps, that they had some intuitive sense of the greater adequacy of the higher stages.
  • While someone with these minimal qualifications can of course be a good foster parent, they do not ascertain that a person is ready for a child with trauma A traumatized child is very difficult to deal with, particularly when expectations go beyond providing basic needs for the child
  • Elicit expectations from audience: Maybe: A hurt, uncared for, deprived, and vulnerable child would walk into your house and realize that you were someone good, someone safe, and that your house was a peaceful place, where s/he could finally be happy, and build long-lasting relationships That this child would be grateful for what you have provided And maybe even love you some day
  • Audience, what they really experience 80% of children from high risk families (suffering from poverty, maltreatment, substance abuse, violence) develop severely compromised attachments 75% of foster children have a family history of mental illness or substance abuse. Over 80% of foster children have serious emotional and behavioral problems. 50% of foster children have cognitive and learning disabilities The youngest age group (0-3 yrs) are victimized most frequently.  Interestingly: Substance abuse and the drug culture account for the majority of young children placed in foster care (Simms, 1991). Many children in foster care have experienced sexual abuse at some point in their lives. 
  • Audience, what they really experience 80% of children from high risk families (suffering from poverty, maltreatment, substance abuse, violence) develop severely compromised attachments 75% of foster children have a family history of mental illness or substance abuse. Over 80% of foster children have serious emotional and behavioral problems. 50% of foster children have cognitive and learning disabilities The youngest age group (0-3 yrs) are victimized most frequently.  Interestingly: Substance abuse and the drug culture account for the majority of young children placed in foster care (Simms, 1991). Many children in foster care have experienced sexual abuse at some point in their lives. 
  • Hypervigilance Sleep Disturbance Inattention Hyperactivity Eating habits Self-Injurious Behaviors Impulsivity
  • Particularly difficult to deal with Aggressive behavior Lack of concern for others Playing with, eating, smearing feces Inability to seek assistance from others
  • So, with children who are aggressive, have little regard for other, cannot pay attention, and smear feces, you are supposed to : Create a therapeutic environment, be a healthy role model, not loose your cool, be predictable and nurturing, not get flustered or surprised in the process
  • Most surprising feelings: Resentment Disgust Helpless Relief when the child left Foster parents often berate themselves for having normal reactions to strange behaviors
  • Child Abuse trauma leads to feelings of powerlessness, shame and guilt, distrust, and often leads to a reenacting of abusive patterns in current relationships. The abuse is the one thing the child can count on. S/he knows what it takes to elicit it. But kindness was often followed by abuse. The state between unpleasure and pain. Karen: Abused, sexually, physically Very seductive, telling people she wanted to have sex, have a baby Feared rejection Did everything the foster family said they had difficulty tolerating Bio family very sadistic, her behavior never doing homework never studying engaging in sexual behavior in problematic places This all pulled for sarcasm, anger, frustration, low tolerance and patience
  • recognize the limits of their emotional attachment to the child Understand the mixed feelings toward child understand mixed feelings toward the child's birth parents deal with the complex needs (emotional, physical, etc.) of children in their care Work with sponsoring social agencies dealing with the child's emotions and behavior following visits with birth parents Wanting to be loved and not getting it
  • Foster children are typically very high needs They get everyone’s attention one way or another Aggression Sexual Other children want attention but there is little time for them because they are well-behaved If you do not give the foster child what s/he wants, s/he will up the ante, increasing severity of behavior until you do (or after you have set consistent, firm limits for a while) B/c some children are healthier, stronger, more capable, more is expected of them than those with lesser abilities You would not expect someone with less intelligence to make honor roll You would not expect someone disabled to run a marathon Thus they get privileges sooner which may feel “unfair”, confusing, and make you feel like a bad parent
  • There are many different approaches, but what we have found most helpful is a comprehensive approach , which provides information which is as useful to the consumer as it is to the provider. Thus, having a clear and accurate picture of what is actually happening, why, and how you can address it from a variety of angles is important. I will address the difficulties with having inaccurate or unclear information later, as well as the importance of a team approach and support.
  • You may only need some addressed, but usually there is an interaction effect. That is, a person is more than just one component. Thus, his emotional life will impact his academic life and access to cognitive potential, and vice versa.
  • Those working with foster children/traumatized children benefit from not only knowing what the problem behaviors are, but why they are happening and what to do about it. The problem with difficult behavior due to a form of trauma is that people are likely to respond in the very way the perpetrator did Angry Frustration Being overly strict or permissive Feeling guilty The same behaviors can occur for different reasons, thus, knowing the reason helps to find the solution. There is a difference in being permissive b/c a child is conduct disordered and wants others to give up trying to limit him vs someone who gets others to give up and be permissive b/c he is masochistic and depressed
  • Self-report measures are just that, a self-report. That means: biased if the person thinks s/he is depressed or has trouble with attention they can respond as such and look ADHD While this is useful in terms of understanding his/her subjective experience, it does not necessarily indicate the underlying cause example of self-report making everyone think Monique is ADHD and medicating her as such Objective : Questions that are answered Yes/No but the test is able to tell: when a person is truthful or not When a person is exaggerating and for what purpose Thus the results are able to accurately assist with diagnosis Projective : These are the most difficult for people to Fake b/c there is no right answer understand
  • History: often not known of foster children due to moves, not everything is reported or accessible, and often bio parents were not the type to keep track of developmental milestones or have reasonable expectations of what is “normal” Family standards: often very surprising to see foster children and how they learned to behave Losses and Traumas ( unexpected events that occur as the child develops) and when they occurred in a person’s life are important to know about. A child who is 3 and loses a parent is very different from someone who first loses a parent at 15 or 25.
  • Interactions : The child’s interaction with their parents and family members begins to frame their expectations for others around them Hostile home life leads to expecting the same The foster parent being different does not immediately change expectations Birth order : Oldest tends to be more responsible, caretaker Youngest tends to take on “baby” role, most permissive Social Interactions : Conflict : Learn how to deal with conflict from others
  • Psychosocial – Deficits or disorders in the psychological or family development Trauma, Abuse, Neglect Lack of developmental milestones due to various areas of difficulty that the entire family faced together Psychological problems that would occur even in the “perfect” family environment due to temperament
  • The child’s expression of their own temperament and ways of interacting with the world The child’s repetitive patterns of behavior and why the do the same patterns The child’s capabilities of expressing their needs, or lack thereof, depending on their current level of sophistication The child’s neurology, genetics, and biochemistry and the interplay with the real world Behavioral disorders/disabilities Behavioral treatment plan needs
  • The child’s development and areas of struggle We all struggle to develop, and it wasn’t easy for any of us – no one gave us a choice in the matter The child’s individual temperamental preferences for various phases The child’s internal biochemistry and how it affects their interactions with others and how they respond to their own pain or pleasure The awareness of how many of these skills do not occur “as planned” even in the best of circumstances – otherwise known as “decalage.” When that occurs, even if a child is “advanced” in some area, they have a hard time with areas that fall behind Emotional disorders/disabilities
  • Memory, Speed of processing, Capacity for different kinds of thoughts, Attention, Learning, Verbal and Nonverbal Abilities Executive Functioning How the brain works together to integrate various parts and execute responses that are good and adaptive How a person approaches a decision Areas of strength and weakness for intelligence and compensation/skill building How the deficits interplay with reality-based situations What parents can reasonably expect from their child and what are realistic goals What teachers can expect in performance Cognitive disorders/disabilities
  • If all of that was done, you should have an accurate diagnosis Diagnosis: Can change over time due to resolving conflict or conflict becoming more ingrained Retesting: After a year or two of therapy and treatment Or, after the 3 rd grade Medication complications: Same issue of attentional difficult might mean different things Most common misdiagnosis right now is ADHD
  • Stimulants: Can also help with depression Even helps those w/o ADHD Problematic for those with bipolar in family history Antidepressants: Problematic for those with a family history of Bipolar or those with agitated mood states Antipsychotics: Used for sleep and thinking or mood issues Mood stabilizers: Also used for seizure control and certain types of depression, particularly if the child has an anxious depression Difficulties: Social stigma When the bio family fights services: meds & therapy, foster parents are often in a difficult position Team disagreements on use of med and types of med
  • The recommendations from a testing might involve: Emotional: therapy (Jessica will talk about this) and medication Cognitive: school accommodations such as a para, 1 on 1, individual classroom, how assignments or tests ought to be completed Behavioral: How to effectively discipline a child with trauma, how to talk to the child to avoid triggering oppositionality
  • All children need rules and expectations to help them learn appropriate behavior. Children do not always do what parents want. Foster children rarely do what their foster parents want. This can be a difficult scenario in either instance, but particularly difficult when you are dealing with someone who is essentially someone else’s child, someone who has had a troubled/difficult past, someone you might feel sorry for, if you dislike feeling like you are punishing someone, if you fear anger, hatred, aggression...things foster parents inevitably experience with foster children
  • Most foster children do not come from such a background
  • Team Approach: It’s important that everyone who works with the child be consistent and supports the approach. Example of splitting b/t parents. Prioritize: Foster children and young children can only deal with so much at a time before becoming so overwhelmed nothing is learned. Pick a limited number of behaviors, (3-5), and focus on those Explanation: Explain your plans to the child and that everyone is going to do the same thing Child’s Investment : Important to know what the child hates to lose and wants to earn Praise : for wanted bx so the child knows what you like and what you don’t Logical Consequences : making it about the difference b/t who you are and what you do and comparable to real life, ex: phys agg, no play time with friends Follow-through and Commitment: Demonstrate that you pay attention all the time, apologize for letting them get away with something and that you will try not to do it again
  • Immediate
  • 6 yo highly verbal male: Physical Aggression (including but not limited to hitting, slapping, biting, scratching, kicking, jumping on people, throwing objects at people, using objects as a weapon) Physical aggression is problematic behavior, which could significantly interfere with Nicholas’s schooling and get him into serious trouble as he gets older, such as going to jail. In order to work with him on using other means to express himself, notice when Nicholas is becoming upset and ask him if he wants to “take a break ” and “go to his safe spot.” A place where he can cool down ought to be provided in all environments. Others ought to be stopped from interfering with Nicholas getting to his safe spot. When Nicholas becomes physically aggressive tell him: “ Nicholas, it is never ok to hurt people. You just lost an hour of TV time. What would Dr. Karla tell you?” If Nicholas says something to the effect of “Put it into words,” praise him and ask him to try his best to do this. If he does not know, indicate that she would say “Put it into words,” and ask him to give it his best try. For the first act of physical aggression Nicholas loses 1 hour of TV time, the same day. If he continues to be physically aggression after you have intervened, he loses another hour of TV time. 4 yo male with autism: Physical Aggression with Self and Others: A major problem area for Fred is his tendency to become physically aggressive both with himself and with other people. The above interventions are designed to decrease his stimulation so he is less likely to reach the point of physical aggression. The following interventions are for the times when Fred does engage in physical aggression towards people. “ No,” has become a stimulus for Fred’s aggressive behavior so this word should be avoided. So instead of saying “No Fred, that’s not your toy.” You should say, “Fred that is John’s car. You and teddy bear can play with this car or read this book.” Or instead of saying “No Fred, take that toy out of your mouth.” You should say, ”Fred are you and teddy bear hungry? We can get some food if you are hungry. We play with toys with our hands.” Whenever possible give Fred choices while redirecting him. When Fred does hit himself or others he should be reminded of the need for safety and taken to his quiet area. “ Fred, we don’t hit. Hitting hurts. We stay safe here. Let’s take teddy bear to the quiet spot for a break so we can stay safe.” Safety of Fred and others should be the top priority. If caregivers have difficulty redirecting Fred, and he continues to be aggressive, he will likely need to be physically brought to his quiet area. It is still important to prepare Fred for the physical touch. “ Fred, I need to help you stay safe. I won’t hurt you. I am going to pick you up and bring you to the quiet spot. I won’t hurt you. We stay safe here.”
  • 13 yo female: Verbal Aggression (yelling, cursing, back-talking) Viola may say anything in her therapy sessions without getting in trouble Viola may say anything to her mother, provided she speaks with her in a calm voice If Viola is engaging in verbal aggression (defined above), adults ought to say: “ Viola, I’m glad you’re using your words. Make sure to let Dr. Karla know how you’re feelings. Is there a better way you can let me know what’s going on?” If Viola is able to speak about her concerns or chooses to take a time-out, praise her for being mature and making a good choice. If she continues engaging in verbal aggression, provide her with a total of 3 warnings. If she continues after the 3rd warning, let her know that she just lost her outing with her mother. If Viola is able to stop engaging in verbal aggression by the end of 3 warnings for a week, she earns an outing alone with her mother. 13 yo male: Verbal Aggression (defined as cursing, raising his voice to the point of yelling, asking “why” more than 3 times) At times Jeremiah resorts to verbal aggression. In order to work with him on finding more adaptive behavior, give him the following warning: “ Jeremiah, you’re being verbally aggressive. Think about the message you are sending. This is strike ______ (one, two).” If Jeremiah continues to be verbally aggressive after 2 warnings, he loses the option for any activities for 24 hours. If he is verbally aggressive two times in one week he must attend three therapy sessions. 7 yo male: Cursing When Eric curses ( limited to words involving ‘shit,’ ‘fuck,’ ‘ass,’ and ‘damn.’), tell him: “ Think about the way you are coming across. It’s not ok to do it here. Save it for Dr. Karla.” If Eric discontinues cursing, praise him for “turning it around”. If he continues cursing, provide him with a second warning (see above). If Eric discontinues curing, praise him again. If Eric curses a third time, tell him “ Eric, you know the consequence for cursing. Now you lose the chance to use your Black Pearl for the next 24 hours.”
  • Oppositionality/Argumentative Behavior Oppositionality is defined as when David does not follow through with an activity he has been assigned by a person in authority or attempts to argue with a person in authority. When David is oppositional/argumentative, tell him : David ,you have a choice. You can ______ when I ask you or you can lose computer time. If David continues to be oppositional, give him a second warning, reminding him that if he continues, he will lose computer time. Consequence : For each act of oppositionality that has required 2 warnings, David loses 15 minutes of computer time.
  • This means with a young child, the effort you put in gets clear, direct results. With older children it is much more difficult. How do you convince a child you are different from his or her birth mother/father.
  • We designed a Foster Parent Group to address these issues.
  • We designed a Foster Parent Group to address these issues.
  • SKIP this page if short on time
  • Can address these issues in group: dual process What the child feels the parent feels “ My chaos is your chaos” Some of these feelings are emotional reactions, feeling what the child is feeling: unprepared, underserved, unclear on what is expected, never included in case planning, information kept from them Sounds a lot like the concerns of a foster child
  • Fostering Hope by Bridging the Gap

    1. 1. Fostering Hope by Bridging the Gap How to Meet the Unique Developmental and Emotional Needs of Foster Children
    2. 2. Emotional Needs of Young Children <ul><li>Goals for the first 3 years of life: </li></ul><ul><li>What is Necessary to Reach These Early Goals? </li></ul>
    3. 3. Emotional Needs of Young Children <ul><li>It is through interacting with others, particularly caregivers, that young children develop the competence they need to engage in relationships and act in the world </li></ul><ul><li>Often see deficits here with foster children </li></ul>
    4. 4. Developmental Milestones 0-6 Months <ul><li>Expected: </li></ul><ul><li>Feeding </li></ul><ul><li>Holding Head Up </li></ul><ul><li>Facial Recognition </li></ul><ul><li>Natural Reflexes and Muscle Development </li></ul><ul><li>Expressing Sounds, Begin to Imitate Sounds </li></ul><ul><li>Pushing, Reaching, and Grabbing with Limbs </li></ul><ul><li>Beginning awareness of their dependency and helplessness </li></ul><ul><li>Temperament begins to emerge </li></ul><ul><li>Foster Children: </li></ul><ul><li>Children in chaotic, neglectful, and/or abusive homes can show delays in these areas. </li></ul><ul><li>May look like “failure to thrive” children </li></ul><ul><li>Can get stuck trying to reach these basic goals resulting in continued developmental delays </li></ul>
    5. 5. Developmental Milestones 6-12 Months <ul><li>Expected: </li></ul><ul><li>Sitting Up </li></ul><ul><li>Scooting and Crawling </li></ul><ul><li>Standing While Holding On </li></ul><ul><li>Emergence of first meaningful words </li></ul><ul><li>An awareness of frustration and anger </li></ul><ul><li>Learn at a basic level to “trust” the family to care for them and keep them alive </li></ul><ul><li>Foster Children: </li></ul><ul><li>Delays in motor development </li></ul><ul><li>Delays in language development </li></ul><ul><ul><li>May rely more on gesture or have minimal attempts to communicate with others </li></ul></ul><ul><li>Difficulty forming a concept of their own and other’s frustration and anger </li></ul><ul><li>Lack this basic sense of trust </li></ul><ul><ul><li>Often have difficulty forming later even once in a safe environment </li></ul></ul>
    6. 6. Developmental Milestones 12-18 Months <ul><li>Expected: </li></ul><ul><li>First Steps </li></ul><ul><li>Increased vocabulary, small phrases emerge </li></ul><ul><li>Imitation of facial expressions and words </li></ul><ul><li>Parents are center for trust and getting needs met; also center for frustration when needs are not met </li></ul><ul><li>Solitary Play Emerges </li></ul><ul><li>Curiosity; attention moves towards objects </li></ul><ul><li>Focus is on repetition and practice </li></ul><ul><li>Foster Children: </li></ul><ul><li>Motor skill delays </li></ul><ul><ul><li>May begin walking but have excessive clumsiness </li></ul></ul><ul><li>Language Delays </li></ul><ul><li>With unreliable parents will have difficulty with trust and problems with where to place their frustration </li></ul><ul><li>May show less interest in play and interaction with others and the objects in their world </li></ul><ul><li>Lack curiosity- will effect further development </li></ul><ul><li>Trouble learning through repetition due to inconsistent environment </li></ul>
    7. 7. Developmental Milestones 18-24 Months <ul><li>Expected: </li></ul><ul><li>Continued language development- large increase in vocabulary </li></ul><ul><li>Gross Motor Coordination Develops for Increasingly Complex Skills (e.g. running, throwing things) </li></ul><ul><li>Clear Imitation of Others by quote or action </li></ul><ul><li>Direct aggression when angry or envious </li></ul><ul><li>Parallel play begins, start to be more aware of others </li></ul><ul><li>“ Rapprochement” Phase- </li></ul><ul><ul><li>Move towards and away from caregiver </li></ul></ul><ul><li>Foster Children: </li></ul><ul><li>May lack ability to communicate with others verbally </li></ul><ul><li>Continued delays in gross motor skills </li></ul><ul><li>May not imitate others or show much interest in interpersonal relationships </li></ul><ul><li>Can see excessive aggression towards others or self; inability to modulate aggression </li></ul><ul><li>May not begin parallel play or get stuck here and don’t become more interactive </li></ul><ul><li>Excessive clinginess or withdrawal from caregiver </li></ul>
    8. 8. Developmental Milestones 2-3 Years <ul><li>Expected: </li></ul><ul><li>Finish Toilet Training </li></ul><ul><li>Language in Full-throttle and continuing to expand </li></ul><ul><li>Concept of wanting some independence and separation from parents </li></ul><ul><li>Beginning awareness that parents are the same kind of person whether angry or happy with them </li></ul><ul><li>Focus shifts from getting basic needs met (e.g. food, nurturance) to control </li></ul><ul><ul><li>Cleanliness vs. Messiness </li></ul></ul><ul><ul><li>Learning to master their environment </li></ul></ul><ul><li>Foster Children: </li></ul><ul><li>Delayed toilet training </li></ul><ul><ul><li>May refuse to try </li></ul></ul><ul><ul><li>May reach and then regress </li></ul></ul><ul><li>Limited language, difficulty communicating with others </li></ul><ul><li>Clinginess or withdrawal from parents; difficulty with strangers </li></ul><ul><li>Lack of awareness about emotions of others not effecting who the person is; confused about emotions in general </li></ul><ul><li>Focus may remain on getting basic needs met </li></ul>
    9. 9. Developmental Milestones 3-5 Years <ul><li>Expected: </li></ul><ul><li>Speech now includes full sentences and complex sentence structure </li></ul><ul><li>Knowing what behaviors parents approve and don’t approve of </li></ul><ul><li>Begin interactive play and sense of competition </li></ul><ul><ul><li>Play becomes more imaginative </li></ul></ul><ul><li>Awareness of their own gender and differences of opposite gender </li></ul><ul><li>Increased emotional sophistication </li></ul><ul><ul><li>Begin to realize they don’t change just because their mood does </li></ul></ul><ul><li>Foster Children: </li></ul><ul><li>Language delays </li></ul><ul><ul><li>Some may only have a few words </li></ul></ul><ul><li>Lack understanding of what behaviors are appropriate and inappropriate </li></ul><ul><ul><li>Prone to acting out </li></ul></ul><ul><li>Parallel play or problematic peer interactions </li></ul><ul><ul><li>Play does not become more sophisticated </li></ul></ul><ul><li>Lack curiosity about gender, excessive confusion about gender, hypersexuality </li></ul><ul><li>Delayed emotional development </li></ul><ul><ul><li>Don’t understand their feelings or others, and don’t know how to regulate their mood states </li></ul></ul>
    10. 10. Developmental Milestones 5-7 Years <ul><li>Expected: </li></ul><ul><li>Basic skills for educational development in place; curiosity established </li></ul><ul><li>Lessened emphasis on earlier developmental struggles, not focus on school </li></ul><ul><li>Awareness of caregivers as necessary for their own successful development </li></ul><ul><li>Gross and Fine Motor Coordination moves towards complex skills (e.g. riding a bike, sports, etc.) </li></ul><ul><li>Beginnings of abstract reasoning make sense (i.e. bad jokes) </li></ul><ul><li>Play increases in sophistication and will reenact drama </li></ul><ul><li>Foster Children: </li></ul><ul><li>Lack of curiosity; delays in areas needed for success in school </li></ul><ul><li>Inability/difficulty moving forward, still negotiating early developmental struggles </li></ul><ul><li>Difficulty relying on adults for help/guidance, don’t seek assistance when needed </li></ul><ul><li>May be more clumsy than peers, can effect socialization (e.g. difficulty with sports) </li></ul><ul><li>Lack evidence of abstract reasoning, thinking may remain concrete for a long period- will eventually cause learning difficulties </li></ul><ul><li>May lack sophistication; may not play much; reenactment may be of trauma </li></ul>
    11. 11. Developmental Milestones 7-11 Years <ul><li>Expected: </li></ul><ul><li>Focus on interests, friends, competition, rules, and all things school related </li></ul><ul><li>Focus on developing skills and learning about the world </li></ul><ul><li>Less “problems with authority” than in prior years </li></ul><ul><li>Speech and language development takes on more of an adult quality </li></ul><ul><li>Imitation takes a full form in sophisticated dramatic play patterns </li></ul><ul><li>Foster Children: </li></ul><ul><li>Difficulty focusing on age appropriate demands due to energy taken by focus on past demands and experiences </li></ul><ul><li>Often have social difficulties with peers and adults </li></ul><ul><li>Mental illness symptoms may become increasingly present, inattention results in difficulty at school </li></ul><ul><li>Problematic behaviors may increase </li></ul><ul><li>Speech remains childlike </li></ul><ul><li>Play less creative; stuck reenacting unresolved stages and/or trauma </li></ul>
    12. 12. Developmental Milestones 11-13 Years for Girls <ul><li>Expected: </li></ul><ul><li>Prepubescent time with preparation for the bodily changes during puberty </li></ul><ul><li>Emotional arousal begins to display more in cycles </li></ul><ul><li>Speech and play becomes focused on other friend/enemies </li></ul><ul><li>Social relationships are emphasized to work out developmental needs </li></ul><ul><li>Beginning to understand that parents are adults, not gods </li></ul><ul><li>Curiosity takes a more self and other-centered focus </li></ul><ul><li>Early developing girls tend to be more anxious and worried about how they appear to others </li></ul><ul><li>Foster Children: </li></ul><ul><li>May have more intense emotional arousal and increased difficulty modulating their emotions </li></ul><ul><li>May have difficulty with social relationships </li></ul><ul><ul><li>Lack friendships </li></ul></ul><ul><ul><li>Peer group that is a poor influence </li></ul></ul><ul><li>May split between foster/adoptive caregivers and parents as all good and all bad </li></ul><ul><li>May lack the curiosity they need to work towards their adult identity </li></ul><ul><li>May become hypersexual and seek out nurturance, acceptance, and their identity through relationships with males </li></ul>
    13. 13. Developmental Milestones 11-13 Years for Boys <ul><li>Expected: </li></ul><ul><li>Prepubescent time focuses more on coping with aggression and a hierarchy </li></ul><ul><li>Sports become a more clear focus for status </li></ul><ul><li>Early developing boys tend to feel more powerful and work through the anxiety of reaching puberty early faster than girls </li></ul><ul><li>Interest in girls is not sophisticated and may not be evident, but an awareness of sexuality begins to emerge </li></ul><ul><li>Social status is focused on success and attributes </li></ul><ul><li>Foster Children: </li></ul><ul><li>Prior difficulties coping with aggression can intensify, may begin to have legal difficulties </li></ul><ul><li>May have increased difficulty sublimating aggression through sports or other activities </li></ul><ul><li>May have difficulty with sexual awareness and what it will eventually look like for them to be an adult male </li></ul><ul><li>Their focus for social status may be through excessive inappropriate behavior (e.g. bully, troublemaker, etc.) </li></ul>
    14. 14. Developmental Milestones 13+ Years <ul><li>Expected: </li></ul><ul><li>Puberty </li></ul><ul><li>Adolescents will try out different identities searching for what feels right for them </li></ul><ul><li>Increased desire for independence </li></ul><ul><li>Focus more on peers and their opinions than caregivers </li></ul><ul><li>Increased focus on relationships with opposite gender peers </li></ul><ul><li>Begin to form goals for the future </li></ul><ul><li>Foster Children: </li></ul><ul><li>Often girls who did not struggle earlier begin to have difficulty when they reach puberty </li></ul><ul><li>May foreclose on their identity or attempt to remain childlike and not move forward </li></ul><ul><li>May attempt to be excessively independent or remain overly dependent </li></ul><ul><li>Social problems, often feel isolated and victimized </li></ul><ul><li>Hypersexuality is common, girls may seek out relationships with older men as parental substitutes </li></ul><ul><li>Lack goals and motivation towards their future </li></ul>
    15. 15. Development of Child’s Play <ul><li>Importance of Play </li></ul><ul><li>Benefits </li></ul><ul><ul><li>Emotional-Behavioral </li></ul></ul><ul><ul><li>Social </li></ul></ul><ul><ul><li>Bio-Physical </li></ul></ul><ul><ul><li>Cognitive </li></ul></ul>
    16. 16. Child’s Play Stages <ul><li>Types of Play </li></ul><ul><ul><li>Quiet </li></ul></ul><ul><ul><li>Creative </li></ul></ul><ul><ul><li>Active </li></ul></ul><ul><ul><li>Cooperative </li></ul></ul><ul><ul><li>Dramatic/Role Playing </li></ul></ul>
    17. 17. Disrupted and Disturbed Play <ul><li>Aggressive / Hyper-aroused </li></ul><ul><li>Breaking things </li></ul><ul><li>Non-inclusive </li></ul><ul><li>Impaired relationships </li></ul><ul><li>Thematically problematic </li></ul>
    18. 18. Child’s Drawing <ul><li>Factors </li></ul><ul><ul><li>Socioeconomic factors </li></ul></ul><ul><ul><li>Gender </li></ul></ul><ul><ul><li>Crayon vs. Paint </li></ul></ul><ul><ul><li>Overlap </li></ul></ul><ul><ul><li>Environment </li></ul></ul>
    19. 19. Child’s Drawing <ul><li>Stages </li></ul><ul><ul><li>Scribbling </li></ul></ul><ul><ul><li>Symbols </li></ul></ul><ul><ul><li>Stories </li></ul></ul><ul><ul><li>Landscape </li></ul></ul><ul><ul><li>Realism </li></ul></ul><ul><ul><li>Pseudo-Naturalistic </li></ul></ul><ul><ul><li>Decision </li></ul></ul>
    20. 20. Child’s Drawing <ul><li>Stages </li></ul><ul><ul><li>Scribbling </li></ul></ul><ul><ul><li>Pre-Symbolism </li></ul></ul><ul><ul><li>Symbolism </li></ul></ul><ul><ul><li>Realism </li></ul></ul>
    21. 21. Drawing as a Vehicle <ul><li>“ In his schematic drawing, the child tailors pictorial creations not according to his knowledge of the environment, but according to the flow of his ideas and feelings. If a person is important in his picture, he may make him larger than the other figures, using size as an emphatic device. . . Similarly, the child may exaggerate a part of an object to stress its important functions . . . Exaggeration, shrinking, or omission of parts may also express things that cannot be fulfilled in reality.” (Horovitz, Lewis, Luca, 1967:59) </li></ul>
    22. 22. Trauma in Drawings <ul><li>Carole </li></ul><ul><ul><li>8 yo </li></ul></ul><ul><ul><li>Viewed pornography in bed with father </li></ul></ul><ul><ul><li>Divorce </li></ul></ul><ul><ul><li>Depressed mother </li></ul></ul><ul><ul><li>Cared for mother and younger brother </li></ul></ul>
    23. 23. Trauma in Drawings <ul><li>Ralph </li></ul><ul><ul><li>5 yo </li></ul></ul><ul><ul><li>Twin </li></ul></ul><ul><ul><li>Physical & Sexual abuse </li></ul></ul><ul><ul><li>Pornography </li></ul></ul><ul><ul><li>Photographed </li></ul></ul>
    24. 24. Trauma in Drawings <ul><li>Roger </li></ul><ul><ul><li>5 yo </li></ul></ul><ul><ul><li>Ralph’s Twin </li></ul></ul><ul><ul><li>Physical & Sexual abuse </li></ul></ul><ul><ul><li>Pornography </li></ul></ul><ul><ul><li>Photographed </li></ul></ul><ul><ul><li>Could not verbalize </li></ul></ul>
    25. 25. Trauma in Drawings <ul><li>Kinetic Family Drawing </li></ul>
    26. 26. Understanding Abuse as Seen in Drawings Figure 1 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
    27. 27. Understanding Abuse as Seen in Drawings Figure 2 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
    28. 28. Understanding Abuse as Seen in Drawings Figure 3 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
    29. 29. Understanding Abuse as Seen in Drawings Figure 4 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
    30. 30. Understanding Abuse as Seen in Drawings Figure 5 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
    31. 31. Understanding Abuse as Seen in Drawings Figure 6 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
    32. 32. Understanding Abuse as Seen in Drawings Figure 7 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
    33. 33. Understanding Abuse as Seen in Drawings Figure 8 & 9 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
    34. 34. Understanding Abuse as Seen in Drawings Figure 10 & 11 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
    35. 35. Understanding Abuse as Seen in Drawings Figure 12 from “Sexual Abuse of Children: Selected Readings” – US Dept of Health and Human Services
    36. 36. Moral Development
    37. 37. Piaget’s Stages of Moral Development <ul><li>2 Stage Theory </li></ul><ul><ul><ul><li>Difference between younger than 10 and older </li></ul></ul></ul><ul><li>Younger children </li></ul><ul><ul><li>Regard rules as fixed and absolute </li></ul></ul><ul><ul><li>Handed down by adults or by God </li></ul></ul><ul><ul><li>Cannot be changed </li></ul></ul><ul><ul><li>Based on consequences </li></ul></ul>
    38. 38. Piaget’s Stages of Moral Development <ul><li>Older Children (over 10 yo) </li></ul><ul><ul><li>Rules are relative </li></ul></ul><ul><ul><li>Can be changed if all agree </li></ul></ul><ul><ul><li>Devices used so all get along </li></ul></ul><ul><ul><li>Base judgments on intentions </li></ul></ul><ul><ul><li>Intellectual development does not stop </li></ul></ul>
    39. 39. Moral Development – Kohlberg’s Theory <ul><li>Some overlap with Piaget but went beyond </li></ul><ul><li>1958, 72 boys, middle & lower class families in Chicago </li></ul><ul><li>Later added others to the study </li></ul><ul><li>Heinz Steals the Drug </li></ul><ul><li>6 Stages </li></ul>
    40. 40. Kohlberg’s Theory – 6 Stages <ul><li>Level 1: Preconventional Morality </li></ul><ul><li>See morality as something external to themselves </li></ul><ul><ul><li>Stage 1: Obedience and Punishment Orientation </li></ul></ul><ul><ul><ul><li>Quote </li></ul></ul></ul><ul><ul><li>Stage 2: Individualism & Exchange </li></ul></ul><ul><ul><ul><li>Quote </li></ul></ul></ul><ul><li>Both Stage 1 & 2 are about punishment </li></ul>
    41. 41. Kohlberg’s Theory – 6 Stages <ul><li>Level 2: Conventional Morality </li></ul><ul><li>See morality as more than favors </li></ul><ul><ul><li>Stage 3: Good Interpersonal Relationships </li></ul></ul><ul><ul><li>Quotes </li></ul></ul><ul><ul><li>Don, age 13 </li></ul></ul><ul><ul><li>Similarity to Piaget </li></ul></ul><ul><ul><ul><li>Shift from expectation of unquestioning obedience to relativistic outlook to concern for good motives </li></ul></ul></ul>
    42. 42. Kohlberg’s Theory – 6 Stages <ul><li>Level 2: Conventional Morality </li></ul><ul><ul><li>Stage 4: Maintaining Social Order </li></ul></ul><ul><ul><li>Quote </li></ul></ul><ul><ul><li>Similarity to Piaget </li></ul></ul><ul><ul><ul><li>Shift from expectation of unquestioning obedience to relativistic outlook to concern for good motives </li></ul></ul></ul>
    43. 43. Kohlberg’s Theory – 6 Stages <ul><li>Level 3: Postconventional Morality </li></ul><ul><ul><li>Stage 5: Social Contract & Individual Rights </li></ul></ul><ul><ul><li>Quote </li></ul></ul><ul><ul><li>Stage 4 vs. 5 </li></ul></ul><ul><ul><li>Stage 6: Universal Principles </li></ul></ul><ul><ul><ul><li>Law vs. Justice </li></ul></ul></ul><ul><ul><ul><li>Civil disobedience </li></ul></ul></ul><ul><ul><ul><ul><li>Martin Luther King </li></ul></ul></ul></ul>
    44. 44. Moral Development – Summary of Kohlberg’s Theory <ul><li>Ages 4-10 (Stage 1 & 2) </li></ul><ul><ul><li>Stage is characterized by compliance with rules to avoid punishment and get rewards </li></ul></ul><ul><ul><li>Moral judgment is self-centered and children act based on self-interest </li></ul></ul><ul><ul><li>Early focus is on avoiding punishment </li></ul></ul><ul><ul><li>Later focus moves towards obedience with rules in hope of reward </li></ul></ul>
    45. 45. Moral Development – Kohlberg’s Theory <ul><li>Ages ~10-13 /16 for stage 4/ 20s-30s for males (Stage 3, 4, 5) </li></ul><ul><ul><li>Emphasis is on conforming to rules to get approval from others </li></ul></ul><ul><ul><li>Begin to internalize standards of authoritative people in their lives </li></ul></ul><ul><ul><li>Early in stage their concern is for gaining approval through obedience </li></ul></ul><ul><ul><ul><li>Want to be seen as a good boy/girl </li></ul></ul></ul><ul><ul><li>Later in stage focus moves towards doing one’s duty and maintaining social order </li></ul></ul>
    46. 46. Moral Development – Kohlberg’s Theory <ul><li>Ages 13-Adulthood/Mid 20s (Stage 6) </li></ul><ul><ul><li>Recognizing that there are sometimes conflicts between moral or socially accepted standards </li></ul></ul><ul><ul><li>Begin to make moral decisions based on what’s right, fair, or just </li></ul></ul><ul><ul><li>Early in stage will value the will of the majority and welfare of society </li></ul></ul><ul><ul><li>Final level is morality based on what the individual believes is right, regardless of legal restrictions and what others think </li></ul></ul><ul><ul><li>Many individuals never reach or complete this stage </li></ul></ul>
    47. 47. How Moral Development Occurs <ul><li>Not genetic blueprint or maturation </li></ul><ul><li>Not socialization </li></ul><ul><li>Rather through discussion and challenges </li></ul><ul><ul><li>The role of asking “What do you think,” versus telling or lecturing </li></ul></ul><ul><ul><li>Debate: obey laws without question </li></ul></ul><ul><ul><ul><li>Totalitarian government/Nazi Germany </li></ul></ul></ul><ul><ul><li>Role playing </li></ul></ul>
    48. 48. How the Unusual Needs & Difficult Behaviors Impact the Family
    49. 49. So you decided to become a foster parent . . . <ul><li>You had a good life </li></ul><ul><li>Wanted to share it </li></ul><ul><li>Who better than a foster child? </li></ul>
    50. 50. Qualifications <ul><li>In the state of Wyoming the qualifications for becoming a foster parent are : </li></ul><ul><li>age 21 years and older, </li></ul><ul><li>“ good” physical and emotional health, </li></ul><ul><li>financial stability, </li></ul><ul><li>no documented history of abuse or neglect of a child, </li></ul><ul><li>and no significant criminal history (Wyoming Foster/Adopt Parent Association, 2005).  </li></ul><ul><li>Additional Expectations </li></ul><ul><li>create a therapeutic environment </li></ul><ul><li>be a healthy role model, offering a predictable, safe, and nurturing family experience </li></ul><ul><li>Most people who want to engage in human service think: “of course,” or “no problem.” </li></ul>
    51. 51. Expectations <ul><li>Expectations </li></ul><ul><li>Common expectations </li></ul>
    52. 52. Reality…. <ul><li>Audience Experiences </li></ul>
    53. 53. Reality…. Statistics show: <ul><li>Compromised attachments </li></ul><ul><li>Family history of mental illness or substance abuse. </li></ul><ul><li>Serious emotional and behavioral problems. </li></ul><ul><li>Cognitive and learning disabilities </li></ul><ul><li>Victims </li></ul><ul><li>Substance use </li></ul><ul><li>Sexual abuse </li></ul>
    54. 54.
    55. 55. Common Difficulties Seen in Foster Children <ul><li>Low frustration tolerance </li></ul><ul><li>Difficulty coping with stress (internal and external) </li></ul><ul><li>Inability to delay gratification </li></ul><ul><li>Anxiety Symptoms </li></ul><ul><li>Hypervigilance </li></ul><ul><li>Sleep Disturbance </li></ul><ul><ul><li>Nightmares </li></ul></ul><ul><ul><li>Night Terrors </li></ul></ul><ul><ul><li>Cannot sleep alone </li></ul></ul><ul><ul><li>Difficulty going to sleep and/or staying asleep </li></ul></ul><ul><ul><li>Excessive sleep </li></ul></ul><ul><li>Excessive fears </li></ul><ul><li>Inattention </li></ul><ul><li>Hyperactivity </li></ul><ul><li>Hoarding </li></ul><ul><li>Clinginess </li></ul><ul><li>Depressive Symptoms </li></ul><ul><li>Low/Fragile Self-esteem </li></ul><ul><li>Feeling worthless </li></ul><ul><li>Feeling Hopeless </li></ul><ul><li>Overly hash/punitive with self and/or others </li></ul><ul><li>Excessive guilt </li></ul><ul><li>Under or over eating </li></ul><ul><li>Isolation and withdrawal </li></ul><ul><li>Psychomotor agitation or retardation </li></ul><ul><li>Lack of energy </li></ul><ul><li>Lack of motivation </li></ul><ul><li>Suicidality </li></ul><ul><li>Self-injurious behaviors </li></ul><ul><li>Risk Taking </li></ul><ul><li>Hypersexual Behaviors </li></ul><ul><li>Impulsivity </li></ul>
    56. 56. Common Difficulties Seen in Foster Children <ul><li>Oppositionality </li></ul><ul><li>Excessive risk taking </li></ul><ul><li>Substance use/abuse </li></ul><ul><li>Aggressive Behaviors (self, others, property) </li></ul><ul><ul><li>E.g. tantrums, spitting, hitting, breaking things, etc. </li></ul></ul><ul><li>Lack of concern/regard for others </li></ul><ul><li>Playing with, eating, or smearing feces </li></ul><ul><li>Inability to seek assistance from adults </li></ul><ul><li>Social difficulties </li></ul><ul><li>Learning difficulties </li></ul><ul><li>Immaturity </li></ul><ul><li>Others? </li></ul>
    57. 57. An Underestimated Challenge Create a therapeutic environment, be a healthy role model, offering a predictable, safe, and nurturing family experience, to children who have no inner locus of control
    58. 58. The “Rollercoaster Ride” <ul><li>Foster children often engender the very opposite emotions of what foster parents expected </li></ul>
    59. 59. The “Rollercoaster Ride” <ul><li>You expected feelings of : </li></ul><ul><li>Safety </li></ul><ul><li>Love & Caring </li></ul><ul><li>Being valued </li></ul><ul><li>Appreciated </li></ul><ul><li>Embrace </li></ul><ul><li>Clarity </li></ul><ul><li>In control </li></ul><ul><li>Happiness </li></ul><ul><li>Contentment </li></ul><ul><li>“ Normal” </li></ul><ul><li>Sadness over loss </li></ul><ul><li>You felt feelings of : </li></ul><ul><li>Fear & Worry </li></ul><ul><li>Anger & Hate </li></ul><ul><li>Resentment </li></ul><ul><li>Unappreciated </li></ul><ul><li>Disgust </li></ul><ul><li>Confusion </li></ul><ul><li>Helplessness </li></ul><ul><li>Sadness </li></ul><ul><li>Frustration </li></ul><ul><li>Misunderstood </li></ul><ul><li>Relief when they left </li></ul>
    60. 60. Pushing Buttons Foster children “pull” for repeating the trauma
    61. 61. Important challenges for foster parents include: <ul><li>Recognizing the limits of their emotional attachment to the child </li></ul><ul><li>Understanding the mixed feelings toward child </li></ul><ul><li>Understanding mixed feelings toward the child's birth parents </li></ul><ul><li>Recognizing their difficulties in letting the child return to birth parents </li></ul><ul><li>Dealing with the complex needs (emotional, physical, etc.) of children in their care </li></ul><ul><li>Working with sponsoring social agencies </li></ul><ul><li>Finding needed support services in the community </li></ul><ul><li>Dealing with the child's emotions and behavior following visits with birth parents </li></ul>
    62. 62. Challenges other children in the house face: <ul><li>“ Squeaky wheel” effect </li></ul><ul><li>Envy </li></ul><ul><li>Upping the ante </li></ul><ul><li>Different requirements for privileges </li></ul><ul><li>New person disrupts harmony </li></ul><ul><li>Others . . . </li></ul>
    63. 63. Understanding the Difficult Behaviors & Recognizing Emotional & Developmental Needs
    64. 64. Preschool- Case Example #1 <ul><li>4y.o. Male </li></ul><ul><li>Problems identified during intake </li></ul><ul><li>Recommendations </li></ul><ul><li>Result </li></ul>
    65. 65. Preschool- Case Example #2 <ul><li>4y.o. Male </li></ul><ul><li>Problems identified during intake </li></ul><ul><li>Recommendations </li></ul><ul><li>Result </li></ul>
    66. 66. Preschool Case Example #2 Cont. <ul><li>After 1 year of treatment: </li></ul><ul><ul><li>Child has improved significantly in all developmental areas </li></ul></ul><ul><ul><li>No current violence against self and greatly reduced violence against others </li></ul></ul><ul><ul><li>No night terrors, minimal sleep disturbance, now able to sleep alone in own room </li></ul></ul><ul><ul><li>Can tolerate frustration and put feelings into words </li></ul></ul><ul><ul><li>Can ask for help when needed and state how adults can provide assistance </li></ul></ul><ul><ul><li>Play themes are becoming more developmentally appropriate and sophisticated (e.g. questions about gender, dyadic and triadic interactions) </li></ul></ul>
    67. 67. Elementary School- Case Example #3 <ul><li>8y.o. female </li></ul><ul><li>Formulation: </li></ul><ul><li>Recommendations: </li></ul><ul><li>Result </li></ul>
    68. 68. Elementary School- Case Example #4 <ul><li>10y.o. male </li></ul><ul><li>Formulation: </li></ul><ul><li>Recommendations: </li></ul><ul><li>Result </li></ul>
    69. 69. Middle/High School- Case Example #5 <ul><li>13y.o. male </li></ul><ul><li>Problems identified during intake </li></ul><ul><li>Recommendations </li></ul><ul><li>Result </li></ul>
    70. 70. Middle/High School- Case Example #6 <ul><li>14y.o. female </li></ul><ul><li>Problems identified during intake </li></ul><ul><li>Recommendations </li></ul><ul><li>Result </li></ul>
    71. 71. How to work through it <ul><li>Many different approaches, but . . . </li></ul><ul><li>The most important thing for any child with emotional difficulties, an unstable background, and/or trauma, is . . . </li></ul>
    72. 72. How to work through it <ul><li>Many different approaches, but . . . </li></ul><ul><li>The most important thing for any child with emotional difficulties, an unstable background, and/or trauma, is . . . </li></ul>
    73. 73. How to work through it : <ul><li>Useful psychological evaluation </li></ul><ul><li>Accurate diagnosis </li></ul><ul><li>Accurately medicated (if necessary) </li></ul><ul><li>The team approach </li></ul><ul><li>A plan of attack </li></ul><ul><li>Real, immediate, effective support </li></ul>
    74. 74. How to work through it . . . A useful psychological evaluation <ul><li>Can include all of the following areas: </li></ul><ul><li>Psychological </li></ul><ul><li>Emotional </li></ul><ul><li>Behavioral </li></ul><ul><li>Interpersonal </li></ul><ul><li>Cognitive </li></ul>
    75. 75. How to work through it . . . A useful psychological evaluation <ul><li>Should include an explanation or summary of these components to help explain: </li></ul><ul><li>Behaviors </li></ul><ul><li>Problems </li></ul><ul><li>Areas of developmental need </li></ul><ul><li>Ways that the individual/family can help </li></ul>
    76. 76. How to work through it …. Assessment Tools (type of tests) <ul><li>Getting the information you need </li></ul><ul><li>Observation </li></ul><ul><li>Intellectual & Cognitive measures </li></ul><ul><ul><li>Achievement </li></ul></ul><ul><ul><li>IQ </li></ul></ul><ul><li>Neuropsychological tests </li></ul><ul><li>Emotional measures </li></ul><ul><ul><li>Self-report measures </li></ul></ul><ul><ul><ul><li>Their use </li></ul></ul></ul><ul><ul><li>Objective </li></ul></ul><ul><ul><ul><li>Their use </li></ul></ul></ul><ul><ul><li>Projective </li></ul></ul><ul><ul><ul><li>Their use </li></ul></ul></ul><ul><ul><li>Example: Ms. ND </li></ul></ul>
    77. 77. Diagnosis <ul><li>Oppositional Defiant Disorder (ODD) </li></ul><ul><li>Conduct Disorder (CD) </li></ul><ul><li>Attention Deficit Hyperactivity Disorder (ADHD) </li></ul><ul><li>Post-Traumatic Stress Disorder (PTSD) </li></ul><ul><li>Reactive Attachment Disorder (RAD) </li></ul>
    78. 78. How to work through it …. Psychosocial <ul><li>Accounts for history </li></ul><ul><ul><li>Can be difficult with foster children </li></ul></ul><ul><li>Includes the culture and subculture, and an awareness of the family’s standards </li></ul><ul><li>Accounts for losses and trauma </li></ul><ul><li>Understands the importance of the way each area would affect the normal development of the child </li></ul>
    79. 79. How to work through it …. Psychosocial… <ul><li>The child’s interactions begin to frame their expectations </li></ul><ul><li>Birth order, exposure to children </li></ul><ul><li>Social interactions </li></ul><ul><li>The way the child responds to others </li></ul><ul><li>Conflict </li></ul><ul><li>Areas of undeveloped maturity </li></ul>
    80. 80. How to work through it …. Psychosocial… <ul><li>Deficits or disorders </li></ul><ul><li>Trauma, Abuse, Neglect </li></ul><ul><li>Lack of developmental milestones </li></ul><ul><li>Psychological problems that would occur even in the “perfect” family </li></ul>
    81. 81. How to work through it . . . Behavioral <ul><li>The child’s </li></ul><ul><ul><li>expression of temperament </li></ul></ul><ul><ul><li>repetitive patterns of behavior </li></ul></ul><ul><ul><li>capabilities of expressing needs </li></ul></ul><ul><ul><li>neurology, genetics, and biochemistry and the interplay with the real world </li></ul></ul><ul><ul><li>Behavioral disorders/disabilities </li></ul></ul>
    82. 82. How to work through it . . . Emotional <ul><li>The child’s development and areas of struggle </li></ul><ul><li>Temperamental preferences for various phases </li></ul><ul><li>Internal biochemistry and how it affects interactions </li></ul><ul><li>How s/he responds to own pain or pleasure </li></ul><ul><li>Emotional disorders/disabilities </li></ul>
    83. 83. How to work through it . . . Cognitive & Intellectual <ul><li>Memory, Speed of processing, Capacity for different kinds of thoughts, Attention, Learning, Verbal and Nonverbal Abilities </li></ul><ul><li>Executive Functioning </li></ul><ul><li>Areas of strength and weakness </li></ul><ul><li>How the deficits interplay with reality-based situations </li></ul><ul><li>What parents can reasonably expect </li></ul><ul><li>What teachers can expect in performance </li></ul><ul><li>Cognitive disorders/disabilities </li></ul>
    84. 84. How to work through it . . . continued <ul><li>Accurate diagnosis informs treatment </li></ul><ul><ul><li>May change over time </li></ul></ul><ul><ul><li>When to do a retesting </li></ul></ul><ul><li>Accurately medicated (if necessary) </li></ul><ul><ul><li>Statistic of greatest success with combined approach </li></ul></ul><ul><ul><li>Different issues, same behavior </li></ul></ul><ul><ul><ul><li>Disruptive behavior </li></ul></ul></ul><ul><ul><ul><li>Attention problems </li></ul></ul></ul><ul><ul><ul><li>Social problems </li></ul></ul></ul><ul><ul><ul><li>Academic problems </li></ul></ul></ul>
    85. 85. How to work through it . . . continued <ul><li>When to medicate with psychotropics: </li></ul><ul><li>Diagnosable mental disorder </li></ul><ul><li>Disorder improves with medication </li></ul><ul><li>Level of distress is high enough that benefit from therapy is impossible without reducing distress </li></ul><ul><li>Typically effective behavioral approaches have not reduced psychiatric symptoms </li></ul>
    86. 86. How to work through it . . . Psychotropics <ul><li>Difficulties with meds & children </li></ul><ul><li>Minimal research </li></ul><ul><li>Off label use with children </li></ul><ul><li>Little research on long term effects </li></ul>
    87. 87. How to work through it . . . Psychotropics <ul><li>Medication Classes </li></ul><ul><li>Stimulants : ADHD </li></ul><ul><li>Antidepressants : Depression or anxiety </li></ul><ul><li>Antipsychotics : Psychosis or PTSD </li></ul><ul><li>Mood stabilizers : Bipolar Disorder </li></ul><ul><li>Difficulties </li></ul>
    88. 88. Useful Recommendations <ul><li>Emotional </li></ul><ul><ul><li>Therapy </li></ul></ul><ul><ul><li>Medication </li></ul></ul><ul><li>Cognitive </li></ul><ul><ul><li>School accommodations </li></ul></ul><ul><li>Behavioral </li></ul><ul><ul><li>Discipline </li></ul></ul><ul><ul><li>Behavior Plans </li></ul></ul>
    89. 89. Therapeutic Services <ul><li>Types: </li></ul><ul><ul><li>Individual play therapy </li></ul></ul><ul><ul><li>Individual talk therapy </li></ul></ul><ul><ul><li>Individual combination of play/talk therapy </li></ul></ul><ul><ul><li>Parent-child play therapy </li></ul></ul><ul><ul><li>Family therapy </li></ul></ul><ul><ul><li>Group therapy </li></ul></ul><ul><ul><li>Parent-guidance </li></ul></ul><ul><ul><li>Support groups </li></ul></ul>
    90. 90. How Does Therapy Work? <ul><li>Provides a safe, structured, and consistent environment where the child can express anything without fear of consequence </li></ul><ul><li>Interpretations of play or talk themes provides the child with increased insight about problems </li></ul><ul><li>Provides support to help the child move forward developmentally and emotionally </li></ul><ul><li>Play: Children use play to express what they are unable to express in words </li></ul>
    91. 91. Goals of Therapy/ How It Can Help <ul><li>Help children negotiate early childhood difficulties </li></ul><ul><li>Help children get back on track developmentally </li></ul><ul><li>Decrease problematic behaviors and symptoms of mental illness </li></ul><ul><li>Increase coping skills </li></ul><ul><li>Help children to stop repeating patterns from biological family with their new family </li></ul><ul><li>Help foster parents learn how to parent children with these unique needs </li></ul><ul><li>Improve social skills and interpersonal relationships </li></ul><ul><li>Increase skills needed for success in other areas (e.g. school, work) </li></ul><ul><li>Improve self-esteem and self-confidence </li></ul><ul><li>Provide support and guidance to all individuals involved with these children, increasing the effectiveness of the team </li></ul>
    92. 92. When to Refer for Therapeutic Services? <ul><li>Psychological evaluation identified a need for services </li></ul><ul><li>Behavioral difficulties </li></ul><ul><li>Child experienced trauma </li></ul><ul><ul><li>Clinical symptoms may or may not be easily evident </li></ul></ul><ul><li>Foster parents, teachers, etc. are having difficulty working with the child </li></ul><ul><li>Child having significant difficulties in one or more areas </li></ul><ul><ul><li>School </li></ul></ul><ul><ul><li>Socially </li></ul></ul><ul><ul><li>Home </li></ul></ul><ul><li>Child’s functioning begins to decrease </li></ul><ul><li>Upcoming transition </li></ul><ul><ul><li>Changing foster homes </li></ul></ul><ul><ul><li>Reunification </li></ul></ul><ul><li>Foster family needs support/guidance </li></ul>
    93. 93. Discipline & Behavior Plans
    94. 94. Discipline <ul><li>Research shows that effective parents : </li></ul><ul><ul><li>raise well-adjusted children who are more self-reliant, self-controlled, and curious than children raised by parents who are punitive, overly strict, or permissive. </li></ul></ul><ul><ul><li>operate on the belief that both the child and the parent have certain rights and that the needs of both are important </li></ul></ul><ul><ul><li>are more likely to set clear rules and explain why these rules are important </li></ul></ul><ul><ul><li>reason with their children and consider the youngsters' points of view even though they may not agree with them.   </li></ul></ul>
    95. 95. Theories Behind Behavior Plans <ul><li>Operant Conditioning </li></ul><ul><li>Positive and Negative Reinforcers </li></ul><ul><li>Positive and Negative Punishment </li></ul>
    96. 96. Discipline for difficult children (i.e. lack of internal stability) <ul><li>Team approach </li></ul><ul><li>Prioritize </li></ul><ul><li>Explanation </li></ul><ul><li>Get the child invested </li></ul><ul><li>Praise </li></ul><ul><li>Logical consequences </li></ul><ul><li>Follow-through & commitment </li></ul>
    97. 97. Effective Discipline (consequences) <ul><li>Reasonable expectations </li></ul><ul><li>Tone of voice </li></ul><ul><li>Clear, firm, specific </li></ul><ul><li>Flexibility when appropriate </li></ul><ul><li>Testing the limits </li></ul><ul><li>Delivery ought to be immediate </li></ul>
    98. 98. Behavior Plan Examples of Problem Behavior <ul><li>Physical Aggression </li></ul><ul><li>Verbal Aggression, Cursing </li></ul><ul><li>Oppositionality </li></ul><ul><li>Praise </li></ul><ul><li>Social Skills, Spitting </li></ul><ul><li>Using Words </li></ul><ul><li>Touching, Sexual Touching </li></ul><ul><li>Preparation </li></ul><ul><li>Choices </li></ul>
    99. 99. Behavior Plan Physical Aggression <ul><li>6 year-old highly verbal & intelligent male </li></ul><ul><li>4 year-old male with autism </li></ul>
    100. 100. Behavior Plan Verbal Aggression <ul><li>13 year-old female </li></ul><ul><li>13 year-old male </li></ul><ul><li>7 year-old male </li></ul>
    101. 101. Behavior Plan Oppositionality <ul><li>5 y.o. male </li></ul>
    102. 102. School <ul><li>IEP, 504 Plans </li></ul><ul><li>Children develop not because they are shaped through external reinforcements but because their curiosity is aroused. </li></ul>
    103. 103. How to work through it . . . <ul><li>Useful psychological evaluation </li></ul><ul><ul><li>Accurate diagnosis </li></ul></ul><ul><ul><li>Recommendations for therapy, home, & school </li></ul></ul><ul><li>Therapy (if needed) </li></ul><ul><li>Accurately medicated (if necessary) </li></ul><ul><ul><li>Meds are helping, not exacerbating issues </li></ul></ul><ul><li>A plan of attack </li></ul><ul><ul><li>Evaluation gave you an idea on how to make progress </li></ul></ul><ul><ul><li>Behavior plan </li></ul></ul>
    104. 104. How to work through it . . . <ul><li>Team approach </li></ul><ul><ul><li>Everyone is consistent, on the same page and using the behavior plan at school, home, day care, etc. . . </li></ul></ul><ul><li>Real, immediate, effective support </li></ul><ul><ul><li>FPG </li></ul></ul>
    105. 105. Among infants placed in foster care at less than a year of age, the nature of the infant-foster mother relationship is a reflection of the foster mother’s attachment style. Conversely , with toddler placements (and older children), the child-foster mother relationship reflects the child’s previous attachment experiences (Stovall & Dozier, 1998). 
    106. 106. Foster Parent Group <ul><li>Foster Parents often blame themselves </li></ul>
    107. 107. Foster Parenting the Defiant Child <ul><li>One parent played against the other </li></ul><ul><li>The “perfect” loving family is squashed </li></ul><ul><li>Parents withdraw from social functions </li></ul><ul><li>Feel their parenting is unfair, overly strict, hostile </li></ul>
    108. 108. Foster Parent Group (FPG) <ul><li>Issues </li></ul><ul><li>Systemic </li></ul><ul><li>Support </li></ul><ul><li>Emergency questions </li></ul><ul><li>New situations </li></ul><ul><li>Self-image </li></ul><ul><li>Goals </li></ul><ul><li>Retention </li></ul><ul><li>Efficiency </li></ul><ul><li>Support </li></ul><ul><li>Education </li></ul><ul><ul><li>Individualized </li></ul></ul><ul><ul><li>Predictive </li></ul></ul><ul><ul><li>Preventative </li></ul></ul><ul><li>Therapeutic </li></ul>
    109. 109. Retention: Foster Family Shortage <ul><li>40% of foster families leave fostering in the first year of being licensed </li></ul><ul><ul><li>role confusion and lack of support from the agency is a major reason, </li></ul></ul><ul><ul><li>lack of respite care, </li></ul></ul><ul><ul><li>behaviors of the children, </li></ul></ul><ul><ul><li>interaction with the birth families, </li></ul></ul><ul><ul><li>worker-foster family-birth family relations. </li></ul></ul>
    110. 110. Concerns & How to Address Them : Retention <ul><li>Foster parents are typically: Unprepared, Underserved, Underappreciated. </li></ul><ul><li>Foster Parent Role Ambiguity : Statements include: </li></ul><ul><ul><li>We were unclear about what agency social workers expected of us </li></ul></ul><ul><ul><li>We were never “really” included in case planning </li></ul></ul><ul><ul><li>Complete information was kept from us </li></ul></ul><ul><ul><li>Our input was treated as trivial, or minimized </li></ul></ul>
    111. 111. Concerns & How to Address Them : Education <ul><li>Lack of Relevant Pre/Post Placement Training </li></ul><ul><li>Exit surveys and research show foster parents cite feeling inadequately prepared and not having relevant on-going training.   </li></ul><ul><li>Unprepared for the realities of their foster child </li></ul><ul><li>Challenging bx problems but no resources to address </li></ul><ul><li>No system in place to identify their specific needs </li></ul>
    112. 112. Concerns & How to Address Them : Support <ul><li>Lack of Avenues of Support and Connections needed to deal with day-to-day fostering duties. Comments included: </li></ul><ul><li>I’m afraid to ask my case manager for a respite break, last time I did I got the feeling that, ‘I must not be handling the job correctly.’ </li></ul><ul><li>When I called my worker to schedule respite, she told me firmly that was something she didn’t do, I would have to arrange my own.  I don’t know any other foster parents </li></ul><ul><li>“ Our agency does not encourage our foster parents to exchange phone numbers.  If had someone to call for help, I wouldn’t always have to rely on my worker.” </li></ul>
    113. 113. Concerns & How to Address Them : Therapeutic <ul><li>Family assessment </li></ul><ul><ul><li>identifying their own abilities, motivations and qualifications in light of the children they foster </li></ul></ul><ul><ul><li>allows foster parents to see how the foster child might be tapping into their unresolved issues, allowing them to master this so they might best help the child </li></ul></ul>
    114. 114. Our Findings with a FPG <ul><li>Topic Analysis </li></ul><ul><ul><li>Topic Classification Definitions </li></ul></ul><ul><ul><ul><li>Legislative </li></ul></ul></ul><ul><ul><ul><li>Foster Care </li></ul></ul></ul><ul><ul><ul><ul><li>System    </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Child </li></ul></ul></ul></ul><ul><ul><ul><li>Behaviors </li></ul></ul></ul><ul><ul><ul><li>Insights  </li></ul></ul></ul><ul><ul><li>Types of Interventions    </li></ul></ul><ul><ul><ul><li>Group </li></ul></ul></ul><ul><ul><ul><li>Doctor </li></ul></ul></ul>
    115. 115. Our Findings with a FPG <ul><li>Trends Observed </li></ul><ul><ul><li>Initial Trends : Months 1-3 </li></ul></ul><ul><ul><li>Middle 1 Trends : Months 3-6 </li></ul></ul><ul><ul><li>Middle 2 Trends : Months 6-9 </li></ul></ul>
    116. 116. Efficiency, Support, Education <ul><li>Group vs. Individual </li></ul><ul><li>All going through similar situations </li></ul><ul><li>Real-life information </li></ul><ul><li>Current </li></ul><ul><li>Predictive </li></ul><ul><li>Preventative </li></ul><ul><li>Positive regard </li></ul><ul><li>Respite potential </li></ul>
    117. 117. References & Resources <ul><li>h ttp:// </li></ul><ul><li>National Foster Parent Association </li></ul><ul><li>Wyoming Foster Parent Association    </li></ul><ul><li>Pat Hans, State President  </li></ul><ul><li>Phone:  307-265-9123  </li></ul><ul><li>American Academy for Child and & Adolescent Psychiatry </li></ul><ul><li>Terry Faulkner, Ph.D. </li></ul><ul><li>Alica Clark, Psy.D. & Karla Steingraber, Psy.D., LifeQuest Behavioral Health </li></ul><ul><li>http :// </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li>American Art Therapy Association on the WWW at: . </li></ul><ul><li>New Horizons for Learning </li></ul><ul><li> </li></ul><ul><li>For more information visit </li></ul><ul><li>Viktor Lowenfeld & Betty Edwards </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul>
    118. 118. Contact Information <ul><li>Aprioris Psychological Health Services </li></ul><ul><ul><li>666 Dundee Rd., Ste 502 </li></ul></ul><ul><ul><li>Northbrook IL 60062 </li></ul></ul><ul><li>847-778-3997 </li></ul><ul><li>[email_address] </li></ul><ul><li>  </li></ul>
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