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Megan Chambers presentation


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Megan Chambers presentation

  1. 1. USING A TRAUMA LENS FOR CHILDREN IN CARE The reparative parenting group programme for foster and kinship carers
  2. 2. Why are we talking about this? <ul><li>Children in care present with high rates of “the D’s” -Oppositional defiant Disorder </li></ul><ul><li>-Conduct Disorder </li></ul><ul><li>-Attention deficit Hyperactivity Disorder </li></ul><ul><li>-Post traumatic stress disorder </li></ul><ul><li>-Reactive Attachment Disorder </li></ul><ul><li>-Mood disorder </li></ul><ul><li>-Bipolar Disorder </li></ul><ul><li>-Sleep/arousal/regulatory disorders </li></ul>
  3. 3. Why are we talking…… <ul><li>Children in care have high levels of presentations to hospital and emergency departments </li></ul><ul><li>Children in care have high levels of medication use </li></ul><ul><li>Emotional and behavioural problems are the most common cause of placement disruptions. </li></ul><ul><li>Poor educational, occupational and relational outcomes. </li></ul><ul><li>“ Hard to treat” </li></ul>
  4. 4. High and complex needs <ul><li>Children in OOHC commonly have high and complex needs which bring them to the attention of support services. </li></ul><ul><li>This population has significantly higher rates of mental, developmental and physical health problems than their non-fostered peers. </li></ul><ul><li>These children are more likely to access public sector services such as specialist health, therapeutic and education programmes. </li></ul>
  5. 5. Low service uptake <ul><li>While present in relatively greater numbers, children in OOHC have a very low rate of service uptake. </li></ul><ul><li>The majority of foster children identified as needing support do not access services. </li></ul><ul><li>Where looked after children do access support, service providers often struggle to conceptualise complex and fragmented trauma histories or engage with children with limited connection to care figures. </li></ul>
  6. 6. Using a trauma lens…. <ul><li>Most/all children in care have suffered physical, emotional and /or sexual abuse in their early development, and at the hands of parental figures. </li></ul><ul><li>Most/all have suffered neglect. </li></ul><ul><li>Most/all have suffered from losses and dislocations from attachment figures. </li></ul><ul><li>For most/all there has been a failure of appropriate developmental experiences leading to impaired developmental trajectories. </li></ul>
  7. 7. Using a trauma lens….. <ul><li>These developmental assaults have left sequelae- most commonly- </li></ul><ul><li>-affect dysregulation </li></ul><ul><li>-chronic high arousal and hypervigilance, with consequent poor concentration and learning </li></ul><ul><li>-a complex array of attachment strategies, including a need to control, lack of trust in adults, a dismissive style and reluctance to show feeling and need, exaggerated affects and needs, a poor capacity to protect themselves. </li></ul><ul><li>-high levels of aggression </li></ul><ul><li>-an impoverished sense of themselves and other people </li></ul><ul><li>-a poor capacity for imagination and play </li></ul><ul><li>-verbal skills often poorer than non-verbal. </li></ul><ul><li>- poor sleep </li></ul><ul><li>- a range of specific trauma-related symptoms. </li></ul>
  8. 8. Using a trauma lens…. <ul><li>These difficulties impact on the relationship the child can develop with their carers- both foster and kinship carers. </li></ul><ul><li>Yet the recovery from these traumas involves the experience of safe predictable sensitive secure attachments, which allow the child to grow and develop. </li></ul><ul><li>The child’s behaviours and fears work directly against this type of relationship, often making it hard for the carer to accept, understand and provide a corrective experience of care. </li></ul><ul><li>The carer often becomes puzzled, disappointed and alienated from the child, and in this context may search for mental health diagnoses in an attempt to understand what is wrong with the child. </li></ul><ul><li>This may be reinforced by the school, when the child has trouble concentrating, can have violent outbursts and fails to keep pace with peers. </li></ul><ul><li>This is a current common pathway for help provision- and largely ineffective. </li></ul>
  9. 9. Trauma informed practice <ul><li>Trauma informed practice seeks to understand foster children’s presenting difficulties from a developmental perspective (e.g., aversive experiences of care, separation from attachment figures, adjustment to new care environments) as well as in the context of their current care environment (e.g., caregiver needs, expectations, perceptions). </li></ul>
  10. 10. OOHC in context
  11. 11. Correlates of childhood trauma <ul><li>Early and persistent experiences of trauma have a fundamental impact on brain development, organisation and functioning. </li></ul><ul><li>Repeated experiences of aversive or inadequate care confound children’s capacity to connect with others and contribute to enduring attachment anxiety. </li></ul><ul><li>These neurodevelopmental and attachment correlates are complex in presentation, entrenched and persist long after a child is removed from their aversive care environment. </li></ul>
  12. 12. Disconnection <ul><li>The decision to remove a child from their family-of-origin (FOO) is based on aversive experiences of care. </li></ul><ul><li>However – the child’s history of aversive care reduces their capacity to adapt to being removed and placed in an unfamiliar care environment. </li></ul><ul><li>Children’s resources are further strained by experiences of care following removal such as subsequent changes in carer, contact with FOO and changes within foster family systems (e.g., entry/extrusion of foster siblings). </li></ul><ul><li>Entry into OOHC represents a dislocation not only from FOO but pre-existing school, peer and community connections. </li></ul>
  13. 13. The care system <ul><li>The number of children in OOHC is growing and the demand for placements commonly exceeds caregiver capacity. </li></ul><ul><li>Pressure on existing carers is increasing in terms of the number of children placed with a family and competition for existing support resources. </li></ul><ul><li>Foster carers often have limited connection to support services due in part to scarce resources and foster children’s high and complex needs. </li></ul><ul><li>Where present the efficacy of support is often reduced by common misperceptions – particularly under-estimation of foster children’s needs, over-estimation of providers’ capacity to effect change and limited understanding or time frames required for progress. </li></ul><ul><li>These misperceptions are based in part by the siloing of support services and disconnection between child, carer and family supports. </li></ul>
  14. 14. Fostering children <ul><li>Foster carers bring an array of pre-conceptions, expectations, attributions, narratives and experiences to their care role. </li></ul><ul><li>These factors fundamentally shape the way carers understand and interact with children in their care. </li></ul><ul><li>Carers may have significant trauma histories themselves, be unable to have biological children or are isolated from extended families because of their decision to foster. </li></ul><ul><li>Kinship carers must maintain dual roles in caring for the traumatised child while remaining connected with the traumatising FOO. </li></ul>
  15. 15. Foster narratives <ul><li>Foster carers and children exist within dominant and often competing narratives regarding children in OOHC (e.g., ‘children should be OK after being removed from abusive parents’). </li></ul><ul><li>These narratives stem from personal, family, community and professional sources and shape carers’ perceptions of children’s needs and how these are best met. </li></ul><ul><li>Two of the most common narratives from carers is dissonance between expectations and reality of care role and isolation associated with being a foster carer. </li></ul>
  16. 16. Therapeutic foster care training
  17. 17. Genesis <ul><li>The Alternate Care Clinic (ACC) developed a therapeutic foster care group training programme to address: </li></ul><ul><ul><li>Foster children’s high and complex needs </li></ul></ul><ul><ul><li>Low service uptake </li></ul></ul><ul><ul><li>The reality that the carer relationship is core to the child’s recovery. </li></ul></ul><ul><ul><li>The need for an intervention which was acceptable to carers. </li></ul></ul><ul><ul><li>The need for an intervention which could be available to a range of people working therapeutically with carers and children in OOHC. </li></ul></ul><ul><li>These groups were developed from a trauma informed perspective that incorporated neurodevelopmental, attachment and systemic approaches. </li></ul>
  18. 18. Group process <ul><li>Training is provided in a group format using psychodynamic principles – arousing content and processes are mediated by group facilitators and connection to shared experience of fellow group members. </li></ul><ul><li>Increased arousal in a supported environment allows group members to access, reflect and process a greater spectrum of care experiences and facilitates connection to psycho-educational components of training. </li></ul>
  19. 19. Format <ul><li>Group composition includes foster and kinship carers. </li></ul><ul><li>Groups are currently composed of a range of carer types, experience and make-up (e.g., child age, single carer homes, Indigenous children). </li></ul><ul><li>9 content sessions and 1 follow up session. </li></ul><ul><li>Sessions are 2.5 hours in length and run fortnightly at Redbank House. </li></ul><ul><li>Each group contains 2 facilitators who share responsibility for content and process. </li></ul><ul><li>Facilitators contact group members individually by phone on alternate weeks to check in, monitor family progress and connect to additional supports if requested. </li></ul><ul><li>Childcare is provided on request. </li></ul><ul><li>Psychometrics are administered pre- and post-training to monitor progress and session feedback forms are provided throughout the training. </li></ul>
  20. 20. Training structure <ul><li>Metaphor of House of Reparative Care. </li></ul><ul><li>Foundation of reparative care is relationship between child and carer. </li></ul><ul><li>From this foundation cornerstones may be laid by understanding impact of trauma on children’s neurodevelopmental trajectory and attachment relationships. </li></ul><ul><li>Effective parenting strategies emphasise the importance of connection between children and carers and the neurodevelopmental and attachment needs of children in OOHC. </li></ul>
  21. 21. REPARATIVE PARENTING <ul><li>WHAT IS IT? </li></ul><ul><li>A way of focusing on the parenting skills needed by carers parenting children who have experienced abuse and neglect within attachment relationships, at vulnerable times in their development. </li></ul><ul><li>With children who have experienced multiple losses before coming into their care. </li></ul><ul><li>Who they may not know much about, </li></ul><ul><li>Who will be very different from their own children. </li></ul>
  22. 22. What is reparative parenting <ul><li>Foster children who are nurtured within a safe relational environment are more likely to develop trust in the capacity of others to care for them and less likely to maintain maladaptive attachment strategies </li></ul><ul><li>Foster children’s early attachment relationships are often damaged by recurrent experiences of abuse and neglect </li></ul><ul><li>Reparative parenting encourages the development of safe relational environments, within which traumatised children are able to develop secure attachment relationships </li></ul><ul><li>Secure attachment relationships contribute to children’s neurobiological development and can have a reparative effect on key psychological processes (e.g., emotion regulation, executive functioning, reflective capacity) </li></ul>
  23. 23. REPARATIVE PARENTING <ul><li>Is it different from other parent training? </li></ul><ul><li>Is it different from other psychoeducation? </li></ul><ul><li>Focus on the personal- the interactions between that carer and that child, and the feelings elicited in each. </li></ul><ul><li>Finding ways for the foster parent to be the chief agent for recovery of the child. </li></ul><ul><li>Finding ways for carers to look after themselves. </li></ul>
  24. 24. REPARATIVE PARENTING <ul><li>Incorporates- </li></ul><ul><li>Assistance with behaviour management </li></ul><ul><li>PLUS identifying attachment anxieties and their expression, and responses which help. </li></ul><ul><li>PLUS identifying trauma issues from the child’s story and understanding the way “aggressive outbursts”, “manipulative behaviour”, “being the boss” etc might be understood. </li></ul><ul><li>PLUS managing the feelings and automatic responses these evoke. </li></ul>
  25. 25. How does reparative parenting differ from ‘normal’ parenting <ul><li>Shifts emphasis from seeking control over child behaviour to helping children heal </li></ul><ul><li>Reflects on current behaviour and emotions within a historical context </li></ul><ul><li>Some methods of behaviour management which are effective with non-traumatised children escalate traumatised children’s behaviour (e.g., time out strategies) </li></ul><ul><li>Emphasises the importance of caregiver resources, availability and reflective capacity </li></ul><ul><li>Requires a greater investment of time, energy and commitment </li></ul>
  26. 26. Reparative Parenting training model – framework Wider System Carers Child or Young Person 3. Improve Functioning 2. Improve Reflection and Coherence. 1. Improve Safety
  27. 27. Reparative Parenting training model – The House I can trust adults to be in charge II csafely. I have a good relationship with my carer My feelings are OK I am a “good kid”
  28. 28. Reparative Parenting training model – components <ul><li>Manualised training program completed over a period of ten group sessions by two Psychologist/Social Worker presenters </li></ul><ul><li>Provide model to help explain arousal and the need to increase child’s feeling of safety, based on trauma model </li></ul><ul><li>Provide model to help understand attachment and the concept of a ‘secure base’, based on circle of security model </li></ul><ul><li>Teach child-directed play strategies to promote a secure relationship, based on Parent Child Interaction Therapy model </li></ul><ul><li>Teach strategies for setting limits while managing strong emotions, based on social learning and emotion coaching theories </li></ul><ul><li>Enable reflection on meaning of behaviour and caregiver responses from an attachment perspective, based on circle of security and cycle of repair theories </li></ul><ul><li>Caregivers are encouraged to attend individual follow up sessions with clinicians following conclusion of group sessions </li></ul>
  29. 29. Circle of Security <ul><li>Cooper, Hoffman, Marvin & Powell (1998) </li></ul><ul><li>Caregivers attending to children’s needs </li></ul><ul><li>Provide a secure base for children to explore from </li></ul><ul><li>Provide a haven to which children are able to return to </li></ul><ul><li>Try to be bigger, stronger, wiser and kinder </li></ul><ul><li>Whenever possible follow the child’s lead </li></ul><ul><li>Whenever necessary take charge </li></ul>
  30. 30. Cycle of Repair <ul><li>Maintaining trust and respect in the child-caregiver relationship </li></ul><ul><li>Stress: </li></ul><ul><ul><li>Am I calm? </li></ul></ul><ul><ul><li>What triggers my alarm system? </li></ul></ul><ul><ul><li>What helps me to feel calm? </li></ul></ul><ul><li>I am calm: </li></ul><ul><ul><li>Is my child calm? </li></ul></ul><ul><ul><li>What triggers my child’s alarm? </li></ul></ul><ul><ul><li>What helps to calm my child? </li></ul></ul><ul><li>Our repair routine: </li></ul><ul><ul><li>When I am calm and my child is calm what can we do together that feels good to help repair our trust and respect? </li></ul></ul><ul><ul><li>Be positive and avoid blame </li></ul></ul>
  31. 31. Why is teaching reparative parenting difficult <ul><li>Effective reparative parenting is fundamentally different from ‘traditional’ parenting </li></ul><ul><li>Caregivers often assume parent training will be only behaviourally oriented and focus on controlling problem behaviour </li></ul><ul><li>Caregivers may be challenged by : </li></ul><ul><ul><li>The commitment required (e.g., time, patience, self-care) </li></ul></ul><ul><ul><li>Understanding children’s needs within an attachment framework (e.g., neurobiological factors, pace and scope of changes) </li></ul></ul><ul><ul><li>Integrating reparative parenting information with other sources of support (e.g., school, counselling, wider family group) </li></ul></ul>
  32. 32. Challenges of teaching reparative teaching in a group format <ul><li>Differing experiences of foster carers within group depending on: </li></ul><ul><ul><li>Kinship or non-kinship caregivers </li></ul></ul><ul><ul><li>Age range and number of children in care </li></ul></ul><ul><ul><li>Presence of non-fostered siblings </li></ul></ul><ul><ul><li>Length of time spent as foster carer </li></ul></ul><ul><ul><li>Level of external support foster carer is receiving </li></ul></ul><ul><li>Vicarious trauma associated with caring for children who have experienced abuse and neglect </li></ul><ul><li>Differing capacity for empathy and tolerating behaviour, including rejection. </li></ul><ul><li>Differing expectations and vulnerabilities, and commitment levels </li></ul><ul><li>Caregivers own trauma histories may be activated </li></ul><ul><li>Differing levels of individual, family, community and professional resources </li></ul>
  33. 33. REPARATIVE PARENTING <ul><li>Foster Carers are very positive </li></ul><ul><li>See it as different from other training and helps them. </li></ul><ul><li>Enables a group to use it, and gain from each others knowledge. </li></ul><ul><li>Enables a focus on the particular relationships likely to be the most reparative without stigmatising the carers, or making them anxious about being involved with “therapy”. </li></ul>