Wednesday, December 6, 2017

Open Adoption as a Protective Factor for Adoptees

Another excerpt from an assignment last semester which applies to adoption: 
Competency #2- Critically evaluate the current research evidence on how adoptive families fare.
Statistics show (DeAngelis, 1995a)- p. 284, Ashford text, that about 25% of adoptive children, compared with 15% of non-adoptive children, require clinical intervention for severe behavioral problems.  However, an adoption researcher from Rutgers University who has been studying adoption for more than 20 years reported that 75-80% of adopted children are within the “normal” psychological range.
Researchers at the Search Institute in Minneapolis conducted a study of 181 adopted adolescents and found that “most of the teens were functioning within the normal mental health range” and the teens described themselves as attached to their parents.  It was also found that in the case of open adoptions, adopted children who maintained contact with their birth mothers weren’t confused about their parents’ identity- they still view their adoptive mother as their mother and view their birth mother more as more of an aunt or friend.

How does understanding this competency apply to my own personal development?

 I have three children and all of them are adopted so I was very interested in this research.  I readily admit that I am totally guilty of over-analyzing my children’s mental health [particularly their neurocognitive development as at least two of my children were exposed to drugs in utero] and to a lesser degree, their physical health, and wondering, “How much of this is due to genetics and how much is due to their environment?”  I’ve come to the conclusion that I have to stop speculating about the “why’s” but focus my energy on seeking the earliest possible professional interventions, if necessary,  and advocating for any special needs they might have.
How does understanding this competency apply to social work practice in general?
Adopted children are most often referred to for clinical treatment for acting out & aggression at about 5-7 years of age because this is an age where they are beginning to understand that they’ve lost their birth family.  It’s imperative for social workers to understand that no matter how awesome an adopted child’s adoptive family is, adoptees will have to sort through issues of grief and loss.  David Brodkinsky, the adoption researcher from Rutgers I mentioned earlier, found that the coping styles of adoptive families affected the experiences of their adopted children: those whose families engaged in an assistance-seeking style of coping did much better than those with an avoidant style of coping.  This knowledge is very helpful so that social workers can aid in helping adoptive families model affective ways to process grief and loss.

Tuesday, December 5, 2017

When Children Lose A Caregiver

The following is an excerpt from a paper I did a couple of months ago.  Because the topic is very pertinent to issues in fostering and adoption and because the assignment specifically asked that I share how the understanding of the concept or theories related to my personal experiences AND since I happen to have a blog called Adoption & Foster Care: My Personal Experiences, I now have new material to share on my neglected blog.  How convenient!

Incidentally, I was delighted to learn about the Skeels study mentioned in the second paragraph* because I was not familiar with it until I had finished my reading.  Upon further research, I learned that the women caregivers of the previously neglected infants functioned at the developmental levels of about six or seven years old.

Competency #1-  Identify and describe how loss of a caregiver affects a child after he or she has developed an attachment to that caregiver.
There were five or six attachment studies cited in Chapter 6, so I will just pick two of them which explain how the loss of a caregiver affects a child.   In 1980, John Bowlby, the founder of Attachment Theory, examined adolescents who had spent their infancy and childhood in institutions or foster care, often with several moves.  These adolescents displayed a lack of empathy and affection for others.  Because they were not shown love consistently as babies, they were unable to model showing love for others.  Further research on the subject (Trout, 1995). came to the same conclusion: many children who fail to form attachments as infants grow up to show lack of empathy and even delinquent behavior.
*The good news is that another study (Skeels, 1936) showed that the effects of early deprivation and lack of attachment can be reversed with care at a later age.  In 1936, two baby girls (13 and 16 months old) from neglectful families were admitted to an overcrowded Iowa orphanage.  Because these babies only functioned at about the level of a 6 or 7 month old, they were placed in a home for women with “retardation.”  Six months later the baby girls were lively, alert and functioning on much higher levels than they had been because the women in the home had provided these girls with plenty of stimulation and interaction. 

How does understanding this competency apply to my own personal development?
I’ve been a foster parent for over ten years now and about a third of my foster children have been babies and toddlers- who seem to be the most vulnerable to the effects of being separated from their primary caregivers.  Even though I’m a very nurturing caregiver and the babies and children I foster are in a safer environment than they were before being removed, I obviously worry about how these babies and children are going to adjust to being removed from, in some instances, the only caretaker they have ever known, and in a few cases, from moving to another foster home and being placed with me- a total stranger!  Fortunately, babies in foster care get more supervised weekly visits with their families than older foster children do, so that helps somewhat, not only for the child but for the child’s birth family as well.
I tend to worry even MORE when these babies or children have been in my care for 6-11 months, have clearly formed an attachment to me and my family (referring to me as “mom” in many cases) and then are sent back to live with their family or relatives whom they may or may not know.  How is this separation from me as their full-time primary caregiver for several months, going to affect them?!
Social workers need to be aware of the reasons behind attachment problems in both young children and adults.  “Research suggests that the quality of a child’s attachment with a primary caregiver is an excellent predictor of later functioning (Ciccheti & Wagner, 1990).”- p. 268, Ashford text.  Furthermore, the table in the text on page 269, “Exhibit 6.8- Assessing attachment problems in young children,” provides an overview of signs of attachment disorders broken down by behaviors which could be a very helpful assessment tool for social workers in recognizing attachment issues.
Research also shows that children who are separated from primary caregivers but are able to remain with a sibling or other family member, adapt more easily to the separation. (Bremmer, 1998).- page 273, Ashford text.  This is crucial for child welfare workers and policy makers to understand so that they can keep siblings together as much as possible in foster care and adoption cases.

Friday, November 10, 2017

Problems & Possible Legislative Solutions to the U.S. Foster Care System & Adoptions

The last time I wrote about the Adoption Tax Credit was about five years ago.  I will be mentioning it again since last week I got word that the Adoption Tax Credit was at risk of being abolished under the proposed Republican Tax Reform.  I was happy to learn (just last night) that because of feedback and advocacy, the credit will now be staying!

Sometimes as a foster parent I feel like I have very little power in actually implementing real change in the foster care system.  After all, I'm not in a position of influence and lasting change often requires funding and legislation.  

I thought it was timely that last month in one of my graduate Social Work courses I had a short assignment following the completion of reading the textbook chapter on child welfare issues in which I was to answer the question,

"Identify three problems with the current children, youth, and family service delivery system.  What are some possible solutions?"

"Just three?" was my first thought. 😜 Before I even started reading my textbook chapter the first thought/pet peeve that came to my mind was: "I hate it when the best interest of children gets overlooked because the rights of bio family takes precedence!"  Which got me thinking, "What could change or what has worked in the past to solve this problem?"  Enacted time limits for the amount of time children stay in foster care so that they can have permanency is something that has worked- in theory at least.

Another possible solution for making sure that the best interest of children in foster care are met could be more involvement on the parts of their guardian ad liteums.  In over a decade of fostering I have only had two GALs make home visits on behalf of the children in my care.  And I don't think it's that GALs don't want to be involved, but it's probably the same principal with caseworkers: they have too large of a caseload to devote the individual time they would like to each case.  That is why I love hearing about CASA volunteers- Court Appointed Special Advocates.

Another problem with foster care that came to my mind is simply too few foster homes available.  But how does one solve that problem?  Awareness can be spread, but fostering is hard and is not for everyone, so I don't think anyone should become a foster parent out of guilt.

As for adopting from foster care, I know that the affordability is a big incentive and factor for families.  This goes back to the Adoption Tax Credit, which I mentioned at the beginning of this post.  If a family is going to bring another child into their home (or more than one child at a time in the case of sibling groups) that's KIND OF A BIG DEAL!  Especially if there is a high probability that the child will have special needs which can be time-consuming and expensive.  I know that when my husband and I were first exploring fostering or adopting from foster care, learning that adoption subsidies could be available and that insurance for the child would be provided through Medicaid came as a relief to us financially- especially when we debated whether or not to accept sibling groups as a foster adopt placement or to inquire on sibling groups who were already legally free for adoption.

Those are just a few of my thoughts about changes to the children, youth, and family service delivery system.  As for my school assignment, I tended to focus on specific acts of legislation enacted to deal with some of the problems that have and still exist in the foster care system which were specifically mentioned in my text:

Reading Response 3
Three problems with the current children, youth, and family service delivery system are: intervention when it is too late, children aging out of the foster care system with no permanency, and the overrepresentation of children of color who are placed in foster care and remain in foster care longer than white children.
Most interventions for families occur after the problems have occurred, so the services are residual in nature rather than preventative.  One solution to this is a focus on in-home services which deliver services to families before children have to be placed in foster care.  These services are also much less costly than have a child in an out-of-home setting.  The good news is that studies show that children who receive in-home services have lower rates of PTSD symptoms than children placed in substitute care.  (Ambrosino, p.348) The bad news is that research shows that any short-term gains achieved by in-home service don’t persist over time.
Each year 20,000 youth “age out” of foster care when they turn 17 or 18 because they are unable to return to the care of their parents and are not adopted.  Youth who age out of foster care are at a greater risk for substance abuse problems, homelessness, incarceration, teen pregnancy and even sex trafficking.  One of the solutions to this problem is child welfare advocates pushing for the age of when children are forced to leave foster care from 17 or 18 to 21 years old.  In 1986, PL 96-272 established the Independent Living Program which provided funding for states to strengthen services to youth 16 and older who either were in or had been in the foster care system. Another specific piece of legislation which was intended to help youth who leave foster care get extra support including access to health care, life skills training, housing assistance, and counseling was the Foster Care Independence Act, passed in 1999.

       Because African American children are more likely than white children to be placed in and remain in foster care, Congress passed the Multiethnic Placement Act in 1994 (Ambrosino, p. 365) which prevents children from being denied being placed with a foster or adoptive home solely on the basis of race, color, or national origin of either the child or the foster adoptive parent.  Other foster and adoption agencies have implemented special outreach programs to African American and Latino communities in an effort to recruit adoptive parents.

ANY FOSTER PARENTS, SOCIAL WORKERS, CHILD WELFARE ADVOCATES, CASAs, GALs or  especially CURRENT OR FORMER FOSTER CHILDREN READING THIS:  Is there anything else you would add to the list?  What do you see as the biggest problem or problems within the child welfare system?  And what are some possible solutions?

Thursday, October 26, 2017

ACEs & The Protective Power of Connection

I have been fascinated with the concept of Adverse Childhood Experiences (ACEs) having an impact on physical health since I first heard about the groundbreaking study and acronym at a Child Abuse Prevention Conference I attended years ago.

Here's an infographic which serves as a good Cliffs Notes Version of ACEs:

As equally intriguing to me to learn about the impact of risk outcomes for ACEs, is just how the ACE study came about- so I'll tell you:

Dr. Vincent Felitti was a medical doctor and chief of Kaiser Permanente's Department of Preventative Medicine in the 80's.  Dr. Felitti ran an obesity clinic with the purpose of helping bring about dramatic weight loss without surgery in individuals who were significantly overweight- not just needing to lose 10 or 20 pounds but hundreds of pounds.  (On a personal note, the findings in Dr. Felitti's work with his patients is of particular interest to me since I have been both thin and obese throughout my life without any significant attributable physical explanation for my fluctuations in weight, such as a glandular disorder).

What Dr. Felitti found was that although his patients were successful at losing hundreds of pounds of weight with the aid of his methods, many of them would gain an extreme amount of weight back afterwards.  Long story short: Upon further investigation and inquiries, Dr. Felitti and his team of researchers discovered that most of his morbidly obese patients had been sexually abused as children.
After hearing the data Dr. Felitti presented about his obese patients in 1990, another medical doctor and epidemiologist from the Center for Disease Control and Prevention (CDC) by the name of Robert Anda encouraged Dr. Felitti to start a much larger study researching a more general population.  This was the beginning of the ACE Study which included more than 50,000 patients.  As a measurement tool, Drs Felitti and Anda spent more than a year developing ten questions for their patients about different categories of adverse childhood experiences such as physical and sexual abuse, physical and emotional neglect, and having parents who were divorced, mentally ill, addicted, or in prison.

[Any readers interested in discovering your ACEs score can use the ACES Too High website for a quick assessment.]

As one might conclude, children in foster care have a much higher rate of ACEs than the general public. In her memoir, Garbage Bag Suitcase, which I reviewed here,  Shenandoah Chefalo brought up ACEs.

So . . . speaking of ACEs,  I saw this Ted Talk a couple of weeks ago (during my night class to be exact) in which a doctor introduces the concept of ACEs to those who may not be familiar with them and I just have to recommend that you take 10 minutes and watch this clip all the way through to the end. I found it to be so inspirational and extremely pertinent to foster parents or ANYONE who works with youth.

So . . .  if research has shown that early secure attachment to caregivers is crucial to preventing addictions and major health problems later in life . . . 

AND if we also recognize the sad fact that many children and youth do not have that kind of crucial connection in their own families to serve as a protective factor, the reassuring news, as illustrated in Dr. Allison Jackson's TED Talk, is that any caring adult can make a huge difference in a child's life- even if they aren't necessarily related by blood. This certainly includes teachers, neighbors, coaches, clergy, social workers, etc. 

I was also reminded as I watched Dr. Jackson's TED Talk that in Heather Spencer's memoir, Ezra and Haddasah, which I reviewed here, Heather specifically noted that her level of hope and resiliency in overcoming her traumatic upbringing was greatly impacted by one single adult in her life- namely, her school librarian.

In his book, The Body Keeps Score: Brain, Mind, and Body in the Healing of Trauma, Dr. Bessel Van Der Kolk recalls the first time he heard Dr. Robert Anda presenting the results of the ACE study.
"The first time I heard Robert Anda present the results of the ACE study, he could not hold back his tears.   In his career at the CDC he had previously worked in several major risk areas, including tobacco research and cardiovascular health.  But when the ACE study data started to appear on his computer screen, he realized they had stumbled upon the gravest and most costly public health issue in the United States: child abuse.  He had calculated that its overall costs exceeded those of cancer or heart disease and that eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters.  It would also have a dramatic effect on workplace performance and vastly decrease the need for incarceration."
Wow, right?  I'm not sharing all of this information to be a Debbie Downer or to guilt anyone into going out and fostering five children right this minute.  But I do think it's absolutely necessary to understand both the harming and healing power of early relationships.

The hopeful news is that for those who may not have had a stable or loving environment with their parents or other adults in their life or who feel discouraged because their ACEs score is too high, how reassuring to know that you can still BE a loving parent or adult in a child's life.

Thursday, October 5, 2017

Avoiding Burnout

Last night I went to a foster care training which touched upon compassion fatigue.  Compassion Fatigue is a term that was initally coined in the 1950s after studying some of the occupational hazards unique to the nursing profession.  (That little fact wasn’t shared at the training, but since I am nerdy I googled some of the studies and research about compassion fatigue afterwards.)  Compassion fatigue can also be known as “burnout” and is related to secondary traumatic stress.   Here is an official Merriam-Webster definition of compassion fatigue:

Medical Definition of compassion fatigue

:the physical and mental exhaustion and emotional withdrawal experienced by those that care for sick or traumatized people over an extended period of time

  • Some researchers consider compassion fatigue to be similar to posttraumatic stress disorder (PTSD), except that it applies to those emotionally affected by the trauma of another (eg, client or family member) rather than by one's own trauma.
  •  —Michael K. Kearney et al.,  The Journal of the American Medical Association,  18 Mar. 2009

  • One of the most interesting facts I learned at the training was the risk factors contributing to compassion fatigue.  And since I’m in student mode right now, I jotted them down on paper.
    Our trainer sited these three risk factors for developing compassion fatigue:

    Being FEMALE.  (Females are more likely to develop compassion fatigue than their male counterparts.)

     -Being an EMPATH by nature.


    I don’t know which particular study was the reference for these three risk factors (hence my aforementioned Googling), but they totally make sense to me.

    I’d like to briefly examine each of these factors. 

    As to the first risk factor:  The “being female” factor seems like a given.  At the risk of sounding sexist, it appears that certain helping professions- such as nursing and social work- seem to statistically have a lot more women than men employed.  Although I do admit I have had some great post-op nurses who were male.

    The majority of foster parents I know are also female- whether their marital status is single and they’re doing all of the fostering without a partner or spouse or if they are married, most times the female is the primary caregiver in providing foster care, which is why I have to have twelve hours of in-service training a year to renew my foster care license and my husband only has to complete four hours. 

    As to being empathetic by nature- totally makes sense.  What person is going to decide to go through the process of becoming a foster parent (or a social worker or a nurse) if they aren’t empathetic by nature?  It just seems like a logical fit; people choose those professions because they are natural helpers and they care about others.  Case in point: How many foster parents or social workers go into that line of service or work because they are motivated to make loads of money?  (That comment was both rhetorical and highly sarcastic).

    As for the third factor, having unresolved trauma, I ABSOLUTELY see how that could be a risk factor leading to increased burnout, especially in the case of fostering.  If someone had an abusive home life growing up or even if they had a relatively safe and stable home life but have had an experience of bullying or sexual assault it seems more than likely that having a child in their home who has been through similar victimization circumstances will bring up some triggers. 

    I think the keyword in the phrase “having unresolved trauma” is the word unresolved.  Because who hasn’t experienced trauma, right?  Very few people go through life unscathed.

    A large part of discussion at the training was, inevitably: What are we doing as foster parents to prevent burnout?  I think that answer can be summed up in two words: self-care.  And while self-care is going to look different to everyone- one person may use running or physical activity as their preferred form of self-care while another may prefer relaxing in a bubble bath, whatever works for you is necessary. 

    It’s also interesting to me as both a foster parent and a graduate student of social work that my professors- just one semester into our program- have continually stressed the importance of self-care as well as exploring and resolving, if necessary, any unresolved personal issues we may have in order to not get “triggered” when working with clients in similar circumstances.

    Another topic the training I attended last night touched upon was the impact that fostering can have on a marriage and also on the other children in the family.  This is a topic which could be worthy of a whole separate post or two! [I’m making a mental note of that].

    I guess the bottom line is that it is ESSENTIAL to take care of yourself first before you can take care of anybody else.  (Ironically, this counsel is coming from the woman who got her kids fed, bathed, and out the door for school by 8:30, but who still hasn’t taken a shower herself an hour later.)  But that’s totally okay, because for me, personally, writing (while wearing my sweats) is part of my self-care/unwinding/processing “me time” regimen.