Tuesday, December 31, 2019

2019 Hiatus & Update

You might be in your final year of graduate school if. . .

You have only written four blog posts IN ONE YEAR!

Yep, I’m still here.  I’ve just taken a brief hiatus as I focus on balancing my graduate studies with my family life and working part-time.  I’ve been made painfully aware that it’s impossible to be “perfect” in all areas of one’s life- something’s got to give and be put on the back burner.  And this blog has definitely been put on the back burner over the past couple of years.

The good news is that I am starting to see the proverbial “Light at the End of the Tunnel” as this Spring I will be finishing up my graduate studies and required hours of supervised internship experience to receive my Masters in Social Work.   Eventually, after 4,000 MORE supervised hours and passing the licensing exam I will be an LCSW (Licensed Clinical Social Worker).

          I am currently working in my second internship placement and I am quite satisfied with both the population I serve and the work I am involved with.  I felt a loss last year, as well as a bit of guilt, when we came to the decision to close our foster care license after 12 years of fostering.  Then in 2019 I was presented with a job opportunity (at my current internship) which seemed to fill that particular “void” of helping children in the foster care system without necessarily being a foster parent.  

        At my current practicum placement I not only get to work with children and adolescents in the foster care system, but with their caseworkers, their foster parents, their biological parents (in some cases), as well as a few Guardians ad Liteums and judges on occasion.  More specifically, I have been trained to conduct mental health assessments and provide in-home therapy to these children and their families.  To learn more about the type of modality I’ve been trained in and use, which is both trauma-informed and attachment-based refer to this post.  Other modalities I draw from in my work with clients are Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Parent-Child Interaction Therapy (PCIT), and Trust-Based Relational Intervention (TBRI).
          Although I can’t and won’t give details about my experiences for obvious reasons, I’d like to provide some general observations (not necessarily in any particular order) of things I’ve learned over the past year in my therapeutic role to children and families impacted by being placed in state custody.  I feel like I could honestly write an individual post for each one of these observations, but for the sake of space and time these summaries will do for now:

-      Caseworkers have a tough job- witnessing a lot of emotional pain and having high caseloads.  It's challenging to work with clients who are court-ordered and don't believe they need any services.   It’s not surprising that child welfare workers have a heavy turnover rate.

-    I appreciate relatives who are able to step up and open their homes to becoming Kinship Placements- especially grandmas, who forfeit their role as grandparent to that of “parent” to their grandchildren in what could be their years of retirement.  In some cases, these grandmas are the bedrock and/or savior of their family

-      Parentification isn’t just about taking care of younger sibling’s physical needs: (getting them dressed or to school on time, and making sure they have enough to eat), but there’s an emotional aspect a well where the child feels responsible for their parent’s emotional needs.

-   Regarding parentification and patterns I’ve seen, many children from early to middle childhood (grade school) continue to worry about and feel false responsibility for their parents who are or have been absent from their lives due to substance abuse struggles and/or mental illness, and readily excuse and overlook any dysfunction on the part of their parents.  However, by the time these same children reach adolescence or young adulthood they are more prone to be filled with resentment for caring for younger siblings for so long and/or they become tired of having the roles reversed after constantly worrying about or covering for their parents for so long.

-      Attachment is everything.  Children can become hurt, broken, and damaged in relationships (especially in family relationships) but healing can take place with the proper interventions and resources, including supportive relationships.

-     So many disorders can be preventable because of early traumas and one’s family life.  One semester when I had a class delving into the DSM, I would find myself immediately jumping ahead to the section of “Risk Factors” for disorders to find just how many disorders are influenced or precipitated by neglect and abuse, including Oppositional Defiant Disorder, Conduct Disorder, Borderline Personality Disorder, Reactive Attachment Disorder (which is probably the most obvious) but trauma and stressor-related disorders and Depressive and Anxiety Disorders.  
 I believe it’s more important to treat a person than a diagnosis.  And although diagnoses are helpful in formulating a Treatment Plan or understanding which symptoms to focus on (and are necessary for Medicaid reimbursement), a person is much more than their diagnosis.

-   I wish Developmental Trauma were an officially recognized DSM-V Disorder because although it has similarities with other traumas the attachment and trust component require such specialized care and a unique approach.

-      It is essential to understand that someone’s developmental age may be vastly different than their chronological age.  It was very insightful to me to read a very comprehensive neuropsychological evaluation of one of my clients from a developmental psychologist who measured different aspects of one’s IQ.  I realized that I needed to approach this client in a different way based on his developmental age.

-      Symptoms of ADHD and Trauma can look a lot alike.  Sometimes it’s hard to unravel the two- especially if both exist.

         (I got this graphic off of Pinterest- don't know where exact credit should go)

-      Just like “It takes a village to raise a child” , it takes a team to work together for children in foster care.  I’ve been able to attend Child and Family Team Meetings in a new role this past year- as a therapist versus a foster parent- but my observations are the same:  There are so many facets of support to a youth in state custody: physical health, mental health, schooling, other opportunities- that the more professionals and caregivers can step forward and come together in behalf of a child, the more hope and resources there are for the child.  

    I was touched to be able to attend one CFTM where not only the teacher and after-school coordinator of a client were present, but the principal of the school as well.  In a different meeting, a Transition to Adult Living Coordinator was there to help the youth who was preparing to age out of the system.  In other meetings nurses are ready to make sure all appointments or physical concerns are followed through with.  I even discovered that my state has a specific nurse assigned to oversee any youth who are prescribed psychotropic medications.

-      School is children’s work- where they spend most of their day.  Because of that, I’m grateful for trauma-informed classrooms and sensitive teachers.

-      Because I’m a social worker, I try to get the “big picture” of what’s going on in a client’s life: not just their mental health, but their physical health, their social environment, their school, etc.  Having said that, I would like to learn to incorporate more physically-based interventions (besides just deep breathing and meditation- maybe somatic experiencing or sensorimotor techniques) with my clients who have sleep problems- particularly insomnia, or who have a lot of muscle tension as a result of past traumas or whatever reasons.  I feel so frustrated for children and adolescents who can’t relax because muscle aches and insomnia seem like “old person problems”.  Many of these kids have tried melatonin which may help them get to sleep but they cannot sustain restful sleep.  And then they're expected to go to work (school) the next day and perform like nothing is wrong!

-      I use various assessment measures when conducting Mental Health Assessments with clients for the first time, but I recently started using the ACEs- not necessarily because it will give me a diagnosis, but because it helps me to gather a more complete social history of the client.  After one session this year, I was both amazed and saddened that I came across one client who had an ACES score of 9 (out of 10). He had experienced all but one of the adverse childhood experiences.  As I was driving home from work that night and the enormity of what my client had been through sunk in with me I wanted to cry.
    On a more hopeful note, here are some protective factors to help mitigate a high ACES score:

Using Attachment, Regulation, and Competency Modality with Foster Children

This is a summary/review of an assignment I did last semester.

Background:  This year I am doing my internship with an agency that contracts with DCFS to provide Mental Health Assessments and Individual and Family Therapy to children and adolescents who are currently in the foster care system or who have been adopted (in many instances) from foster care. 

Employees at my work are required to read the book Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience and through Attachment, Self-Regulation, and Competency written by two clinicians, Margaret Blaustein and Kristine Kinniburgh.  Blaustein and Kinniburgh are a clinical psychologist and a clinical social worker who both specialize in treating complex childhood trauma and/or in incorporating trauma-informed practices into a range of settings.  These two women were influenced by the work of Dr. Bessell Van der Kolk, among other clinicians, who work with clients impacted by trauma and they have developed a specific treatment framework called the ARC Modality which is used to treat developmental trauma and accompanying problems in youth.   

Before I explain the ARC Modality, I will summarize what Treating Traumatic Stress in Children and Adolescents teaches about developmental trauma and how that fits into my internship:  The population that I work with would never have come into state custody in the first place if they hadn’t suffered from abuse, neglect, or abandonment.  Although the symptoms and diagnoses of my clients vary, all of these children are suffering in some degree from the affects of developmental trauma which can be defined as chronic trauma caused by a child’s caregivers early in life which greatly affects, among other areas, their ability to form safe and healthy attachments with others.  There are many other traumas such as a car accident, natural disaster, or sexual assault which can result in the victim developing acute stress disorder, adjustment disorder, or PTSD.  The difference between a traumatic event such as a car accident or fire, for example, versus parental neglect and child abuse is that they are not usually caused by an individual’s caretaker who has the responsibility to care for them so the child’s ability to trust and form safe and healthy attachments is greatly impacted, sometimes resulting in attachment disorders such as Reactive Attachment Disorder or Disinhibited Social Engagement Disorder.  Many children suffering from early trauma at the hands of their caregivers also have trouble regulating their emotions since so much of their energy and brain is stuck in “fight, flight, or freeze” mode or they are triggered easily.

ARC stands for Attachment,Regulation, and Competency which are the three different domains of their treatment.  When I develop treatment plans and therapy goals with my clients at work I am required to use the ARC Modality.  

 Attachment refers to being able to connect with people in a safe way which is hard for a lot of kids if they never had the opportunity for their parents or first families to meet their needs and model what a healthy, nurturing parent-child securely attached relationship looks like for them.  Regulation simply refers to not only being able to identify emotions in oneself and others but being able to express those emotions in healthy ways (not kicking or hitting other people when you’re angry, etc).  or, on the other extreme, not ignoring or dissociating from unpleasant emotions and sensations.  Competency refers to being able to function executively and follow through with basic tasks of everyday living. 

The majority of my sessions with clients focus on the simple goal of affect identification and regulation- or simply put, being aware of one’s emotions and keeping them in check.  This book not only gives an overview of attachment theory and developmental trauma, but also contains some assessment questions and suggested interventions for treating each of the domains in the ARC Modality- Attachment, Regulation, and Competency.  It’s been especially helpful to get ideas for interventions for attachment because I’ve recently started doing family therapy with a few clients either between parent and child or siblings together and attachment is almost always primarily what we work on in those sessions.  In addition, some of the attachment interventions are ones I can use to increase attunement with my own children in my own home.

If you currently work with or have an interest in working with clients or families who have suffered attachment injuries or developmental trauma I recommend reading the book Treating Traumatic Stress in Children and Adolescents.

Saturday, July 27, 2019

The Child Protection Plan

Earlier this year my husband and I had the humbling and sobering experience of meeting with an attorney to draw up the papers for our personal Family Trust.  As part of the process, we had to come up with “nominations” of family members we trusted enough to become guardians to our children in the case that we both died or became incapacitated while our children were still minors. 

Part of the paperwork we had to fill out in our Trust included a document called a “Child Protection Plan” in which we also had to provide information for any possible future guardians of our children.  The name alone of the document, “Child Protection Plan”, sounded like some sort of form a child welfare worker would fill out, but rather than being filled out by a social worker, it was filled out by two parents concerned for the welfare of their children’s futures.  Some of the questions on the document we had to answer were:

“What values do you want instilled into your children?”

“What special holidays or observances would you like them to participate in?

“How would you like your children to be disciplined?”   (I had a whole list of books & theories for this question when, perhaps, the words “lovingly” and “just” would suffice.)

“What community or extracurricular activities would you like your children to be involved in?”

“What people do you want to be a part of your child’s life?”

It was a bit overwhelming to answer these questions because it really hit home what an enormous responsibility and commitment parenting is.  My husband and I found ourselves exploring topics such as “How are we doing raising our children?” and “What kind of legacy do we want to leave for our children after we’re gone?” 

It was also very depressing to think about not being able to be there for our kids when they need us the most.  I automatically equated the way I was feeling to how an expectant parent or birth parent might feel when choosing to make an adoption plan for their child and trying to decide what kind of a family or person to entrust with the sacred responsibility of raising their child.  What an incredible sense of loss and a huge relinquishment of control!  I saw the following quote last year and it helped me to get a glimpse of what it might be like to be a birth parent:

I also thought of what it would be like to be a parent whose children are taken into state custody: Who would I want my child placed with?  Do I even have a say in the matter?  Or, I imagined what it would be like to be an unwed mother in the “olden days” of unethical and unregulated adoption practices who had their child taken from them against their will (I’m knocking on wood that most of those horror stories were in the past and don’t currently exist).  In either case, I would be in a state of utmost panic for the sake of my child:  Would my child’s new caregivers be able to give them the care they need?  If they have children, will they treat my child as well as they treat their own children?

Whether you are a birth parent/first parent reading this who grieves for the child you brought into this world but whom you aren’t raising, or perhaps you had your children taken away from you and placed in foster care or have had to, by necessity, have family members step in and raise your children, and may be shouldering burdens of resentment, guilt, or grief . . .  I think there are some feelings any parent can relate to- namely, It’s tough- [whether you had a say in where your child ended up or if it was against your will and personal choice]- not to be able to raise your children the way you want- or perhaps, by whom you want.  It takes an extreme amount of trust that there are other people out there who have enough love in their hearts and room in their homes (and resources- because raising children isn’t cheap!) to commit to raising a child.

It is also a helpful reminder to those of us raising children who weren't ours to begin with to be mindful of their first families.

Thursday, February 14, 2019

Reflections on Instant Family

I finally got around to seeing Instant Family and I thought it was a good blend of accuracy and humor in portraying what foster-adoptive families experience.

Rather than give a complete plot summary, here are some scenes and themes I’d like to share which stood out to me in particular, as someone who has fostered and adopted children through the foster care system:

Fantasy Children vs. Reality Children- In a training class prior to becoming licensed foster care providers, members of the class were asked to do an exercise in which they drew their “fantasy” children on a chalkboard.  The social workers teaching the class instructed the foster parents in training to immediately erase their envisioned fantasy children and to prepare themselves for whatever comes next.

I think the theme of expectations versus reality is a universal one that almost anyone can relate to.  Sometimes the most difficult thing to do in life is to let go of our expectations, relinquish any perceived control of how we think things should turn out and accept- or make the best out of- what actually comes our way.

When applying the concept of control and predictability to fostering, I think many foster families or pre-adoptive couples may be set on only fostering or adopting children who are a certain age or gender (Or in the case of the movie’s character October, are looking specifically for a black, male, athletically inclined child who can get a full football scholarship, reminiscent of The Blindside).  It can be difficult to try to broaden preferences at the risk of getting out of one’s comfort zone and venturing into the unfamiliar.  However, Pete & Ellie did just that as they inquired about a teenager available for adoption- something Ellie initially openly verbalized against doing.

Foster Parents Supporting Each Other- The best source of support is someone who has been through the same thing or been in a similar situation; Therefore, I think that the best source of support and understanding for foster parents are other foster parents! 

Throughout the movie, Pete & Ellie meet in an adoption support group with other couples and individuals.  Although each couple’s reasons for wanting to pursue foster adoption was unique: some felt “called”, others were struggling with infertility, another couple was gay and thus couldn’t procreate, they all shared the desire to welcome children into their families.  It was humorous when the gay couple commented something to the effect of, “We’ve been trying to conceive for years with no success!”

I was particularly touched in one scene towards the end of the movie as the adoptive families had shared their personal struggles with each other and got to know each other better, when the gay couple announced to the group that their upcoming adoption would be official and the first people to go up and hug them was a conservative Christian couple, whom at the beginning of the training, showed through their body language, disapproval or discomfort about the gay couple adopting.

Once we take the time to get to know each other, it becomes evident that we all have more in common than we don’t have in common.

The Honeymoon Period- Speaking of holding on to a sense of “control” or predictability, I think some parents are under the false impression that if kids are well-behaved or turn out all right, then it is a direct reflection on their competency as a parent or caretaker.  Wrong! 

Pete & Ellie entered one of their support meetings with an attitude of “Hey- We have this under control- the kids aren’t acting out.  Things aren’t so bad!” and the other more experienced foster parents in the room were laughing or had smirks on their faces because likely, they had experienced the phenomenon referred to as “The honeymoon period” in which everything seems peachy-dandy with a placement.  The reality, however, is that a foster child’s behavior has less to do with structure and discipline of the home or parenting style, but everything to do with a mode of survival. 

Most people would think ‘It’s great that these kids aren’t acting out!” and admittedly, that is much easier than the alternative and it makes for a much more peaceful environment.  But it’s actually when the child starts acting out that they feel safe enough to do so.       
I recall the shock my husband and I went through when the honeymoon period ended with our first placement, who was typically a delightful preschooler.  When, after about three weeks of being in our home, he started being less delightful and talking back and complaining, we were worried.  I believe it was another more experienced foster parent that explained to us, even though it was hard, “That’s actually a good thing- he feels safe enough to be himself without the fear of any harsh consequences!”

Parentification- It was obvious that Lizzie, the oldest child of the sibling group Pete & Ellie were fostering, had taken upon herself the role of “parent” to her younger brother and sister, Juan and Lita.  It was interesting to observe the struggle it was for Lizzie to give up that parenting role and let her foster parents take over, especially when she knew her siblings better than Pete & Ellie did.  Equally of interest to observe was the conflict of loyalty Ellie felt with letting her foster mom be a “mother” to her without somehow betraying her own mother.

Ongoing Struggles with Adopted Children- I was very touched by the guest speaker the social workers invited to speak at one of the trainings the adoptive couples went through at the beginning of their training.  Brenda was an articulate and inspiring young woman who had a history of neglect and abuse, including being traded to her mom’s drug dealers for drugs, if I remember correctly. 

Brenda was accompanied to the meeting by her adoptive parents and spoke to the class about what it meant to her to be adopted as a teenager after spending years in foster care.  This young woman was so inspiring and I think that sometimes adoptive parents are under the impression that ‘There’s nothing LOVE can’t fix!” and that once a child is adopted it’s going to be the beginning of happily ever after.  The reality is that adoption does not erase the early experiences and traumas that a child had been through.  Neither will adoption erase a child’s genetics or predispositions. 

Later in the movie when Pete & Ellie are going through a rough patch with their teenage foster daughter, Lizzie, they seek out Brenda’s adoptive parents for some hopeful advice and direction. It was heartbreaking to hear Brenda’s adoptive mom share that her daughter was back in rehab when Ellie asks where she is. But I loved the mom’s retort to Ellie’s disappointment (the slap in the face was unexpected and humorous as well)!  Like a protective and loving Mama Bear, Brenda’s mom says something to the effect of “But look at where she came from and how far she’s come!”  A great reminder that unless we’ve been in someone else’s shoes we have no right to judge.  It’s also a good reminder that, as I mentioned earlier, no matter how stellar a parent is, adoption does not erase a child’s predispositions or former traumas.  This can be particularly frightening to accept when a baby or child is born addicted or exposed to drugs as addiction has such a strong genetic component, as well as when there is severe mental illness on one or both sides of a child’s family lines.

Conflicting Feelings About Birthparents- This is such a real struggle for foster parents!  Honestly, it’s one of the hardest things, other than the grief of reunifications, that I’ve had to deal with while fostering. 

At one point in the movie’s storyline, foster mother Ellie says to her husband, “She looks so normal.” regarding their foster children’s mother when they meet for a visit.  Ellie recognizes that their mom is just that- a mom who loves her children.  Yet it’s hard to think of someone who would endanger their children as “normal” or sometimes, even deem them worthy of having a relationship with their children.  After all, this woman set the children’s home on fire from a lit crack pipe!

But behind someone’s criminal history or case file is a person.  It’s harder to judge someone when you look them in the eyes and meet them in person.  I also think it was telling that the children’s biological mother was also a product of the foster care system as one of the caseworkers remarked, “She never learned how to appropriately care for her children.”

In another support group meeting Rose confesses to feeling guilty for wanting her kid’s biological mother to fail- especially after all of the work she and her husband have gone through to care for these children and open up their home to them.  I’ve been there and have felt guilty for thinking the exact same thing.  It’s such a difficult task as a foster parent to recognize that family preservation is the goal while also noting, “Look at what these kids have been through and look at the life we could give them!”

Overall, I would highly recommend the movie Instant Family to anyone over 13 (the PG-13 rating was appropriate) and I am grateful that the director chose to draw on his life’s experiences to highlight the crucial, yet often overlooked issues of fostering and foster care adoption.