Meeting the needs of foster children within the EI System IECC Conference Tacoma, WA—5/03/12 Julie Fisher, MSW, LICSW Jill Reece, MSW, LSWAIC Marnie Klaasen,

Meeting the needs of Meeting the needs of foster children within the foster children within the EI SystemEI System

IECC ConferenceTacoma, WA—5/03/12

Julie Fisher, MSW, LICSW

Jill Reece, MSW, LSWAIC

Marnie Klaasen, Foster Parent

Kindering—Bellevue, WA

Questions guiding our Questions guiding our discussiondiscussion

Why foster children and EI?How to qualify foster children for

EI services?When to assess foster children

for services?Who is involved when you are

working with foster children?What is Infant Mental Health?

Where does it happen?

““Children who are removed Children who are removed from their homes and placed from their homes and placed into foster care due to abuse, into foster care due to abuse, neglect or abandonment, neglect or abandonment, almost by definition have almost by definition have special needs.”special needs.”

State Early Childhood Policy Technical State Early Childhood Policy Technical

Assistance NetworkAssistance NetworkJune 2003June 2003

Risk FactorsRisk FactorsNeglectPre or Post-natal Substance AbuseEarly losses/Multiple CaregiversDomestic Violence ExposurePhysical or Sexual abusePrenatal RejectionChild HospitalizationChronic IllnessCaregiver’s Mental IllnessFamily Members Incarcerated

Developmental ConsiderationsDevelopmental ConsiderationsIDEA & CAPTAIDEA & CAPTA

Part C (ages 0-3) of the Individuals with Disabilities Education Act (IDEA) was established by the federal government in 1986.

The Child Abuse & Prevention Treatment Act (CAPTA) of 2003 requires that infants and toddlers involved in substantiated cases of maltreatment be referred to EI services.

Foster children under age three experience developmental days at TEN times the rate found in the general population (NCCP, Sept. 2010)

Medical considerations & Perinatal Medical considerations & Perinatal InsultsInsults

Almost 80% of young foster children have prenatal exposure to substance abuse

More than 40% are born prematurely or at low birth weight, two additional risk factors

Over 50% suffer from physical health problems

--Columbia University’s National Center for

Children in Poverty

WA State Maltreatment WA State Maltreatment Statistics (from 2007) Statistics (from 2007)

10,000 children in foster care

1/3 of these children placed with relatives (in formal kinship arrangements)

42,300 referred to CPS

How to Qualify Kids?How to Qualify Kids?Breakdown by domains

◦Speech Receptive—particularly with infants, social

communication lacking Expressive—lack of opportunity/speech not

encouraged

◦Adaptive—feeding, sleeping, sensory issues, medical issues

◦Motor—hypertonic with drug exposure; delayed due to too much confinement

◦Social/Emotional—Behaviors; use of DECA-I/T & DECA-C as well as ICO

Importance of timingImportance of timingSchedule as soon as possible

after child comes into foster care—we have evaluation spots dedicated to foster children, as well as a dedicated FRC

Relationships with CHET screeners—CHET has to be out to the foster home within 30 days of the foster child coming into care

Who are the players?Who are the players?Foster Parent or Relative CaregiverBirth ParentChildren’s Administration Social

WorkerBirth Siblings--may be in a different

foster homeVisit SupervisorCASA/VGAL

Tips for Early Intervention staff Tips for Early Intervention staff regarding the Foster Care Systemregarding the Foster Care System

•What to call the foster child?•What to call the foster parents?•Who has legal rights?•Myths about foster parents•Differences between foster parents and kinship caregivers

What is CHERISH?What is CHERISH?CHildren Encouraged by Relationships

In Secure HomesCHERISH provides reparative and

preventative interventions for foster children and caregivers that address their traumatic experiences and developmental impacts.

Foster Children ages 0-3 living in King County, WA in out-of-home care are eligible for the CHERISH program

CHERISH Services for KidsCHERISH Services for KidsComprehensive developmental evaluationPsychosocial assessment in the home◦ Early history (risk factors)◦ Historical and current symptoms◦ Direct observation of relationship patternsDevelopmental therapies if there is a delayStepping Stones toddler preschool classesDyadic developmental psychotherapy (home visiting model)◦ Adjustment issues (i.e. infant temperament/caregiver fit,

grief & loss, transitions)◦ Bonding (forming an attachment)◦ Attunement (accurately reading and responding to the

social-emotional cues of another)◦ Trauma◦ Psychoeducation

CHERISH Support ServicesCHERISH Support Services“If we value our children, we must cherish their parents.”“If we value our children, we must cherish their parents.” - John - John Bowlby, MDBowlby, MD

Brief therapy for foster & relative caregivers

Systems consultation for staff and caregivers

Mamas & Papas kinship support group for relative caregivers (collaboration with Youth Eastside Services)

Topical trainings around parenting and children with special needs

Foster Parent SupportFoster Parent SupportAccording to researchers at the Oregon

Social Learning Center, supporting foster parents and helping them manage their stress are the biggest keys to placement preservation… (Healey presentation, 3/5/11)

“The interventions that have provided the most robust evidence of effectiveness…have typically focused on providing services to support the caregiver-child relationship (Dozier, et al., 2002; Fisher et al, 2006).”

CHERISH Program CHERISH Program OutcomesOutcomesChild & Caregiver well-being:

◦PIR-GAS Scores (part of DC: 0-3R)◦DECA-I/T Scores◦Parent satisfaction surveys

Placement preservation:◦In their first 12 months of care,

98.3% of our clients had 1-2 placements

◦The federal practice standard is 86.7%; King County stat is 66.6%

What is Infant Mental What is Infant Mental Health?Health?

Infant Mental Health (age 0-3) is the capacity of the child to experience, regulate, and express emotions; form close and secure interpersonal relationships; and explore the environment and learn.

IMH is synonymous with healthy social and emotional development.

- Zero to Three

What is Attachment?What is Attachment?The basic concept is that every infant needs at least one close, dependable relationship providing nurturance, security, responsive interaction and encouragement of exploration to develop to their fullest potential.

Attachment is a biologically-based process.

“Relationships with intimate caregivers promote physical, emotional, and behavioral regulation in infants through repeated interactions that are predictable, responsive, and nurturing.”

Zero to Three, July 2005

Attachment PatternsAttachment PatternsSECURE

INSECURE◦Avoidant: characterized by high

degrees of dissociation and withdrawal

◦Ambivalent: characterized by a persistent highly aroused, vigilant state

◦Disorganized: characterized by role-reversal with caregiver

Juvenile & Family Court Journal, 2004

When a Secure Attachment When a Secure Attachment is formed…is formed… Studies of resiliency have consistently found

that the most basic and important protective factor is the history of caregiver-child attachment.

Secure attachments are a primary defense against the development of severe psychopathology associated with adversity and trauma. In children who have been exposed to early loss and stress, the quality of parent-child attachment is the most important determinant of long-term damage. Even when securely attached children deteriorate in the school years due to extreme adversity, they are more likely to rebound later.”

Levy & Orlans, 1998

Neurobiology of Neurobiology of TraumaTrauma

Fight, flight, freeze alarm reactions to acute stress or danger is instinctive and normal

HOWEVER, traumatic experiences in infancy & early childhood can trigger prolonged alarm reactions which alter the neurobiology of the brain and the central nervous system

“Your brain will become the kind of brain you need.” --Stirling, MD 3/27/07

Symptoms of Maltreatment Symptoms of Maltreatment Developmental delays/skill regressionEating patterns—food refusal, stuffing mouth, hoarding, no knowledge of “full”Sleep issues (separation problems, falling asleep/waking up, night terrors)Self-soothing behaviorsEmotional functioning—incessant crying or not crying when should; refusal to make eye contact; dislike of touch; serious affect; clingy behaviorsAggression/IrritabilityHypervigilance & PanicDecreased exploration/play

Parenting Interventions—it Parenting Interventions—it all starts with building a all starts with building a secure attachment…secure attachment…Consistency, predictability, reliabilityParenting based on emotional age;

expect regression & ENCOURAGE it Understand reasons behind

behaviorsModeling, narrationPatience—repetition is the name of

the gameRepairs & Re-do’sSelf-care—caregiver HAS to attend

to own self-regulation

Reflective PracticeReflective Practice

“Kiss me when I’m bad, that’s when I need it the most.”

--Maura Stuard, age 9

Books for Foster & Adopted Books for Foster & Adopted ChildrenChildren

Kids Need to Be Safe by J. Nelson

The Way I Feel by J. Cain

Maybe Days by J. Wilgocki & M. Wright

Hug by Jez Alborough

Families Change: A Book for Children Experiencing Termination of Parental Rights by J. Nelson

My Many Colored Days by Dr. Seuss

Calm-Down Time by Elizabeth Verdick

Website ResourcesWebsite Resourceswww.talaris.org

www.adoptmed.org

www.abcintervention.com

www.nccp.org

www.circleofsecurity.org

www.zerotothree.org

www.childtrauma.org

www.cpeip.fsu.edu

Selected ReferencesSelected References

Gray, Deborah. 2007. Nurturing Adoptions: Creating Resilience After Neglect and Trauma. Perspectives Press.

Hopkins-Best, Mary. 1997. Toddler Adoption: The Weaver’s Craft. Perspectives Press.

Jones-Harden, Brenda. 2007. Infants in the Child Welfare System: A Developmental Framework for Policy & Practice. Zero to Three Press.

Levine, P.A. & Kline, M. 2007. Trauma Through A Child’s Eyes. North Atlantic Books.

Levy, T. & Orlans, M. 1998. Attachment, Trauma, & Healing. CWLA Press.

Siegel, D. & Hartzell, M. 2003. Parenting From the Inside Out. Tarcher/Penguin.