Xena.centervideo.forest.usf.edu/qpi/sciattachabridge/...you a little bit about himself and let's welcome. Come doctor, Xena. Thanks very much. Is that too loud? Okay, it's nice to

Okay, so one word about dr.

Xena.

Okay, he's a friend of carole's chauffeur close friends.

So that's really all we need to know but he's also a professor

of Psychiatry and clinical Pediatrics and vice chair for

Child and Adolescent psychiatry in the department of Psychiatry

and neurology at Tulane University School of Medicine.

So also executive director of The Institute of infant and

early childhood mental health.

Okay, and I could go on and on and on but he will also tell

you a little bit about himself and let's welcome.

Come doctor, Xena.

Thanks very much.

Is that too loud?

Okay, it's nice to be with you this morning.

I always welcome the opportunity to come to Florida.

I feel with a group like this.

It's a little bit of a of bringing the coals to Newcastle

because I think what's happened in Florida child welfare

has been very dramatic and impressive and enviable to those

of us in other places.

So the first part of my talk is going to be about the science

of it.

A treatment and that part I actually want to cover.

This is John Bowlby a British child psychiatrist and psychoanalyst

who after World War II was asked by the newly formed World

Health Organization to prepare monograph on the mental health

needs of young children.

There were large numbers of children who were orphaned and

separated from their parents in World War II and a lot of

concerns in the World Health Organization about what these

kids needed and so he wrote an extensive monograph surveyed

the world's literature talk to all the experts that he could

and essentially.

That if the one thing that was most important for ensuring

the well the mental health of young children was a warm intimate

and continuous relationship with a mothering figure that

was 1952 six decades since we have lots of research in support

of this and really it stands more or less unchallenged as

a statement.

So it's important to know that what we're talking about is

not new stuff.

It's tough.

We've actually known for a while, okay.

So now I want to talk about attachment because it's a word

that gets used in a lot of different ways and we have sort

of Ale meaning of the term and then their professional meanings

of the term and there's a lot of confusion about it.

So I want to sort of talk about the different definitions

because they're all somewhat useful in grasping what we mean

by attachment.

So the first definition is attachment as an emotional bond

an emotional connection between two people obviously that

happens in all sorts of relationships but today We're just

talking about parent-child relationships and in parent-child

relationships. It's asymmetrical that is it's the parents

job to provide Comfort support and nurturance to the child

and not the child's job to provide Comfort support and nurturance

to the parent.

So it's an asymmetrical emotional connection between two

people. The second way that the term gets used is as a behavior

and this is describing a behavior in the young child.

Any behavior that is designed to promote physical proximity

to the adult attachment figure is an attachment Behavior.

So that could be crawling over to the attachment figure clinging

onto the attachment figure smiling in order to elicit physical

closeness crying in order to get a response.

It's not the behavior itself.

Often it makes it an attachment Behavior.

It's when it's used by the child in the service of promoting

physical proximity or closeness.

That makes sense everybody with me.

Okay, the Third Way that the term gets used is attachment

as a motivational system and in attachment Theory there are

four major systems that govern the child's Behavior the attachment

system the exploratory system affiliation system the fear

weariness system.

So bear with me as we go Oh these the attachment system motivates

the child to seek physical proximity in times of distress.

So when the child is distressed, the child is motivated to

seek physical proximity or closeness to an attachment figure

we infer from that behavior that the reason the child seeks

physical proximity is in order to feel more secure.

So we say the external observable goal of proxy is proximity

seeking but the internal goal Is a feeling of security okay,

the exploratory system motivates the child to explore the

physical object world.

There's a large literature now on children's motivation to

explore unfamiliar to master challenges to be curious about

the world around them.

That's the exploratory system.

And as you'll see in a minute, there's a special relationship

between the attachment system and the exploratory system.

The third motivational system that's often confused with

attachment, but you will no longer have to be confused by

this. I know you've been troubled is the affiliation system

the affiliation system is what motivates the child to want

to be with and interact with people because it turns out

people are especially attractive for babies to interact with

they can't get enough of interacting socially with people.

That's the affiliation system number attachment is seeking

physical. Proximity in times of distress affiliation is just

wanting to be with people and enjoy interacting with people

and finally there's a system that we call fear weariness

which allows the child to take action in the face of danger.

This is fight or flight reactions.

Probably the best thing to do if you're very young child

is to turn to someone bigger and stronger and smarter and

say hey, what should I do?

This look scary to me.

So the attachment system Also may be activated by fear, but

the child also has a motivational system to take over in

the absence of the presence of an attachment.

Figure okay.

So those are the four systems.

And as I said, there's a special relationship reciprocal

relationship between attachment system and the exploratory

system and that is when one is highly activated the other

is deactivated.

Okay?

What does this mean?

You guys are thinking?

What is this guy talking about?

Right?

So let's imagine there's a little toddler up here with me.

Let's say he's my toddler and here we are in a strange place.

There's a room full of strange people.

What's the toddler doing?

He's clinging pretty close to me.

Right?

So his motivation to seek proximity is elevated.

His motivation to explore is diminished.

But as time goes on you seem like nice people.

I'm sort of droning on and he begins to get kind of feeling

comfortable and then kind of curious and begins to go off

and explore and he thinks that camera over there looks pretty

good that on the tripod.

So he goes over and gives the tripod a tug and the camera

crashes into the cheer makes a loud noise.

What does he do?

Runs back to me right his motivation to explore diminishes

in his motivation to seek proximity intensifies what the

attachment people call this is attachment exploration balance.

And if you think about places where you observe young children

and their caregivers in the doctor's office in the grocery

store in the park, you can observe this moving out to explore

coming back to check in moving out to explore coming back

to check in sometimes.

Check in just for refueling sometimes it's a check in because

something frightening or scary or distressing occurred, right?

So a special relationship between attachment and exploration.

So we've talked about attachment as an emotional connection

or a bond.

We've talked about attachment as a behavior in the child

designed to promote physical proximity to the attachment

figure talked about attachment as a motivational system motivating

the child to seek proximity in order to feel more secure.

And the final way that the term gets used is attachment relationship.

So what is an attachment relationship in the context we're

talking about and how does it differ from the parent-child

relationship is it the same thing is different.

What's the deal?

So now we're going to digress a little bit and talk about

parent-child relationships.

So what I've done is parsed if you will the relationship

into these various functional domains, so we have the parents

side and the child side so parents.

Emotional availability which helps the child's developing

capacity for emotion regulation initially kids can't regulate

their own emotions.

They depend on the caregivers there with to help them regulate

their emotions and out of lots of interactions with their

caregivers over time.

They begin to develop patterns of emotion regulation parents

provide warmth empathy and nurturance and that helps the

child's developing sense of security and basic interpersonal

trust parents provide.

Comfort to young children and from those experiences of being

provided Comfort children learn to seek Comfort when they're

distressed. It may seem like children are just born knowing

to seek Comfort when they're distressed, but it turns out

they're not and I'll show you an example in a minute of a

little girl who doesn't know that parents provide protection

and here we mean not only physical protection.

This is a crucial point.

We also mean psychological protection kids have to feel psychologically

safe as well as physically safe.

And from those experiences of being protected children develop

the capacity to be vigilant about their environment to protect

themselves. And if you think about it, you probably have

known a child or an adult who seems to repeatedly get themselves

into risky dangerous situations over and over and over again,

we think in part that derives from early experiences of not

feeling protected and safe.

Other domains parents are extremely important play partners

for children and children learn an enormous amount about

social world and social relationships from experiences of

playing with their parents parents are constantly teaching

children and children are developing an interest in learning

mastering the unfamiliar being curious about the world around

them the nuts and bolts of parenting structure instrumental

care and routines how the day is organized.

This is very important for young children who really five

when there it work.

Yeah, when they're being cared for in a reasonably well structured

environment with lots of routines and they develop the capacity

to regulate themselves and to adapt to routines which is

crucial to school Success kids who come from very chaotic

backgrounds where there's never any organization never any

structure. These are kids who often struggle a lot when they

get to school settings where now it's time to put the blocks

away and have Circle time and now it's time for snack and

now it's time for this those kids will really struggle with

that. Parents provide limit setting and discipline for young

children and out of experiences of having limit set and being

disciplined children learn how to control themselves and

how to conduct themselves.

Hopefully in a reasonable manner.

So those are the functional domains what we call the functional

domains of the parent-child relationship and what I'm arguing

is that the first four comprise the attachment relationship.

So these are very important, but they're not part of the

Relationships their separable from the attachment relationship.

It's these first four that this is what we mean in terms

of adult behaviors when we're thinking about attachment.

This is what we mean by child behaviors only thinking about

attachment. So any questions about those definitions, we're

going to continue to sort of fill out some of these ideas

as we continue Okay, so How does it happen develop over time?

First of all first question always is when two babies become

attached. Let's talk about that because attachment it turns

out unfolds over the first several years of life and we can

also talk about attachment from the standpoint of the baby.

We can talk about attachment from the standpoint of the parents

how many parents are attached to their babies at Birth?

Yes.

Every parent always but typically you would say yes.

Okay.

Alright.

So the first thing is with regard to parents.

It depends on when you ask the question you may get somewhat

different answers.

So let's say a month after birth.

You posed the question to parents.

When is the first time you felt love for your baby?

What will they say?

So it turns out a small minority will report as minute.

I knew I was pregnant.

I immediately was in love with this baby.

I that was just it period another group will say We'll really

it was as the pregnancy continued.

I felt the baby moving really kind of towards the end of

pregnancy sometime maybe in the third trimester.

I really felt connected to this baby and thought about the

baby a lot felt love for the baby a bigger group will say

when I first saw the baby I just Love or within the first

few hours some people describe it as a light switch other

people it was, you know, somewhat more gradual and finally

there's a group that says, you know, I was wiped out by labor

and delivery.

I had to get home from the hospital kind of get my legs under

me took really a week or two for me to really feel love for

this, baby.

The point is all of those are well within the normal range.

If at a month a woman says I don't feel any love for this

baby. Then that's a red flag that needs to be investigated

because it turns out we are hard-wired as a species to fall

for these little babies.

It's hardwired in us and it's true throughout mammalian species.

It turns out The physical attributes of babies are designed

to elicit our Attention our interest and our affection there

physically designed that way.

And again, this is a this is a mammalian thing.

So puppies are cute kittens are cute babies are cute.

It's that's just how they're built.

And it's probably a good thing that they're built that way

because what our babies do in the first couple of months.

They sleep about 18 hours.

They cry they poop.

They eat.

I mean it's not it's not a social time.

You know, it's they're not doing much in the way of social

stuff, but they're incredibly cute and very appealing and

we're drawn to them in this period of the first couple of

months babies when they're born have a very limited ability

perceptually to discriminate amongst different people so

you can show with carefully constructed experiments that

they know what their mothers sound like and they What their

mother smells like but believe me you can go to a newborn

nursery and observe babies and not notice any difference

in how they behave with different people.

If no matter how long you look very limited ability to even

make discriminations about who people are so a limited capacity

is there but it's not really something that's going to be

seen behaviourally.

This is just to show this is a functional Imaging scan that

shows that different parts of the brain are activated when

women are shown adult faces and baby faces.

So this is this is what I mean by it's hardwired and us our

brains are affected differentially depending on whether we've

shown the face of a woman or the face of a newborn, baby.

Okay.

So after the first two months something very dramatic happens

babies become much more socially aware and active what happens

at two months.

Smile who said that smiling, oops smiling social responsive

smiling baby smile in the first two months of life and grandma

always says that sag a smile the stuffy scientists say it's

REM sleep grimacing, but in any case it's not responsive

to social Smiles, but after 2 months babies begin you smile

at them they smile back at you.

It's very powerful experience.

They also make more sustained eye to eye.

Contact and they cou responsively it's as if suddenly there's

just this huge blossoming of social behavior, but what's

characteristic but about it?

It's in discriminant.

Anyone armed with a slow approach in a smile can get something

going on with a baby this age.

So if you see this little baby in the drugstore mom's holding

the baby up to her shoulder this Baby's three and a half

months old and you start smiling and cooing at the baby.

You'll get something going on right babies.

Never seen you before has no clue who you are but is perfectly

happy to engage with you socially so that period between

about 2 & 7 And that's the height of the affiliation system.

This is the affiliation system unchecked.

I'm just going to be social with everybody.

I'm going to love doing I can't do very much.

I'm cognitively limited.

I'm toric Li limited, but I can smile and coo and interact

with people and so I'm going to do that as much as I can.

That's what two to seven months is like.

Now, it doesn't mean that babies in this period can't tell

the difference in different people.

In fact, they can and the way we know this is if you study

the way the baby interacts with Mom, it has certain characteristic

features and the way the baby interacts with Dad that has

certain characteristic features which are distinct from the

way the baby interacts with Mom.

And then if you add an unfamiliar person the baby will interact

with that person differently with Mom and differently with

Dad. So the baby makes discriminations and understands, you

know, these are different people in this person is familiar

in this person isn't but doesn't have a preference doesn't

mind interacting with almost anyone now some moms will tell

you I'm the person who can most readily soothe my baby and

that probably is true but the baby doesn't say I'm only going

to be sued by Mom forget about it.

Everybody else.

I'm not going to let you do that the baby's perfectly fine

being sued by someone else and Mom can leave in the baby

doesn't Test at all.

Now all that changes at 7 and 9 months.

Between seven and nine months to behaviors become apparent

that have never been seen before the first is stranger weariness.

And the second is separation protest sometimes Stranger wariness

Comes First sometimes separation protest comes first, but

they both come in roughly at the same time in this period

of seven and nine months stranger weariness means now all

of a sudden it is not okay to just immediately interact with

anyone the baby has Certain amount of reticence about unfamiliar

people and their big individual differences in babies some

babies just burst into tears of a stranger approaches them

others. Just kind of get this kind of quizzical look and

like, who do you think you are anyway interacting with me

and they sort of check with Mom make sure it's okay to interact

with this strange person.

But if You observe babies carefully from let's say five or

six months through about nine months for each baby, you'll

see this change occur and the second thing that happens is

now Now it's not okay for Mom to just leave the babies going

to get upset and distressed some parents think this is a

bad thing.

This is actually a good thing.

This means their attachment is developing in the way that

we want it to but leaving the child with a babysitter is

now a much bigger deal than it was just a few months before

because the baby knows when Mom goes out the front door that's

trouble. What's interesting is the baby begins to make to

against a figure out it's okay for Mom to go in the kitchen

because then she's going to be right back, but she goes out

the front door.

I'm an I'm upset that's trouble right.

So when separation protest and stranger weariness are present

now we say the baby has formed an attachment.

So babies form attachment at around 7 to 9 months of age

and we know they're attached and those are cognitive ages

by the way not chronological ages.

We're talking about the age of their cognitive ability.

So the baby's delayed then you can't pay attention to their

chronological age.

You have to pay attention to their cognitive age.

But now we say the baby has formed an attachment.

Okay.

So how many people Do babies form attachments to so science

has a very clear answer for us.

We don't know.

However, this is what we do know, we do know actually that

it's not Infinity.

How do we know that because if we look at children who are

raised in settings in which they have multiple caregivers

really short amounts of time with multiple people find many

children who don't form attachments at all.

So as you pointed out what's critical is in order to form

an Attachment the individual has to have substantial amounts

of time with the child.

This is a critical point for this morning young children,

first three years of life in particular, but even four and

five cannot sustain attachments in the absence of substantial

amounts of physical contact because the way that you get

on the baby's list of Of these are my people.

These are my go-to people is the baby has experiences with

you. You can't send the baby a text message.

You can't send them a tweet.

You can't you have to prove it with your presence your physical

presence. You can't talk to him on the phone.

None of that works.

It is impossible for a baby in Orlando to be attached to

a mom in Tampa.

If the mom in Tampa isn't spending substantial amounts of

time with the baby that has critical implications for what

we're going to be talking about in a little bit.

This is the foundation of the child's social and emotional

development. So if you severely damaged the child's Foundation,

you're setting that child on a trajectory that's going to

be very hard to recover from that later on not impossible,

but very very difficult.

Okay now so in our culture I would say typically kids have

between one and maybe for attachment figures.

I'm sure you can come up with a case where it's five.

You might be able to come up with six.

I you know, I don't know but all of those people have to

spend substantial amounts of time proving to the baby when

you're distressed.

I'm there for you to respond to you.

So when that baby wakes up at 2:00 in the morning scared

and frightened who?

Is it who goes in and Comforts the baby?

That's how you get on the baby's list, you're there when

the baby's attachment system is activated.

You're providing distress and the baby says, okay.

This is someone I can count on to be there for me when I

need them.

That's how you get on the baby's short list.

And that's the question is who's on the go tool is now on

this go to list as it turns out babies rank people hierarchically.

This is my number one preferred person.

This is number 2.

This is number.

3 this is number 4 and the baby is always going to go to

the highest rank person on the list.

Now.

The list can change over time circumstances can change the

list can change that the baby is going to go.

So if number one and number two are their baby's going to

number one when they're distressed make me feel better.

Okay, alright, so at 12 months babies begin to walk they

can get around they can now get into things and now we can

observe what we were talking about a little while.

go this balance between attachment and exploration and what

we see is the child moving out to explore the world coming

back in to check in with Mom going back out to explore coming

back in to check in and what the attachment people call the

venturing out is secure base behavior and what they call

the venturing back to check in Safe Haven behavior and that's

graphically represented by the circle of security that some

of you may have heard about but basically it's just an Hurt

you, man.

I think this thing's leaking.

So the hands are the Parents emotional presence and the child

on the top of the circle has needs for the parent to support

exploration. I need you to Watch Over Me helped me enjoy

in the delighted me.

This is supporting exploration.

And this is supporting Comfort seeking on the bottom of the

circle. It's just a graphic representation of that.

Okay, so then around 18 to 20 months children develop expressive

language in the capacity to imagine and to pretend representational

intelligence kicks in and now they have a much greater appreciation

for the fact that they have goals their parents have goals

those goals conflict.

They have to negotiate they have to learn the painful toddler

lessons of delayed gratification and having to negotiate

to get what you want and all that and Here we can very easily

observe children's balance between independent functioning

on the one hand and dependent functioning on the other that

is relying on people that you trust to help you when you

need it, but also being willing to take on challenges that

are manageable yourself.

So what began as a behavioral description of exploration

and proximity seeking behaviors now has become a cycle.

A logical construct that is the ability to function independently

when needed independently when needed and I believe that

that is a lifespan issue first of all and not a bad index

of someone's mental health functioning whatever problems

they have if they can function independently when the Situation's

calls for that and rely on others for help when the situation

calls for that then they're in pretty good shape and in large

part the ability to do that depends.

upon experiences in these attachment relationships Okay,

so Several points attachment is a relationship construct.

It's not a characteristic of the child.

What does that mean?

That means that the child is going to form different attachment

relationships with each adult caregiving attachment figure

based on the nature of experiences with that person.

So you cannot necessarily know what the child's relationship

with one caregiver is because you know what it is with another

caregiver. It depends on the nature of the child's interactions

and experiences with each individual caregiver what their

attachment is going to be like we know that in order to Be

an Effective attachment figure for a child.

The person has to be consistently available so that the child

gets the message when I need you you're there for me reliably.

Malleable and available not just physically present but present

in a way that is emotionally tracking the child's will be

because some parents can be physically present but of no

use to the child because they're not really emotionally present.

So it requires physical presence and emotional presence now,

possibly the most important slide and the talk is this which

says that you're not just attached.

Or not there's a whole bunch of stuff in between those two.

So things begin with the child recognizes an adult.

I've seen this person before and then kind of becomes familiar

with them.

And then okay, I've seen them before they're kind of familiar

and I'm beginning to feel a little bit comfortable around

them. Then I'm not just comfortable around them.

Actually.

I can enjoy them and have a good time with them.

and then I can not just have a good time with him.

I can kind of rely on them a little bit for certain things.

And then not only do I rely on them.

I've learned I can count on them.

I'm going to prefer them.

There are now on the far right there on my list my short

list of go-to people.

But only at the far right?

Is the adult on the go-to list?

So there are whole bunch of spots for the adult before we

get to the onto list.

So going to come back to this when we talk about when kids

are in foster care and what are we doing in all that kind

of stuff?

Okay, so just to wrap up because I'm running Along on this

part and I'm sorry about that.

So babies are born biologically predisposed to form attachments

only in extraordinary species a typical circumstances, like

severe neglect or institutional rearing.

Something like that.

Well, we find children who don't have not formed attachments

adults similarly are biologically predisposed to form attachments

to kids.

So the good news is we've got biology on our side.

All we have to do is figure out what are the barriers that

are keeping a healthy attachment from developing here.

Is it substance abuse in the parent?

Is it depression in the parent?

Is it trauma?

Is it whatever what are our barriers that we need to address?

Attachment young children develops gradually over the first

few years of life, but we say that children have formed attachments

by 7 and 9 months of age.

I'll come back to that later and separation protest and stranger

wearing a sort of the Hallmarks of that.

So once children reach the age of seven and nine months cognitively,

they have the capacity to form attachments and they can form

attachment to people they've never seen before.

No problem, because once I have the capacity and I have the

direct experiences of substantial amounts of time, then I

can form an attachment to this person.

So you can get on the baby's list, even if the baby hasn't

seen very much of you young children need literal physical

contact to sustain attachment relationships.

It can't be electronic contact.

It's got to be literal physical contact and attachments are

going to be different with different caregivers depending

on the baby's experiences.

fat individual and the reason this matters is because these

experiences that children have with their attachment figures

are what leads them to write rules in their heads about how

Intimate Relationships work.

The other person is reliable.

The other person's Dependable the other person's there for

me when I need them or I never know if they're going to be

there for me or not, or I have to be careful because I don't

want to upset them because they've got a lot of thing, you

know, all those kind of all those rules will get written

in the baby's head.

There's lots of research indicating that attachment is a

particularly important developmental indicator of the quality

of the child's attachment strong predictor of their subsequent

functioning particularly in high risk groups maltreated kids

Etc. And it's particularly related to Psychopathology.

It's a secure attachment to powerful protection protection

against the development of Psychopathology and young kids.

Okay.

Okay.

So so the let me just get to my basic premise here.

My basic premise is why do we have child protection?

Child Protection is an intervention designed to help kids

who are endangered and in my for my money we have to be concerned

not just about physical danger.

We're not just about trying to prevent death.

We're trying to prevent harm and the harm can be physical

harm or it can be psychological harm.

So if we're going to protect kids Then let's make that the

goal and so, you know as Carol brought up earlier.

There are two alternatives to foster care.

You can keep kids in the home and provide them with intensive

services and we have three decades of research saying that

does not work now of course and so there's a little bit of

evidence from home builders in the state of Washington.

That is it's the only favorable data in a large number of

studies that have looked at the question of family preservation.

So, okay.

So yes.

In some circumstances some models may show efficacy, but

all of you know, there are many children who cannot be kept

in their homes.

It's just not going to be safe.

So we're always going to be left with what do we do?

The other alternative is to put them in group care and we

have overwhelming evidence that group CARE is not the answer.

So for my money, what we should be doing is trying to move

from the foster-care box to the high-quality foster-care

box because that's what we're not taking seriously in my

opinion. We have two Layton models of foster care latent

means that nobody goes out and says this is my model.

But in fact, this is what you run into right?

The first is the extended respite model.

I'm taking this child out of this home and I'm putting them

here. And what do I want?

I want him to be safe.

I want them to get food clothing and shelter and I want this

person to just be a placeholder just stand-in for the parent

until I can get the child back to the parent.

Okay.

Then there's what I'm calling the child-centered model.

Can you tell which one I like best?

Love the child as if it's your own child, how about that?

Make a full psychological commitment to the child.

That's what we want from foster parents.

It's an impossible job, but that's what we need.

So we know from Decades of Developmental research.

We know what kind of outcomes we want.

We want kids to be safe both physically and psychologically

we wanted to be securely attached want to be socially competent

and emotionally well-regulated large literature's about all

of those things when those are not present children are at

huge risk for very serious problems.

And in fact, we know what kind of Parental behaviors lead

to these outcomes sensitive caregiving knowing and valuing

the child as an individual and being able to place the needs

of the child ahead of your own needs.

Remember that poor mom who says now you see what I go through

she can't place that child's needs ahead of her own needs.

She needs a lot of help with that.

What drives this is psychological investment in commitment

by the parent whoever the parent is.

Okay.

Now the question is we're not just talking about average

kids here.

We talking about kids who've experienced severe neglect various

kinds of maltreatment and who already in many cases have

serious problems.

Is it really possible that you can take kids who already

been damaged if you will and put them in foster care and

expect them to be able to form healthy relationships and

the answer is it depends upon the Foster parent if the faucets

of Mary dozers work if the foster parent is securely attached

then those kids are going to do as well as kids who had not

been maltreated.

But if the foster parent is not securely attached those kids

are going to be at even more risk than kids who had not been

maltreated before.

Interest of time.

I'm going to skip that for those of you who don't like antidotes

who wants some data.

Here's some data.

This is kids who were abandoned at Birth placed in large

impersonal institutions in Romania an average of 22 months.

The range was six to 31 months in these horrible places where

they were severely neglected and then half of them were placed

in foster care, and these are typically developing Romanian

kids who've never Been institutionalized as you can see almost

two-thirds of those kids are securely attached kids in foster

care about 49% are securely attached, but for the kids who

remain in prolonged institutional care only 17% are securely

attached so very substantial increases for children removed

from these places and put into foster care.

It's a similar story in the US.

This is Mary dozers work.

looking at disorganized attachment, which is the most problematic

attachment in the most closely associated with Psychopathology

looking at foster kids and intact kids if the kids in foster

care have a secure Foster mother they're still at increased

risk for disorganized attachment, but it's at a much lower

level than if they don't have secure Foster mother just in

just think of those two foster mother's that I just Did you

to illustrate what that means?

Okay.

So in my opinion foster care for kids under five or under

six somewhere in that range is a different or should be a

completely different intervention than four kids older than

five or six completely different.

And the reason is the first hour and 15 minutes that we spent

this morning the urgency of these young kids attachment needs

are so powerful that they must have have an attachment figure

Children after the age of 5 or 6 or you know, maybe for somewhere

in that range are as I said able to sustain attachments to

people in the absence of literal physical contact so five

and six-year-olds can be attached to someone they're not

seeing on a regular basis, but these younger kids are not

able to do that and they're decreasing lie able as you move

down in time.

So the implication of that is it's the foster parent kids.

I don't know about here.

But in Louisiana young children in foster care 12-18 months,

sometimes even longer than that.

You cannot put those kids in the freezer and thaw them out

18 months later.

You've got to be concerned about what is the caregiving setting

that they're in while parents are working their case plan,

and that means you must Encourage a healthy attachment between

the foster parent and the child the young child.

You've got to have that that in no way threatens or makes

it less likely that the child can attach to the parent wants

their return.

In fact, it makes it more likely.

Because if you damage a child for 18 months by having them

in an unhealthy caregiving setting where they're instrumentally

well cared for but emotionally not well cared for you're

not doing that bio parent any favors because they're going

to have then a more damage child to try to reconnect with

that the other end.

and this is something that I don't think happens very much

is that we don't give much thought to what's going on in

the foster home as long as they're safe as long as they're

getting fed as long as they're mostly getting to their appointments

okay check it off I got a lot to worry about but it turns

out it matters a lot yeah so I want to shift into some of

the challenges of foster care and then sort of apply it to

some specific situations that we talked about one of the

challenges is how foster care is perceived here's Time Magazine

here's the Miami Herald here's the Providence journal-bulletin

here's the LA Times Here's 2020 news.

So just Google foster care and what you get is Nightmare

stories. So I thought maybe things were so bad that I couldn't

have a reporters like to be kind of contrarian sometimes

and write the story that runs against what everybody's thinking

so I thought great.

I'm going to get them to tell the story of a good Foster

placement and how things went well and how these foster parents

really made a huge difference in this child's life.

No, uptake not interested.

Now if they had tied him up in the basement and tortured

him. I'm quite certain I could have gotten people lining

up to tell that story, but nobody wanted to tell that story

unfortunate. It's not just the media.

Here's the Joann and Raymond Welsh chair of child welfare

and family bonds University of Pennsylvania child welfare

systems in trouble fails to protect children from harm the

child fell through the cracks.

These are not small cracks their National fault lines long

deep and always on the verge of swallowing up more victims.

So foster care is pretty poorly perceived children who come

into foster care have all sorts of problems.

These are somewhat older data, but they're unfortunately

not very different now than they were when Jane netzer published

this more than a decade ago.

These kids come in having all sorts of Developmental behavioral

and often psychological challenges.

Now we're asking a tremendous amount of foster parents.

We're asking them to love the child as if it's their own

child and at the same time be prepared to give the child

up and often to give the child back to a family whom they

may feel did not care for the child to begin with and if

you love the child as your own and you see them going into

something. It's a really big challenge.

There's also the uncertainty that hangs over this process

and sometimes you know has has big effects on people.

I was calling a foster mother who had been the original placement

for this child who'd been with her for about two months before

being transferred to a relative and I was just trying to

find out what had happened in those first two months.

So I called her up and said I want to talk to her about it.

She burst.

Into tears.

She said that the child came to her.

This was about a two and a half year old had no language

could barely feed herself, you know was in terrible terrible

shape and the child made very dramatic gains over the first

several weeks.

She fell completely in love with the child and was very committed

to her and on Wednesday evening the child protective services

worker called her up and said, oh good news.

We found a relative.

I'm picking her up tomorrow morning at nine o'clock.

Which he did?

And the worker drove the child.

So imagine the white van state of Louisiana on the door pulls

up in the driveway this foster mom places the child in the

back seat straps her in the child is crying the foster moms

crying the worker drives her over to court gets to court

hands her to the relative who shown up at court and the worker

says I don't know what was wrong with that child.

She cried all the way from the foster home to the court.

Now it's not because the workers unintelligent.

It's because she's not thinking what is it like for this

child? She's perfectly capable of doing that, but she's not.

She's not thinking what is this experience?

Like and the system is not thinking what is it like to disrupt

a 2-month placement in a child who was so severely neglected

that she's made these very dramatic gains.

And now we're going to just move her to a relative because

that's our policy.

is that a good thing to do you know certainly the way it

was done is not a good thing to do and there's absolutely

no evidence that this kids going to be better off in this

new placement than she was before so if we're thinking about

this from the best interest of the child would thinking wait

a minute wait a minute okay the foster parents that I know

uniformly complain about lack of support from Child Protective

Services they feel badly treated they feel like they're not

listen to their feel like they're not supported they feel

like they don't get help when they need it they feel excluded

from anything important They get called.

I'm desperate.

Please take this child.

They take the child and then that's the end of any sort of

positive support.

Now, of course, there are exceptions, but that's the modal

thing that I hear from foster parents.

Okay.

So want to talk about three issues disruptions in transitions,

which I'll sort of talk about together visits and then talk

a little bit about Kim care.

So the first point to make is that disruptions are bad once

child children have formed attachments disrupting that attachment

relationship increases the risk of harm to the child because

imagine that you are 15 months old.

And someone pulls up in your driveway and straps you into

the back seat and drives you over somewhere else and drops

you off.

What how do you understand that?

And if that happens a lot, what do you think?

This is how the world works at.

Any time.

Someone can come and pick me up and take me somewhere and

drop me off in a place that I've never been before.

So imagine when you go home tonight someone pulls up in your

driveway takes you out to their van straps in the back seat

and takes you and drops you off somewhere else with people

that you don't even know.

I mean There's no way for very young children to have any

understanding of why this is happening.

They can't possibly get the legal arguments and the you know,

all that stuff.

So if we were thinking developmentally we would have that

foremost in our minds.

How can we do this in a way that actually makes sense for

the child.

If you want evidence, there's plenty of evidence that disruptions

are harmful disruptions after 12 months or more harmful than

disruptions before twelve months disruptions before six months

or less harmful than disruptions after six months and the

increasing number of disruptions is related to increasing

risk for problems controlled run survive.

Well sure.

But children can survive a broken leg also, but that doesn't

mean we're going to break their leg just because they can

survive it.

We don't want kids to break their legs and we don't want

kids to be harmed by disruptions.

So how can disruptions be minimized and transitions be handled

in a way that makes sense for the child with the first thing

is that it's approached plan fully and thoughtfully and planful

and thoughtful is not pulling up in the driveway in a right

a white van and strapping the child in the back seat and

driving them across town that is not a planful transition.

Now, this child was somewhat older.

This was actually a five-year-old five-year-old had multiple

disrupted placements finally gets into a pre-adoptive home

with a relative.

And this the mom was a kitchen designer.

So she being sensitive to the fact that the child had had

these disruptions didn't want to just plunk the child into

child care right away.

Wanted to spend time with the child, but she had to do her

job. She had to work but it was the kind of job where she

just kind of went around to people's houses and show them.

These are the cabinet colors you can have these are the tiles

you can have that kind of stuff.

She said well, I'll just take her with me.

So she packs her up.

They drive over she goes in and goes into this house and

the little girl walks into the house and immediately goes

into the living room and covers herself up with her raincoat.

And the adopted mom is kind of embarrassed like, you know,

this is not our home.

We've never been here before and I'm supposed to be selling

kitchen tiles to this lady's you know, so, you know, she

handles it at the time that they get out in the car and she

says why did you do that?

Little girl said I thought it was my new home.

How could she think anything else?

This is how the world works.

You cannot trust this person is going to be there for you

because people come people go people disappear and So eventually

what happens is you don't want to invest in anyone because

it's too hurtful.

And we see kids who get to the point where I sort of think

of it as the point of no return now, I can't ever think that

there is a point of no return but sometimes you feel that

way this kid has just experienced too much stuff and we can't

convince them.

But the way to convince them, this is not how the world works

is to give them an alternative experience in which you are

there for them and you hope that over time if you can convincingly

convey that to the child they will get the message.

Okay bad things happen to me.

But now this is my forever home.

I'm safe here.

Everything's going to be okay, but it can be a challenge.

So this work began in the early 1950s.

As I said, I'm not telling you new stuff.

I'm telling you stuff.

We've known for a while in London in the 1950s when women

had babies.

They went to the hospital for about a month.

It's called being in confinement.

And or at least weeks and so the mom had let's say has a

two-year-old. She's got to go in the hospital for several

weeks to have this baby.

And so she places the child in a residential Nursery, which

is a little congregate group setting maybe 10 or 15 kids

and several caregivers and the kid stays there and the Robertsons

James and Joyce Robertson were social workers and they were

concerned about the effects.

This was having fun kids and nobody thought it was harmful.

So they took movies.

Eight millimeter.

I don't know some kind of movies of these kids and they produce

these movies and basically what they show is the gradual

psychological deterioration over the child placed in the

residential nursery for the first several weeks.

And then when the child was reunited with the mom three or

four weeks later, the child didn't just immediately feel

better. It took varying amounts of time for the child to

kind of re-establish a relationship with that Mom.

They said, you know, this isn't right.

So mrs.

Robertson Joyce decided to do an intervention and the intervention

she was the intervention.

So before the mother went to the hospital she began to visit

regularly in the mother's home and play with the child and

get to know the child establish a relationship with the child.

Probably not enough time to become an attachment figure,

but at least a familiar person for the child and then when

the mom went into confinement she cared for the child and

when the mom came out and the child was returned to the mom

she was returned.

A gradual return and then even after the child was returned.

Mrs.

Robertson continued to make regular visits to the child.

So she didn't just disappear from the child's life and they

compared a group of kids who got that intervention to a group

of kids who got the business as usual just go to the nursery

come out of the nursery Etc.

What did they show mrs.

Joyce the mrs.

Joyce kids looked far better than the non.

Mrs.

Joyce kids those like 1951 1952.

So what we do in transitions is we add attachment figures

we have increasing amounts of time with the biological parent

as we're moving towards returning the child, but with regular

contact with the foster parent and ideally we have them together.

So the child sees them both together and thinks okay.

These people are working together in my best interest.

They all get along everything's fine.

And then after the child is returned home.

Have the foster parent continued to visit with the child

even in the bayou home.

Obviously.

I'm look I do this kind of work.

I know this is not always possible, but it's never possible.

If you don't try it at all.

It will never happen.

It takes a big effort to try to make this work and it can

in fact work.

Okay.

So what about the issue of visits visits to me are the most

kind of wasted opportunity we have in child welfare.

These are really important events that can be important for

the child and important for the parents but we get hung up

on all this stuff.

Like how many visits a week instead of what is the visit

actually like because you can have five visits a week where

the moms just stuffing M&M's in the kid and that's all that's

really having the kids around.

All around the place that's not helping anybody.

It's not helping the child is not helping the parent what

happens in the visit matters much more.

So if I were designing a child-centered child protection

system, I would have something in between a policy and a

law depending on how radical I felt that the child must have

an attachment figure present during the visit if the child's

more than 6 months old.

And I would be kind of inclined most days to say even if

they're younger than 6 months.

I want their person there with them.

So think about that.

How different is that than the van goes and picks up the

18-month old and schlep some over to the visit with the parent

which is often quite stressful.

And then the child's taken home on the van and then back

to the foster parent says well, you know, they're acting

up really well.

I wonder why that is.

And I would have something between a policy and a law wait.

I just have to get this out that children don't ride in Vans

with people.

They don't know two visits.

That's against the policy or against the law or something.

They have to be accompanied by someone who they feel comfortable

with. And so let's talk about what's going to happen during

the visit.

How's it going to go?

How are we going to structure this?

How we going to organize it?

What are your goals for the visit?

What do we want to see happen Okay.

Well, of course, you want your child to run and give you

a big hug, but maybe it's a little soon for that.

So let's back off.

Let's say what if the goal for this visit is just that the

child can be comfortable around you and then next visit will

talk about what the goal is for that visit and then after

the visit, how did that go?

What was different?

And then what you expected so you're prepping them before

the visit and your debriefing with them after the visit about

what happened in preparation for the next visit.

So this is taken very seriously.

It's not that the parent and child are put in the room the

child gets off.

The van Gogh's in the room is there and the CPS worker walks

up and down the hall and glances in the room every now and

then I know that doesn't happen in Florida, but it does happen

in Louisiana.

I can promise you instead of this being like like this is

the moment for us where we can really work on repairing things.

It's just you know, I don't know what the intervention is

passage of time.

That's not a very good intervention for kids who've experienced

these kind of things.

So so instead of passage of time, let's take it seriously

and let's think about this individual child and hopefully

let's have the foster parent there and let's talk about how

was that for you having that Foster?

That's really hard to see the child get upset and run to

them and not run to you that must be very difficult.

But from the child's point of view, we're glad that the child

has someone they can go to and we want to get you in that

position back in that position where the child is going to

go to you.

So, I mean, it's such an opportunity and yet it's not an

opportunity. We take advantage of very often.

Okay.

So back to this guy, let me just tell a little case vignette.

So we I didn't bring this tape, but I've got the most amazing

video tape of a visit between a mom.

And I think almost five-year-old almost five-year-old mom's

got a serious substance abuse history has been sober for

some time gotten out of residential treatment program been

visiting regularly with the child wants desperately to get

this child back and he is frantic about the possibility of

leaving his foster home to return to her but not wanting

to offend her in any way clearly cares.

Her wants to be with her and so he's bargaining with her.

We'll look you can come and visit me at Mommy Valerie's house

and you can see my new toys and I'll show you all around

and then I'll just stay there and then you can come back

the next day and we can put do more, you know on and on so

so that is a very painful tape to watch that.

This little boy can be so articulate about all this stuff.

Well, so the mom unfortunately relapsed very late in the

game. And now it looks like the child may not go back now

the other side of his ambivalence is out and he's saying

I want to be with her.

I need to be with her.

It's you know, it's just such an intense struggle and conflicting

loyalties about you know, who he wants to be with.

It's really it's very challenging to be in these situations.

If the transition is done well over a period of usually several

weeks. Then there's less likely that that's going to happen

then if it's done suddenly and secondly what's important

from the child's perspective is to understand that people

who care about them and who they care about don't just disappear

from their lives and not exist anymore.

That's the scariest outcome.

So the the period of Transition this is another sort of missed

opportunity where we often don't spend a lot of time talking

to the dot of the bio parents who are getting the child back

talking to the foster parents.

This is a period of intense stress for everyone for the parents

involved on both sides for the child involved and it's something

that requires a lot of extra support and a lot of care and

a lot of kind of in the midst adjustments so you can come

up you can ask me to design for you.

Ian plan and I can design the plan but because of this individual

child and this individual circumstance that plan isn't so

great and needs to be adjusted.

So that's the problem with getting a court-ordered plan.

This is how we're going to do it and you have to go back

to court to modify and it takes a couple of weeks give it

that that's no good.

You've got to have the flexibility to make adaptations on

the Fly based on this child's reaction based on the circumstances

in both of the homes and be able to do it that way so I really

strongly opposed the idea of having a moratorium of visits

with the foster parent.

In fact, just the opposite is what is indicated.

And yes, there may be some painful scenarios in which the

child protest separation from the foster parent and stays

in the biological parent on that requires extra support and

reassurance, but it will get better over time as the child

adapts to the new home.

I think the Kin Care issues the ones that we run into more

commonly, I'll just say briefly.

Briefly are the Ken parent as babysitter.

So the clinical issue that we run into all the time is I

don't want to usurp the mom or dad's position as the child's

parent. I'm Grandma.

I'm Auntie.

I'm great.

Grandma.

I'm whatever I am.

And so I'm not going to try to act like this child's mom.

I'm going to say no you have a mom.

Well, you can't say that to a 15 month old the twenty five

month old at 35 month.

All they know is someone's there for me.

No one's there for me.

And so we spend our time with relatives trying to say look

while the child is with you.

You must be mom and I don't care if you're in LA or Uncle

Joe or grandpa or whoever you are the child needs a mom.

Not a babysitter.

Not a respite care worker not a substitute.

It doesn't work for young kids because every day that goes

by when their attachment system gets activated someone's

either there for them or not.

And if I'm a disengage aged disinterested relative who's

kind of taking one for the team in the family and keeping

this kid, but not really that invested in them.

Then that is not going to be good for the child and ultimately

it's not going to be good for the bio parent who gets a child

back who's been living in those kind of circumstances.

So we have to work hard to get relatives to appreciate how

critically important they are.

So I'm all for blood runs thicker than water at the time

of initial placement after that.

I'm much more reluctant about it.

But don't worry.

I don't live in Florida so you can send me back to where

I belong.

I'm so I just want to I just want to get back to this one

more time because I think this is really a critical point

and then I'm happy to go back to questions.

So so just getting back to this.

There's two often concern about getting here with young children

and their biological parents when the children are in care.

When the children are in care, I'm perfectly happy having

the bio parents here and making this a part of the visits.

This is where I'd like to get to then if the parent has worked

the case plan, if it's clear, they're headed for unification.

Then I can start moving in this direction, but I can't give

the child enough time with the parent while the child is

in care.

To have that parent of a very young child beyond the child

short list of go to people it's just not going to be possible

unless it's one of these weird deals where the grandmas the

Foster mother in the mothers living in the home something

like that, but short of some situation like that.

It's just not and it shouldn't be it shouldn't be even an

issue. It shouldn't be a focus.

We get sometimes people get all wound up about you've got

to have three times a week visits for three hours each bottle

bubble, you know the from the get-go go in order to maintain

an attachment between the bio parent and the child.

It's developmentally not possible.

Now, you know, maybe there's an exception.

I don't know that is always an exception but for the most

part young kids are not going to be able to do this and if

you can keep them here remember once you have the capacity

to form attachments, somebody was asking this you don't lose

that doesn't go away.

You can reconstruct an attachment relationship with the bio

parent and if your Having three times a week visit from the

get-go plus you have to go to substance abuse intervention.

Plus you have to go to your psychiatric appointment-plus.

You have to go to anger management and domestic violence

and all that other stuff.

You can actually undermine the parent by giving them so much

to do that.

It becomes impossible for them to do those things.

So initially, let's just get them comfortable and enjoying

one another the child in the bio parent and don't worry about

the attachment piece initially that should be a later phase.

It's a crucial phase.

It has to be done.

Well, it can't just be done in a perfunctory way but it's

not something that needs to be an issue the day the child

comes into care the day the child comes into care we need

to be working on doing this with the foster parent because

that's where the child is going to be four months maybe a

year maybe a year and a half and so that's the relationship

that we really should be focusing on with the child initially.

Does that make sense?

You don't have to agree but it was long as it makes sense.

I'm okay.

Thanks.

I'll just say in conclusion that I enormously value and appreciate

the work that all of you do.

I know how every aspect of this system.

I've been in it long enough to know how challenging it is

to be a foster parent to be a worker to be a supervisor to

be an administrator to be an attorney to be a judge.

These are vexing and critical questions and they really require

Our best efforts all the way around and I appreciate all

that you do.

So.

Thank you.