Thursday, May 29, 2014

Book Review: The Adoptive & Foster Parent Guide

The following is an adaptation of a post that was originally posted at Sea Glass & Other Fragments. I received a review copy of the book in exchange for my honest review.

While reading Carol Lozier's book The Adoptive & Foster Parent Guide: How to Heal Your Child's Trauma and Loss, I often found myself excitedly underlining key phrases and jotting notes in the margins. I like a lot of things about this book. I appreciated that the author views attachment as a relationship issue between two people rather than as a diagnosis assigned to the child. ("A child cannot be characterized in one particular attachment style. For instance, it is incorrect to say a child is ambivalent or avoidant." Pg. 9) Though attachment styles are examined in detail, the focus is on healing and on helping the child develop a secure bond in the new family. That healing is possible is one of the core assumptions of the book, and a viewpoint that I heartily endorse.

I became especially enthusiastic when I got to Part Two of the book: "Healing My Child's Past Trauma." I love that this section opens not by focusing on the child, or on any challenging behavior that the child may be exhibiting, but rather on the parent and the parent's state of mind. "What is the energy between my child and myself?" is a question raised in Chapter 7. That same chapter includes a section titled "THE FIVE S'S: DISCOVERING AND MAINTAINING CALM," which consists of "five suggestion to help parents find and maintain a state of calm with their children." That section alone is worth the price of the book. Why does parental calm matter so much? Because the parent's emotional state has a huge impact on the child's emotional state, and when the child is calm and grounded he or she is better able to think and to maintain self-control.

All in all, I would consider this book a useful addition to the library of anyone who is parenting or considering parenting a foster or adoptive child affected by early trauma. The book is easy to read, well organized (chapters stand on their own so the book can be read cover-to-cover or dipped into at any point), and provides a good overview of the complexities of parenting a child with a painful history. I can't speak to the effectiveness of the specific parenting and therapeutic strategies that the book recommends because I didn't have the book when my foster-adopted daughter was in her more active healing phase, but if you are looking for practical suggestions you will find plenty of them here. If you try them and find they work well for your family, please let me know!

Tuesday, May 27, 2014

Medication in Foster Care

Many children taking antipsychotic medications do not have psychosis but trauma-induced behavioral problems with symptoms that mimic mental illness, researchers and child advocates said....

Foster kids in 2012 were prescribed anti-psychotics at 12 times the rate of other children on government insurance, which has raised alarms that the drugs are overprescribed to a vulnerable group.  
Jennifer Brown and Christopher N. Osher, The Denver Post, April 15, 2014

As I have mentioned previously on this blog, this issue is one of personal importance to me because of my daughter. When she joined our family by way of the foster system at age 8 she struggled to keep her eyes open as a result of all the medication she had been prescribed. As mentioned in the Denver Post article I quoted above, some of the medications typically taken by foster children are prescribed for "off-label" reasons that fall beyond the scope of the Food and Drug Administration's recommendations. My daughter was prescribed one such drug; it had potentially serious side effects and had to be approved by a judge in order for her to take it. 
The judged approved it, but neither her first mother nor I would ever have done so! In foster care she was in limbo, with no mama-bear advocate on her side. Happily, once she was placed in the care of my husband and myself we were able to wean her off all of the medications fairly quickly, with the support of a psychiatrist who agreed with us that she didn't need the drugs. She experienced nothing but positive effects as a result of their discontinuation. 
Giovan Bazan, the young man in the man in the video below, had to wait until he was 18 to get himself off the medications that subdued his emotions, preventing him from fully expressing himself and enjoying life. He speaks powerfully of the damaging potential of labels, listing the many different diagnoses that were attached to him over the years and adding, "Once I removed those labels I was able to choose what I wanted to be for myself." Please take a few moments to watch the video and listen to his story. Foster alumni are the true experts on the foster-care system. We do well to listen to what they have to say.

Image courtesy of nuchylee /

Saturday, May 24, 2014

Innovations in Early Intervention for Childhood Trauma

"It is easier to build strong children than to repair broken men." -- Frederick Douglass

Left untreated, trauma experienced in childhood can have lifelong implications, including higher rates of addiction, incarceration, and involvement in domestic violence incidences. It's hard to imagine an intervention that could have a greater societal impact than finding ways to help children heal from trauma as effectively and as early as possible.

I was therefore pleased to learn recently, by way of an article by David Bornstein in The New York Times, about something called Head Start Trauma Smart, an innovative program in Kansas City, Missouri.

Head Start-Trauma Smart was created by the Crittenton Children's Center and, according to their website, it "provides the appropriate mental health treatment to help [3- to 5-year-old] children concentrate in school and develop social and emotional resilience to carry them into adulthood."

Another news story that caught my attention recently was a piece in The Denver Post focusing, in part, on the use of brain-science therapies with foster and at-risk children and on the efforts of state child welfare programs to ensure that such children are getting access to trauma-focused therapies.
[Colorado] State child welfare leaders are pushing to increase trauma-focused treatment. The state received a federal waiver in 2012 that allows it to divert money previously spent on foster care toward keeping children in their homes, including therapies for those children and their families. 
Part of the funds will pay for trauma-informed assessments of children to determine their therapy needs, as well as treatment. 
-- Jennifer Brown and Christopher N. Osher, "New thinking on brain-science therapies could help foster kids" 
Of course, these are just a two examples, in two states, and they raise additional questions. What other innovative programs are out there? What's happening in other states? What can be done to increase the rate of access to effective trauma-informed therapies throughout country? What can we do to help policymakers see the wisdom of investing in early trauma interventions rather than dealing with the repercussions of unhealed trauma down the road?

Image courtesy of imagerymajestic /

Thursday, May 22, 2014

Criminalizing Trauma

Yesterday, I wrote about children with trauma histories and behavioral challenges, and I encouraged my readers to think of such children as "hurt" rather than "bad." Today, I invite you to take that a step further and think about what happens when youth with untreated trauma histories begin encountering the criminal justice system.

According to data collected by The National Crittenton Foundation in 2011 more than 62 percent of surveyed girls involved in juvenile justice had been exposed to "four or more forms of adverse childhood experiences," including violence.

What the statistics also don't tell us is how girls cope with the dangerous, damaging and traumatic circumstances in their lives. In fact, their "adaptive coping behaviors," including running away from homes where violence is prevalent, self medication with drugs and alcohol, truancy and unruly behavior, are the very same behaviors that put them at risk of entering the juvenile justice system because they are detained for a status offence.  
In other words, we criminalize them for coping behaviors that are actually signs of strength and resiliency against the abuse and neglect they have experienced.

-- Jeannette Pai-Espinosa, "Five Ways to Stop Criminalizing Victimized Girls," Women's eNews

Consider this in light of what I wrote yesterday: "The ability to adapt to threatening environments with survivalist strategies is an inherent part of our human nature."

What does it say about us as a society when we fail to protect children from harm and then penalize them for coping strategies? What can be done to interrupt this cycle?

We can begin by supporting organizations like the Coalition for Juvenile Justice, as recommended in the Women's eNews article, but we must also think about ways to intervene in children's lives earlier on, to prevent harm when possible and to help children heal from trauma when traumatizing events do occur. 

(In my next post I'll be talking about some strategies for early intervention.)

Image courtesy of sakhorn38 /

Wednesday, May 21, 2014

Child Trauma: "Hurt Child" Versus "Bad Child"

When kids are under stress, they're more likely to act out. "When a child is presenting difficult behavior, the first thing to ask is 'What happened to the child?' rather than 'What is wrong with the child?'" said Lieberman.   
-- Rachel Barclay quoting Alicia Lieberman (director of the Child Trauma Research Program at San Francisco General Hospital) in News Analysis: Are We Misdiagnosing Childhood Traumas as ADHD?, May 6, 2014
Every once in a while I come across a quote that goes right to the core of what I consider to be good trauma-informed parenting philosophy. This quote is one of them.

If there is one piece of advice that I would offer to parents and others who are interacting with children who are exhibiting challenging behaviors as a result of a trauma history, it is this: view the child as a hurt child in need of healing rather than a bad child in need of correction.

It's easy to focus on the troubling (and at times frightening) behaviors when that's what you are seeing every day. I know -- I've been there.

But the behaviors are not the child. They are defense mechanisms that were developed to help the child survive at times when his or her whole world was not as it should be. It's not the child who is bad, wrong, flawed, or crazy. Rather, it is the world that the child has inhabited that has been horribly askew. The ability to adapt to threatening environments with survivalist strategies is an inherent part of our human nature.

Freeze. Flight. Fight.

How does a child know that the danger is over if he or she has never known safety?

Children need to feel safe before they can begin to let go of defensive tactics acquired during times of high stress.

Think of a time that you yourself have been in an environment where you were experiencing criticism, punitive tactics, or other strategies intended primarily to influence your behavior. Did you feel safe? Did you feel connected? Did you feel like letting down your guard?

So much depends on the questions we ask. What would happen if parents, teachers, therapists, and others who interact with behaviorally challenging children started asking, "What can be done to help this child feel safe?" instead of "What can be done to change this child's behavior?" on a regular basis? Or, to return to the opening quote, how would the substitution of "What happened to the child?" for "What is wrong with the child?" influence our response to challenging behavior?

Image courtesy of David Castillo Dominici /

Tuesday, May 20, 2014

We Can Do Better: A Call to Move Beyond Adoption as We Know It

There was a time in history when children without parents or extended family members to care for them ended up in poor houses, orphan asylums, or baby farms, all of which were pretty horrid places. One could certainly argue that the societal shift from viewing unattached children as potential sources of labor, as in indentured servitude, to viewing them as children to be raised as one's own offspring represented a clear improvement. But the horrors of the past do not excuse us from looking critically at the institutions of the present. We can focus on moving forward, rather than back. We do not have to accept the status quo as merely "better than before" or "good enough." We can do better.

Let's take a clear look at adoption as it exists today. Is it an institution that truly exists to meet the needs of children who lack parents or other family members to care for them? In the foster system there are certainly a number of children who are in need of the love and permanency that adoption can provide, but there are also many who might not have ended up there in the first place if our social structures were different. Many at-risk families could benefit from family preservation/strengthening services early on, before kids come into state care, but this is not an area where our society chooses to place funds. Also, many of today's adopters are not drawn to adopt the older, traumatized children found in the foster system.

Instead, they want babies--and the current domestic infant adoption system can hardly be said to be primarily about finding parents for children who need them. There are far more prospective adopters than there are available infants. This situation has led to an industry rife with corruption and coercion. The desires and dollars of prospective adopters, combined with cultural biases against young parents and a societal structure marked by an ever widening gap between age of sexual activity and age of financial stability, have led to an untenable situation. These are not the orphans of yesteryear. These are "orphans with parents," who also happen to be valuable commodities. Unethical adoption agencies, rather than serving the true needs of children, have become have become agents in the creation of "parentless" children, at times using highly questionable methods to separate children from living parents and place them (for a substantial fee) with others.

In inter-country adoption, it can be nearly impossible for prospective adopters, however well-intentioned, to distinguish true orphans from those whose biological families did not give full, informed consent and even from those who were outright kidnapped. And even in situations in which the child's parents are actually deceased, the complete separation of the child from his or her culture, language, and birth identity is an extreme measure. Is this truly in the best interest of the child? (Many adult international adoptees would argue that it is not.)

Are there some children who are helped by adoption? Are there some who end up in situations that seem better than what they might have otherwise experienced? Are there agencies that are more ethical than others? Are there adoptive parents who are compassionate, moral, and committed to supporting their adopted children as they process loss and find their way in the world as members of more than one family? Yes.

Does any of that excuse us from the responsibility of looking at the flaws in the current system and seeking ways to move forward to something better? Absolutely not.

Stuart Miles

This post was originally published at Sea Glass & Other Fragments.

Monday, May 19, 2014

Can We Create a More Humane Child-Welfare System? Where Do We Start?

How do children end up in foster care?

One commonly held view is that it they end up there because of abusive, neglectful, or otherwise unworthy biological parents. This is an ideological framework that many people find comforting because it fits with their sense of justice. The failure is seen as a personal, individual failure on the part of flawed parents, who, rightfully, lose their rights. Children in care are perceived as moving from unworthy biological parents to replacement caregivers who are both more capable and more deserving. Children are understood to be benefactors of a benign or even humanitarian system. 

My own impression--formed through reading and experience, including multiple conversations (online and off) with social workers, biological parents, foster and foster-adoptive parents, and foster alumni--is that the reality is a more complex. 

I want to emphasize that I am not giving a pass to abusive parents, biological or otherwise. I am not denying that there are, at times, very real and urgent reasons for children to be removed from unsafe environments. I am not saying that we should throw up our hands and walk away. If even one child has ended up in the system as a result of biological parent abuse, that is one child too many. Child-abuse is always a serious issue, and I am not in any way, shape, or form implying otherwise.

But I also think it's a mistake to assume that abuse of children by biological family members is the the only reason that children end up in foster care, when in reality the reasons are many and complex. Yes, some children do end up in care as a result of abusive or incompetent biological parents. Others end up there because of the actions of a step-parent or live-in partner of the biological parent (even when the non-abusive parent is herself a victim). Other factors include discriminatory practices in society or within the child welfare system and separation of families as a result of immigration laws. And then there are those parents who are unable to provide sufficient food or adequate housing--in other words, parents in poverty:

The single most common factor in families whose children are placed in foster care is not cruelty or rage or sexual perversion; it is poverty. In 2012, about 16 million children in the U.S. lived below the poverty line. Child abuse and neglect occur across all racial, socioeconomic, religious, and cultural lines, yet most children who enter foster care are from impoverished homes. -- Deb Stone, U.S. FOSTER CARE: A FLAWED SOLUTION THAT LEADS TO MORE LONG-TERM PROBLEMS?, May 12 2014
Why does all of this matter? 

As I see it, it matters because the framework we start from dictates the kind of response we create. The framework that currently dominates has lead to a system that is both punitive to parents and ineffective at helping children. What would happen if we started seeing family breakdowns as societal failures rather than individual ones? 

I have various ideas, and I'll be talking more about my social-change wish list in future posts, but I'd also love to hear from you. What's your vision for creating a more humane child-welfare system?

Images courtesy of imagerymajestic /