As stated above, some children in foster care come from
a situation in which they were abused; some sexually abused. Read below about what happens when children are sexually abused to get more of an idea as to what these children are feeling, as well as what foster parents
are faced with taking in sexually abused children.
Foster families taking in kids that have experienced abuse need to understand the ramification of taking care of a child that has been abused - they have additional special needs that aren't usually faced by children that come from a loving family.
Child sexual abuse has been reported up to 80,000 times a year, but the number of unreported instances is far greater, because the children
are afraid to tell anyone what has happened and the legal procedure for validating an episode is difficult.
The problem should be identified,
the abuse stopped and the child should receive professional help. The long-term emotional and psychological damage of sexual abuse can be devastating to the child.
Child sexual abuse can take place within the family, by a parent, step-parent, sibling or other relative; or outside the home, i.e.,
by a friend, neighbor, child care person, teacher, or stranger. When sexual abuse has occurred, a child can develop a variety of distressing feelings, thoughts and behaviors.
No child is psychologically
prepared to cope with repeated sexual stimulation. Even a 2 or 3 year old, who can't know the sexual activity is wrong, will
develop problems resulting from the inability to cope with the overstimulation.
The child of 5 or older who
knows and cares for the abuser becomes trapped between affection or loyalty for the person and the sense that the sexual activities
are terribly wrong. If the child tries to break away from the sexual relationship, the abuser may threaten the child with
violence or loss of love.
When sexual abuse occurs within the family, the child may fear the anger, jealousy or shame of other family members, or be afraid the
family will break up if the secret is told.
A child who is the victim
of prolonged sexual abuse usually develops low self-esteem, a feeling of worthlessness and an abnormal or distorted view of sex. The child may become
withdrawn and mistrustful of adults and can become suicidal.
Some children who have been
sexually abused have difficulty relating to others except on sexual terms. Some sexually abused children become child abusers or prostitutes, or have other serious problems when they reach adulthood.
Often there are no obvious
physical signs of child sexual abuse. Some signs can only be detected on physical exam by a physician.
Sexually abused children may develop the following:
- unusual interest in or avoidance of all things of a sexual
- sleep problems or nightmares
- depression or withdrawal from friends or family
- statements that their bodies are dirty or damaged, or fear
that there's something wrong with them in the genital area
- refusal to go to school
- delinquency/conduct problems
- aspects of sexual molestation in drawings, games, fantasies
- unusual aggressiveness, or
- suicidal behavior
Child sexual abusers can make
the child extremely fearful of telling, and only when a special effort has helped the child to feel safe, can the child talk
If a child says that he or she has
been molested, parents should try to remain calm and reassure the child that what happened wasn't their fault. Parents
should seek a medical examination and psychiatric consultation.
Parents can prevent or lessen the chance of sexual abuse by:
- Telling children that if
someone tries to touch your body and do things that make you feel funny, say NO to that person and tell me right away
- Teaching children that respect
doesn't mean blind obedience to adults and to authority, i.e., don't tell children,"Always do everything the teacher or baby-sitter
tells you to do."
- Encouraging professional
prevention programs in the local school system
Sexually abused children and their families need immediate professional evaluation and treatment. Child and adolescent psychiatrists can help abused children regain a sense of self-esteem, cope with feelings of guilt about the abuse and begin the process of overcoming the trauma.
Such treatment can help
reduce the risk that the child will develop serious problems as an adult.
Source: AACAP No. 9; Updated July 2004
To Child Sexual Abuse
When a child tells an adult
that he or she has been sexually abused, the adult may feel uncomfortable and may not know what to say or do. The following
guidelines should be used when responding to children who say they have been sexually abused:
If a child even hints in a vague way that sexual abuse has occurred,
encourage him or her to talk freely. Don't make judgmental comments.
- Show that you understand
and take seriously what the child is saying. Child and adolescent psychiatrists have found that children who are listened
to and understood do much better than those who are not. The response to the disclosure of sexual abuse is critical to the
child's ability to resolve and heal the trauma of sexual abuse.
- Assure the child that they
did the right thing in telling. A child who is close to the abuser may feel guilty about revealing the secret. The child may
feel frightened if the abuser has threatened to harm the child or other family members as punishment for telling the secret.
- Tell the child that he or
she is not to blame for the sexual abuse. Most children in attempting to make sense out of the abuse will believe that somehow
they caused it or may even view it as a form of punishment for imagined or real wrongdoings.
- Finally, offer the child
protection, and promise that you will promptly take steps to see that the abuse stops.
What to Do
Report any suspicion of child abuse. If the abuse is within the family, report it to the local Child Protection Agency. If the abuse is outside of the family, report it to the police or district attorney's office. Individuals reporting in good faith are
immune from prosecution. The agency receiving the report will conduct an evaluation and will take action to protect the child.
Parents should consult with
their pediatrician or family physician, who may refer them to a physician who specializes in evaluating and treating sexual
abuse. The examining doctor will evaluate the child's condition and treat any physical problem related to the abuse, gather evidence to help protect the child, and reassure the child that he or she is all right.
Children who have been sexually
abused should have an evaluation by a child and adolescent psychiatrist or other qualified mental health professional to find
out how the sexual abuse has affected them, and to determine whether ongoing professional help is necessary for the child
to deal with the trauma of the abuse. The child and adolescent psychiatrist can also provide support to other family members who may be upset by the abuse.
While most allegations of
sexual abuse made by children are true, some false accusations may arise in custody disputes and in other situations. Occasionally,
the court will ask a child and adolescent psychiatrist to help determine whether the child is telling the truth, or whether
it will hurt the child to speak in court about the abuse.
When a child is asked as to
testify, special considerations - such as videotaping, frequent breaks, exclusion of spectators, and the option not to look
at the accused - make the experience much less stressful.
Adults, because of their maturity
and knowledge, are always the ones to blame when they abuse children. The abused children should never be blamed.
When a child tells someone
about sexual abuse, a supportive, caring response is the first step in getting help for the child and reestablishing their trust in adults.
Source: AACAP No. 28; Updated July 2004
fear and anxiety
social withdrawal or isolation
Posttraumatic stress disorder (PTSD)
difficulty regulating emotional responses
effects on self-perception
Children who have been physically abused demonstrate a variety of problematic reactions and behaviors including:
Children who have been physically abused demonstrate a variety of problematic reactions and behaviors including:
From the website: Adopting.org
parents provide a temporary, safe home for children in crisis. They are part of the child's support, treatment, and care programs. They are partners of the child's social worker, attorney, teachers, and doctors. Being a foster parent is not a passive act of opening one's home and providing food, clothing, and shelter.
It is a proactive statement of nurturing, advocacy, and love.
Children who need foster families have been removed from their birth family homes for reasons of neglect,
abuse, abandonment, or other issues endangering their health and/or safety. Many of these children are filled with fear, anger,
confusion, or a sense of powerlessness at having been removed from the only home they have ever known. Many are sibling groups,
older children, or young teens. Some have developmental, physical, emotional, or behavioral problems.
They all need safe, supportive environments.
These are questions
to ask yourself before taking the next step:
- Can you love and care for
a child who has come from a difficult background?
- Can you help a child develop
a sense of belonging in your home even though the stay is temporary?
- Can you love a child who,
because of a fear of rejection, does not easily love you back?
- Are you secure in yourself
and your parenting skills?
- Can you set clear limits,
and be both firm and understanding in your discipline?
- Do you view bed-wetting,
lying, defiance, and minor destructiveness as symptoms of a child in need?
- Can you tolerate major failures
and small successes?
- Can you accept assistance
and guidance from trained social workers?
- Can you maintain a positive
attitude toward a child's parents; even though many of the problems the child is experiencing is a direct result of the parent's
- Can you love with all of
your heart and then let go?
All states offer financial support. The amount varies from state to state, but in all cases, you must be able to prove that your current family needs can be met without having to use any of this income. Many states also offer clothing, daycare and/or day camp allowances.
Check foster care rates and requirements in your
Requirements to become a foster parent vary from state to state, but this list from the National Foster Parent Association covers the basics. Be sure to check with the Foster Care Specialist (or equivalent)
in your state or province for detailed information.
- Be at least 21 years old.
- Have enough room (and beds) in your home for a foster child to sleep and keep
his or her belongings.
- Live in a home that can meet
basic fire, safety and sanitary standards.
- Be physically and emotionally
capable of caring for children and have no alcohol or drug abuse problems.
- Be able to pass a criminal
background check and have no substantiated record of abusing or neglecting children.
- Make enough money to provide
for your own family, so you do not need to depend on the foster care reimbursement you receive from the state as income.
Pre-placement training is
required to help prepare prospective parents for issues that can arise after a child or sibling group is placed with them.
Many children bring not only unique special needs, but a history of life experiences that may affect interactions with foster parents, other
children in the family, school mates, and others. Issues related to disability, culture, early abuse, birth family members, etc., should be discussed with your social worker to your satisfaction.
These programs go by various names (MAPP and others) and
online training programs are also available. Your foster care
specialist can provide more information, and check the Resources Page for more information.
source site: click here to visit Adoption.org
PEDIATRICS Vol. 106 No. 5 November 2000, pp. 1145-1150
AMERICAN ACADEMY OF PEDIATRICS:
Developmental Issues for Young Children
in Foster Care
Committee on Early Childhood, Adoption and Dependent Care
of young children with complicated, serious physical health, mental health, or developmental problems are entering
foster care during the early years when brain growth is most active. Every effort
should be made to make foster care a positive experience and a healing process
for the child. Threats to a child's development from abuse and neglect should be understood by all participants in the child welfare system. Pediatricians have
an important role in assessing the child's needs, providing comprehensive services, and advocating on the child's behalf.
The developmental issues important
for young children in foster care are reviewed, including:
1) the implications and consequences
of abuse, neglect, and placement in foster care on early brain development;
2) the importance and challenges
of establishing a child's attachment to caregivers;
3) the importance of considering
a child's changing sense of time in all aspects of the foster care experience; and
4) the child's response to
addressed relate to parental roles and kinship care, parent-child contact, permanency decision-making, and the
components of comprehensive assessment and treatment of a child's development and mental health needs.
More than 500 000 children
are in foster care in the United States.1,2 Most of these children have been
the victims of repeated abuse and prolonged neglect and have not experienced a nurturing, stable environment during the early years
of life. Such experiences are critical in the short- and long-term development of a child's brain and
the ability to subsequently participate fully in society.3-8
Children in foster care have disproportionately high rates of physical, developmental, and mental health problems1,9
and often have many unmet medical and mental health care needs.10 Pediatricians, as advocates for children and their families, have a special responsibility to evaluate
and help address these needs.
Legal responsibility for establishing
where foster children live and which adults have custody rests jointly with the child
welfare and judiciary systems. Decisions about assessment, care, and planning should be made with sufficient
information about the particular strengths and challenges of each child.
an important role in helping to develop an accurate, comprehensive profile of the child. To create a useful assessment,
it is imperative that complete health and developmental histories are available to the pediatrician
at the time of these evaluations. Pediatricians and other professionals with expertise in child development should
be proactive advisors to child protection workers and judges regarding the child's needs and best interests, particularly regarding issues of placement, permanency planning, and medical, developmental,
and mental health treatment plans.
For example, maintaining contact
between children and their birth families is generally in the best interest of the child, and such efforts
require adequate support services to improve the integrity of distressed families. However, when keeping a family together may not be in
the best interest of the child, alternative placement should be based on social, medical, psychological,
and developmental assessments of each child and the capabilities of the caregivers to meet those needs.
Health care systems,
social services systems, and judicial systems are frequently overwhelmed by their responsibilities and caseloads.
Pediatricians can serve as advocates to ensure each child's conditions and needs are evaluated and treated properly and to improve the overall operation of these systems. Availability and
full utilization of resources ensure comprehensive assessment, planning, and provision of health care.
about each child's development supports better placement, custody, and treatment decisions. Improved programs for all children enhance the
therapeutic effects of government-sponsored protective services (e.g., foster care, family maintenance).
The following issues should
be considered when social agencies intervene and when physicians participate in caring for children in protective
Early Brain and Child Development
More children are entering
foster care in the early years of life when brain growth and development are most active.11-14
During the first 3 to 4 years of life, the anatomic brain structures that govern personality traits,
learning processes, and coping with stress and emotions are established, strengthened, and made permanent.15,16
If unused, these structures
atrophy.17 The nerve connections and neurotransmitter networks that are forming during these critical years are
influenced by negative environmental conditions, including lack of stimulation, child abuse, or violence within the family.18 It is known that emotional and cognitive disruptions in the early lives of children
have the potential to impair brain development.18
Paramount in the
lives of these children is their need for continuity with their primary attachment figures and a sense of permanence that is enhanced when placement is stable.10 There are critical periods of interaction
among physical, psychological, social, and environmental factors. Basic stimulation techniques and stable, predictable nurturance
are necessary during these periods to enable optimal cognitive, language, and personal socialization skills.
children have suffered significant emotional stress during critical periods of early brain development and personality formation, the support they require is reparitive; as well as preventive. The pediatrician, with knowledge of the child's medical and family history,
may assist the social service and judicial systems in determining the best setting to help the child feel safe and heal.
To develop into a psychologically
healthy human being, a child must have a relationship with an adult who is nurturing, protective, and fosters trust and security.19
Attachment refers to this relationship between 2 people and forms the basis for long-term relationships or bonds with other persons.
Attachment is an active process - it can be:
- secure or insecure
- maladapative or productive.
Attachment to a primary caregiver is essential to the development of emotional security and social conscience.20
Optimal child development
occurs when a spectrum of needs are consistently met over an extended period. Successful parenting is based on a healthy, respectful, and long-lasting relationship
with the child.
This process of parenting,
especially in the psychological rather than the biologic sense, leads a child to perceive a given adult as his or her "parent."
That perception is essential for the child's development of self-esteem and self-worth.21
A child develops attachments and recognizes as parents adults who provide "... day-to-day attention to his needs for physical care, nourishment, comfort, affection, and stimulation."21
Abused and neglected children (in or out of foster care)
are at great risk for not forming healthy attachments to anyone.9,10 Having at least 1 adult who is devoted to and loves a child unconditionally, who is prepared
to accept and value that child for a long time, is key to helping a child overcome the stress and trauma of abuse and neglect.
The psychosocial context and
the quality of the relationship from which a child is removed, as well as the quality of alternative care that is being offered
during the separation, must be carefully evaluated. This information should be used to decide which placement is in the child's
The longer a child and parent
have had to form a strong attachment with each other (i.e., the older the child) the less crucial the physical
proximity will be to maintain that relationship.
Separation during the first
year of life - especially during the first 6 months - if followed by good quality of care thereafter, may not have a
deleterious effect on social or emotional functioning. Separations occurring between 6 months and about 3 years
of age, especially if prompted by family discord and disruption, are more likely to result in subsequent emotional disturbances.
This partly results from the
typical anxiety a child this age has around strangers and the normal limitations of language abilities at this age. Children
older than 3 or 4 years placed for the first time with a new family are more likely to be able to use language to
help them cope with loss and adjust to change.
These preschool-aged children
are able to develop strong attachments and, depending on the circumstances from which they are removed, may benefit psychologically from the new setting.
consequences of multiple placements or disruptions are likely to be harmful at any age, and the premature return of a child
to the biologic parents often results in return tofoster care or ongoing emotional trauma to the child.22 Children with attachment disorders and an inability to trust and love often grow up to vent their rage and pain on society.19
Children's Sense of Time
Children are placed in foster care because of society's concern for their well-being. Any time spent by a child in temporary
care should be therapeutic but may be harmful to the child's growth, development, and well-being. Interruptions
in the continuity of a child's caregiver are often detrimental.
Repeated moves from
home to home compound the adverse consequences that stress and inadequate parenting have on the child's development and ability to cope. Adults cope with impermanence
by building on an accrued sense of self-reliance and by anticipating and planning for a time of greater
Children, however, especially
when young, have limited life experience on which to establish their sense of self. In addition, their
sense of time focuses exclusively on the present and precludes meaningful understanding of "temporary" versus
"permanent" or anticipation of the future.
For young children,
periods of weeks or months are not comprehensible. Disruption in either place or with a caregiver for even
1 day may be stressful. The younger the child and the more extended the period of uncertainty or separation, the more detrimental
it will be to the child's well-being.21
Any intervention that separates
a child from the primary caregiver who provides psychological support should be cautiously considered and treated as a matter of urgency and profound importance. Pediatricians
should advocate that evaluation, planning, placement, and treatment decisions be made as quickly as possible, especially
for very young children.
The body's physiologic
responses to stress are based on involuntary actions of the brain. Physical and mental abuse during the first few years of life tends to fix the brain in an acute stress response mode that makes the child respond in a hypervigilant, fearful manner.18,22
chemical and electrical evidence for this type of brain response pattern.18,23 The age of the child
dictates the developmental response and manifestations to stress. When an infant is under chronic stress, the response may be:
- poor feeding
- failure to thrive
When the infant
is under acute threat, the typical "fight" response to stress may change from crying (because
crying did not elicit a response) to:
- temper tantrums
- aggressive behaviors
The child, rather
than running away (the "flight" response), may learn to become:
- psychologically disengaged, leading to detachment
- excessive daydreaming
Some abused and neglected children learn to react to alarm or stresses in their environment reflexively with immediate
cessation of motor activity (freeze response). Older children
who have been repeatedly traumatized often suffer from post traumatic stress disorder and automatically freeze
when they feel anxious, and therefore are considered oppositional or defiant by those who interact with
The same areas of the brain
that are involved in the acute stress response also mediate motor behavior and such functions as state regulation and anxiety control.23 Repeated
experiencing of traumatic events can lead to dysregulation in these various functions resulting in behaviors such
- motor hyperactivity
- mood swings
- sleep problems.18
Effects of Neglect
An increasing number of
young children are being placed in foster care because
of parental neglect.1 Neglect has very profound and long-lasting consequences on all aspects of
child development -
- poor attachment formation
- development delay
- poor physical development
- antisocial behavior.8,17,25-27
Being in an environment in
which child-directed support and communication is limited makes it more difficult for a child to develop the brain connections that
facilitate language and vocabulary development, and therefore may impair communication skills.28
Recent findings in infant
mental health show how development can be facilitated, how treatment can enhance brain development and
psychological health, and how prevention strategies can lessen the ill effects of neglect.29
Comprehensive Assessment Of The At-Risk Child - Before Placement
Knowledge of normal
child development and family functioning helps identify children receiving insufficient and inappropriate care
as well as children who are victims of, or at risk for, abuse or neglect. Comprehensive pediatric assessments can
complement programs that prevent abuse and neglect, decrease the likelihood of placement in foster care, identify whether a child's current needs are being met, and allow placements to be customized to meet each child's needs.
Comprehensive Assessment Of Children - After Placement
A pediatric assessment should
be done within 30 days of placement.30 This evaluation must be:
Appropriate in breadth and depth, assessing physical, behavioral, emotional, cognitive, relational, and environmental
Address the effect any 1 domain of function has on another domain of function (e.g.,
impact of motor deficits on speech).
Age-appropriate using validated instruments that are sensitive to changes in development over time.
- Preventive: Anticipatory,
focusing on early identification and interventions.
Based on data collected over time to determine problems, each child's abilities, and future course.
- Summative: Able
to synthesize and compile results for the purpose of prioritization.
- Culturally Sensitive:
Sensitive to different values, meanings, and perceptions of importance.
Conducted in settings and in a manner that protects the child's comfort and that controls and limits the stress of the evaluation.
Sensitive, specific, valid, and reliable.
- Child Welfare-Sensitive:
Consistent with norms, standards, and goals of child welfare.
Compact, efficient, and able to be completed in a reasonable amount of time.
At a minimum, the following
areas should be assessed:
- Gross motor skills
- Fine motor skills
- Speech and language function
- Self-help abilities
- Emotional well-being
- Coping skills
- Relationship to persons
- Adequacy of caregiver's parenting skills
The comprehensive assessment
should lead to an individualized court-approved treatment plan and ongoing monitoring by a multidisciplinary team
skilled in working with this population in the context of a medical home.31
In-home monitoring, placement
with a relative ("kinship care"), or out-of-home placement should support each child's psychological and developmental needs. Parents and foster parents must be well-informed about the importance of the
environment in the development of normal brain function and the specifics needed for the child under care.
Children can often be helped
by providing predictability, nurturance, support, and cognitive or insight-oriented interventions to make them feel safe, comfortable, and loved. Specific mental
health plans must be developed to meet the functional needs of each child.
Early interventions are key
to minimizing the long-term and permanent effects of traumatic events on the child's brain.14,17,32-36
After the first several years
of a child's life, patterns of interaction with the world are formed, both psychologically and in the
brain structure, making it more difficult, though still possible, to improve a child's physical, cognitive, and
Several studies have shown
how favorable and stimulating environments for infants and young children can lessen the adverse effects of
prior negative environments.27 Pediatricians have an important role in recognizing problem situations in
the home and for children already in foster care. Prompt referrals should be
made for early intervention services to secure full developmental assessments and treatments under the Individuals
With Disabilities Act.
Courts with jurisdiction over
families and children have been charged by Congress and the states to ensure that "reasonable efforts" are made to preserve
and repair families or to place children in foster care when necessary. The courts also
have the responsibility to make foster care a healing process.
Given limited social, economical,
educational, and health care resources, the judiciary has a responsibility to try to make needed resources available in the community and to decide whether application of available resources has been reasonable and appropriate.
An array of supportive services should be available to assist families in child rearing and to offer alternative and therapeutic parenting(i.e., foster care) when temporary removal of the child
from the home is required.
The measure of reasonable
and appropriate should always be what is in the best interests of the child. Lack of agreement exists about what constitutes
such reasonable efforts. Principles of child development and expert consultation can provide guidance to assist in determining
what is in the best interest of the child and whether these interests can be best met within the biologic family or another
family. The lack of available resources to ensure a reasonable effort should not be used by the protective services agencies
as an excuse to delay a permanent placement plan for a child.
Parental Roles and Kinship Care
number of children entering foster care, the insufficient number of suitable foster homes,
and the increased interest by extended families to care for their kin have led social service agencies to place children with
their extended families.
a relative has psychological advantages for a child in terms of knowing his or her biologic roots and family identity. It
may offer a better chance for stability and continuity of care giving. However, little is known about the outcomes of kinship
placement, and it should not be assumed to offer a superior home environment.37
social workers of relatives providing foster careis often less intense and family support services are less available than when a child is placed in non-kinship foster care. Placement with a relative may lead to
a circuitous and unintended return of the child to his or her parents.
The report by
the National Commission on Family Foster Care states: "The use of kinship care has expanded so rapidly that child welfare
agencies are making policy, program, and practice decisions that lack uniformity and/or a substantive knowledge base.
Kinship care provides
an opportunity to affirm the value of families. But the assessment process and support should include unique family strengths and needs, cultural and ethnic identification, necessary financial and service supports, continuity of care, and permanency goals."38
that a range of parenting arrangements can provide the feelings of permanency, security, and emotional constancy necessary
for normal development.39
Visiting (Parent - Child Contact)
Children in out-of-home
dependent care are usually accorded a schedule of visits with their parents. The intent is to maintain or improve the child-parent
relationship, to give the social service agency an opportunity to observe and improve the parent-child interaction, and to
monitor the parents' progress. The visits are frequently brief encounters occurring on a weekly basis, in a neutral setting
if possible, often under the supervision of a caseworker.
For younger children,
this type of visit is not conducive to optimal parent-child interaction and may minimally serve the parents' needs for ongoing contact with the child or may even be harmful for the child.
A young child's
trust, love, and identification are based on uninterrupted, day-to-day relationships. Weekly or other sporadic "visits" stretch
the bounds of a young child's sense of time and do not allow for a psychologically meaningful relationship with estranged
biologic parents. For older children, such sporadic and brief visits may be sufficient to maintain a meaningful parent-child
visits to be beneficial, they should be frequent and long enough to enhance the parent-child relationship and to effectively
document the parent's ongoing interest and involvement with the child. Sporadic visits are appropriate if an older child has
established a strong attachment to the parent before entering foster care or if the visits
are sufficient in frequency, length, and content to contribute to the child's continuing normal development and enhanced parent-child
Stable Placement Versus Legal Custody Versus Permanence
Children who have experienced
abuse or neglect have a heightened need for permanency, security, and emotional constancy and are, therefore, at great risk because of the inconsistencies in their
lives and the foster care system. Every effort should be made to rapidly establish a permanent
placement for the child. Tangible continuity in relationships with family and friends is essential for a child's healthy development.
Stability in child care and
the school environment is important. Multiple moves while in foster care (with the attendant
disruption and uncertainty) can be deleterious to the young child's brain growth, mental development, and
regardless of their type of placement, must receive individual attention from their caregivers. Foster
parents and extended family members can play a significant role when the child's mother or father cannot. Impersonal
placement settings do not effectively support young children who have been abused and neglected.
including conferring legal status, are usually of little or no consequence to children, whose needs are much more fundamental. Generally, assignment of custody should reinforce a child's perception of belonging and should
not disrupt established psychological ties except when safety or emotional well-being are in jeopardy.
All placement, custody, and
long-term planning decisions should be individualized for the child's best interest and should maximize the healing
aspects of government-sponsored protective services. These decisions should be based in part on a comprehensive
assessment and periodic reassessment of the child and family by professionals who are experts in pediatrics
and child development (e.g., pediatrician, psychiatrist, or psychologist).22
An ongoing relationship between
the pediatrician and the child and family can provide valuable insights about a child's needs and the ability of a family to meet them. Pediatricians should actively participate in prevention services
for at-risk families and placement, custody, and long-term planning decisions for children for whom
they provide care, taking into account the following considerations.40
important concepts should guide pediatricians' activities as they advocate for the child:
- Biologic parenthood does not necessarily confer
the desire or ability to care for a child adequately.
- Supportive nurturing by primary caregivers is crucial to early brain growth and to the physical, emotional, and developmentalneeds of children.
- Children need continuity, consistency, and predictability from their caregiver. Multiple placements are injurious.
- Attachment, sense of time, and developmental level of the child
are key factors in their adjustment to environmental and internal stresses.
- Pediatricians can play a constructive role in the referral,
assessment, and treatment of children who are at risk for being abused, neglected, or abandoned or who are involved in the protective services system.
- Pediatricians need to encourage caregivers to:
- give the child plenty of love and attention.
- be consistent with love, stimulation, and discipline.
- stimulate the child through exposure to developmentally
appropriate holding, conversation, reading, music, and toys.
- expose the child to opportunities to improve language
via direct voice and face-to-face contact.
- match the environment to the child's disposition.
7. Parents should
be given reasonable assistance and opportunity to maintain their family, while the present and future best interests of the
child should determine what is appropriate.
8. A child's attachment history and sense of time should guide the pace of decision-making.
9. Foster care placements should always maximize the healing aspects of foster care and be based on the needs of the child.
10. Foster care placement with relatives should be based on a careful assessment of the needs of the child and of the ability of the kinship care to meet those needs. As with all foster care placements, kinship care must be supported and supervised adequately.
source site: click here
Child Abuse - The Hidden Bruises
The statistics on physical
child abuse are alarming. It's estimated hundreds of thousands of children are physically abused each year by a parent or close relative. Thousands die.
For those who survive, the
emotional trauma remains long after the external bruises have healed. Communities and the courts recognize that these emotional “hidden
bruises” can be treated.
Early recognition and treatment
is important to minimize the long term effect of physical abuse. Whenever a child says he or she has been abused, it must be taken seriously and immediately evaluated.
Children who have been abused may display:
- a poor self image
- sexual acting out
- inability to trust or love others
- aggressive, disruptive and sometimes illegal behavior
- anger and rage
- self destructive or self abusive behavior, suicidal thoughts
- passive, withdrawn or clingy behavior
- fear of entering into new relationships or activities
- anxiety and fears
- school problems or failure
- feelings of sadness or other symptoms of depression
- flashbacks, nightmares
- drug and alcohol abuse
- sleep problems
Often the severe emotional
damage to abused children doesn't surface until adolescence or later, when many abused children become abusing parents. An adult who was abused as a child often has trouble establishing intimate personal relationships.
These men and women may have
trouble with physical closeness, touching, intimacy and trust as adults. They're also at higher risk for anxiety, depression,
substance abuse, medical illness and problems at school or work. Without proper treatment, physically abused children can be damaged for life.
Early identification and treatment
is important to minimize the long-term consequences of abuse. Qualified mental health professionals should conduct a comprehensive evaluation and provide treatment for children who have
Through treatment, the abused child begins to regain a sense of self-confidence and trust. The family can also be helped to learn new ways of support and communicating with one another. Parents may also benefit from support, parent training and anger management.
Physical abuse isn't the only kind of child abuse. Many children are also victims of neglect, or sexual abuse, or emotional
abuse. In all kinds of child abuse, the child and the family can benefit from evaluation and treatment from a qualified mental health professional.
Source: AACAP No. 5; Updated July 2004
National Facts About Children in Foster Care
513,000 children were in
the U.S. foster care system on September 30, 2005. Most children are placed temporarily
in foster care due to parental abuse or neglect.
Average Age: 10.0 years
||< 1 year|
Race and Ethnicity:
As a percentage, there are more children of
color in the foster care system than in the general U.S. population. However, child abuse and neglect occur at about the same rate in all racial / ethnic groups.
||In out-of-home care
||In general population|
||Am. Indian/Alaska Native (non-Hispanic)
||Asian/Pacific Islander (non-Hispanic)
||2 or More Races (non-Hispanic)
Length of Stay
For the children in foster
care on September 30, 2005, the average amount of time they had been in the system was 28.6 months. Half of those leaving
care that year had been away from home for a year or longer. 54% of the young people leaving the system were reunified with
their birth parents or primary caregivers.
In 2004, there was a total of 153,000 licensed / certified
/ approved kinship and non-relative foster homes nationwide. In 2005, 24% of youth living foster
care were residing with their relatives.
In 2005, 60% of adopted children were adopted by their foster parent(s).
The "foster parent" category excludes anyone identified as a relative of the child. 25%
of children adopted in FY 2005 were adopted by a relative. A "relative" includes a step-parent or other relative of the child.
Siblings and Extended Families
Over 2 million American children
live with grandparents or other relatives because their parents cannot care for them. When relatives provide foster care (known as kinship care), siblings can often
stay together. Kinship care also improves stability by keeping displaced children closer to their extended families, their
neighborhoods, and their schools.
Youth in Transition
Each year, an estimated 20,000 young people "age out" of the U.S. foster
care system. Many are only 18 years old and still need support and services. Several foster care alumni studies show that without a lifelong connection
to a caring adult, these older youth are often left vulnerable to a host of adverse situations:
||Regional or Local|
|Earned a high school diploma
||50% - 63%|
|Obtained a Bachelor's degree or higher
|Became a parent
|Had no health insurance
|Had been homeless
|Were receiving public assistance
source site: click here
Should I Do Foster Care?
Points to Consider
By Carrie Craft, About.com
One day I came home from working
at our local children's home and asked my husband what he thought about becoming a foster
parent. He had numerous fears and logical concerns. Many men are good about the latter,
We decided the best first
step was to take the training classes and go from there. Several months later, we were so nervous when we drove our first foster child home, but we knew we had taken stock of our skills and limitations and decided that
we were ready to become foster parents.
After gathering information
from your state's foster care agency; ask yourself the following questions:
Do you have a strong support system of friends and/or family?
This is important, as fostering can become very stressful at times. It's good to have someone who will listen if you need to vent. If you don't have a support system already in place and decide to go ahead with fostering, be sure to participate in
support groups. Many agencies hold their own support group meetings. If not consider starting your own with other foster parents.
Are you a patient person?
Are you willing to continually give and very rarely get anything in return, except for the knowledge that you are helping
Many people enter into foster care thinking that they are rescuing a poor child from an abusive parent. These foster parents believe that the child will be grateful and relieved to be out of
their home situation. This is rarely the case.
Abuse is all that the child
may know. The child's bad situation is her "normal." Be prepared for the child to be anything but happy about being in your
home. In other words, examine your expectations. What are you expecting? Not only from the child, but from his or her parents,
the state and the fostering experience itself? High expectations can lead to your fall!
Kids in care have sometimes
been neglected, physically, sexually, mentally and emotionally abused. The children can be angry, resentful and sad. They may take it out on their foster parents,
usually the foster mother. Are you willing and able to deal with what the children may put
on you, and not take it personally? This is harder than it seems, especially when you are being kicked or cussed out.
Are you willing to have social
workers in your home, sometimes every month? Can you work in a partnership with a team of professionals to help the child
either get back home or to another permanent placement, such as adoption? This goal requires excellent communication skills
on your part, and a commitment to follow the plan set forth by the social workers.
Can you say goodbye? Foster care is not a permanent arrangement. The children will move on someday. Permanency is what
you want for them. However, you and your family will attach to this child, so don't fool yourself into thinking otherwise.
Attachment is a good thing, for both you and the child. If the child can attach and trust you, they will be able to do the
same with others in their lives and this leads to a healthier future. Goodbye does not have to mean for forever.
In some cases, with permission
from the birth parent or adopted parent, a relationship with your foster children can remain
intact after a move. We have a relationship with a few of our past foster daughters and enjoy seeing them and receiving cards
and phone calls. They even still ask us for advice.
If you have children, how
do they feel about doing foster care? It's important to consider every member of your family
when thinking about fostering. Everyone in the house will be living and interacting with
the foster child and his behaviors. Your children will have to share their home, room, toys
and parents. They sacrifice a lot in becoming part of a fostering family.
Ask your children how they
feel and listen! Also, be aware that your child may learn or pick up whatever the foster child
knows, both the good and the bad. Are you prepared to stand guard at all times, making your home safe for all who live there?
What ages of children can
you parent at this time? Consider the ages of your own children and where another child would fit into your family. Is a baby
right for you? While you won't have to deal with foul language, you will have to give up sleep and basically "start over"
if your children are grown. Or would a school age child work better. In this situation you may not have to worry about day
Also, consider the sex of
the child. These are choices that are all up to you as a foster parent. You
will also be given choices on what behaviors that you feel you can and cannot parent at this time. Be aware of the fact that
many behaviors may not surface until the child feels safe enough to be himself. The social workers are also not always aware
of a child's behavior at the time of placement.
Finally, do you have a lot
of love to give? Are you ready to throw a child her first birthday party? Can you help him decorate a first Christmas tree
or carve a first pumpkin? Help the child to see that families are a great place to grow up and show him an excellent role
model of healthy family relationships? Give her an opportunity to heal and grow?
If you can say "yes" to most
of these questions, then call your state foster care representative. You have an excellent
chance of being a wonderful foster parent!source site: click here
When children blame themselves for their parents' unhappiness
1 September 2008
No surprise to learn from
new UK research that children whose parents fight run a high risk of underachieving at school. But the evidence being assembled
by Gordon Harold and his Cardiff University colleagues is also beginning to explain why, by shedding light on the psychological
processes that translate cause into potentially damaging effect.
The link between the family
context and children’s psychological development is well established. There are known connections between levels of
psychological adjustment (particularly in relation to their emotions and behavior)
and factors such as parental mental illness and divorce – as well as inter-parental conflict.
However, investigations such
as those by Cardiff's School of Psychology are extending the range of the known effects by unpicking the broader family context
and examining other aspects of children’s development.
The study tracked the experience
of 230 UK schoolchildren aged between 11 and 13 and that of their parents and teachers over a two-year period (1999-2001).
Researchers cataloged children’s and parents’ reports of inter-parental conflict, as well as information about
the parent-child relationship, the children’s appraisals of inter-parental conflict, teachers’ reports of children’s
behavior, and children’s scores on Key Stage Three standardized academic tests (SATs).
The findings suggest that
children living in households characterized by high levels of inter-parental conflict are indeed at risk of lower attainment
at school, and, importantly, that children’s own appraisal of their parents’ conflict and their tendency to blame
themselves for what they see happening is the mechanism through which any damage is done. Self-blaming was found to lead to
lower academic attainment and, in some cases, to aggressive behavior.
Some clear lessons for researchers,
practitioners and policy makers are emerging. For example, the finding that the inter-parental relationship has a direct influence
on the development of the child is a strong argument for early intervention, particularly in light of the fact that academic
success is consistently shown to be an important predictor of adult adjustment.
Secondly, such services should
surely involve direct work with child as well as parents if they are to deal with the condition of self-blame that seems to
have the power to translate the risk factor of inter-parental conflict into negative outcomes for children.
• Summary of Harold G T, Aitken J, Shelton K H. (in press)
"Inter-parental Conflict and Children’s Academic Attainment: A longitudinal analysis", Journal of Child Psychology
• first published in Prevention Action
on November 15th 2007
When a Parent Has a Mental Illness: Issues and Challenges
Mental illness can cause mild to severe disturbances in thought and behaviors and can result in an inability
to cope with life's ordinary demands and routines. Consequently, it can have a significant impact on family stability. Parents
with mental illness have lower marriage and higher divorce rates than the general population. Some parents with mental illness
may face problems with parent-child attachment due to repeated separations or family instability.1 Therefore, families with
a parent who has a mental illness require unique services that include both prevention and intervention services for the parent
and child(ren). The issues and challenges faced by the one in four American families affected by mental illnesses, such as
depression, anxiety disorders and schizophrenia, are numerous and varied.2 These issues, which are explored in greater detail
in other fact sheets in this series, include:
The impact of mental illness on parenting capacity.
The impact of parental mental illness on children.
The stigma surrounding mental illness.
Legal issues - parents maintaining custody and contact with their children.
Need for integrated services for parents and families.
Impact of Mental
Illness on Parenting Capacity
Mothers and fathers with mental
illness experience all of the challenges of other adults attempting to balance their roles as workers, spouses and parents.
The symptoms of mental illness, however, may inhibit these parents' ability to maintain a good balance at home and may impair
their parenting capacity. When parents are depressed, for example, they may become less emotionally involved and invested
in their children's daily lives. Consequently, parent-child communication may be impaired.3 The severity of a parent's serious
mental illness and extent of the symptoms may be a more important predictor of parenting success than diagnosis.
To be effective, intervention
programs and supports for families need to be comprehensive, addressing the needs of the whole family. Services should also be long-term, supporting the family until their primary needs are addressed.
Impact of Parental Mental Illness on Children
The impact of parental mental
illness on family life and children's well-being can be significant. Children whose parents have a mental illness are at risk
of developing social, emotional and/or behavioral problems. The environment in which children grow affects their development
and emotional well-being as much as their genetic makeup does.
Service providers and advocates
working with families in which a parent has a mental illness have identified a number of challenges faced by their children.
For example, children may take on inappropriate levels of responsibility in caring for themselves and managing the household. Children sometimes blame themselves for their parents' difficulties, and experience anger, anxiety or
guilt. Feeling embarrassed or ashamed as a result of the stigma associated with their parents' mental illness, they
may become isolated from their peers and other community members. They may be at increased risk for problems at school, drug
use and poor social relationships. Children of parents with any mental illness are at risk a range of mental health problems,
including mood disorders, alcoholism, and personality disorders.
Despite these challenges,
many children of parents with mental illness are resilient and are able to thrive in spite of genetic and environmental vulnerability.
Resiliency is directly proportionate to the number of risk and protective factors present within the family: the greater number
of protective factors and smaller number of risk factors, the greater the likelihood of a child being resilient. Therefore,
services for families and children should include opportunities to reduce risk and enhance resiliency.
The Stigma Surrounding
The most pervasive factor affecting parents' access to and participation in mental health
services is the stigma accompanying mental illness.4 The stigma of mental illness is likely borne out of misconceptions of
mental illness and exacerbated by disproportionate media misrepresentations of people with mental illnesses as violent or
unfit. The stigma keeps many parents from seeking the help they need,5 particularly in cases where they are afraid of losing custody of their children. The stigma of mental illness is more severe
than that of other serious or chronic conditions like heart disease, diabetes, and cancer. Being labeled with a psychiatric
disorder can profoundly and negatively affect the experiences of parents and their family members, adults and children alike.
Legal Issues -
Parents Maintaining Custody and Contact with their Children
Parents with mental illness
may be quite vulnerable to losing custody of their children. Some studies have reported as many as 70 percent of parents have
lost custody.6 The primary reason for custodial challenge is the stigma surrounding mental illness. Many people believe that
consumers of mental health services are naturally unfit as parents. Another common misconception is that parents with mental
illness are violent and are therefore at increased risk for abusing their children.
As a result, many families
find themselves in a "no win" cycle of loss. They are aware that if they openly seek help, their symptoms may give an impression
of unfitness. Therefore, these families may not seek the services or supports they need, and without those services their
parenting capacity is diminished. In cases where a state government determines it to be in the child's best interest to remove
the child from the home, the child may end up in temporary or permanent substitute care.
Need for Integrated Services for Parents and Families
Addressing the needs of families in which a parent has a mental illness requires a shift in the way most health and human service systems operate.
Providing family centered care is essential. However, the current managed care emphasis on time-limited treatment and the
narrow focus on symptom management are incompatible with a treatment approach that includes the whole family.
Treatment is most effective
when multiple systems work together. For example, schools should provide more mental health consultation to students, foster
social competencies, provide support for students in transition, and encourage peer support and counseling. The child welfare system could provide caseworker training related to parents with mental illness and cross-training
in adult and child issues. Communities should invest in improved prenatal care and expand access to high-quality childcare
to help a range of vulnerable families.
1. American Academy of Child and Adolescent Psychiatry. Children
of Parents with Mental Illness. No. 39. May, 2000.
2. Context of Parenting. May, 1998. Vol. 49. No. 5.
3. Roberta Sands.
“The Parenting Experience of Low-Income Single Women with Serious Mental Disorders. Families in Society.” The
Journal of Contemporary Human Services. 76 (2), 86-89. 1995.
5. Virginia Child
Protection Newsletter. “Parents With Serious Mental Illness.” Vol. 56. Summer, 1999. Critical Issues For Parents
With Mental Illness and Their Families. Center for Mental Health Services. July, 2001.
6. Joanne Nicholson,
Elaine Sweeny, and Jeffrey Geller. Mothers With Mental Illness: II. Family Relationships and the Context of Parenting. May
1998. Vol.49. No. 5.
This fact sheet is made possible through an unrestricted
educational grant from The E.H.A. Foundation.