Therapeutic Foster Care in rural Western North Carolina

I hope that Creative Families will support, encourage, and refresh those of you who provide therapeutic services for children in desperate situations. I also hope to stir the desire of others to open their homes and hearts to children who have no where else to go.

Monday, January 23, 2012

Knight in Shining Pajamas?

My 3 year old has just been initiated into an age old guild of young boys, Knighthood.  He is a brave knight, the protector of his family, invisible sword in hand, conquering dragons and lions and tigers and whatever other threatening animals dwell in the darkness up the stairs at bed time. His fool proof "armor" are his safari pajamas.   Having developed a general trust in the world and the people in it, established confidence in his own independence and will, he as come to the point at which he must develop initiative versus guilt.  He must develop his sense of purpose, his knowing that he is in this world for a reason and that what he does matters. He must move forward in his life knowing that he can try new things and fail, explore the world both imaginary and real,  and that he will be loved and supported while he does so.

A child in this developmental stage of life needs to be affirmed that he is powerful and capable and that his explorations into the world around him are important.  A child also needs to be taught that his power is his to wield in the service of others.  He has the ability to change things as well as the ability to help others.  He has the right to his emotions, but also the responsibility to experience consequences.  This is the foundation of an emotionally intelligent and compassionate soul.

If, however, the struggle for initiative is thwarted, a child may easily experience guilt in his life.  He may feel that he is worthless, doing things wrong, or not doing enough.  A child experiencing this guilt may withdraw for fear of doing something wrong or overcompensate and try to take command of everything.  The foundation of the child continues to be damaged when at every turn he's not allowed to touch things or talk to people in public or he's laughed at for not being able to competently do a task or he's corrected at every turn or he is allowed to do anything he wants without parental intervention or  he is told that his made up story is a "lie" or he is punished for crying or getting angry.

Children come into foster care with many cracks in their developmental foundation.  As each developmental stage builds upon another, guilt builds upon shame and shame builds upon mistrust.  Foster parents have the job of going back to re-examine the foundations, no matter what the child's age, and filling in the cracks.  Therefore a 10 year old might need to be held and rocked like a 1 year old, an 8 year old might need to yell and tell you "no", and a 14 year old might need to play pretend.  They need help filling in those cracks, building back trust and autonomy and initiative.

We all have cracks, that is part of being human.  And there is no shame in being a parent who has not built a strong foundation for their child.  We act out of our own brokenness and we don't know any better than what we have been taught ourselves.  Thankfully we have friends, family, teachers, foster parents and more to help us build where we aren't able, but that never replaces the role of a parent in the heart of a child.

The Childhood Affirmations Program, www.childhoodaffirmations.com, provides the following list of suggestions on concepts of how to encourage your 3-6 year old child.  Try your best to communicate that:

1) We enjoy having you explore who you are and finding out who other people are.
2) You can feel powerful and capable and still ask for help when you want it.
3) You can learn that behavior has consequences.
4) You can imagine things without being afraid they will come true.
5) We gladly give you our support and love.
6) All of your feelings are okay with us.

Build these affirmations in your child, no matter what the age.  Some of us adults still need them!


Monday, January 16, 2012

I Walk the Line

Every child is unique and tests boundaries in different ways.  Some test boundaries subtly, slyly slipping their toe over "the line" when you're not looking; others test boundaries within the letter of the law, standing toe to toe with "the line" but never crossing it; still others test boundaries boldly, stomping over "the line" while you stand there and tell them not to do so.  My younger son, born with a brave conqueror's spirit, can do all three.  His name does not mean "spear of God" for nothing!

At two years old, I have already seen glimpses of him at 16: rolling his eyes, stomping away, and slamming his bedroom door.  I've witnessed his defiance and direct rebellion in the smallest of ways, and I am thankful that in direct alignment to this warrior's spirit is a compassionate heart.  This brute of a two year old is also the cuddliest snuggler, the hugger and kisser, the one who gently rubs his parents awake in the morning.  I also take heart that my two year old is doing exactly what he's supposed to do and he trusts me enough to do it.

Between 18 months and 3 years of age children are finding their autonomy and establishing themselves as separate beings from their parents and siblings.  Now is the time for him to exert his will, his independence, his control.  It is also the time for him to find courage to be in the world, to speak his mind, to challenge what is put before him. He must express himself, but then he must learn self-control.  He must learn that there are consequences for his actions.  He must learn that there are limits to what he can and can't do, what is acceptable exertion of one's self and what is not acceptable.  The child must know that it is okay to say "no", but that saying "no" does not give him the right to hurt himself or others.

This time period is a trial for the parents, both those controlling and those lenient.  If you are too controlling you break the spirit, if you are too lenient you get run over.  Any way, you are exhausted.  Parenting takes time, attention, energy, and dedication.  For foster parents it can be even more difficult because you do not have the affection a parent is given and in most cases you don't see the little child.  You get a hurt and angry teenager on your doorstep, ready to prove they don't need you.  But somewhere in the middle is the balance between respecting the child's discovery of his own autonomy and teaching him healthy limits.

Without balance and respect, the child is confused.  His security in his independence is wavering.  He tests his boundaries in order to learn what is right and wrong, not because he knows what is right and wrong.  If he doesn't get a consistent answer he experiences shame instead of confidence.  He's unsure.  When he acts he doesn't know if he will be rebuked, praised, or ignored.  He becomes embarrassed or defiant.  A child who cannot be confident in his ability to express himself, feels shame when he is corrected, shame when he is singled out, shame when he is confronted.  He feels shame at the core of his identity because the message he receives is that he is not worth being corrected or not worth being paid attention.

As caregivers for children in foster care, our goal is to make children feel capable, lovable, responsible, and worthwhile.  This is our mantra.  Capable, lovable, responsible, and worthwhile.  We must go back.  We must teach the child that he is worth loving, that he is worth protecting, and that he is worth listening to.  We teach a child this by allowing him to express himself in safe ways, having conversations along the way, and drawing the line when someone's health and safety is threatened.  This self expression may show itself in clothes that you don't approve of or change in hair color or the word "no" (or much worse!) or rolling of eyes or not eating at meal times.  Don't be side tracked or thrown off the scent by focusing on the individual behaviors.  Don't get offended by behaviors that don't adhere to your values.  See them for what they are, a search for autonomy and self-worth, a testing of the limits, a journey out of shame.

Thursday, January 12, 2012

Big Person in a Little Body

"Life Unexpected" was a TV drama over the last few years that detailed the life and family drama of a 15 year old girl reunified with her parents after a childhood spent in the foster care system.  Amid the drama and crazy relationships of soap opera proportions, there are beautiful nuggets of truth and redemption that keep one coming back to the screen.  Recently, I watched an episode in which Luxe, the main character, has a conversation with a high school English teacher.  Luxe is frustrated and hurt by the juvenile and mean spirited antics of some classmates and bemoaning the fact that she doesn't fit it.  The teacher points out to Luxe that the other kids are just trying to be grown ups, whereas Luxe is a grown up just trying to be a kid.

This is true for most of our kids in foster care.  How many times have we remarked that these little kids are dealing with adult issues?  This makes the job of parenting sticky, complicated.  Often, children in foster care have been there own parent, they've been the ones responsible for feeding their families, for protecting their siblings, for nursing their parents, for deciphering what it means to be loved.  After so much responsibility, it's a struggle to be told what to do, an insult to the overdeveloped independent spirit, a threat to take something away when so much else has already been lost.

Children do need boundaries and they do need parents.  Developmentally they are not equipped to handle adult situations or adult emotions, but they do because they are adaptable and creative.  Children are survivalists.  However, all this time spent doing adult things they miss out on the stages of childhood development and never learn how to do child things.  As teachers, we have to gently, respectfully, and creatively teach them how to be children again.  And we must start at the very beginning, the foundation of development, Trust versus Mistrust.

Teach the child in your home that she can trust you.  Do not say, "You can trust me."  It is likely she has heard these words many times before and they were not true.  You must teach the child in your home that she can trust you through your actions.  In every small way, earn trust.  This means lots of different things, but do not be deceived into thinking that years of reinforcement of mistrust will be wiped away by a few weeks in your home or because you know that your home and your family are trust worthy.  You must prove that you can be trusted, again and again and again.

Here are some simple ways to SHOW that you are trustworthy:

1) Be where you said you would be, when you said you would be there
2) Keep your voice within normal levels, avoid any yelling
3) Serve 3 meals a day at regular times
4) Post your rules and consequences in your home and give the child a copy
5) Follow through with consequences consistently
6) Follow your own rules
7) Speak positively of the child both in the home and in public
8) Ask permission before you touch the child or enter her room
9) Explain what you are doing and why you are doing it
10) Apologize when you have hurt feelings or made a misstep

Children interpret what they see and what they're told through the mind of child without the benefit of experience or knowledge.  As a result they draw conclusions and connections that don't really exist.  We have to help them draw accurate connections between what we say and what we do and thereby teach them healthy ways of relating to the world around them.  A co-worker recently went to a movie with friends one night.  Meanwhile, her 6 year old son left a message on her phone that she was "neglecting" him.

A 6 year old is not neglected because his mom has healthy social life, but he might feel neglected.  A child from a stable family might feel neglected, but know in reality that he is not.  Trust has been developed.  But a child from an unstable family who has experienced more mistrust than trust, truly might believe a parent is neglectful.  It's our duty as parents to help a child understand healthy interactions and explain that  it is important for people to have family and friends and multiple support systems.  It is also important for people to take care of themselves and do safe things that they enjoy. And in reality it can be difficult to share people we love, but one way we love them is through sharing them.

Monday, January 2, 2012

Be Careful Little Mouths What You Speak

While sitting in the airport waiting for a delayed flight, I overheard a very loud exposition on people with mental illness.  The speaker, a fellow traveler, was marveling a group of young listeners with her experiences as a prison nurse and the appalling criminals she had met.  The oration included such radical statements as "all their heads should be cut off" and "people with personality disorders do not have a chemical imbalance like people with mental illness; they're sociopaths; they have a choice to do what they do."  I must address this situation because unknowingly this woman was impacting public stigma towards people with mental illness, a stigma that does not need help in the realm of negative impressions.

Kids in foster care are in the same position.  They do not need our help to look bad in the public eye, nor do they need our help to look pitiful or feel shameful or guilty.  Foster kids are often dealing with mental illness (depression, bipolar disorder, post-traumatic stress disorder, disruptive behavior, reactive attachment disorder) on top of having suffered neglect, abuse, and removal from the only family they have ever known.  Kids deal with big adult issues the only way they know how, and often this means reverting to the coping mechanisms they've learned from they're environment, coping mechanisms that allow for survival not necessarily for social norms.  Successful coping mechanisms may include stealing, fighting, drinking and drugging, sexually inappropriate behaviors, hoarding food.  The list goes on and on.

To many people these behaviors are quickly interpreted with moral judgments (ranging from our dear traveler's "they're sociopaths and their heads need to be cut off" to the more common this child is "lazy", "rebellious", "ungrateful", or "a tramp").  Our job, as foster care workers and foster parents, is not to fall into this trap of placing value judgments on behaviors.  It is our job to see past the behaviors and help the child identify the feelings that cause them. We must be extremely sensitive to our words, our offhand comments both in our home and in public.  More importantly we must guard our hearts for "As a man thinketh in his heart, so is he" (Proverbs 23:7).  We influence our community's perception of the children we have in our care.  How we talk about them in public or to our spouses impacts the hurdles they meet in the community.  We cannot help those whom we pity or objectify with our judgments.

I would like to take this moment to say that we all have a choice to do what we do, but we make those choices based on our perceived reality.  This perceived reality varies from person to person.  Your reality is based on chemical influences (internal or external), cultural backgrounds, and family grooming, personal experiences and what they've taught you to believe. Someone with paranoid schizophrenia may experience a reality in which people are constantly spying on them which will result in some very out of the ordinary behaviors.  Children who believe that they are worthless and cannot get attention any other way may resort to sexual exploits that are unsafe or far beyond their age level.  We all have our own struggles and our own personal realities that we respond to, whether that is believing you are fat or ugly or unlovable, whether it is believing you will be denied what you want, or cheated out of what you work hard for, or rejected when you reach out.  We behave in response to the things we have been taught and the things that we believe about ourselves.

For ourselves, for each other, and for our children we need to speak and believe a higher Truth.  A truth that says we are capable, lovable, responsible, and worthwhile; a Truth that is not based on our behaviors, but on how we were created.  We are created Good.

Monday, December 26, 2011

Hyper-Active Intervention

A foster parent came to me with a question, "My child is hyper active to the point the dog is nervous to be around her.  Any suggestions?".  The dog used to go to sleep in the car; after being around this 11 year old girl the dog urinates in the car, won't sit down, and begs to get out.  The child talks endlessly, jumps out to scare the parent when he gets home from work, startles when approached from behind, can't settle down once she gets wound up.  All this activity without any reprieve and the parent is going to get burnt out.  With holiday activities in full gear and additional family members in the home, some members whom the child has never met before, anxiety and hyperactivity are only increasing.

 I have more questions than suggestions.  Does the child have the ability to control herself?  Often times medications physically effect a child, beyond her control.  What has happened recently that might have influenced her behavior?  Changes can include medication, people she comes in contact with, family visits, change in legal status, situations at school, change in season, or simply the end of a honeymoon period.  Does the child realize that her behavior is hyperactive?  The child may or may not recognize her behavior as out of the ordinary or problematic.  And even if she does recognize that she is "hyper", she may not be able to identify in concrete terms what "hyper" means.

Three cheers for this foster parent!  First, this dad preserved the safety of his home for everyone, including the animals.  He put limits on time with family pets.  Therapeutic Foster Homes need to put safety first.  Ensuring a safe environment allows for children to trust.  If dad had not protected the animals, then how does the child know who in the home falls within dad's protective bounds.  Second, both dad and mom provided opportunities for the child to play, go outside, draw, do pottery, talk and sing to herself (what child doesn't love an opportunity to be their own rock star!).  The family bakes, does crafts, and puts on puppet shows together.  What a rich opportunity for this child to be active and creative after sitting still and being quiet at school all day.

However, all the activities do not negate the need for learning the appropriate times for such heightened activity and the appropriate times for calm. Often times children do not make the connection between their feelings and their behaviors.  As emotional teachers, parents need to facilitate children making those connections for themselves.  I'm all the time helping my own children make the connection between their grumpy, whiny tantrums and their recent sugar consumption.  My hope is that as they grow older they will be able to take care of themselves and make healthy decisions.  I also hope that they will be aware enough of their own body to put precautions into place when needed.  I suppose this is the 3 year old's equivalent of appointing a designated driver when attending a party where alcohol is being served.

We have to teach children emotional intelligence; teach them how to pay attention to their bodies and feelings, understand how those feelings impact their behavior, recognize how that behavior impacts themselves and others, and then know how to alter their behavior and make safe decisions.

The first step is to engage that child in a conversation.  The child is the clue to the interventions that will work for her.   Always use the sandwich model for these conversations: remember positive-what needs to change-positive.  ("Honey, I'm really proud of you for staying calm and focused at school."- "Let's talk about how you might be able to do that at home a little more."- "You are an amazing kid to help me figure all this out.  Thank you so much.")

 1)  Explore the problem and desired behaviors.  Lead the child in a brainstorming session about what hyper looks like: what does she feel when she's hyper, what does she do when she's hyper, how do those behaviors impact her and other people?  What does calm look like: what does she feel when she's calm, what helps her feel calm, what can others do to help her be calm?
2)  Define Expectations.  Children need to know they can trust someone else to be in charge.  They also need to concretely know what we expect. ("Listen to me" is not a clear instruction.  Define "Listen", what does "listen" look like.  Listen means to close your mouth, look at my eyes, hear what I am saying, then be able to repeat it back to me.)  Discuss important times to be calm: school, meal times, bed time, church.  Discuss times when it's okay to be hyper and what levels of hyper are okay: recess, after school, running outside, screaming outside, etc.
3)  Make a game.  Come up with a way that together you and the child can help her achieve success.  Help her start connecting her feelings and behaviors.  Is there a secret signal you can give when her hyperactivity is starting to increase?  Think baseball.  Can you pull your ear or scratch your nose to signal her to use some of her calming skills?
4) Reward.  What does the child like?  What does she think she deserves if she's able to accomplish the task at hand?  How is she going to earn that reward?  Maybe she gets a sticker every time she is able to calm down 5 minutes after you flash the secret signal.  If she gets 4 stickers in a week, maybe she earns a magazine or a trip to roller rink or a special outing with dad.  Figure out what works and use it to REINFORCE positive behaviors.

Remember a lot of adults do not have the emotional intelligence to make safe decisions.  Don't expect your child to be perfect.  Catch her using her skills and reward her.  Do this again, and again, and again, and again.

Monday, December 19, 2011

Home for the Holidays

I think by adulthood most people understand that holidays and anniversaries are not always as easy or as happy as we are led to believe.  Even a close-knit, healthy family has its share of dysfunction riding above the underlying joy.  As we grow and mature, we hopefully become better able to work out our differences, establish our own personal boundaries, and love each other through our humanity.  We learn the gift is giving, more so than receiving.  We learn that our families are our heritage, where we come from, but not necessarily where we are going.

Children in foster care have not necessarily learned these lessons yet.  Often the hurt of fear and rejection is still too raw to establish healthy boundaries, too raw to effectively balance the pain and the joy.  Holidays, anniversaries, and family visits throw a child into a whirlwind of expectations, excitement, hopes, confrontations, and dichotomies.  Often, children are reminded of what they don't have or confronted by the reality of home not being what they remember it to be.  Children are unconsciously being asked to weigh the life with their foster family against their life with their birth family.

This is an unfair expectation to place on a child.  As loyal advocates of the child, it is a family's and a worker's job to not make the child choose between parents.  We know asking a child to choose between parents in a divorce situation is wrong; it is just as wrong to ask a child to choose between sets of parents in a foster care situation.  Our job, as champions of the child, is to help in the restoration of the family.  Restoration does not always mean reunification, though that is certainly optimal.  Restoration means bringing the family relationships back to an earlier and better condition.

Here are some practical ways foster parents can enable this restoration to occur and make being home for the holidays easier on both the family and the child:

1)  Talk with the child before visits, being candid and respectful of what the child can expect from their family.
2)  Discuss with the child and with the family what would make this a good visit.
3)  Brainstorm with the child good ways to handle situations that might come up.
4)  Discuss and validate the child's emotions surrounding the event.
5)  Help the child to establish rules for himself (what is okay for my family to do with me and what is not).
6)  Always speak positively about the visits and the family members (this includes to other people and includes facial expressions).
7)  Provide the child with a way to connect with family (photos, work that the child has done, gifts for the family).
8)  Set the family up for success (one foster parent shared how she never let the child receive more presents at the foster family's house than at home, sometimes this meant giving the family presents to give to the child).
9)  Communicate with the family about what they can expect from the child and parenting techniques that have worked for you.

Monday, December 12, 2011

Pieces

I heard tell of a man, a used bookseller, who collected items used as bookmarks that he found in used books.  He found concert ticket stubs, love letters, receipts, postcards, letters from a daughter to her dying father in a nursing home.  The thought of collecting these items fascinates me and tugs at my heart.  Think of the lives these items represent, the hands who so often touched these items.  So often, I mindlessly grab things to stick into a book, but often the items are significant in some way and represent some memory that I want to hold on to or revisit often.  Bookmarks are only glanced at, but for a moment they recreate that special memory every time you open the pages of a book.  To other people, the items stuck in a book look like random worthless items, but to the keeper the item is a link to pieces of their life.

Imagine that you hear a knock on your door.  A person of authority enters your home and explains that she is taking you to a new home to live with new people.  If you say you won't go, the person explains very calmly and firmly that you have to and you will.  If you say you will run away, the person explains that you will be found and brought back.  If you ask why, the person explains that there is no other choice.  You are told to pack your things, but there is not room for any living things.

You are then taken from your home, your family, and brought to a new home, with new people you have never met.  This new family has been told all about you and they are very excited to have you come live with them.  You are shown to a room and told to make yourself comfortable.  You do not know when you will see your family again.  All that you have of your family, of where you come from, are those few things you packed in the 30 minutes before you were taken from your home.

What did you pack?  Some clothing essentials, a toothbrush, a favorite t-shirt, a book or some pictures.  Did you pack a blanket or a pillow?  An item belonging to someone you love?  How would you feel if your new family tried to replace those items, buy you "nicer" clothes and give away the clothes that you came with?  What if they washed that blanket or pillow and that familiar smell of home disappeared?  What if, as you sat on your new bed in your new home, your new family tried to "help" you and unpack all of your belongings, touch everything that you brought of your old life?

Children removed from their families and placed in foster care often show up on doorsteps with a garbage bag of belongings.  Often the children have little time to prepare for a move, little time to pack, little control over what happens in his life.  He has no control over the home he is placed in or when he can talk to or see his family.  Everything is new, the people he is living with, the school and church he attends.  Be careful how you treat a lice infested stuffed animal or a crumpled carton of cigarettes or a holey t-shirt. What a child brings may look like random worthless items, but for the child the item is a link to pieces of their life.