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Understanding the Social and Emotional Development of Young Children in Foster Care

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Understanding the Social and Emotional Development of Young Children in Foster Care Vanessa R. Lapointe Megan Tardif May 11, 2006 Goals Risk associated with ... – PowerPoint PPT presentation

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Title: Understanding the Social and Emotional Development of Young Children in Foster Care


1
Understanding the Social and Emotional
Development of Young Children in Foster Care
  • Vanessa R. Lapointe
  • Megan Tardif
  • May 11, 2006

2
Goals
  • Risk associated with identification as a child in
    foster care
  • Issues predating placement in care
  • Issues arising from placement in care
  • Related literature
  • Clinical snapshot of population
  • Implementation of a developmental screening and
    surveillance program

3
Early Development Key Points
  • Interrelatedness of domains
  • Establishment of internal working models of
    attachment (first 2 years)
  • Resilience (Schofield Beek, 2005)
  • Matthews Principle

4
Matthews Principle What makes a difference for
kids?
  • Early intervention is key

Development
  • The more time that elapses, the further behind
    the child that faces developmental challenges
    falls

Typically developing
Challenges
Time
5
Some statistics
  • Very little Canadian research on this population
  • Approximately 50 000 foster children in Canada
  • Approximately 500 000 foster children in USA,
    with 230 000 entering foster care every year
    (Antoine Fisher, 2006)
  • Young children are the largest group of children
    living in out-of-home care
  • In USA, 30 of foster children in 0-5 age range

6
Issues predating placement in care
  • Prenatal history
  • Poor prenatal care
  • Prenatal exposure
  • Genetic conditions
  • Transmission of parental challenges
  • Genetic component of mental health
  • Developmental disabilities and other
    exceptionalities
  • More difficult children to engage
  • Less responsive
  • Less regulated

7
Issues predating placement in care
  • Abuse and/or Neglect
  • Physical, emotional, sexual
  • More likely to receive mental health services
    (Pears Fisher, 2005)
  • Neglect - Standard of care is not met
  • Suggestion that in terms of development, neglect
    can be more detrimental (Pears Fisher, 2005)

8
Issues predating placement in care
  • Abuse and/or Neglect
  • Maltreated children have poorer skills in
  • Initiating interactions with peers
  • Responsibility
  • Maintaining self-control
  • Internalizing behaviors
  • Hyperactivity
  • Reduced quality of play
  • (Veloz Fordham, 2005)

9
Issues predating placement in care
  • Abuse and/or Neglect
  • After accounting for socioeconomic and foster
    family characteristics, these family of origin
    issues hold the most causal weight in terms of
    foster childrens challenges (Buehler et al.,
    2000)
  • Children birth to 3 highest victimization rate of
    child maltreatment (US Department of Health and
    Human Services)

10
Issues predating placement in care
  • Placement in care of a relative
  • Continuation of kinship ties
  • Lack of significant relationship with child prior
    to child entering care
  • Preparedness to parent
  • Life stage
  • Pre-existing issues
  • Substance abuse
  • Parental substance abuse (biological parent) is
    one of the strongest predictors of foster care
    placement instability (5-9x) this instability
    exacerbates existing behavioral difficulties
    (Holland Gorey, 2004)

11
Issues predating placement in care
  • Experience of poor parental strategies
  • Deficient family management skills
  • Harsh and inconsistent discipline
  • Low levels of supervision and involvement in
    childs life
  • Lack of appropriate prosocial reinforcement
  • Leads to increased risk for mental health
    problems
  • (Leslie et al., 2005)

12
Issues arising with placement in care
  • Loss/trauma
  • Birth parent(s)
  • Siblings (Leathers Addams, 2005)
  • Consideration of age at placement
  • Change in attachment classification (to secure)
    more likely and more quickly in younger children
    (Stovall-McClough Dozier, 2004)

13
Issues arising with placement in care
  • Frequent changes in care providers
  • of transitions directly impacts development
    (Pears Fisher, 2005)
  • Exacerbates existing social and emotional
    concerns (Newton et al., 2000)
  • Social skills (cooperation, assertion, and
    responsibility) positively correlated with length
    of foster care placement (Veloz Fordham, 2005)

14
Issues arising with placement in care
  • Children in foster care often experience
    multiple placements and varied degrees of service
    provision. This can be devastating to a child
    already struggling to piece together a life
    subjected to abuse and neglect by his or her
    immediate family (McMillan, 2005)

15
Issues arising with placement in care
  • Frequent changes in care providers
  • most any child who has already experienced a
    number of lifespan traumas and then the loss of
    their family of origin will only be further
    harmed by going through a series of developed and
    then lost relationships with foster parents and
    siblings. (p. 117-188, Holland Gorey, 2004)

16
Issues arising with placement in care
  • Quality of care
  • When victims of child abuse and neglect are
    placed in inadequately prepared foster homes, the
    state implicitly colludes in continuing their
    maltreatment (Rich, 1996 as cited in Pasztor,
    2006)
  • Discontinuity in or lack of service provision
    (Pasztor et al., 2006)
  • Physician
  • Early Intervention Services
  • Education

17
Clinical Snapshot
  • The population of abused and neglected children
    who go on to enter foster care may have
    significantly more health problems, and
    especially mental health problems, than other
    poor children (Bilaver et al., 1999)

18
Clinical Snapshot
  • While up to 50 of children in one study
    reportedly had mental health needs, very few of
    them actually accessed the appropriate services
    due to lack of identification and/or barriers to
    service accessibility within the system (Leslie
    at al, 2000)

19
Clinical Snapshot
  • Placement in foster care associated with higher
    rates of behavior issues/disorders (Flynn Biro,
    1998)
  • Decreased levels of educational success
  • 41 repeat grade
  • 43 in Special Education (3-4x)
  • Frequent changes in educational setting (2x)
  • (Flynn Biro, 1998)

20
Clinical Snapshot
  • Placement in foster care associated with
    significantly worse emotion understanding and
    theory of mind capabilities, even after age,
    intelligence and executive function are accounted
    for (Pears Fisher, 2005)
  • Mental health services are typically more
    difficult to access than physical health services
    (Pasztor et al., 2006)

21
Clinical Snapshot
  • Prevalence of developmental delay 13-80 compared
    to 4-10 in general population (Halfon et al.,
    1995 Horowitz, Simms Farrington, 1994 Leslie
    et al., 2002)
  • Decreased language development across all ages
    but worsens as as enter preschool years (up to
    63 will have delays) (Halfon et al, 1995 Silver
    et al, 1999)
  • 63 cognitive delays and 46 motor delays (Leslie
    et al, 2002)

22
Clinical Snapshot
  • Early Interventionist Perspective
  • Often start with regulation difficulties
    possibly related to prenatal factors
  • Difficulty with self-soothing
  • More likely to have extreme and sudden changes in
    their emotional state ( unexplained crying,
    tantrums)
  • Catch up may happen with developmental delays but
    social and emotional difficulties often last

23
Developmental Screening and Surveillance Program
  • In US, The Child Welfare League of America, the
    American Academy of Pediatrics, and the American
    Academy of Child and Adolescent Psychiatry have
    issued policy statements calling for mandatory
    developmental assessments of children within 1
    month of entering foster care as well as periodic
    re-screening over-time

24
Developmental Screening and Surveillance Program
  • Screening Measures
  • Challenge harder to identify younger children
    (Leslie et al, 2002)
  • First-level screen versus more in-depth
    assessment
  • Goal of universality - need to be able to
    administer a large number of assessments with
    minimal cost
  • Parent-completed screening questionnaires
  • Foster parents are reliable informants,
    particularly of externalizing disorders
    (Tarren-Sweeney et al., 2004).

25
Developmental Screening and Surveillance Program
  • Selecting a screening measure
  • Capacity for parent respondent
  • Consider minimal amount of time child must live
    with parent before measure is reliable and valid
  • Consider length of time to complete
  • Ideal to screen for multiple domains, including
    social and emotional well-being

26
Developmental Screening and Surveillance Program
  • Selecting a screening measure
  • Consider sensitivity and specificity of the tool
  • Sensitivity The ability of the test to
    correctly identify children with developmental
    delays (true positives)
  • Specificity The ability of the test to
    correctly identify children without developmental
    delays (true negatives)
  • Gold standard
  • Both specificity and sensitivity should be around
    0.70 to 0.80 (Meisels, 1989)

27
Developmental Screening and Surveillance Program
28
Developmental Screening and Surveillance Program
  • Service Provision/follow-up
  • Identify community/provincial partners and
    agencies and establish collaborative system
  • Scope to assess children and link with
    effective intervention services

29
Developmental Screening and Surveillance Program
  1. Screening
  2. Access to services
  3. Management of information
  4. Coordination of care
  5. Collaboration among systems
  6. Family participation
  • Attention to cultural issues
  • Monitoring and evaluation
  • Training and Education
  • Funding
  • Designing managed care to fit needs of children

(Wolverton, 2002)
30
Broader Program
  • Embedded in a more holistic approach to foster
    care that recognizes the systemic influences on
    young childrens lives
  • Especially relevant is the role of foster parent
    in improving outcomes
  • Need to consider role of existing programs
    and agencies
  • e.g. IDP, Safe Babies, Supported Child
  • Development, MCFD (Child Protection and
  • Mental Health)

31
Broader Program
  • e.g. Multidimensional Treatment Foster Care
    Program for Preschoolers
  • Clinical support to address behavioral and
    developmental concerns
  • Emotional support
  • On-going training
  • Weekly group support meetings
  • Identification of emotional needs of caregivers
    and children
  • Foster home consultant, foster parents, and
    coordinating supervisor
  • Weekly therapeutic playgroup for children
  • Social skill development
  • Preparing children for social experience of
    school
  • (Antoine Fisher, 2006)

32
Developmental Screening and Surveillance Program
  • Challenges
  • Resources
  • Administrative
  • Tools (minor)
  • Early Interventionists
  • Shortage!
  • Defining delay

33
Developmental Screening and Surveillance Program
  • Benefits
  • Early identification (Matthews Principle)
  • Building capacity
  • Raising awareness of importance of early
    development
  • Increasing knowledge of key early development
    milestones
  • For social workers, birth parents, foster parents
  • A lack of awareness contributes to adverse
    outcomes

34
Conclusions
  • Children in foster care, as a result of exposure
    to risk factors such as poverty, maltreatment,
    and the foster care experience, face multiple
    threats to their healthy development, including
    attachment disorders, inadequate social skills,
    and mental health difficulties (Harden, 2004)

35
Conclusions
  • Developmentally sensitive policies and practices
    designed to promote the well-being of the whole
    child, such as ongoing screening and assessment
    and coordinated systems of care, are needed to
    facilitate the healthy development of children in
    foster care. (Harden, 2004)

36
Questions/Comments
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